First Edition: March 6, 2018

Kaiser Health News: CMS Issues Split Decision On Arkansas Medicaid Waiver
Arkansas follows Indiana and Kentucky this year in winning CMS’ approval for the work requirement. Arkansas plans to start the new requirement affecting adults under age 50 by June, making it the first to do so. (Galewitz, 3/5)

Kaiser Health News: At New Health Office, ‘Civil Rights’ Means Doctors’ Right To Say No To Patients
The Trump administration is embarking on a sweeping effort to redefine civil rights in health care, with critics accusing the Department of Health and Human Services of sidestepping the rights of patients to soothe a far smaller constituency: conservative nurses, hospitals and other caregivers. The department’s Office for Civil Rights (OCR) has been greatly strengthening and expanding protections for health care providers who have religious- or conscience-based objections to procedures such as abortion. (Huetteman, 3/5)

Kaiser Health News: From The ER To Inpatient Care — At Home
Phyllis Petruzzelli spent the week before Christmas struggling to breathe. When she went to the emergency department on Dec. 26, the doctor at Brigham and Women’s Faulkner Hospital near her home in Boston’s Jamaica Plain neighborhood said she had pneumonia and needed hospitalization. Then the doctor proposed something that made Petruzzelli nervous. Instead of being admitted to the hospital, she could go back home and let the hospital come to her. As a “hospital-at-home” patient, Petruzzelli, 71 this week, learned doctors and nurses would come to her home twice a day and perform any needed tests or bloodwork. (Andrews, 3/6)

California Healthline: What Medicaid Pays For Education Services At U.S. Public Schools
Gerardo Alejandrez used to punch classmates, throw chairs and curse at his teachers, conduct that forced him to switch from school to school. “I had a lot of anger issues,” the 16-year-old said recently. Then Gerardo entered a class at Oakland Technical High School for students who have mental health or behavior issues. In that classroom, the teacher gets support from Erich Roberts, a psychiatric social worker assigned to the group. Oakland Unified School District bills Medicaid, the nation’s insurance program for low-income residents, for Roberts’ services. (Gorman and Heredia Rodriguez, 3/6)

California Healthline: States Strive To Curb Costs For A Crucial — But Exorbitant — Hemophilia Treatment
The child is well-known in the halls where state bureaucrats oversee health care for millions of Californians — not by name, but by a number: $21 million. His medications alone cost state taxpayers that much in a single year, not including other health care. The boy, whose identity has not been released, was California’s most expensive Medicaid patient in recent years. His case was singled out in a tweet last year by the state’s top health care official to highlight the public insurance program’s extraordinary obligations as a backstop for low-income patients. (Ostrov, 3/5)

California Healthline: User-Friendly Or Error-Ridden? Debate Swirls Around Website Comparing Nursing Homes
Earlier this year, the state Department of Public Health launched a new website, Cal Health Find, intended to help people compare the quality of nursing homes and other health care facilities. Now, California nursing home advocates are calling on the state to take it down, saying the new site is incomplete, inaccurate and “a huge step in the wrong direction.” (Wiener, 3/5)

The Associated Press: Work Requirement Approved For Arkansas' Medicaid Expansion
The Trump administration has approved Arkansas' plan to require thousands of people on its Medicaid expansion to work or volunteer, the third state allowed to impose such restrictions. Gov. Asa Hutchinson announced Monday that the Centers for Medicare and Medicaid Services approved the requirement for Arkansas' program, which uses Medicaid funds to purchase private insurance for low-income residents. More than 285,000 people are on the program, which was created as an alternative to expanding traditional Medicaid under the federal health care law. (DeMillo, 3/5)

The New York Times: Trump Administration Delays Decision On Scaling Back Medicaid In Arkansas
[T]he administration held off on approving another request from the state that could have much broader consequences for the future of the program — a proposal to cut back the expansion of Medicaid that was instituted under the Affordable Care Act. Seema Verma, the Trump appointee who oversees Medicaid, did not elaborate when asked twice about the delay at a news conference with Gov. Asa Hutchinson in Little Rock. She said only: “We are still working through some issues in that particular area.” (Goodnough, 3/5)

CNN: Thousands Of Arkansas Medicaid Recipients Must Start Working In June
Arkansas will roll out the work requirement in stages. This year, only enrollees age 30 to 49 will be subject to the work mandate, which will be broadened to include 19- to 29-year-olds in 2019. Up to 39,000 recipients could be affected this year, according to Arkansas' Department of Human Services. (Luhby, 3/5)

The Washington Post: Arkansas Wins Federal Permission To Impose Medicaid Work Requirements
While seeking new conditions for some Arkansans to qualify for Medicaid, the state made a novel request last year: One of the few Southern states to expand Medicaid under the Affordable Care Act, it told federal officials that it wanted to partly retreat. Instead of including people with incomes up to 138 percent of the federal poverty line, as designed in the ACA, Arkansas wanted to set its expansion limit at 100 percent of poverty — a change that would jettison an estimated 60,000 people from the program. (Goldstein, 3/5)

The New York Times: Bring Back The Asylums? Critics Fear A New Wave Of Abuse
In the wake of the horrific school shootings in Parkland, Fla., President Trump has called repeatedly for building or reopening mental institutions. Strangely, perhaps, he has echoed an argument made by some experts who study the mental health care system. It’s not that they believe that having more institutions would somehow prevent spree killings, as Mr. Trump apparently does. The majority of these murderers appear to be angry, antisocial individuals — with access to guns — whom the mental health system probably could not have spotted in advance. (Carey, 3/5)

The Associated Press: Florida Senators Pass Gun Restrictions; House Yet To Act
In response to a deadly Florida school shooting last month, the state's Senate narrowly passed a bill that would create new restrictions on rifle sales and allow some teachers to carry guns in schools. The 20-18 vote came Monday evening after three hours of often emotional debate. Support and opposition crossed party lines, and it was clear many of those who voted for the bill weren't entirely happy with it. (Spencer and Fineout, 3/6)

Los Angeles Times: Florida State Senate Passes A Marjory Stoneman Douglas Gun Control Act — And Some Call It An Insult To Its Namesake
Senate Bill 7026, named the Marjory Stoneman Douglas High School Public Safety Act, would raise the age to purchase a firearm from 18 to 21, require a three-day waiting period for most gun purchases, and ban the sale or possession of "bump stocks," which allow semiautomatic rifles to fire faster. (Jarvie, 3/5)

The Associated Press: Oregon Governor Signs First Gun Law Since Florida Massacre
A bill prohibiting domestic abusers and people under restraining orders from owning firearms became America's first new gun control law since the Feb. 14 Florida high school massacre. "Well done Oregon," Democratic Gov. Kate Brown exclaimed Monday after signing the law on the steps of the state Capitol as some 200 people, including victims of domestic abuse and high school students, applauded and cheered. (Selsky, 3/6)

The Hill: Trump's Health Chief Warns Hospital Execs About Health Care Costs: 'Change Is Coming' 
President Trump’s new health secretary issued a warning Monday to a room of hospital executives about soaring health care costs: change is coming, whether you like it or not. Speaking at the Federation of American Hospitals convention in D.C., Health and Human Services (HHS) Secretary Alex Azar laid out a series of actions the administration will take that are aimed at lowering health care costs, and warned that it wouldn’t be deterred by powerful special interests. (Hellmann, 3/5)

CQ: Blunt: Policy Issues Bedevil Labor, Health, Education Bill
Extra funding for health, education and labor programs in the fiscal 2018 omnibus package depends on whether lawmakers can iron out policy differences between the House and Senate bills, a top GOP negotiator said Monday. ... CQ reported last week that a dispute over about $3 billion in offsets known as changes in mandatory programs, or "CHIMPs," to free up more discretionary spending in the Labor-HHS-Education bill remains an outstanding issue for lawmakers working to construct a catchall omnibus spending bill for fiscal 2018. (Mejdrich, 3/5)

The Hill: Jon Stewart Makes Capitol Hill Appearance For 9/11 Bill
Former late-night host Jon Stewart joined New York lawmakers on Monday to call on the White House to withdraw a proposal to reorganize the health-care program for 9/11 first responders. ... The Trump administration is considering a reorganization that would move the 9/11 health-care program from oversight by the National Institute of Occupational Safety and Health (NIOSH), a worker safety agency. (Sullivan, 3/5)

The Hill: Sanders Says New Health-Care Plan Shows Dems Moving Toward 'Medicare For All'
Sen. Bernie Sanders (I-Vt.) said Monday that he thinks a new health-care plan from a Democratic think tank shows that the party is moving toward his position on health care. Asked if he thinks the plan from the Center for American Progress (CAP), which comes very close to Sanders’s signature idea of "Medicare for all," shows the Democratic Party is moving his way, Sanders told The Hill, "Yes, I do." (Sullivan, 3/5)

The New York Times: Can This Judge Solve The Opioid Crisis?
Here are a few choice mutterings from the scrum of lawyers outside Courtroom 18B, about the federal judge who summoned them to a closed-door conference on hundreds of opioid lawsuits: “Grandstander.” “Pollyanna.” “Over his head.” And the chorus: “This is not how we do things!” (Hoffman, 3/5)

The Washington Post: FDA Chief Wants More Mail Inspectors To Stem Opioid Influx
The head of the Food and Drug Administration wants to more than double the number of packages his agency inspects for illicit drugs, an effort to stem a deadly flow of opioids that increasingly runs through the international mail supply. FDA Commissioner Scott Gottlieb said Monday he needs more staffers to intercept opioids that are being disguised as other drugs and supplements. (Perrone, 3/5)

The Hill: Manchin Unveils Bill To Change Controversial Opioid Enforcement Law
Sen. Joe Manchin (D-W.Va.) unveiled legislation Monday aimed at helping the Drug Enforcement Administration (DEA) improve its ability to stop suspicious shipments of opioids from flooding communities. Manchin’s bill changes a law that drew a firestorm of criticism after an explosive "60 Minutes"–Washington Post joint investigation reported the bill made it harder for the DEA to freeze opioid shipments from drug companies in the midst of a full-blown crisis. (Roubein, 3/5)

Stat: Proposed Limits To Opioid Prescriptions Draw Opposition From Docs, Patients
In the final hours of public input on a controversial new rule limiting opioid prescriptions, a last-minute coalition emerged on Monday to oppose it. The Centers for Medicare and Medicaid Services rule would restrict opioid doses to Medicare patients to the equivalent of 90 milligrams of morphine per day. (Facher, 3/6)

The New York Times: Overshadowed By The Opioid Crisis: A Comeback By Cocaine
The opioid epidemic just keeps getting worse, presenting challenges discussed at length at a White House summit last week. But opioids are not America’s only significant drug problem. Among illicit drugs, cocaine is the No. 2 killer and claims the lives of more African-Americans than heroin does. In a recent study published in The Archives of Internal Medicine, researchers from the National Cancer Institute and the National Institute on Drug Abuse found that drug-related deaths have grown across all racial groups and among both men and women. The analysis found that between 1999 and 2015, overdose deaths of any kind of drug for Americans 20 to 64 years old increased 5.5 percent per year. (Frakt, 3/5)

The Wall Street Journal: Opioid Maker Insys Still Has Fans On Wall Street
Insys Therapeutics has lost its former CEO and co-founder, John Kapoor, and several top executives, all charged with conspiracy to illegally distribute an addictive prescription painkiller. The company has lost more than 80% of its market cap since its peak price in 2015 amid declining sales and multiple lawsuits from states over how it marketed Subsys, a mouth-spray version of the potent opioid painkiller fentanyl that is approved by the Food and Drug Administration to treat cancer-related pain. (Prang, 3/5)

The Associated Press: Mom Who Had Heroin-Addicted Baby Gets 30 Years For His Death
A Baltimore woman whose baby was likely born addicted to heroin and survived only nine days will serve 30 years in prison. The Office of the State’s Attorney for Baltimore City said in a Monday release Anne Kirsch was sentenced to 75 years in prison, with 45 suspended, after she was convicted of manslaughter and child abuse resulting in death in 2017. (3/5)

The Washington Post: Babies With Down Syndrome Are Put On Center Stage In The U.S. Abortion Fight
Karianne Lisonbee stepped up to the lectern to talk about what she called “a terrible form of discrimination. ”The Republican state representative in Utah had just introduced a bill that would make it a crime for a doctor to perform an abortion if a woman is seeking one “solely” because the fetus has Down syndrome. “In recent years, there has been a shocking increase in abortions performed for no other reason than because a prenatal test identified the potential for a trait a parent didn’t like,” she said at the news conference last month.  (Cha, 3/5)

The Associated Press: West Virginia House Opposes Constitutional Abortion Rights
West Virginia lawmakers say the main goal of a constitutional amendment they are proposing is to end Medicaid funding for abortions — but opponents say the change could lead to a future ban on abortions altogether. The House on Monday voted 73-25 to pass the resolution, which was approved by the Senate a month ago and will now go before voters in a November referendum. (Virtanen, 3/5)

The Washington Post: Many Type 2 Diabetics Can Relax Their Blood Sugar Control, Doctors Group Says
Many of the nation’s 29 million people with Type 2 diabetes should relax their blood sugar control, an influential physicians group recommended Monday, arguing that the current standard is causing substantial harm without commensurate benefits. But the American Diabetes Association, the leading organization in the fight against the condition, said it disagrees with the new recommendation from the American College of Physicians and would not change its advice that Type 2 diabetics pursue tighter blood glucose control. (Bernstein, 3/5)

NPR: The American College Of Physicians Recommends A1C Levels Between 7 And 8 Percent
Half a dozen medical groups have looked carefully at the best treatment guidelines for the 29 million Americans who have Type 2 diabetes and have come up with somewhat differing guidelines. The American College of Physicians has reviewed those guidelines to provide its own recommendations, published in the Annals of Internal Medicine. It has decided that less stringent goals are appropriate for the key blood sugar test, called the A1C. "There are harms associated with overzealous treatment or inappropriate treatment focused on A1C targets," says Dr. Jack Ende, president of the ACP. "And for that reason, this is not the kind of situation where the college could just sit back and ignore things." (Harris, 3/5)

The Wall Street Journal: Common ‘Superbug’ Found To Disguise Resistance To Potent Antibiotic
Some common “superbugs” appear to harbor a little-known type of resistance to a last-resort antibiotic, a new study shows, suggesting a worrying new way in which dangerous bacteria can evade one of the few remaining treatment options. Bacterial populations are normally viewed as either totally impervious to an antibiotic, or totally treatable. But researchers from Emory University identified a different pattern in a certain type of drug-resistant bacteria, in which some cells in a bacterial colony are resistant to a last-resort antibiotic called colistin. This “heteroresistance” isn’t easily detectable in standard lab tests because most of the cells are susceptible to the drug. (McKay, 3/6)

The New York Times: Americans Might No Longer Prefer Sons Over Daughters
Around the world, parents have typically preferred to have sons more than daughters, and American parents have been no different. But there are signs that’s changing. It may be because there’s less bias against girls, and possibly more bias against boys. Gallup surveyed Americans 10 times from 1941 to 2011, and their answers remained virtually unchanged: If they could have one child, 40 percent would prefer a boy and 28 percent a girl (the rest showed no preference). (Miller, 3/5)

The Wall Street Journal: How To Spot Teenage Depression
Is your child’s moodiness a sign of typical teenage angst—or the beginning of a depression that needs professional attention? Statistics show that teen depression is on the rise. In 2016, around 13% of U.S. teenagers ages 12-17 had at least one major depressive episode in the past year, compared to almost 8% in 2006, according to the Substance Abuse and Mental Health Services Administration, which collects this information. Rates for teenagers ages 18 and 19, which are tracked separately, grew as well: More than 11% had a major depressive episode in 2016, compared with 9-10% in 2006. (Bernstein, 3/5)

The New York Times: For Heart Disease Patients, Think Exercise, Not Weight Loss
For people with coronary heart disease, losing weight will not prolong life, a new study reports, but increasing physical activity will. To their surprise, Norwegian researchers found that in some coronary heart disease patients — those of normal weight — weight loss actually increased the risk for death. (Bakalar, 3/5)

The New York Times: Football’s Brain Injury Crisis Lands In Family Court
In this city with a deep and proud relationship with football, a custody dispute has pushed the debate about the sport’s safety into a new arena: family court. A father, John Orsini, has gone to court to prevent the youngest of his three sons from playing high school football because, he said, scientific studies have revealed the perils of repeated blows to the head — especially for an athlete, like his son, who has a history of concussions. The boy’s mother, Mr. Orsini’s ex-wife, believes he should be allowed to continue playing because he understands the risks. (Belson, 3/5)

The Washington Post: Irma Nursing Home Deaths: Backup Power Rule OK’d In Florida
Florida’s Legislature has approved a rule requiring backup power sources in the state’s nursing homes, prompted by the deaths of several residents at a sweltering nursing home in the aftermath of Hurricane Irma. The state House and Senate both unanimously okayed the measure Monday and it now heads to the desk of Gov. Rick Scott, who is expected to sign it. The measure would require facilities to have a generator capable of keeping facilities at 81 degrees Fahrenheit (27 degrees Celsius) or lower for at least four days. It also requires them to keep 72 hours of fuel on site. (Reedy, 3/5)

The Associated Press: Judge Delves Into Science Behind Roundup Cancer Claim
A federal judge on Monday waded into the arcane science behind claims that the widely used weed killer Roundup can cause cancer. The expected weeklong testimony is intended to help him determine whether a jury should hear from doctors who link the product to non-Hodgkin’s lymphoma. U.S. District Judge Vince Chhabria heard from an epidemiologist at the University of California, Los Angeles about how she evaluated scientific studies of glyphosate, the active ingredient in Roundup, to arrive at her conclusion that it can cause cancer. (Thanawala, 3/5)

The Associated Press: 3 Day Care Workers Charged With Giving Children Melatonin
Police in suburban Chicago say three day care workers are charged with giving children gummy bears containing the sleep aid melatonin. Des Plaines police said Monday that officers were called to Kiddie Junction on Friday. Police said the children were given the melatonin "in an effort to calm them down before nap time." Authorities say parents hadn't given permission for their children to receive the melatonin. Police contacted parents and no children were sickened. (3/5)

The Associated Press: Lawmakers Want Say In 3M Settlement Dollars
Republican lawmakers on Monday questioned the structure of a multimillion-dollar settlement between the state of Minnesota and 3M Co., arguing they should have a say in how the money is used to ensure it doesn't become "consumed by bureaucracy." The company agreed to pay the state $850 million last month to resolve a massive lawsuit in which the state alleged some of the company's chemicals damaged natural resources and groundwater in the Twin Cities' eastern metropolitan area. (3/5)