First Edition: March 29, 2019

Kaiser Health News: Doughnut Hole Is Gone, But Medicare’s Uncapped Drug Costs Still Bite Into Budgets
Recent proposals by the Trump administration and Sen. Ron Wyden (D-Ore.) would address the long-standing problem by imposing a spending cap. But it’s unclear whether any of these proposals will gain a foothold. The 2006 introduction of the Medicare prescription drug benefit was a boon for seniors, but the coverage had weak spots. One was the so-called doughnut hole — the gap beneficiaries fell into after they accumulated a few thousand dollars in drug expenses and were on the hook for the full cost of their medications. Another was the lack of an annual cap on drug spending. (Andrews, 3/29)

Kaiser Health News: World’s First HIV-To-HIV Kidney Transplant With Living Donor Succeeds
The world’s first kidney transplant from a living HIV-positive donor to another HIV-positive person was successfully performed Monday by doctors at a Johns Hopkins University hospital. By not having to rely solely on organs from the deceased, doctors may now have a larger number of kidneys available for transplant. Access to HIV-positive organs became possible in 2013, and surgeries have been limited to kidneys and livers. (Knight and Heredia Rodriguez, 3/28)

Kaiser Health News: Podcast: KHN’s ‘What The Health’ Health Care’s Back (In Court)
A federal district court judge in Washington, D.C., has blocked work requirements for Medicaid recipients in Arkansas and Kentucky. Since the Arkansas program took effect in 2018, more than 18,000 people have lost health coverage because they failed to report their work hours to the state. Meanwhile, the Trump administration changed its position in a lawsuit filed by Republican state officials challenging the constitutionality of the Affordable Care Act. The administration is now officially supporting cancellation of the entire health law in light of Congress’ elimination in the 2017 tax bill of the penalty for failing to have insurance. (3/28)

The New York Times: Dealing Another Blow To Trump, Federal Judge Strikes Down Rule Skirting Requirements Of Health Act
A federal judge on Thursday struck down a Trump administration rule that allows small businesses to band together and set up health insurance plans that skirt requirements of the Affordable Care Act. The rule is “clearly an end-run around the A.C.A.,” said the judge, John D. Bates, of the Federal District Court for the District of Columbia. The ruling was the second big defeat this week for President Trump on a top-priority item on his health care agenda as he has sought to use the courts to obliterate his predecessor’s signature achievement. Another judge on Wednesday blocked Medicaid work requirements in Arkansas and Kentucky. (Pear, 3/28)

Reuters: U.S Judge Strikes Down Rule Allowing 'Skimpy' Health Insurance Plans
The rule, put forward by the U.S. Department of Labor, would have allowed small businesses and those who are self-employed to band together and buy lower-cost health insurance policies, similar to large employers. In the suit filed by 11 states and the District of Columbia, the judge found the department unreasonably expanded the definition of employers to include groups without any real commonality of interest as well as business owners without employees. (3/28)

The Washington Post: Judge Strikes Down Trump’s Health Care Plan To Go Around Obamacare
The 43-page ruling, submitted by U.S. District Judge John D. Bates of the District of Columbia, blocks new rules from the Trump administration overseeing “association health plans,” which would allow small businesses to combine their forces to offer less expensive plans outside the ACA that would be both less expensive and provide fewer health protections. “The final rule is clearly an end-run around the ACA,” Bates, an appointee of President George W. Bush, wrote in the Thursday ruling. “Indeed, as the president directed, and the secretary of labor confirmed, the final rule was designed to expand access to AHPs to avoid the most stringent requirements of the ACA.” (Bella, 3/29)

Politico: Trump Administration Suffers Another Obamacare Blow In Court
“We are pleased that the District Court saw past the Trump Administration’s transparent effort to sabotage our health care system and gut these critical consumer protections in the service of its own partisan agenda,” New York Attorney General Tish James, one of the parties to the suit, said in a statement. It was not immediately clear if the administration would appeal. (Demko, 3/28)

The Wall Street Journal: Federal Judge Blocks Trump Rule On Association Health Plans
An additional four million people were expected to enroll in these less comprehensive plans by 2023, according to the Labor Department, which issued the final rule. “We disagree with the district court’s ruling and are considering all available options,” Justice Department spokeswoman Kelly Laco said. “The administration will continue to fight for sole proprietors and small businesses so that they can have the freedom to band together to obtain more affordable, quality health-care coverage. The Association Health Plan rule opened health-care options for dozens of associations representing thousands of small businesses and sole proprietors and provided them with access to the same type of affordable health-care options offered by other employers.” (Armour, 3/28)

The Wall Street Journal: Trump, Congressional Republicans In Standoff Over Health Law
President Trump continued to reach out to Republican lawmakers Thursday to take the lead on crafting a health plan to replace the Affordable Care Act, working to hand off the politically sensitive effort ahead of the 2020 elections. Senate Republicans, meanwhile, want the administration to take the lead on developing a plan while they remain on politically safer ground, working on popular voter issues such as lowering drug prices and ending surprise medical bills. (Armour and Peterson, 3/28)

Politico: McConnell To Trump: Health Care’s All Yours
Mitch McConnell has no intention of leading President Donald Trump’s campaign to transform the GOP into the “party of health care.” “I look forward to seeing what the president is proposing and what he can work out with the speaker,” McConnell said in a brief interview Thursday, adding, “I am focusing on stopping the ‘Democrats’ Medicare for none’ scheme.” (Everett, 3/28)

The Hill: Trump: Group Of GOP Senators Writing 'Spectacular' ObamaCare Replacement 
President Trump said Thursday that a group of GOP senators will come up with a "spectacular" plan to replace ObamaCare if the courts strike down the law. Trump told reporters at the White House that lawmakers including Sens. John Barrasso (R-Wyo.), Bill Cassidy (R-La.) and Rick Scott (R-Fla.) are working on the plan, at Trump's request. (Sullivan, 3/28)

The Hill: Meadows Says ObamaCare Replacement Will Come From Congress 
Rep. Mark Meadows (R-N.C.), one of President Trump’s closest congressional allies, on Thursday said any plan to replace ObamaCare will come from Congress, rather than the administration. “It’s my impression there will be a plan the president and White House endorses, but I think it will be a collaborative effort between House and Senate Republicans,” Meadows told reporters. (Weixel, 3/28)

The Hill: GOP Faces Tough Battle To Become 'Party Of Health Care' 
Republicans face an uphill battle in their bid to fulfill President Trump's prophecy that the GOP will become "the party of health care." The presidential directive, handed down in a tweet on Tuesday, came at an inopportune time for Republicans, less than a day after the Trump administration called for the courts to invalidate the Affordable Care Act in its entirety. (Greenwood, 3/29)

The Hill: Trump's Decision On Health Care Law Puts Spotlight On Mulvaney 
President Trump’s decision to call for ObamaCare’s complete dismantling in court is shining the spotlight on Mick Mulvaney, the acting White House chief of staff who reportedly pushed for the action. Mulvaney, a former member of the conservative House Freedom Caucus, argued in favor of backing a lawsuit to nullify the Affordable Care Act during a White House meeting with other officials, according to two published reports. (Sullivan and Fabian, 3/28)

The Associated Press: Ruling Creates Uncertainty For States' Medicaid Work Rules
The governor whose state is at the center of the fight over work requirements for Medicaid recipients said Thursday he wants to fight a judge's ruling blocking those rules, while Republicans elsewhere are trying to determine the decision's effect on their state. Arkansas Gov. Asa Hutchinson urged the federal government to appeal the ruling against his state's requirement that certain people covered by its Medicaid expansion work or lose their coverage. A day earlier, a federal judge in Washington blocked work requirements in Arkansas and Kentucky. (DeMillo, 3/28)

The Washington Post: Arkansas Governor Seeks Appeal Of Decision Voiding Medicaid Work Rules
Arkansas Gov. Asa Hutchinson (R) said Thursday that “no one will lose coverage from this day forward,” after a Washington federal judge blocked rules that compelled many poor people to work in exchange for public health insurance. But calling the previous day’s court ruling “a great disruption of the status quo,” Hutchinson pledged to fight vigorously to continue the first-in-the-nation work requirements that Arkansas imposed last year on people in a part of Medicaid that expanded under the Affordable Care Act. He said he had urged the Trump administration to swiftly appeal the judge’s decision and seek a stay that would allow the state to resume the program while the legal case continues. (Goldstein, 3/28)

The Hill: Trump Hits Obstacles In Effort To Reshape Medicaid
The Trump administration faces a long, tough road ahead in its mission to reshape Medicaid, the primary federal health program for the poor, after losing three legal challenges in less than one year. Trump and leaders at the Department of Health and Human Services (HHS) — Secretary Alex Azar and Medicaid Administrator Seema Verma — are pushing to make employment a precondition for receiving Medicaid coverage in all 50 states. (Hellmann, 3/29)

Politico: Exclusive: Key Trump Health Official Spends Millions On GOP-Connected Consultants
The Trump appointee who oversees Medicare, Medicaid and Obamacare quietly directed millions of taxpayer dollars in contracts to Republican communications consultants during her tenure atop the agency — including hiring one well-connected GOP media adviser to bolster her public profile. The communications subcontracts approved by CMS Administrator Seema Verma — routed through a larger federal contract and described to POLITICO by three individuals with firsthand knowledge of the agreements — represent a sharp break from precedent at the agency. Those deals, managed by Verma’s deputies, came in some cases over the objections of CMS staffers, who raised concerns about her push to use federal funds on GOP consultants and to amplify coverage of Verma’s own work. CMS has its own large communications shop, including about two dozen people who handle the press. (Cancryn and Diamond, 3/29)

The New York Times: How Joe Biden Struggled With Abortion Rights For Decades
It was a new era in Washington in 1981, and abortion rights activists were terrified. With an anti-abortion president, Ronald Reagan, in power and Republicans controlling the Senate for the first time in decades, social conservatives pushed for a constitutional amendment to allow individual states to overturn Roe v. Wade, the Supreme Court ruling that had made abortion legal nationwide several years earlier. The amendment — which the National Abortion Rights Action League called “the most devastating attack yet on abortion rights” — cleared a key hurdle in the Senate Judiciary Committee in March 1982. Support came not only from Republicans but from a 39-year-old, second-term Democrat: Joseph R. Biden Jr. (Lerer, 3/29)

The New York Times: Bernie Sanders Says ‘No’ To Incrementalism, Highlighting Divide Among Democrats
When House Speaker Nancy Pelosi introduced legislation this week to strengthen the Affordable Care Act, Democrats across the ideological spectrum were quick to express their support: moderates, liberals, even Representative Alexandria Ocasio-Cortez, the often uncompromising progressive freshman. But not Bernie Sanders. When asked on Tuesday night whether he, too, supported the House bill, Mr. Sanders was defiant. “No,” he said tersely. “No,” he said again, when pressed. “The incremental reform that I support is phasing in ‘Medicare for all.’” (Ember, 3/29)

The New York Times: New York Sues Sackler Family Members And Drug Distributors
As investigators closed in on Purdue Pharma, the maker of the opioid painkiller OxyContin, more than a decade ago, members of the family that owns the company began shifting hundreds of millions of dollars from the business to themselves through offshore entities, the state of New York alleged in a lawsuit on Thursday. The legal complaint, released at a news conference by the state attorney general Letitia James, was heavily redacted. Even so, it contains striking details alleging systematic fraud not only by the Sacklers but by a group of large but lesser-known companies that distributed alarming amounts of prescription painkillers amid a rising epidemic of abuse that has killed hundreds of thousands of people nationwide. (Rabin, 3/28)

Reuters: N.Y. Accuses Opioid Maker Purdue Of Illegal Fund Transfers To Sacklers
The lawsuit alleged Purdue and other manufacturers engaged in deceptive marketing that downplayed the dangers of the addictive painkillers and accused distributors of failing to detect the diversion of the drugs for illicit purposes. "As the Sackler family and the other defendants grew richer, New Yorkers' health grew poorer and our state was left to foot the bill," James said in a statement. (3/28)

The Wall Street Journal: Purdue’s Sackler Family Accused Of Fraud In Transfers Of Opioid Profits
Members of the Sackler family who control OxyContin-maker Purdue Pharma LP allegedly used a web of corporate entities to transfer funds from the company to themselves, moves the New York attorney general says were fraudulent, on the basis that the company was already insolvent or close to it. An amended lawsuit filed Thursday by New York Attorney General Letitia James against Purdue and eight individual Sackler family members is pushing a novel argument that profits paid to Purdue’s owners should be clawed back because of mounting litigation filed against the company. The claims hinge on a legal theory meant to protect creditors from debtors that try to stash or shield assets for their personal benefit. (Hopkins and Randazzo, 3/28)

The Washington Post: D.C. Opioid Overdoses: City Officials To Distribute 76,000 Naloxone Kits
D.C. officials have purchased 66,000 naloxone kits, part of a plan to dramatically increase the supply of a lifesaving opioid-overdose antidote that has been scarce on the streets of a city with one of the nation’s highest rates of drug deaths. D.C. officials also intend to buy 10,000 more kits in the coming months, the deputy mayor for health and human services, Wayne Turnage, said in an interview Thursday. The goal is to distribute those 76,000 kits — through community health organizations and police officers — by Sept. 30, the end of the fiscal year, he said. (Jamison, 3/28)

The Wall Street Journal: Johnson & Johnson To Air First TV Ad For Drug That Discloses Its Price
Johnson & Johnson plans to start airing the first U.S. television commercial for a prescription drug that discloses how much it costs, a nod toward rising political pressure over prices. The ad for J&J’s bloodthinner Xarelto—a version of which has already been on the air without mentioning price—will now end by briefly showing its list price of $448 a month. It is scheduled to start running nationally on Friday, according to Scott White, head of J&J’s pharmaceuticals business in North America. (Loftus, 3/28)

Los Angeles Times: Trump Pledged To End The HIV Epidemic. San Francisco Could Get There First 
The immediate goal of the city’s ambitious Getting to Zero campaign is to reduce new HIV diagnoses by 90% between 2013, when there were 394 cases, and 2020. San Francisco is only about halfway there but is moving faster than the nation as a whole and any other big city. (La Ganga, 3/28)

The Associated Press: LGBT Groups Sue Arizona Over HIV/AIDS Instruction Law
LGBT groups sued Arizona Thursday asking a federal judge to strike down a state law prohibiting HIV and AIDS instruction that “promotes a homosexual lifestyle.” The lawsuit, filed on behalf of Equality Arizona, alleges the 1991 law constitutes unconstitutional discrimination and restricts educational opportunity for LGBT students. It says it enshrines in state law that LGBT students can only be discussed in a negative light and communicates to students and teachers “that there is something so undesirable, shameful, or controversial about ‘homosexuality’ that any positive portrayals of LGBTQ people or same-sex relationships must be explicitly barred.” (3/28)

The Associated Press: House Votes To Condemn Trump's Transgender Military Ban
The House delivered a rebuke to President Donald Trump on Thursday by voting to condemn his administration's move to restrict transgender men and women from military service. A non-binding resolution opposing Trump's transgender ban passed 238-185. Every Democrat supported the resolution, while nearly every Republican voted against it. Five Republicans broke ranks and voted in favor: Brian Fitzpatrick of Pennsylvania, Trey Hollingsworth of Indiana, Will Hurd of Texas, John Katko of New York and Tom Reed of New York. (3/28)

The Associated Press: US Begins Organ Transplants From Living Donors Who Have HIV
Surgeons in Baltimore have performed what's thought to be the world's first kidney transplant from a living donor with HIV, a milestone for people with the AIDS virus — and one that could free up space on the transplant waiting list for everyone. Nina Martinez of Atlanta traveled to Johns Hopkins University to donate a kidney to an HIV-positive stranger, saying she "wanted to make a difference in somebody else's life" and counter the stigma that too often still surrounds HIV infection. (3/28)

The Washington Post: First Living HIV-Positive Donor Provides Kidney For Transplant In Medical Breakthrough
“Society perceives me, and people like me, as people who bring death,” Martinez said in an interview Saturday before the operation. “And I can’t figure out any better way to show that people like me can bring life. ”Martinez, who acquired HIV from a blood transfusion as an infant, appeared at a Hopkins news conference Thursday to announce the surgery, the first of its kind. She said she feels well and is looking forward to training to run in this October’s Marine Corps Marathon in Washington. (Bernstein, 3/28)

The New York Times: At 71, She’s Never Felt Pain Or Anxiety. Now Scientists Know Why.
She’d been told that childbirth was going to be painful. But as the hours wore on, nothing bothered her — even without an epidural. “I could feel that my body was changing, but it didn’t hurt me,” recalled the woman, Jo Cameron, who is now 71. She likened it to “a tickle.” Later, she would tell prospective mothers, “Don’t worry, it’s not as bad as people say it is.” It was only recently — more than four decades later — that she learned her friends were not exaggerating. (Murphy, 3/28)

NPR: Why Pedestrian Deaths Are At A 30-Year High
Across the U.S., 6,227 pedestrians died in traffic accidents in 2018, the highest number in nearly 30 years. The findings from a Governors Highway Safety Association report show that many of these deaths occurred in big cities like Houston and Miami. The signs are all over most cities — stretches of road without crosswalks and people needing to walk on roads built for rush-hour traffic. But the real increase, experts say, comes from larger trends: drivers and pedestrians distracted by their phones and a growth of larger vehicles on the road. (Stachura, 3/28)

NPR: Psychotherapist Lori Gottlieb Reflects On Her Own Experiences With Therapy
Even therapists need someone to talk to sometimes. Lori Gottlieb is a psychotherapist who started seeing a therapist herself five years ago, when the man she thought she would marry unexpectedly broke up with her, shattering her sense of the present and the future. "My reaction was the reaction of everybody that I told at the time, [which] was 'This guy's a jerk! You dodged a bullet!' " Gottlieb says. "But once I go to therapy, I start to see — or I'm forced to see — the situation, and my role in it too." (Gross, 3/28)

The New York Times: Are My Allergies All In My Head?
Doctors have long suspected a connection between allergies and the psyche. In 1883, Dr. Morell Mackenzie, a pioneer in the field of ear, nose and throat medicine, observed, “It has long been noticed that attacks of prolonged sneezing are most apt to occur in persons of nervous temperament.” In the 1940s, doctors discovered that allergic patients could be tricked into experiencing allergy attacks. In one case, a doctor exposed a patient to a goldenrod plant, without telling the patient that the plant was artificial. The patient immediately developed sneezing, runny nose and nasal congestion. These symptoms resolved quickly once the doctor revealed his deception to the patient. (Klasco, 3/29)

Los Angeles Times: Using Genetics To Try To Figure Out How To Get Mosquitoes To Stop Biting Us
Among all the beasts in the animal kingdom, perhaps none is more dangerous to humans than the mosquito. The whiny insects aren't just irritating — they can be deadly. In fact, the U.S. Centers for Disease Control and Prevention reckons that mosquitoes are responsible for at least 700,000 deaths worldwide each year, thanks to their ability to transmit diseases such as malaria and yellow fever with a single bite. (Netburn, 3/28)

NPR: How Mosquitoes Use Human Sweat To Find And Bite Us
Targeting this receptor might offer a new way to foil blood-seeking mosquitoes and prevent the transmission of diseases including malaria, Zika virus and dengue, according to the study published Thursday in the journal Current Biology. "We found a receptor for human sweat, and we found that acidic volatiles that come off of us are really key for mosquitoes to find us," says Matthew DeGennaro, a neurogeneticist at Florida International University in Miami. (Greenfieldboyce, 3/28)

The Wall Street Journal: Measles Outbreak Grows To 214 Cases In New York City
New York City’s worst measles outbreak in decades continues to grow in the Orthodox Jewish community, where some families have resisted vaccinating their children, health officials said. There have been 33 cases confirmed in the past week, bringing the total to 214 cases of measles since October, a spokesman for the New York City Department of Health and Mental Hygiene said Thursday. (Brody, 3/28)

NPR: Mumps Outbreak: MMR Vaccine's Protection Against Mumps Can Fade
A mumps outbreak that began at Philadelphia's Temple University in February has snowballed, with the city's health department now reporting 106 cases associated with the flare-up. University officials say the vast majority of students involved had been immunized previously with the MMR vaccine, which protects against measles, mumps and rubella. So why are so many still appearing on campus with the mumps' signature swollen cheeks? (Ellis, 3/28)

The Washington Post: Abortion-Rights Group Sues Mississippi Over ‘Heartbeat’ Law
An abortion-rights group is asking a federal judge to block a Mississippi law that will ban most abortions once a fetal heartbeat can be detected, about six weeks into pregnancy. The Center for Reproductive Rights on Thursday expanded a lawsuit it filed last year challenging a Mississippi law that banned abortions after 15 weeks’ pregnancy. A federal judge declared that law unconstitutional. Republican Gov. Phil Bryant signed the heartbeat bill March 21, and it is set to become law July 1. It’s one of the strictest abortion laws in the nation. (Pettus, 3/28)

The Associated Press: Federal Judge Holding Trial On Alabama Prisoner Suicides
After 15 inmates killed themselves within 15 months, a federal judge will weigh whether the Alabama prison system is doing enough to prevent suicides. U.S. District Judge Myron Thompson on Thursday began a mini-trial on suicide prevention measures. It comes almost two years after his initial 2017 ruling that the Alabama prison system provides "horrendously inadequate" mental health care. (3/28)

The Washington Post: Hawaii Weighs Nation’s First Statewide Ban On E-Cig Flavors
The first state to limit tobacco and electronic cigarette sales to people 21 and older is contemplating a new nicotine crackdown: outlawing flavored electronic cigarette liquids and flavored tobacco to combat a spike in teenage vaping. Hawaii would be the first state to adopt such a ban under a bill before the Legislature. San Francisco was the first U.S. city to do so. The proposal would ban flavored e-cigarette liquids such as Maui Mango and Cookie Monsta, along with cloves and other flavored tobacco products, but it would exempt menthol cigarettes and vaping liquids. (McAvoy, 3/29)

The Washington Post: ‘We’re Human Beings!’ The Homeless Woman Yelled. ‘Acknowledge Us!’ Then People Did — In A Way She Didn’t Expect.
The city didn’t seem to be doing enough. Neither were the nonprofit groups. But maybe she — as nothing more than another human who cared — could accomplish what they couldn’t. Maybe she could get this couple out of a tent where they’d lived for more than two years, at the base of Union Station, and into housing. When The Washington Post published a profile Friday of Monica Diaz, a fast-food restaurant employee simultaneously navigating the homeless and working worlds, Howard University law student Gabriela Sevilla immediately got to work. (McCoy, 3/28)