First Edition: January 12, 2016

Kaiser Health News: Hospitals Step Up To Help Seniors Avoid Falls
Falls are the leading cause of injuries for adults 65 and older, and 2.5 million of them end up in hospital emergency departments for treatment every year, according to the Centers for Disease Control and Prevention. The consequences can range from bruises, fractured hips and head injuries to irreversible calamities that can lead to death. And older adults who fall once are twice as likely as their peers to fall again. Despite these scary statistics, a dangerous fall does not have to be an inevitable part of aging. Risk-reduction programs are offered around the country. (Jaffe, 1/12)

Kaiser Health News: Slipping Between Medicaid And Marketplace Coverage Can Leave Consumers Confused
For people whose income changes shift them above or below the Medicaid threshold during the year, navigating their health insurance coverage can be confusing. Ditto for lower income people who live in states that may expand Medicaid this year. Under the health law, states can expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level (about $16,000 for an individual). Thirty states and the District of Columbia have done so. This week I answered three questions from readers about how Medicaid interacts with plans on the health insurance marketplaces. (Andrews, 1/12)

The Wall Street Journal: Health Law Enrollment Periods To Be Tightened
The Obama administration will tighten the rules for people who enroll in insurance through HealthCare.gov outside of official enrollment periods, hoping to hold down costs that insurers blamed on late sign-ups. A top federal health official said Monday that the administration will eliminate some criteria for late sign-ups and make other criteria language clearer. Insurers say that the rules are so broad that people can wait until they get ill to buy insurance. That raises health-care spending and overall premiums because people who are sicker generally cost more to cover. (Armour and Radnofsky, 1/12)

Politico: Gaming Obamacare
Obamacare customers are gaming the system, buying coverage only after they find out they’re ill and need expensive care — a trend insurers warn is destabilizing the fledgling health law marketplaces and spiking premiums for everyone. Insurers blame the problem on lax rules that allow more than 900,000 people to sign up for coverage outside the standard enrollment season — for instance, when they change jobs or move — without sufficient proof they are eligible. (Demko, 1/12)

The Washington Post: Kentucky Governor Moves To Shut Down State’s ACA Insurance Exchange
In a statement Monday, Bevin’s office said he had taken steps to eliminate the “redundancy” of Kynect. He previously had pledged to shut down the exchange because “it adds no value” given the existence of HealthCare.gov. The former Democratic governor, Steve Beshear, had urged Bevin to maintain the exchange, noting that it is financed through a surcharge on insurance plans. Shutting Kynect would cost at least $23 million in state money, Beshear said. (Sun, 1/11)

The New York Times: Panel Reasserts Mammogram Advice That Triggered Breast Cancer Debate
In 2009, an influential panel of medical experts ignited a nationwide uproar by suggesting that women needed fewer mammograms than had long been recommended. Instead of starting at age 40 and being screened every year, women with average risk of breast cancer could safely begin at 50 and be tested every other year, the group said, citing extensive data to support its advice. It also said that after 74, there was not enough evidence to determine whether routine mammography was worthwhile. Outrage ensued, from advocates for screening who said the advice would lead to delayed diagnoses and deaths. On Monday, the same panel issued an update of its guidelines — and it is sticking to its guns. (Grady, 1/11)

The Associated Press: Task Force: Mammograms An Option At 40, Do More Good At 50
Mammograms do the most good later in life, a government task force has declared in recommending that women get one every other year starting at age 50. It said 40-somethings should make their own choice after weighing the pros and cons. The latest guidelines from the U.S. Preventive Services Task Force, made public Monday, stick with its advice that women should have one every two years between ages 50 and 74. But they also make clear that it's an option for younger women even though they're less likely to benefit. (1/12)

The Washington Post: New Breast Cancer Screening Guidelines At Odds With Congress
The task force's final recommendation is likely to be controversial because some other groups say the screening should start earlier. The American Congress of Obstetricians and Gynecologists, for example, recommends that regular screenings begin at age 40, while the American Cancer Society calls for women to start yearly screening at age 45 and then move to screening every two years starting at age 55. Congress has sided with proponents of earlier screening. Last month, in anticipation of Monday's release of the task force’s final recommendation, lawmakers took preemptive action: It directed insurers to ignore the task force's latest guidelines and, instead, to rely on its 2002 recommendation. (Sun, 1/11)

The Wall Street Journal: Final Recommendations On When To Start Getting A Mammogram
Medical groups decide on guidelines by weighing the potential benefits of breast-cancer screening, mainly lives saved through early cancer detection, against possible harms, including false positives that can lead to unnecessary tests and treatment. Weighing the various factors differently can change the conclusions. ... While regular mammograms for women in their 40s are effective in reducing deaths from breast cancer, the benefit is less than it is for older women and the potential harms are greater, the task force noted. (Reddy, 1/11)

The New York Times: Hillary Clinton Confronts Bernie Sanders As Polls Show Her Lead In Iowa Narrowing
Facing new pressure from Senator Bernie Sanders in Iowa, Hillary Clinton confronted him in direct terms on Monday, warning Iowans that if elected president, he would put their health insurance in the hands of Republican governors and raise taxes on the middle class. ... On health care, Mrs. Clinton said that she wanted to build upon the Affordable Care Act, while Mr. Sanders wanted to scrap it in favor of a universal health plan that would empower the states — and potentially Republican governors, who she has said cannot be trusted. (Rappeport, 1/11)

The Washington Post: Clinton Confronts Rival Sanders As Iowa Polls Tighten
Hillary Clinton has spent much of her 2016 presidential campaign looking past Democratic rival Bernie Sanders, focusing instead on Republicans and the November general election. No longer. ... On Monday, she widened her health care critique to include Sanders, saying he would “rip up” the law and put power in the hands of states. Sanders said during a town hall meeting in Perry that large numbers of underinsured and sky-high deductibles demand a better health care system, which he would seek through his single-payer, Medicare-for-all system. Said Clinton: “I sure don’t want to turn over health care to Republican governors, for heaven’s sake. I think it’s a risky deal.” (Lerer and Thomas, 1/11)

The Washington Post's Fact Checker: Recidivism Watch: Rubio Again Wrongly Suggests He Damaged Obamacare
Sen. Marco Rubio (R-Fla.) is once again spreading the fiction that he was the lawmaker responsible for a provision in a spending bill that has wounded the Affordable Care Act, a.k.a. Obamacare. He previously earned Four Pinocchios for making this claim. (Kessler, 1/11)

The Wall Street Journal: Shire Agrees To Buy Baxalta For $32 Billion
Shire PLC’s six-month pursuit of Baxalta Inc. ended Monday when the two companies unveiled a $32 billion deal that they said would create the world’s biggest rare-disease drugmaker. News of Dublin-based Shire’s deal for the Illinois company comes amid unease in Washington over U.S. tax policy and corporate growth. (Roland and Rubin, 1/11)

The Associated Press: High Court Won’t Hear Appeal Over $124M Drug Penalty
The Supreme Court won’t hear an appeal from a Johnson & Johnson subsidiary assessed more than $124 million in penalties for deceptive marketing of an anti-psychotic drug. The justices on Monday let stand a lower court ruling that said Janssen Pharmaceuticals, Inc. should pay the penalties for violations of South Carolina law. (1/11)

The New York Times: Drug Companies To Try A Unified Front Against Cancer
Some leading pharmaceutical companies are joining forces in an effort to speed the testing of new types of cancer drugs that harness the body’s immune system to battle tumors. The cooperative effort, announced on Monday, will include Amgen, Celgene and some smaller companies. The effort, known as the National Immunotherapy Coalition, will try to rapidly test various combinations of such drugs. (Pollack, 1/11)

NPR: Popular Acid Reflux Drugs Are Linked To Kidney Disease Risk
People who take certain popular medicines for heartburn, indigestion and acid reflux may want to proceed more cautiously, researchers reported Monday. The drugs, known as proton-pump inhibitors (PPIs), appear to significantly elevate the chances of developing chronic kidney disease, according to a study involving more than 250,000 people. (Stein, 1/11)

Reuters: Louisiana Governor Pledges To Expand Medicaid In Inaugural Address
Louisiana Governor John Bel Edwards laid out his agenda during his inaugural address on Monday, pledging to expand Medicaid, enact education reforms, and find long-term solutions to the state's large budget deficit. Edwards, the first Democrat to hold the office of governor in Louisiana since 2008, said he planned to begin accepting federal funding on Tuesday to expand healthcare to residents through the Affordable Care Act, also known as Obamacare. (Carroll, 1/11)

Reuters: State Attorneys General Joining Probe Of Health Insurer Mergers
About 15 state attorneys general have joined the Justice Department's probe of two big insurance mergers, according to people familiar with the matter, increasing the scrutiny on proposed deals that would reduce the number of nationwide health insurers to three from five. The formation of a large group to scrutinize Aetna Inc's plan to buy Humana Inc and Anthem Inc's bid for Cigna Corp complicate what is already expected to be a tough and lengthy review by federal antitrust enforcers. (Bartz, 1/11)

The Associated Press: Health Insurance Companies Agree To Pay $483K In Fines
The three health care insurers providing individual plan coverage to Delawareans under the Affordable Care Act have agreed to pay almost half a million dollars in fines for past violations of state insurance regulations. Insurance department officials say Highmark Blue Cross Blue Shield of Delaware will pay a fine of $383,000 under a recent consent order. Aetna Health Inc. and Aetna Life Insurance Co. have agreed to pay a combined total of $100,000 in fines. (1/12)

Los Angeles Times: Former California Health Regulator Agrees To A Fine For Helping Kaiser
A former top regulator for the state who was involved in an audit of Kaiser Permanente before going to work for the HMO has admitted she acted improperly and has agreed to pay a fine, according to documents released Monday. Marcella Faye Gallagher was supervising attorney for the state’s Department of Managed Health Care while it audited Kaiser to make sure the HMO’s mental health plan complied with state law by providing timely access to services. (McGreevy, 1/11)