First Edition: December 19, 2019

Kaiser Health News: Federal Appeals Court Strikes Down Portion Of Obamacare
Hanging in the balance is not only health coverage for the roughly 20 million Americans directly served by the ACA, but also hundreds of millions more whose health care and coverage have been affected by the thousands of changes enacted in the law. Those include provisions as wide-ranging as changes in Medicare drug copayments, requirements for calorie counts on menus, a pathway for approval of generic copies of expensive biologic drugs and, perhaps most important politically, protections for people with preexisting conditions. (Rovner, 12/18)

Kaiser Health News: Parenting Your Aging Parents When They Don’t Want Help
David Solie’s 89-year-old mother, Carol, was unyielding. “No, I will not move,” she told her son every time he suggested that she leave her home and relocate to a senior living residence. And it didn’t stop there. Although Carol suffered from coronary artery disease, severe osteoporosis, spinal compression fractures and unsteady balance, she didn’t want assistance. When Solie brought in aides to help after a bad fall and subsequent surgery, his mother fired them in a matter of days. (Graham, 12/19)

California Healthline: From Clinic To Courtroom, Fighting For Immigrant Health Care
Jane Garcia started as an intern at La Clínica de La Raza in the late 1970s, attracted by its mission to provide health care to all — especially immigrants, regardless of their legal status or ability to pay. Forty years later, Garcia, 66, is the chief executive officer of the organization, which now operates more than 30 clinics in Alameda, Contra Costa and Solano counties and serves about 90,000 patients a year. About 65% of its patients are Latino, many of whom are immigrants. (Ibarra, 12/18)

Kaiser Health News: Border Fight: Trump’s Plan To Import Cheaper Drugs From Canada Faces Hurdles
Nancy LeaMond, executive vice president of AARP, welcomed the administration’s move. “The ability to import lower-priced medicines would help states manage their ever-tightening budgets, save taxpayers’ money, and lower drug costs for its citizens,” she said in a statement. Yet critics say the administration’s plan ― offered in a 169-page proposed rule seeking comments from states, drugmakers and other stakeholders ― has more to do with President Donald Trump seeking to shore up reelection chances for 2020 than bringing dramatic changes to how people afford drugs. (Galewitz, 12/18)

Kaiser Health News: ‘An Arm And A Leg’: Reporter Says ‘Shame’ Spurred Hospital To Cancel Debt For Thousands
Multiple journalists have spotlighted huge medical bills that have left patients swimming in medical debt. After those stories were made public, in many cases health providers waived the bill or canceled the debt. Sadly, there are a lot of crazy-high medical bill stories out there — and not nearly enough journalists to go around. But in Memphis, Tenn., one journalist’s reporting produced a scaled-up response. (Weissmann, 12/19)

The New York Times: Obamacare Insurance Mandate Is Struck Down By Federal Appeals Court
A federal appeals court on Wednesday struck down a central provision of the Affordable Care Act, ruling that the requirement that people have health insurance was unconstitutional. But the appeals panel did not invalidate the rest of the law, instead sending the case back to a federal district judge in Texas to “conduct a more searching inquiry” into which of the law’s many parts could survive without the mandate. (Goodnough, 12/18)

The Associated Press: Court: Part Of 'Obamacare' Invalid, More Review Needed
The 2-1 ruling handed down by a panel of the 5th U.S. Circuit Court of Appeals in New Orleans means the ultimate fate of the rest of the Affordable Care Act including such popular provisions as protections for those with pre-existing conditions, Medicaid expansion and the ability for children under the age of 26 to remain on their parents' insurance remains unclear. The panel agreed with Texas-based U.S. District Judge Reed O’Connor’s 2018 finding that the law’s insurance requirement, the so-called “individual mandate,” was rendered unconstitutional when Congress, in 2017, reduced a tax on people without insurance to zero. (Santana, Sherman and Alonso-Zaldivar, 12/18)

The Wall Street Journal: Court Rules Affordable Care Act’s Individual Insurance Mandate Is Unconstitutional
The appeals court said the 2017 change meant there was no longer a valid basis for upholding the mandate. “There is no other constitutional provision that justifies this exercise of congressional power,” Judge Jennifer Elrod, a George W. Bush appointee, wrote in the majority opinion, which was joined by Judge Kurt Engelhardt, a Trump appointee. (Kendall and Armour, 12/18)

Reuters: U.S. Appeals Court Sidesteps Major Obamacare Ruling
The court, however, avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis. That means the fate of the signature domestic achievement of Democratic former President Barack Obama remains in limbo. Writing for the majority, Judge Jennifer Walker Elrod said that Texas-based U.S. District Court Judge Reed O'Connor must "employ a finer-toothed comb" to determine if the entire law must be struck down. (Hurley, 12/18)

The Washington Post: Appeals Court Rules ACA’s Individual Mandate Unconstitutional; Lower Court To Decide Whether Rest Of Law Can Stand Without It
The 5th Circuit decision almost certainly will bring the health-care law before the Supreme Court for a third time, and California Attorney General Xavier Becerra, leading a coalition of his Democratic counterparts fighting to preserve the law, said Wednesday night that he was prepared to ask the high court to take the case before the lower court rules again. But by sending a thorny legal question back to the Texas jurist who already has held the law unconstitutional, the judges may effectively slow the progress of the case, so that the high court does not take it during its current term and decide it before the November elections. (Goldstein, 12/18)

Los Angeles Times: Appeals Court Rules Affordable Care Act Insurance Mandate Unconstitutional, But Delays The Impact
Several leading Democrats criticized the appeals court ruling Wednesday evening, saying that it would create continued uncertainty in the healthcare system. “Tonight’s ruling is a chilling threat to the 130 million Americans with preexisting conditions and every other family who depends on the lifesaving protections of the Affordable Care Act,” House Speaker Nancy Pelosi (D-San Francisco) said in a statement. “This ruling should not stop families from continuing to sign up for the quality, affordable coverage they need in states where the enrollment period is still open.” (Levey and Savage, 12/18)

Politico: Court Voids Obamacare Mandate — But Not The Whole Law
Many legal scholars, including Obamacare opponents, have sharply criticized the latest GOP-led lawsuit as baseless. They argue courts typically avoid striking entire laws if they can stand without provisions found invalid, and Congress's decision to zero out just the mandate penalty in 2017 is proof lawmakers meant for the rest of the ACA to stand. The Republican chairman of the Senate health committee, Lamar Alexander of Tennessee, drove home that point Wednesday, describing the Justice Department's argument as "far-fetched." "I am not aware of a single senator who said they were voting to repeal Obamacare when they voted to eliminate the individual mandate penalty," said Alexander, a moderate who is retiring next year. (Demko, 12/18)

Reuters: Trump Says Court Decision On Obamacare Won't Change Healthcare System
President Donald Trump said a U.S. appeals court ruling on Wednesday that a component of the Obamacare law is unconstitutional would not change the current U.S. healthcare system. "This decision will not alter the current healthcare system. My Administration continues to work to provide access to high-quality healthcare at a price you can afford, while strongly protecting those with pre-existing conditions," Trump said in a statement after the court ruled that Obamacare's individual mandate that directed Americans to obtain health insurance was unlawful. (Hurley, 12/18)

CNN: Appeals Court Says Obamacare Individual Mandate Unconstitutional And Sends Law Back To Lower Court
Invalidating the law in only the 18 states in the lawsuit would throw the nation's health care system into chaos and deepen the inequality of access to health care that already exists. Also, several provisions -- such as making it easier to obtain lower-cost versions of certain complex drugs, changing Medicare payment rates or increasing certain taxes on wealthier Americans -- would be difficult to divide up by state. The court acknowledged that when the lower court reviews its opinion it might once again hold that the entire law must fall. But the judges urged limits, writing: "It is no small thing for unelected, life-tenured judges to declare duly enacted legislation passed by the elected representatives of the American people unconstitutional." (Berman, Biskupic, Luhby and De Vogue, 12/18)

The New York Times: Obamacare Ruling May Spare Republicans Some Political Pain
Starting in 2017, the Republicans’ failed effort to repeal and replace large portions of the health law was deeply unpopular and became a central campaign theme of the 2018 election, in which Democrats won a House majority. Democrats cast themselves as the protectors of Obamacare’s most popular provisions, especially its protections for Americans with pre-existing health conditions. While most Democrats would have favored a court ruling that upheld Obamacare, a reprise of those politics could have given them a lift in an election year. Voters tend to trust Democrats more than Republicans on health care, but much of the debate during the primary season has focused on ambitious new expansions of government coverage. Those proposals do not enjoy the widespread support attached to the preservation of Obamacare’s core consumer protections. (Sanger-Katz, 12/19)

CNN: READ: Appeals Court Ruling On Affordable Care Act
The 5th US Circuit Court of Appeals has found the Affordable Care Act's individual mandate unconstitutional, but did not invalidate the entire law. Read the opinion here. (12/18)

The Associated Press: 6 Big Questions Ahead Of Democrats' Final Debate Of 2019 
Just seven Democrats will take the stage for the sixth and final round of presidential debates in 2019. That's down from 20 candidates six months ago. The field may be winnowing, but the primary contest remains deeply unsettled. The tug-of-war between the progressive and moderate wings of the party is deadlocked. There are essentially four front-runners, each with his or her own glaring flaws. ... It was a litmus issue for ambitious Democrats a year ago. But now, only one of the seven Democrats on the debate stage is promising to fight for Medicare for All immediately after taking office. That would be the bill's author, Bernie Sanders, who is nothing if not consistent. (Peoples, 12/19)

The Wall Street Journal: What To Watch For In The Last Democratic Debate Of 2019
As Mr. Buttigieg surpassed Ms. Warren in polls in Iowa, the two have also been at odds over their health-care plans. The mayor has aired ads knocking Medicare for All and said Ms. Warren was being evasive on how much her health-care plan would cost. The Massachusetts senator is now emphasizing that her single-payer plan gives Americans a choice, in the form of a transition period during which people could opt into a government-run program before private insurance is eliminated. (Parti, 12/18)

The New York Times: What Are Independent Voters’ Burning Issues?
Readers wanted to know what was important to independents, defined for the purpose of this study as people who leaned neither Democratic nor Republican (leaners were included in our previous article). Impeachment was the highest priority for them among topics we asked about, which included those related to health care, abortion, taxes, foreign policy, immigration and the environment. (Vavreck, Sides and Tausanovitch, 12/19)

Politico: 4 Reasons Why Trump’s Drug Importation Bill Won’t Work
President Donald Trump has promised that the plan his administration rolled out Wednesday to bring in cheaper prescription drugs from Canada will immediately lower medication costs. Experts say the plan won’t work — and many write it off as a political stunt. Under the proposal, importers would need the cooperation of the Canadian government and the drug industry, both of which oppose it. Importers would have to take many expensive and complicated steps to prove to the FDA that importation wouldn’t harm Americans, and to weave through complex regulations and the intricacies of the U.S. health delivery system. (Karlin-Smith and Owermohle, 12/18)

Axios: Trump Wants To Import Drugs From Canada, But It Probably Won't Lower Prices
Between the lines: Canada doesn't have nearly enough drugs to meet American demand, and even if it did, it doesn't want to send them to us at the expense of its own market. (Owens, 12/19)

The Hill: Grassley Accuses McConnell Of Blocking Progress On Drug Pricing Bill 
Senate Finance Committee Chairman Chuck Grassley (Iowa) on Wednesday accused Senate Majority Leader Mitch McConnell (Ky.) of blocking progress on his bill to lower drug prices, escalating tensions between two powerful GOP senators. Asked why more Republican senators have not signed on to his bill to lower drug prices, Grassley told reporters, “Because McConnell’s asked them not to.” (Sullivan, 12/18)

The Hill: Health Industry Racks Up Wins In Year-End Spending Deal 
Congress started the year with heady talk of bipartisan action to lower drug prices and protect patients from surprise medical bills. It ended the year with a massive government funding deal that did little to address those issues but did cut taxes on the health care industry by $373 billion. The result is a year-end government funding package that was a win for the health care industry and highlighted just how hard it is for lawmakers to overcome powerful industry groups. (Sullivan, 12/19)

NPR: Health Surprises In The Budget: Nixing Taxes, Raising Tobacco Age, Gun Research
[NPR's] health reporting team took a look at what is in the package and picked out notable highlights, including some surprising policy reverses for Congress. The budget provides SAMHSA with $19 million for the Suicide Prevention Lifeline — this includes an increase of $7 million over last year. The additional funding is a "significant improvement," notes Lauren McGrath, the vice president of public policy at Centerstone, a behavioral health care provider working in several states. Calls to the Lifeline are answered by a patchwork of about 165 local call centers that receive only about $1,500 to 2,000 per year of federal money. Most of the federal funds support the Lifeline's national infrastructure. The additional funding "will provide much needed resources to improve consumer access to the National Suicide Lifeline," McGrath wrote in an email. (12/18)

The Hill: Advocates Hopeful Gun Violence Research Funding Will Lead To Prevention
Doctors and advocates are hopeful that new funding for federal agencies to study gun violence will prove to be the first step in preventing mass shootings, suicides and other firearm deaths. For the first time in 23 years, a government spending bill will set aside funds — in this case, $25 million — for the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) to collect data on what the American Medical Association has called a public health crisis. (Hellmann, 12/18)

The Associated Press: Budget Deal Advances VA Private Care Program Backed By Trump
President Donald Trump’s expansion of a program aimed at steering more veterans to private health care is getting an $8.9 billion boost as part of the massive government spending bill approved by the House, setting up a potential battle over the direction of the Veterans Affairs Department. The deal provides $81 billion for VA medical care to treat 9.3 million veterans, including the $8.9 billion for private care under a law passed last year expanding the Veterans Choice program. Another $11.3 billion is on tap for private care in 2021. (Yen, 12/18)

ProPublica: What Happens When A Health Plan Has No Limits? An Acupuncturist Earns $677 A Session.
Judging by the marketing, it would seem that the teachers of New Jersey have collectively thrown out their backs, pulled a muscle or pinched a nerve while engaged in rigorous educating. Last fall, when teachers at about a dozen New Jersey schools returned from break, employees from Thompson Healthcare & Sports Medicine welcomed them with bagels and orange juice. The clinic’s owner also created an empathetic YouTube video titled “We Understand Painful Conditions Suffered By Teachers.” (Allen, 12/19)

The Washington Post: The Abortion War Goes Local As ACLU Lawsuit Seeks To Thwart Town’s Ban
The ACLU of Tennessee filed a lawsuit against a Nashville suburb Wednesday to stop a zoning ordinance that effectively bans surgical abortions within the city’s borders, an antiabortion tactic that is putting town councils on the front lines of one of the most polarizing issues in American life. The suit, joined by the national ACLU and filed on behalf of the nonprofit national women’s clinic Carafem, calls the Mount Juliet City Commission’s zoning ordinance “unconstitutional.” The ordinance is part of “the state’s relentless attack on abortion rights, enacting a multitude of restrictions designed to shutter clinics that have provided safe and affordable abortion care and impose unconscionable obstacles,” the lawsuit states. (Wax-Thibodeaux and Cha, 12/18)

Reuters: Special Report: FDA Targets E-Cigs That Hook Teens But Don't Help Smokers Quit
E-cigarette makers face an existential threat. By May, they must submit applications to the U.S. Food and Drug Administration proving that their products provide a net benefit to public health. If a company fails to make its case, the FDA has the power to order its products off the market. The agency will judge that benefit with a two-part test: Are e-cigarettes effective in getting smokers to quit? (Kirkham, 12/18)

Reuters: FDA Under Fire For Years Of Delays On E-Cigarette Regulation
As the FDA pressures e-cigarette firms to stamp out youth vaping, the agency faces criticism itself for failing to rein in the fast-growing industry after years of bureaucratic delays dating back to the Obama administration. Despite recent tough talk, the FDA has yet to pass any new industry-wide restrictions after two years of rapid growth in teenage vaping tied to the popularity of e-cigarettes made by Juul Labs Inc. (12/18)

The Associated Press: WHO Sees Tobacco Drop Among Men, But Vaping Effects Unclear
Worldwide, the number of men using traditional tobacco products has finally started to decline, health officials said Thursday. Four out of five tobacco users globally are men, so declines among males "mark a turning point in the fight against tobacco,” Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, said in a statement. (Stobbe, 12/18)

The Associated Press: Walk-In Clinics For Opioid Addiction Offer Meds First, Fast
Every time she got out of jail, Jamie Cline started hustling again for heroin, driven by an addiction she didn’t understand. “You want to get clean so bad. You know something’s killing you and you can’t stop,” said the 33-year-old who used heroin for 10 years. This spring was different. While in a jail work-release program, she took a medication called buprenorphine. (12/18)

The Associated Press: Study Estimates That Half Of US Adults Will Be Obese By 2030
There's no way to sugarcoat this news: Nearly half of American adults will be obese within a decade and one-quarter will be severely so, a new report predicts. It corrects for a weakness in previous estimates that may have made the problem seem not as big as it really is. Those estimates often relied on national health surveys and people tend to understate their weight in those. (12/18)

The New York Times: The More Processed Foods You Eat, The Higher Your Diabetes Risk
Eating ultraprocessed foods may increase your risk for Type 2 diabetes. Ultraprocessed foods — including chips, instant noodles, breakfast cereals, chicken nuggets and other industrially processed ready-to-eat or microwaveable fare — are designed for tastiness and long shelf-life. They typically contain emulsifiers, thickening agents, food coloring and other additives of no nutritive value. In previous studies, they have been linked to an increased risk for cancer, depression and cardiovascular disease. (Bakalar, 12/18)

The New York Times: The Movement To Bring Death Closer
Heidi Boucher loaded two big straw baskets into her Toyota Highlander. She always kept them packed, ready for death. Inside were a pair of leather work gloves and a hammer, a bunch of bed pads, a few adult diapers (dead bodies sometimes leak), Q-tips for cleaning ears, noses and mouths and for applying lipstick, cotton balls, disinfectant spray, a plastic zip bag of safety pins to help drape silk and other fabrics around a gurney or casket, a small screwdriver to tightly close a casket, latex gloves, a hairbrush and oils infused with rose, lavender and rosemary. (Jones, 12/19)

The New York Times: She Told Police A Pediatrician Abused Her. Why Was He Never Charged?
A prominent pediatrician on Long Island lost his medical license after allegations emerged that he had sexually abused girls in his care for decades. But he never spent a day in court. The doctor, Stuart Copperman, was never charged with a crime by local authorities. According to the Nassau County district attorney’s office, not one victim came forward within the statute of limitations for the crime. (Rabin, 12/18)

The New York Times: There’s No Winter Break From ‘Publish Or Perish’
Jay Van Bavel, a social neuroscientist at New York University, is vowing not to work during the Christmas holidays. A few years ago, Dr. Van Bavel had agreed to conduct peer review on a couple of manuscripts before the end of the semester. But he got really busy and ended up having to do one on Christmas Day and another on New Year’s Eve, while his family was visiting. (Chawla, 12/18)

NPR: Med Students Strike A Pose At Former Slave Quarters: 'Our Moment Of Resiliency'
"I don't think as a kid I ever saw a minority physician," says Russell J. Ledet. Ledet is a second-year medical student in the M.D./MBA program at Tulane University School of Medicine, and African American. Last weekend he organized a trip to Whitney Plantation, now a museum, in Edgard, La., for fellow members of the Tulane chapter of the Student National Medical Association, a student-run organization that supports black medical students. (Vaughn, 12/19)

Reuters: That Puppy In The Window Could Make You Sick As A Dog, U.S. Health Agency Warns
Beware of dog, especially the cute puppies in pet store windows, U.S. health officials warn. A bacteria resistant to common antibiotics has sickened 30 people this year, sending four of them to hospitals, and puppies are the likely culprit, according to an advisory issued late Tuesday by the Centers for Disease Control and Prevention. (12/18)

The Associated Press: Denver, Los Angeles Airport Measles Cases Connected
U.S. health officials have confirmed that three children recently hospitalized with measles in Colorado traveled from New Zealand to Los Angeles International Airport before arriving in Denver. The Denver Post reported Tuesday that the Centers for Disease Control and Prevention has issued warnings at airports in Denver and Los Angeles involving the same airline passengers. (12/18)

The Associated Press: Washington Governor Wants To Spend $300M To Help Homeless
Washington Gov. Jay Inslee said Wednesday he wants to spend more than $300 million from the state’s emergency budget reserve to add 2,100 shelter beds and provide other help to combat homelessness. In unveiling his supplemental spending plan in Olympia, Washington for the state’s current $52.4 billion two-year budget, Inslee said Washington must do more to find housing for people. (12/18)

The Associated Press: Lawsuit: Children In State Care Abused At Chicago Hospital 
Children as young as 7 were subject to or witnessed sexual abuse by staff and peers, according to the lawsuit. When children reported the abuse, they were further victimized, the complaint said. One was allegedly given a powerful sedative when it wasn't necessary. “Instead of being placed in a safe environment where they could focus on their treatment, each plaintiff found himself or herself in a hospital of horrors where they were subjected to sexual, physical and emotional abuse and otherwise not properly supervised or monitored,” the lawsuit said. (12/18)

The Wall Street Journal: Bronx Teen’s Death Was Vaping-Related, Chief Medical Examiner Says
The New York City chief medical examiner on Wednesday ruled that the October death of a teenage boy was caused by complications from a lung injury related to use of an e-cigarette or vaping product. The Bronx teenager, Denis Byrne Jr., was 17 years old, the chief medical examiner said. The manner of death is considered an accident. It was the state’s first reported vaping-related death. The teenager’s family hadn’t responded to requests for comment. (West, 12/18)

Los Angeles Times: Homeless Man Found Dead Outside L.A. City Hall, Official Says
A man, who by at least one city official’s account was homeless, was found dead outside Los Angeles City Hall on Wednesday. The Los Angeles Police Department received a call about a deceased man and responded at 7:40 a.m. to 200 N. Main St. in Los Angeles, said LAPD Officer Lizeth Lomeli. She had no other information about the man. However, Los Angeles City Atty. Mike Feuer told reporters at an unrelated event Wednesday morning that the man was homeless. (Smith, 12/18)