First Edition: December 21, 2018

Kaiser Health News: Year One Of KHN’s ‘Bill Of The Month’: A Kaleidoscope Of Financial Challenges
In 2018, KHN and NPR launched “Bill of the Month,” a crowdsourced investigation in which we dissect, investigate and explain medical bills you send us. In telling the story behind one patient’s bill each month, our goal is to understand the genesis of the often exorbitant and baffling charges that pervade the American medical system. But also, we aim to offer ideas for patients and policymakers about how they might redress common patient situations that are frustrating and downright unaffordable. So far, we’ve examined bills for conditions as minor as toenail fungus (a $1,500-per-month topical medicine) and as major as a “widow-maker” heart attack ($109,000 after insurance). We’ve looked at bills for simple exams ($18,000 for a urine test) and ambulance rides ($57,000 for an air ambulance). Many of the bills miraculously get resolved once our reports come out. (12/21)

Kaiser Health News: Short-Term Health Insurance Plans Highly Profitable For Insurers And Brokers
Sure, they’re less expensive for consumers, but short-term health policies have another side: They’re highly profitable for insurers and offer hefty sales commissions. Driven by rising premiums for Affordable Care Act plans, interest in short-term insurance is growing, boosted by Trump administration actions to ease Obama-era restrictions and possibly make federal subsidies available to consumers to purchase them. (Appleby, 12/21)

Kaiser Health News: ‘Don’t Wash That Bird!’ And Other (Often Unheeded) Food Safety Advice 
Rinsing chicken or turkey before cooking it is an ingrained step for many home cooks — passed down through generations and reinforced by cookbooks. Recipes like the “Perfect Roast Chicken” in 1999’s “The Barefoot Contessa Cookbook” advise cooks to “Rinse the chicken inside and out.” But that doesn’t reflect the science. To wash or not to wash? That’s a question home cooks ask experts at the USDA Meat and Poultry hotline a lot around the holidays. (Zuraw, 12/21)

California Healthline: Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit
Marcela Villa isn’t a big name in health care — but she played a crucial role in the lives of thousands of Medicaid patients in California. Her official title: denial nurse. Each week, dozens of requests for treatment landed on her desk after preliminary rejections. Her job, with the assistance of a part-time medical director, was to conclusively determine whether the care — from doctor visits to cancer treatment — should be covered under the nation’s health insurance program for low-income Americans. (Terhune, 12/19)

California Healthline: No-Go On Drunken Driving: States Deploy Breathalyzers In Cars To Limit Road Deaths
’Tis the season to be a little too merry, and law enforcement officials across the country are once again reminding revelers not to drive if they’ve been drinking. Along with those warnings comes a bit of good news: Deaths involving drunken driving are only about half of what they were in the early 1980s, though they have ticked back up in recent years. The long-term decline is largely attributable to greater public awareness, stricter seat belt enforcement and the establishment in 2000 of a national blood-alcohol threshold of 0.08 percent — far below the 0.15 percent standard commonly used before then. (Ibarra, 12/21)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ More On That Texas Lawsuit, And The Best And Worst Health Policy Stories Of The Year
Reaction is still coming in about last week’s federal court ruling that declared the Affordable Care Act unconstitutional. And nearly final numbers for insurance sign-ups at healthcare.gov were surprisingly brisk despite the elimination of the health law’s tax penalty for not having insurance and a dramatically shrunken budget for outreach and enrollment assistance. (12/20)

The Associated Press: Health Law's Fines Are Not The Big Stick Everybody Thought
There was one thing that supporters and detractors of former President Barack Obama's health care overhaul agreed on for years: unpopular fines on Americans forgoing coverage were essential for the plan to work because they nudged healthy people to get insured, helping check premiums. Now it turns out that might not be so. (Alonso-Zaldivar, 12/20)

The Hill: California Asks Federal Judge To Block Trump Contraception Rule 
California Attorney General Xavier Becerra (D) asked a federal judge on Thursday to block Trump administration rules that would allow more exemptions to ObamaCare's contraception mandate. The final rules, slated to take effect Jan. 14, would allow most businesses to opt out of covering contraception for their employees if they have moral or religious objections. (Hellmann, 12/20)

The New York Times: Where Government Is A Dirty Word, But Its Checks Pay The Bills
Gov. Matt Bevin skillfully worked the room at the old courthouse building here in Harlan, one more town-hall meeting in the long campaign toward next year’s election. He deplored the parlous state of a half-mile stretch of U.S. 421 and said $802,000 would be spent to rebuild it. He commiserated with the man who wanted to know how he should deal with the bears tearing through his trash bins, now that it’s forbidden to shoot them. The line that got the governor a standing ovation, however, was about Medicaid. More precisely, about his plan — so far frustrated by the courts — to require thousands of able-bodied Medicaid recipients between 19 and 64 to work, get training or perform community service for 20 hours a week to keep their health insurance. (Porter, 12/21)

The New York Times: Justice Department Investigating Migrant Shelter Provider
The Justice Department is investigating possible misuse of federal money by Southwest Key Programs, the nation’s largest operator of shelters for migrant children, according to two people familiar with the matter. The inquiry could upend shelter care for thousands of children, escalating government scrutiny of the nonprofit even as it remains central to the Trump administration’s immigration agenda. The charity operates 24 shelters to house children who were separated from their parents at the border or arrived on their own. (Ruiz, Kulish and Barker, 12/20)

The Wall Street Journal: Democrats Question Homeland Chief Nielsen Over Girl’s Death At Border
Homeland Security Secretary Kirstjen Nielsen’s testimony before the House Judiciary Committee on Thursday offered a glimpse of the strict oversight to come from Democrats still fuming over the Trump administration’s “zero tolerance” immigration policy along the Southern border. Ahead of the hearing, Ms. Nielsen said the U.S. plans to start returning migrants who enter the country illegally to Mexico until their immigration proceedings are complete. (Jamerson, 12/20)

The Wall Street Journal: ICE Drafts Guidelines With Fewer Restrictions On Restraining Pregnant Women
The U.S. is weighing looser standards for some immigration detention centers, including scrapping certain guidelines governing the restraint of pregnant women and ensuring children can visit detained parents. U.S. Immigration and Customs Enforcement has drafted new standards that don’t include a host of current requirements, according to people who have read them. ICE told Congress last year that it planned to issue new standards for scores of detention facilities, such as county jails, that hold both immigrants awaiting deportation and criminal prisoners for more than a week. (Vogt, 12/20)

The New York Times: Climate Team, And Its Boss, Just Got Harder To Find At Top Health Agency
The Centers for Disease Control and Prevention has quietly folded its Climate and Health Program into a branch that studies asthma and expunged the word climate from the name of the newly consolidated office, the agency confirmed on Thursday. An agency spokeswoman, Kathryn Harben, said in a statement that the move was part of a broader reorganization within the agency’s environmental health division that pared eight programs down to four. (Friedman and Kaplan, 12/20)

The Associated Press: Report: US Fails In Funding Obligation To Native Americans
A new report by the U.S. Commission on Civil Rights finds that funding levels for Native American tribes are woefully inadequate despite the federal government's responsibility to provide for education, public safety, health care and other services under treaties, laws and other acts. The report made public Thursday is a follow-up to a 2003 report that described the shortfalls as a quiet crisis. Funding has remained mostly flat since then, leaving tribes unable to tackle an epidemic of suicide, high dropout rates, violence against women and climate change, for example, the report said. (Fonseca, 12/20)

The Associated Press: Stem Cell Shots Linked To Bacterial Infection Outbreak
Health officials on Thursday reported an outbreak of bacterial infections in people who got injections of stems cells derived from umbilical cord blood. At least 12 patients in three states — Florida, Texas and Arizona — became infected after getting injections for problems like joint and back pain, the Centers for Disease Control and Prevention said. All 12 were hospitalized, three of them for a month or longer. None died. (Stobbe, 12/20)

The New York Times: 12 People Hospitalized With Infections From Stem Cell Shots
The F.D.A. said on Thursday that it had also written to 20 clinics that offer unapproved stem cell treatments, warning them that such products are generally regulated by the agency and encouraging the clinics to contact federal regulators before November 2020, when enforcement will tighten. The names of the clinics have not been released. “We’re going to be going in and inspecting more stem cell operators this year,” Dr. Scott Gottlieb, the agency’s commissioner, said in an email. “We’re focused on outfits that may be engaging in unsafe practices and haven’t been working with F.D.A. to come into compliance with the laws they’re subject to. Unfortunately, there are too many firms that fit this description.” (Grady, 12/20)

The Washington Post: FDA Warns Stem-Cell Company Linked To E. Coli Infections
A year ago, the agency issued a “regulatory framework” spelling out the rules on stem-cell products and procedures. And it said it would exercise “enforcement discretion,” giving companies until November 2020 to comply — as long as they don’t pose safety risks to patients. The for-profit, direct-to-consumer stem-cell industry started in other countries but has grown rapidly in the United States. Today, several hundred clinics sell therapies to treat conditions as varied as arthritis, Parkinson’s disease and multiple sclerosis. Some sell stem cells derived from the patients' own blood, fat or bone marrow, while others use stem-cell products manufactured by outside suppliers. (McGinley, 12/20)

CNN: Infections Put 12 People In Hospitals After They Received Unapproved Stem Cell Products
"We see a lot of promise from stem cell treatments, but we also have a lot of concern, and we started by sending these 20 letters singling out these firms that should be engaging with FDA but haven't been," FDA Commissioner Dr. Scott Gottlieb said. "In addition, we are also stepping up our inspections this year. We are concerned that there are firms whose actions could be putting patients at risk and might be subject to additional action." (Christensen, 12/20)

CNN: Certain Antibiotics May Cause Aortic Aneurysm, FDA Warns
The US Food and Drug Administration warned on Thursday that the benefits of fluoroquinolone antibiotics do not outweigh the risks -- which include aortic aneurysm -- for certain patients, according to the latest research. The research is based on reports of patient problems and on studies published between 2015 and 2018. (Christensen, 12/20)

Reuters: Cigna Closes $54 Billion Purchase Of Express Scripts
Cigna Corp on Thursday closed its $54-billion (42.65 billion pounds) deal to buy Express Scripts Holding Co, creating one of the biggest providers of pharmacy benefits and insurance plans in the United States, a combination it says will help it improve healthcare coordination and cut costs. Cigna's deal puts it in direct competition with two other healthcare companies set up the same way - Aetna with CVS Health Corp and UnitedHealth Group Inc with Optum. Cigna's deal has already passed antitrust scrutiny. (Humer, 12/20)

The Wall Street Journal: Cigna And Express Scripts Seal $54 Billion Merger
The Cigna deal, which won an antitrust nod from the Justice Department without requiring divestitures, brings together a health insurer with a strong focus on employers with a major pharmacy-benefit manager. In an interview, Cigna Chief Executive David Cordani said an initial focus of the combined company will be on ensuring continued smooth business-as-usual operations, but it will begin rolling out new initiatives next year that seek to take advantage of the tie-up between medical and pharmacy oversight, including efforts focused on specialty pharmaceuticals and mental health. (Wilde Mathews, 12/20)

Modern Healthcare: Cigna And Express Scripts Close On $67 Billion Merger
"Today's closing represents a major milestone in Cigna's drive to transform our healthcare system for our customers, clients, partners and communities," Cigna CEO David Cordani said in the announcement. "Together, we are establishing a blueprint for personalized, whole-person healthcare, further enhancing our ability to put the customer at the center of all we do by creating a flexible, open and connected model that improves affordability, choice and predictability." (Livingston, 12/20)

The Associated Press: Insurance Giants Bankroll Group That Pushes Private Medicare
A group gaining influence in Washington as a champion for Medicare beneficiaries is bankrolled by major health insurance companies that are trying to cash in on private coverage offered through the federal health insurance program. The Better Medicare Alliance's multi-million dollar budget is supplied by UnitedHealthcare, Aetna and Humana. The three insurance giants account for close to 50 percent of all enrollees in private Medicare Advantage plans and stand to benefit as that part of Medicare keeps growing. (Alonso-Zaldivar and Lardner, 12/21)

The New York Times: Planned Parenthood Is Accused Of Mistreating Pregnant Employees
As a medical assistant at Planned Parenthood, Ta’Lisa Hairston urged pregnant women to take rest breaks at work, stay hydrated and, please, eat regular meals. Then she got pregnant and couldn’t follow her own advice. Last winter, Ms. Hairston told the human-resources department for Planned Parenthood’s clinic in White Plains, N.Y., that her high blood pressure was threatening her pregnancy. She sent the department multiple notes from her nurse recommending that she take frequent breaks. (Kitroeff and Silver-Greenberg, 12/20)

The Hill: Planned Parenthood Employees Accuse Organization Of Mistreating Pregnant Workers
Some women who worked at the reproductive health nonprofit told the Times that they were denied breaks while they were pregnant or saw managers declining to hire women who were pregnant, both in violation of labor laws. “I believe we must do better than we are now,” Leana Wen, the president of the Planned Parenthood Federation of America, said in a statement released to The Hill. “It’s our obligation to do better, for our staff, for their families and for our patients.” (Birnbaum, 12/20)

The Hill: Outgoing GOP Chairman Urges Colleagues To Oppose Trump Drug Pricing Proposal 
Outgoing Senate Finance Committee Chairman Orrin Hatch (R-Utah) wrote a letter to GOP colleagues on Wednesday urging them to oppose a proposal from President Trump to lower drug prices. Hatch’s letter, obtained by The Hill, is an illustration of the divide among Republicans over proposals to lower drug prices, with some Republican lawmakers breaking with Trump. (Sullivan, 12/20)

Stat: Retiring Sen. Hatch To Colleagues: Curtail Trump Drug Pricing Move
In one of his last moves before retirement, Sen. Orrin Hatch (R-Utah) slammed one of the Trump administration’s splashiest drug pricing plans and called for his colleagues to limit the power of the Trump administration to pursue the proposal. Until now, Hatch has largely refrained from openly criticizing the Trump administration’s drug pricing plans, even as some have broken with Republican orthodoxy. Wednesday’s letter is perhaps the clearest sign to date of tensions emerging in the Republican party over the administration’s’ drug pricing policies. (Florko, 12/20)

Bloomberg: Pharma Prepares To Raise Prices In 2019 With A Wink To Trump 
Drugmakers are getting ready to raise prices Jan. 1 on a broader swath of medicines than in prior years, according to Bernstein analyst Ronny Gal. In a move to catch up on delayed hikes from 2018, pharmaceutical companies may raise prices on about 20 percent more drugs than last year, with the average price increase for pharmacy-dispensed drugs in high single digits and around 3 percent for those administered by physicians, Gal estimated after talking with insurance carriers and health-plan sponsors. (Flanagan and Griffin, 12/20)

Stat: Get Ready For Drug Prices To Rise As Much As 9 Percent Next Month
As a new year beckons, there is considerable anticipation that many drug makers will vigorously lift a self-imposed moratorium on price hikes that began last summer in response to political pressure from President Trump. After all, the pharmaceutical industry traditionally boosts prices in January in order to meet financial goals. Moreover, White House efforts to staunch rising drug costs have yielded few gains. Already, a few companies have signaled higher prices are coming, but what might these look like? (Silverman, 12/20)

Stat: Two High-Priced Drugs For Spinal Muscular Atrophy Called Not Cost Effective 
A pair of new medicines designed to treat spinal muscular atrophy, a rare and often fatal genetic disease affecting muscle strength and movement, may be beneficial but appear to be priced too high to be considered cost effective, according to a preliminary analysis. One drug, which is called Spinraza, costs $750,000 during the first year of treatment and $375,000 thereafter. But at that price, the Biogen (BIIB) drug fails to provide sufficient value based on QALY, or quality-of-life years, which measures both the quantity and quality of life generated by providing a treatment or some other health care intervention. (Silverman, 12/20)

The Washington Post: Lawmaker Demands Reform Of Transplant Network After Washington Post Stories
Sen. Todd C. Young (R-Ind.) said Thursday he would introduce legislation next year calling for greater oversight of the U.S. transplant network, contending 10,000 people die annually in a system that is allowed to hide its flaws from the public and Congress. His announcement followed stories published Thursday in The Washington Post that said the transplant industry could more than double the number of organs available for transplant each year if it expanded efforts to collect and use organs from older and nontraditional donors, such as people with hepatitis C. (Bernstein and Kindy, 12/20)

Modern Healthcare: Congress Eyes Intervention In U.S. Organ Sharing Policy 
The board of the United Network for Organ Sharing, or UNOS, which is charged with overseeing organ allocation policy, made the change. UNOS works on behalf of the Organ Procurement and Transplantation Network, or the OPTN. The OPTN is a not-for-profit organization that contracts with the federal Health Resources and Services Administration to manage the complicated, sprawling system. Representatives of all those with a stake in the policy make up the UNOS board—from transplant surgeons to transplant recipients and organ donors and organ procurement organizations. But because the policy debate pits regions against one another, UNOS members have remained gridlocked over any substantial modifications to the current system that left some regions with a steady shortfall. (Luthi, 12/20)

Nerdwallet: Medical Bills Plague Millennials; These Tips May Be The Cure
Chrystal McKay knew enough about medical care costs that she skipped the ambulance ride after a car accident. A friend drove her to the emergency room. That saved her one bill, but she faces another for more than $20,000 after her ER visit. The 29-year-old Stockton, California, woman must balance paying her debt with getting care for a sprained shoulder that may need surgery: "I have to weigh the pros and cons. I'm already $20,000 in debt, and any more treatment will just put me more in debt." (Pyles, 12/20)

The Washington Post: CRISPR Babies Spur NIH Director To Call For Public Debate, New Oversight
Last month’s news that Chinese scientist He Jiankui had gone rogue and conducted an (as-yet-unverified) experiment to modify the genes of two twin girls to make them resistant to HIV has left the scientific world scrambling to discourage creation of other genetically edited babies. The World Health Organization’s director general, Tedros Adhanom Ghebreyesus, acknowledged that we had jumped into “uncharted waters” and announced the formation of an expert panel to set guidelines and standards. The Chinese government has condemned He’s work and vowed serious consequences to discourage others from pursuing similar lines of research, but it has not offered any specifics. (Cha, 12/20)

The Wall Street Journal: Clash Over Same-Sex Adoption Heads To Court
A federal judge is poised to rule on whether an evangelical adoption agency in central New York state that receives no government funding can refuse to place children with same-sex couples despite a five-year-old antidiscrimination law. New Hope Family Services, an evangelical adoption agency based in Syracuse that for decades has refused to place children with same-sex couples, recently drew a warning from child-welfare officials who gave New Hope until December to agree to accept gay applicants or face closure. (Gershman, 12/21)

Los Angeles Times: Voters Have High Tolerance For Politicians Who Lie, Even Those Caught Doing It
In a modern democracy, peddling conspiracies for political advantage is perhaps not so different from seeding an epidemic. If a virus is to gain a foothold with the electorate, it will need a population of likely believers (“susceptibles” in public-health speak), a germ nimble enough to infect new hosts easily (an irresistible tall tale), and an eager “Amen choir” (also known as “super-spreaders”). Unleashed on the body politic, a falsehood may spread across the social networks that supply us with information. Facebook is a doorknob slathered in germs, Twitter a sneezing coworker, and Instagram a child returning home after a day at school, ensuring the exposure of all. (Healy, 12/20)

The Washington Post: 452 Children Died On The Job In The U.S. From 2003 To 2016
Child labor exists in the United States in the 21st century. It's legal and widespread, and it’s also, in some cases, dangerous. Children were killed on the job in construction, retail, transportation and even manufacturing and logging. But most of them, 52%, died working in agriculture. (Van Dam, 12/20)

NPR: Specialized Cells In Eye Linked To Mood Regions In Brain
Just in time for the winter solstice, scientists may have figured out how short days can lead to dark moods. Two recent studies suggest the culprit is a brain circuit that connects special light-sensing cells in the retina with brain areas that affect whether you are happy or sad. When these cells detect shorter days, they appear to use this pathway to send signals to the brain that can make a person feel glum or even depressed. (Hamilton, 12/21)

CNN: What Your Nightmares Could Reveal About Your Health
What's your most frequent nightmare? Is it dreaming that you're dying, or that one of your loved ones is suffering but you can't do anything about it? Or maybe you're waking up with confusion and a racing heart, simply glad that the dream ended. Nightmares are classified as dream sequences that seem realistic and often awaken the person. They are a complex experience. Though fear is the dominant emotion felt during nightmares, a 2014 study reported that sadness, anger, confusion, disgust, frustration or guilt were also common. (Avramova, 12/20)

The Wall Street Journal: Food Companies Get Until 2022 To Label GMOs
U.S. food companies must label products containing genetically engineered ingredients by 2022, federal regulators said, a victory for manufacturers who pushed for more time before disclosing use of the controversial crops. The new rules for labeling “bioengineered foods” also allow companies to skip labeling some ingredients, including refined sugars and corn syrups that often are made from genetically modified crops. That decision, outlined Thursday by the U.S. Department of Agriculture, is a win for food makers that argued traces of genetic material from modified crops in those ingredients are eliminated during processing. (Bunge, 12/20)

The Washington Post: Deadly Marburg Virus Found In Bats In Sierra Leone
Scientists have discovered the deadly Marburg virus in fruit bats in Sierra Leone, the first time this cousin of Ebola has been found in West Africa. There have been no reported cases of people or animals with active infections. But the pathogen’s presence in the bats raises the potential for it to infect humans in a new region more than a thousand miles from previously known outbreaks. There have been a dozen known Marburg virus outbreaks in other parts of Africa, most recently in Uganda in 2017. Like Ebola, Marburg virus initially infects people through contact with wild animals. It can then spread person to person through contact with bodily fluids. It kills up to 9 in 10 of its victims, sometimes within a week. (Sun, 12/20)

Reuters: As Ebola Threatens Mega-Cities, Vaccine Stockpile Needs Grow
Doubts are growing about whether the world’s emergency stockpile of 300,000 Ebola vaccine doses is enough to control future epidemics as the deadly disease moves out of rural forest areas and into urban mega-cities. Outbreak response experts at the World Health Organization (WHO) and at the vaccines alliance GAVI are already talking to the leading Ebola vaccine manufacturer, Merck, to reassess just how much larger global stocks need to be. (12/20)

CNN: The Most -- And Least -- Healthy States In America
As the new year approaches, many people focus on improving their health -- but how does where you live rank when it comes to health? Hawaii now ranks as the healthiest state in America, beating out Massachusetts to return to the top spot in a new report by the United Health Foundation, a nonprofit division of UnitedHealth Group, which also owns the insurance company United Healthcare and Optum. (Howard, 12/20)

The Associated Press: State Audit Slams San Diego Response To Hepatitis A Outbreak
The city and county of San Diego failed to quickly recognize and control a Hepatitis A outbreak that grew into one of the largest in recent history, killing 20 and sending nearly 400 to hospitals, according to a state audit released Thursday. The county lacked a concrete hepatitis A prevention plan that led to a delay in getting the most vulnerable residents vaccinated, and mass vaccinations did not happen until after a health emergency had been declared, according to the audit conducted by the state auditor at the request of lawmakers. (Watson, 12/20)

Los Angeles Times: Here’s How California Can Use Fire To Solve Its Wildfire Problem
If California wants to get out in front of its wildfire problem, scientists have some clear but counterintuitive advice: Start more forest fires. Decades of research shows that lighting fires under safe conditions not only clears out the dead plants and thick underbrush that fuel many severe wildfires, it also restores a natural process that once kept forests healthy and resilient. (Rosen, 12/20)