First Edition: February 15, 2018

Kaiser Health News: Idaho Blue Cross Jumps Into Controversial Market For Plans That Bypass ACA Rules
That didn’t take long. It’s barely been two weeks since Idaho regulators said they would allow the sale of health insurance that does not meet all of the Affordable Care Act’s requirements — a controversial step some experts said would likely draw legal scrutiny and, potentially, federal fines for any insurer that jumped in. (Appleby, 2/14)

Kaiser Health News: Work-For-Medicaid Lifts Off In Indiana, But Even Fans Fret About Red Tape
Indiana is one of the states poised to enact work requirements for some citizens with Medicaid coverage — a controversial policy and long-sought goal for Republicans. But advocates for the poor have protested loudly in recent months, saying many will lose coverage or be ensnared by bureaucratic mistakes. KHN’s Sarah Varney reports in collaboration with PBS NewsHour. Read the full transcript. (2/14)

The New York Times: Report Faults V.A. Secretary Shulkin Over Travel To Europe
A scathing report released Wednesday found “serious derelictions” in a 10-day, $122,000 business trip the secretary of veterans affairs took to Europe, which included airfare for his wife and extensive sightseeing. According to the report, Secretary David J. Shulkin traveled to Denmark and London for meetings about health care for veterans, accompanied by his wife, a small staff and a six-person security detail, but nearly half of his time was spent visiting castles and other tourist sites. (Philipps, 2/14)

Reuters: 'Serious Derelictions' Found In U.S. Veteran Affairs Chief's Europe Trip: Report
The investigation of Shulkin's European trip found several other "serious derelictions," the Veterans Affairs inspector general said in a report on its website. The office opened the probe after receiving an anonymous complaint alleging the secretary had misused travel funds because the trip to Europe, which cost at least $122,344, was more personal than business. (Alexander, Heavey and Volcovici, 2/14)

USA Today: VA Secretary David Shulkin Regrets Travel Errors, Pays Government For Wife's Airfare
The inspector general found Shulkin improperly accepted Wimbledon tickets and taxpayer-funded airfare for his wife for the 10-day trip in July, and he and his chief of staff misled VA ethics officials while seeking official approval for the tickets and flights. Investigators found the chief of staff, Viveca Wright Simpson, doctored an email to make it look like Shulkin was getting special recognition or an award during the trip in order to get approval for his wife’s flights. And they said Shulkin mischaracterized the woman who provided him with the Wimbledon tickets as a friend when they had only met three times at official events. (Slack, 2/14)

The Wall Street Journal: VA Chief Got Free Wimbledon Tickets, Wife’s Airfare On Trip, Watchdog Says
Dr. Shulkin’s response, submitted by his attorneys, said the trip was “immensely valuable” to the VA. They wrote that Dr. Shulkin violated no “ethical regulations” in accepting the Wimbledon tickets. They said Dr. Shulkin had no role in obtaining approval for his wife’s travel, and that the department employee, “on his own initiative,” had undertaken the “detailed planning of tourist activities.” Dr. Shulkin said that he has offered multiple times to reimburse the cost of the Wimbledon tickets, and that a British veterans official obtained them through a personal, not a professional, connection and gave them on a personal basis. (Kesling and Nicholas, 2/14)

Politico: VA Audit: Aide Expensed Shulkin Wife’s European Travel Under False Pretense
Shulkin told POLITICO the IG report was inaccurate — wildly exaggerating the cost of the Wimbledon tickets, for example — and spurred by internal VA opponents of the sweeping changes he is trying to bring to the agency. Shulkin complained that he only had two business days to respond to accusations in the report before it was published.The most reliable politics newsletter. "There are people within my organization who are not happy with the progress we’re making and the direction of the organization, who are deliberately undermining me," he said. Shulkin has demanded more accountability from employees at the VA, which says it removed 1,300 staffers last year and suspended 500 others. "They are really killing me,” he said. (Allen, 2/14)

NH Times Union: Substandard Care At Manchester VA Used By Top Fed For Cover In Flap Over $122k Wimbledon Trip
Confronted by investigators about a European junket that included free tickets to a Wimbledon final, Veterans Affairs Secretary David Shulkin said he worked a lot during the trip and cited the emerging media storm over substandard care at the Manchester VA Medical Center. That’s according to a VA Inspector General, who reports that Shulkin and his wife inappropriately accepted tickets to the ladies final at Wimbledon and ate lunch at the private members dining room at Wimbledon. Investigators also determined that the nine-day, mid-July trip, which cost taxpayers $122,300, involved only 3 1/2 days of meetings, and VA workers arranged numerous sight-seeing activities in Copenhagen and London for the Shulkins. (Hayward, 2/14)

The Washington Post: VA Secretary Shulkin, Under Fire For Europe Trip, To Appear Before House Panel
The Committee on Veterans’ Affairs is scheduled to hold a previously planned hearing at 8 a.m. Its chairman, Rep. Phil Roe (R-Tenn.), intends to “address” the issue in his opening statement, his staff said. The hearing follows a damning report issued Wednesday from VA’s inspector general, Michael J. Missal. Shulkin is challenging the findings as “unfair.” (Wax-Thibodeaux, 2/15)

Politico: How One Conservative State Is Flouting Obamacare
Idaho is going rogue on Obamacare. The Republican-led state has a maverick plan to flout the federal health care law, letting insurers sell plans that don’t meet Obamacare coverage rules and patient protections. And the brazen move — Gov. Butch Otter is plowing ahead on his own, without seeking federal waivers or permission — poses a test for the Trump administration. (Demko and Pradhan, 2/14)

Bloomberg: Ignoring Obamacare Rules, Idaho ‘Freedom’ Plans Come With Limits
After Idaho’s Republican governor promised to find creative ways to get around Obamacare, one health plan in the state plans to offer skimpy coverage that may violate many of the law’s protections for patients. Blue Cross of Idaho said Wednesday that it will offer insurance plans that don’t comply with some Affordable Care Act requirements. The “Freedom Blue” coverage is a way to give some people lower premiums upfront in exchange for less comprehensive coverage. (Tracer, 2/14)

The Wall Street Journal: Republican Foes Of Health Law Try A Patch Job Ahead Of Midterms
Republicans opposed to the Affordable Care Act are showing interest in proposals to shore up the health law and lower premiums, driven partly by their concerns that any big jump in insurance costs may hurt them in the midterm elections. State and federal GOP lawmakers are backing or considering reinsurance proposals that aim to curb premiums by offsetting insurers’ costlier claims. That stance is a reversal from last year, when Republicans almost uniformly opposed measures to aid the health law they tried to repeal. (Armour, 2/15)

The Hill: HHS Head Says He Will Uphold ObamaCare As Law
The top federal health official on Wednesday said he will uphold ObamaCare as long as it remains the law. In response to a question about a controversial plan in Idaho to allow insurers to sell plans that don’t meet ObamaCare requirements, Department of Health and Human Services Secretary Alex Azar told a congressional panel that he has a responsibility to enforce the law. (Weixel, 2/14)

Modern Healthcare: CMS Reports That Repeal Of Mandate Penalty Will Lead To Spike In Uninsured
The Trump administration is projecting that nearly 8 million people will voluntarily lose insurance in the next eight years as a result of the repeal of the Affordable Care Act's financial penalty for not having health insurance. In all, 37.7 million people will be uninsured by 2026, up from the estimated 30 million in 2018, according to an analysis CMS actuaries released Wednesday. (Dickson, 2/14)

The Hill: Drug Industry Scrambles After Rare Loss In Budget Deal
Pharmaceutical companies are pushing to repeal or roll back a provision in last week’s budget deal that delivered a rare loss to their industry, according to two lobbyists familiar with the situation. A provision included in the budget deal approved last week raised the share of costs that drug companies have to pick up as part of closing the “donut hole,” a gap in drug coverage for Medicare Part D beneficiaries. (Sullivan, 2/14)

Stat: Trump Presses Key Republican To Move On 'Right To Try'
President Trump personally pressed a key House committee chairman to move quickly on right-to-try legislation, asking for a timeline on the bill’s delivery at a separate White House event on infrastructure Wednesday. Rep. Greg Walden, who chairs the House Energy and Commerce Committee, said Trump’s question was “How close are you to getting this done?” “And I said we’re very close. And we are,” Walden told reporters at the Capitol on Wednesday, after the meeting. (Mershon, 2/14)

The Washington Post: ‘We Would Literally Not Survive’: How Trump’s Plans For The Social Safety Net Would Affect America’s Poorest
Since the day in January 2010 when teenager Courtney Bias and her 1-week-old daughter were kicked out of her mother’s house, the young family has slept wherever they can: under bridges. On strangers’ floors. In city parks. Today, 25-year-old Bias, her boyfriend and their three young children are renting part of a friend’s apartment outside Baltimore. They scrape by on his wages from construction and landscaping jobs, relying on federal food stamps to help feed their children and Medicaid for doctor’s visits. Bias has also been on a wait list for subsidized housing for the past seven years and was told 2018 would be the year she could finally move into her own apartment. (Dewey and Jan, 2/14)

The Hill: 172 Dems Ask Trump Official To Reject Medicaid Work Requirements
More than 170 House Democrats asked Health and Human Services (HHS) Secretary Alex Azar to reject requests from states to require Medicaid beneficiaries to work. "Such actions to tie health coverage to work are motivated purely on the basis of ideology and mistaken assumptions about what Medicaid is and who it covers," the Democrats wrote to Azar. (Hellmann, 2/14)

The Associated Press: Gov't Says Health Costs To Keep Growing Faster Than Economy
U.S. health care spending will keep growing faster than the overall economy in the foreseeable future, squeezing public insurance programs and employers who provide coverage, the government said Wednesday. Annual projections from number crunchers at the Department of Health and Human Services cite an aging population and an uptick in prices for health care services and goods as factors behind the ongoing growth in costs. (2/14)

The Hill: US Spending On Health Care Estimated To Reach $5.7 Trillion In 2026
Health spending is expected to increase 5.5 percent annually through 2026, according to a report from the actuaries at the Department of Health and Human Services (HHS). That's 1 percentage point faster than economic growth projections. Overall, health spending is projected to make up 19.7 percent of the U.S. economy in 2026, up from 17.9 percent in 2016. In total, spending on health care in the U.S. is estimated to reach $5.7 trillion in 2026, about $2 trillion higher than this year. (Hellmann, 2/14)

The Washington Post: U.S. Spending On Drugs Will Grow Faster Than On Other Health-Care Services Over The Next Decade
Prescription drug spending will grow faster than any other major medical good or service over the next decade, according to a projection from the Centers for Medicare and Medicaid Services. The analysis, published in the journal Health Affairs, estimates that by 2026, national health spending will climb to $5.7 trillion, or nearly a fifth of the economy. Prescription drug spending is forecast to grow at 6.3 percent per year, on average, between 2017 to 2026. (Johnson, 2/14)

Los Angeles Times: U.S. Healthcare Tab To Keep Rising, Led By Higher Costs For Drugs And Services, Government Report Says
"High and rising costs expose two often overlooked problems," Harvard economist David Cutler noted in an article accompanying the new spending projections, published in the journal Health Affairs. "First, spending is too high because many dollars are wasted. … Second, high medical costs combined with stagnant incomes for a large share of the population and the inability of governments at all levels to raise tax dollars leads to increased health and economic disparities," Cutler wrote. (Levey, 2/14)

The Associated Press: A Surprise No One Wants: Big Medical Bill Even With Coverage
This winter’s nasty flu season may smack patients with a financial side effect: surprise medical bills. People who wind up in the emergency room or need an ambulance can be blindsided by hefty, unexpected charges. This often happens after patients visit a doctor or hospital outside their insurance network so coverage was limited. Insurance deductibles that reset every January and must be paid before coverage begins can make these invoices even more painful. Here’s a look at the issue and some tips for dealing with surprises. (Murphy, 2/14)

The Wall Street Journal: Health-Care Deals: An Offer They Can’t Refuse
The health-care industry is in the throes of a major shake-up. That creates a situation in which companies face a greater risk by standing pat than possibly overpaying for an acquisition.Amazon.com Inc., Berkshire Hathaway and JPMorgan Chase announced last month that they would start their own nonprofit company aimed at lowering medical costs for their employees. Separately, The Wall Street Journal reported that Amazon has designs on expanding its hospital-supplier business. (Grant, 2/15)

The Wall Street Journal: HeartFlow Valuation Tops $1.5 Billion For Disease Detection Software
HeartFlow Inc. has raised a fresh funding round that puts the company’s valuation over $1.5 billion. Wellington Management and Baillie Gifford led the a $240 million Series E, with participation from existing investors including the venture arm of HealthCor Partners Management. This brings the company’s total funding to date to about $475 million. (Mack, 2/14)

The New York Times: New York Will Investigate Reports Of Gay Men Denied Insurance
State financial regulators in New York said Wednesday that they would investigate reports that gay men have been denied insurance policies covering life, disability or long-term care because they were taking medication to protect themselves against H.I.V. Such denials would amount to illegal discrimination based on sexual orientation, and the companies doing so could be penalized, said Maria T. Vullo, the state’s superintendent of financial services. (McNeil, 2/14)

The Washington Post: Tracking The Flu Week By Week
This flu season is turning out to be so intense that the number of people seeking care at doctors' offices and emergency rooms has surged to levels not reported since the peak of the 2009 swine flu pandemic, federal officials said Feb. 9. This year's vaccine is less effective against the strain of virus making the rounds. But there's another factor that gives aggressive viruses such as this one an extra punch in the United States: lack of access to paid sick time. (Cameron and Keating, 2/14)

The Associated Press: Flu Kills First Delaware Woman Without Underlying Illness
Delaware health officials say the flu has killed the first person in the state who didn't have an underlying condition. The New Journal of Wilmington reports the 47-year-old woman who died this week did not have this year's flu shot and was infected with influenza B. The 10 other Delawareans who have died from the flu all had underlying conditions; Six of them had received a flu shot. (2/15)

The Associated Press: How Best To Treat Opioids' Youngest Sufferers? No One Knows
Two babies, born 15 months apart to the same young woman overcoming opioid addiction. Two very different treatments. Sarah Sherbert’s first child was whisked away to a hospital special-care nursery for two weeks of treatment for withdrawal from doctor-prescribed methadone that her mother continued to use during her pregnancy. Nurses hesitated to let Sherbert hold the girl and hovered nervously when she visited to breast-feed. (2/14)

Stat: A State Offered All Inmates Addiction Treatment. Overdose Deaths Plunged
A first-in-the-nation program offering a range of medications to Rhode Island inmates who are addicted to opioids appears to have lowered the number of overdose deaths among people recently released from jail and prison, researchers reported Wednesday. Experts have long advocated for expanding the use of medication-assisted treatment, or MAT, in correctional facilities, but for the most part, jails and prisons remain treatment deserts. Starting in the middle of 2016, however, Rhode Island started rolling out its program and making available to all inmates the three medications approved to treat opioid use disorder. (Joseph, 2/14)

The Hill: Surgeon General Offers Advice On Fighting Opioids
The nation’s top doctor offered advice for lawmakers Wednesday on how to help support long-term recovery for people with an addiction, as Congress examines how to curb the opioid epidemic plaguing the country. Connecting people with support services, such as food and housing, pays off, Surgeon General Jerome Adams said Wednesday at an event hosted by The Hill. (Roubein, 2/14)

The Hill: Markey, Paul Want To Know If New Rules Are Helping Opioid Treatment
Two senators are asking the Department of Health and Human Services (HHS) if new measures aimed at increasing access to opioid treatment are working. Sens. Ed Markey (D-Mass.) and Rand Paul (R-Ky.) worked to pass a provision allowing trained nurse practitioners and physician assistants to prescribe buprenorphine, a type of medication-assisted treatment for an opioid addiction. (Roubein, 2/14)

Reuters: Minnesota Renews Push For Tax On Prescription Opioids
Citing rising opioid fatalities, Minnesota Governor Mark Dayton on Wednesday announced a renewed legislative proposal to tax prescription opioid pills to help fund treatment. Minnesota is one of at least 13 states to have considered an opioid tax in recent years to help pay for the fallout from the United States' opioid epidemic, although none have passed, according to the National Conference of State Legislatures. (Kenning, 2/14)

Stat: FDA Approves First Blood Test To Help Diagnose Concussions
The Food and Drug Administration gave a green light Wednesday for the first time to a blood test that doctors can use to help rule out concussions. The Brain Trauma Indicator, marketed by Banyan Biomarkers Inc., measures the levels of two proteins — called UCH-L1 and GFAP — whose elevated presence suggests a certain type of brain damage normally only visible on a CT scan. The test takes three to four hours, and doctors could use it to determine which patients need a CT scan to confirm the damage and which patients can rest easy. (Swetlitz, 2/14)

CNN: FDA Approves First Ever Blood Test For Concussion
Patients are currently diagnosed with concussion based on a combination of symptoms as well as imaging. However, CT scans don't always detect concussion. "Over 90% of CT scans (for concussion) are negative. And you get 200 times the radiation of a chest X-ray. It's expensive; it's not terrific," said Hank Nordhoff, chairman and CEO of Banyan Biomarkers, maker of the new test. It can help determine whether a patient further needs a CT scan, based on a physician's concerns. (Kounang, 2/14)

The New York Times: First Blood Test To Detect Concussions Is Approved
“This is going to change the testing paradigm for suspected cases of concussion,” said Tara Rabin, a spokeswoman for the F.D.A. She noted that the agency had worked closely on the application with the Defense Department, which has wanted a diagnostic tool to evaluate wounded soldiers in combat zones. The Pentagon financed a 2,000-person clinical trial that led to the test’s approval. (Kaplan and Belson, 2/14)

The New York Times: Lena Dunham Says She Had Hysterectomy After Endometriosis
The actress and writer Lena Dunham said in an essay published on Wednesday that she had a hysterectomy last fall at age 31 after living for many years with endometriosis, a painful medical condition affecting pelvic tissue. In the essay, in the March issue of Vogue, Ms. Dunham chronicled her decade-long struggle with the disease, her efforts to manage it without surgery and the choice she made to have her uterus removed after the pain left her “delirious.” (Stack, 2/14)

Stat: Fractional Doses Of Yellow Fever Vaccine Provide Protection, Study Finds
A 2016 emergency yellow fever vaccination campaign that had to resort to using smaller than standard doses because of a global vaccine shortage appears to have protected the people who were vaccinated, a new study suggests. People who received a fractional dose — one-fifth the standard size — showed strong immune responses a month after they received the single dose of vaccine, the authors reported in the New England Journal of Medicine. (Branswell, 2/14)

The Washington Post: How A Transgender Woman Breast-Fed Her Baby
She told doctors that she wanted to breast-feed her baby. She explained that her partner was pregnant but was not planning to breast-feed when the child was born, so she wanted to take it on herself. The 30-year-old, who is transgender, was willing to accept the risks. Following months of hormone therapy last year, doctors say she might be the first reported transgender woman in academic literature to breast-feed, according to a case study published last month in the peer-reviewed journal Transgender Health. (Bever, 2/14)

The Associated Press: Report Details Harm To Cuba Diplomats But Offers No Cause
Doctors are releasing the first detailed medical reports about the hearing, vision, balance and brain symptoms suffered in what the State Department has called "health attacks" on U.S. diplomats in Cuba. Still missing: A clear diagnosis of just what happened to trigger their mysterious health problems. All together, the symptoms are similar to the brain dysfunction seen with concussions, concluded a team of specialists from the University of Pennsylvania who tested 21 of the 24 embassy personnel thought to be affected. (2/14)

NPR: Apple IPhone Software Update Will Support Medical Records
Richard Klein switched doctors last year. The new doctor put him on a new blood pressure drug. But it didn't help. The failure was entirely predictable. Klein, an associate professor at Florida International University in Miami, realized later that he had tried the same medicine unsuccessfully a few years before, but he hadn't remembered that fact during the appointment. (Yu, 2/14)

The Washington Post: A Mom Turned To A Controversial ‘Treatment’ For Her Daughter’s Autism — Feeding Her Bleach
A father in Indianapolis last week accused his wife of feeding their child bleach to help cure her autism — something his wife had read about in a Facebook group. Police arrested the 28-year-old mother on Saturday after she allegedly put drops of hydrochloric acid and water-purifying solution in her young daughter’s drinks. The potentially dangerous chemical combination, which becomes an industrial bleach, is marketed as Miracle Mineral Solution or Master Mineral Solution, which its advocates claim will cure a number of diseases, including autism, cancer, AIDS and hepatitis. (Eltagouri, 2/14)

The Associated Press: Pot-Users Want Judge To Declare Marijuana Safe Under US Law
Army veteran Jose Belen says the horrors of the Iraq War left him with post-traumatic stress disorder, and the drug that helped him cope best with the symptoms was one his Veterans Affairs doctors could not legally prescribe: marijuana. “Once I did use cannabis, immediately I felt the relief,” said Belen, who is now working with other medical marijuana users to mount a long-shot court challenge to federal laws criminalizing the drug. (Matthews, 2/14)

The Associated Press: Soda On Children’s Menus Could Fizz Out In New Hampshire
Fewer children will wash down their chicken fingers and fries with soda if a bill limiting beverage choices for restaurant children’s meals gets through the New Hampshire Legislature. The bill would apply to restaurants that serve children’s meals that bundle together food and a beverage for one price. Drinks served with such meals would be limited to milk, 100 percent juice or juice combined with water, plain water, or flavored water with no sweeteners. Customers still could purchase soda or other sugary drinks on the side. (Ramer, 2/14)

Reuters: McDonald's Plays 'Hide The Cheeseburger' In New Happy Meal Health Push
McDonald's Corp is removing cheeseburgers from U.S. Happy Meal menus and shrinking the french fry serving in one "Mighty Meal" as part of a new global plan to cut calories and make its food for children more healthy. The changes announced Thursday come as the world's biggest fast-food chain for the first time established global limits for calories, sodium, saturated fat and added sugar in Happy Meals, which consultants and franchisees say account for roughly 15 percent of sales in the United States. (Baertlein, 2/15)

Reuters: Illinois Governor Takes Aim At Pensions, Healthcare Costs In Budget
Illinois Governor Bruce Rauner proposed a $75 billion fiscal 2019 budget on Wednesday that would be balanced if lawmakers agree to push some big-ticket costs onto local school districts and universities. The budget for the fiscal year starting July 1, which includes $37.6 billion in general fund spending, would save money by phasing out state funding for certain pension costs. (Pierog, 2/14)