First Edition: November 1, 2019

Kaiser Health News: Obamacare’s Star Ratings Offer A Glimmer Of Insight ― But Not For All
As millions of Americans start shopping Friday for individual health insurance for 2020, they will see federal ratings comparing the quality of health plans on the Affordable Care Act’s insurance marketplaces. But Christina Rinehart of Moberly, Mo., who has bought coverage on the federal insurance exchange for several years, won’t be swayed by the new five-star rating system. (Weber and Galewitz, 11/1)

California Healthline: If Power Outages Are California’s New Normal, What About Home Medical Needs?
Fern Brown, 81, sat in the rear of a tent on the windswept fairgrounds of this historic Gold Rush town, drawing deep breaths through the mouthpiece of a nebulizer plugged into a power strip atop a plastic folding table. Afflicted for years with asthma and chronic obstructive pulmonary disease, Brown uses the nebulizer twice a day to avoid flare-ups that can be life-threatening. It turns her medicine into a fine mist that she can inhale. (Kreidler, 11/1)

Kaiser Health News: Meth Trip Or Mental Illness? Police Who Need To Know Often Can’t Tell
The dispatch call from the Concord, N.H., police department was brief. A woman returning to her truck spotted a man underneath. She confronted him. The man fled. Now the woman wanted a police officer to make sure her truck was OK. “Here we go,” muttered Officer Brian Cregg as he stepped on the gas. In less than three minutes, he was driving across the back of a Walmart parking lot, looking for a man on the run. (Bebinger, 11/1)

Kaiser Health News: KHN’s ‘What The Health?’: Spooky Stuff
Open enrollment starts Nov. 1 in most states for people who buy health insurance under the Affordable Care Act. For the second year in a row, premiums for these individual market plans are down slightly, even without the federal tax penalty for those who remain uncovered. Meanwhile, on the campaign trail, Democratic presidential candidate Elizabeth Warren said she would develop a plan to pay for the “Medicare for All” proposal she supports. (10/31)

The New York Times: Juul’s Meltdown Costs Tobacco Giant Altria $4.5 Billion
The tobacco giant Altria Group said Thursday that it had devalued its investment in the vaping company Juul Labs by $4.5 billion, a move that reflects deepening turmoil in the e-cigarette industry. Altria, one of the world’s largest tobacco companies, invested $12.8 billion in Juul in December 2018, acquiring a 35 percent stake in the Silicon Valley start-up. (Robertson, 10/31)

Reuters: Altria Writes Down Juul Investment By $4.5 Billion Amid Vaping Backlash
Juul appointed a longtime Altria executive as its CEO last month in a bid to rebuild its image. The company has also cut jobs, suspended advertising in the United States and revamped its management. "While we had a range of scenarios when we made the investment, we did not anticipate this dramatic a change in the e-vapor category," Altria Chief Executive Officer Howard Willard said on a conference call with analysts. (Mishra, 10/31)

The Wall Street Journal: Altria Cuts Value Of Juul Stake By $4.5 Billion
Altria for years had a predictable cigarette business and steady profit growth. Acknowledging its shifting fortunes, the company on Thursday lowered its profit forecast for the next three years for growth in a range of 5% to 8%, instead of 7% to 9%. “The industry is becoming increasingly dynamic and complex,” Altria Chief Executive Howard Willard said on a conference call. “Of course, we’re not pleased to have to take an impairment charge on the Juul investment. We did not anticipate this dramatic a change in the e-vapor category.” (Maloney, 10/31)

Reuters: FTC Probes Altria For Role In Juul Executive Changes
U.S. antitrust enforcers are probing Altria Group Inc for potentially exerting influence over electronic-cigarette maker Juul Labs Inc before winning approval for a big share buy, Altria said in a government filing on Thursday. Marlboro maker Altria purchased a 35% stake in Juul in December 2018 for $12.8 billion, but the shares are non-voting and the companies have not yet received antitrust approval for the transaction. (10/31)

The Associated Press: US Vaping Illnesses Rise To 1,888 With Pace Picking Up Again
The number of U.S. vaping illnesses has jumped again, reaching more than 1,800 cases. The Centers for Disease Control and Prevention said 1,888 confirmed and probable cases have been reported in 49 states. An Illinois report brings the toll to 38 deaths in 24 states. (Johnson, 10/31)

The Wall Street Journal: Vaping-Related Cases Surge To 1,888, With 37 Deaths
Investigators still don’t know the specific cause of the illness, which include symptoms such as coughing, shortness of breath, gastrointestinal symptoms, fever and abdominal pain. Public-health authorities attribute most of the cases to products containing THC, the psychoactive ingredient in cannabis, and in particular to products obtained from unregulated or illicit sources such as friends, family, dealers or online. (Abbott, 10/31)

Reuters: Trump Rule On Health Insurance Leaves Immigrants, Companies Scrambling For Answers
Nearly a decade after receiving U.S. citizenship, Guatemalan-born Mayra Lopez thought she had cleared all the hurdles for her parents to join her in the United States. Then on Oct. 4 U.S. President Donald Trump changed the rules she and others had been complying with: Trump signed a proclamation requiring all prospective immigrants to prove they will have U.S. health insurance within 30 days of their arrival or enough money to pay for "reasonably foreseeable medical costs." (10/31)

Politico: White House Plans To Name Chad Wolf Acting DHS Secretary
The White House plans to name Homeland Security official Chad Wolf acting secretary, according to three people familiar with the situation. Wolf will replace acting DHS Secretary Kevin McAleenan, whose last day in the job was supposed to be Thursday. McAleenan will now stay until Nov. 7, according to one of the people with knowledge of the matter. (Lippman, Kullgren and Kumar, 10/31)

The Washington Post: Indiana Backs Away From Medicaid Work Requirements
Indiana has become the second state in two weeks to retreat from compelling some poor people to work or prepare for a job to qualify for Medicaid, pulling back from a central goal of the Trump administration for redesigning the health insurance safety-net. In an announcement Thursday, Indiana’s Medicaid agency joined Arizona in postponing plans to cut off benefits to people who do not meet new requirements. In publicizing their turnabouts, both states cite federal lawsuits challenging what supporters call “community engagement” rules but what critics say violate the program’s basic purpose. (Goldstein, 10/31)

The Hill: Indiana Suspends Medicaid Work Requirements, Citing Legal Challenge
“The Indiana Family and Social Services Administration announced today that it will temporarily suspend the reporting requirements of the Gateway to Work program due to a pending legal challenge,” the state agency said in a statement. A federal district judge has already struck down Medicaid work requirements in Arkansas, Kentucky and New Hampshire. Those cases are now being appealed. (Sullivan, 10/31)

The Wall Street Journal: Medicaid Work Requirement Is Halted By Indiana
Other states are similarly reviewing such work requirements. Pennsylvania will ask beneficiaries if they want job training rather than basing Medicaid benefits on work. Ohio wants to have a caseworker to first connect with beneficiaries before terminating their coverage if they aren’t working. Arizona, which has federal approval to implement work requirements, has opted to delay the program. (Armour, 10/31)

ProPublica: The Trump Administration Cracked Down On Medicaid. Kids Lost Insurance.
In early August, Elizabeth Petersen was home-schooling her children in the kitchen of their northern Idaho home when she got a call from Providence Sacred Heart Medical Center, where her 4-year-old son, Paul, was set to have surgery a few weeks later. Since having a stroke around his first birthday, Paul had been under treatment to restore use of the right side of his body. He had recently graduated from a feeding tube and needed surgery to close a hole in his stomach. (Churchill, 10/31)

The New York Times: Patient Privacy Dispute Shadows Hearing For Last Missouri Abortion Clinic
A furor over patient privacy shadowed a four-day hearing this week that will help determine the fate of the last remaining abortion clinic in Missouri. The hearing, which concluded Thursday, follows months of legal wrangling that threatens to close the clinic, which is in St. Louis and run by Planned Parenthood. A ruling is expected to take weeks or even months. (Tavernise, 10/31)

The Associated Press: Hearing Concludes In Missouri Abortion Clinic Licensing Case
An administrative hearing to decide whether Missouri can revoke the license for the state's only abortion clinic concluded Thursday with emotional testimony from a clinic official. The hearing in St. Louis before a commissioner with the Missouri Administrative Hearing Commission was expected to last five days but wrapped up a day early. A ruling isn't expected until February at the earliest. (Salter, 10/31)

The Associated Press: Georgia Governor Releases Plans For Health Care Overhaul
Georgia Gov. Brian Kemp unveiled a much-anticipated plan Thursday that aims to reduce premiums for residents who buy health insurance under the Affordable Care Act and give the state control of billions of dollars in federal health care funds. The proposal could eventually lead to subsidies for cheaper coverage that doesn't include all the benefits required by the ACA. The plan does not address Medicaid coverage. The Kemp administration is expected to release its Medicaid plans next week. (Thanawala and Nadler, 10/31)

The Hill: Georgia Governor's Health Care Plan Would Allow Subsidies To Pay For ObamaCare Alternatives
"Through these new, innovative measures Georgians will have access to more insurance options like association health plans that cover our friends and neighbors with pre-existing conditions," Kemp said Thursday at an event announcing the plan. The Trump administration has already indicated it would approve state programs that would allow subsidies to pay for plans that don't comply with the law's coverage requirements. (Hellmann, 10/31)

The New York Times: Medicare Can Be Confusing: 6 Of Your Top Questions, Answered
Most people on Medicare report that they are very satisfied with their health care coverage — but the program is complicated. Medicare features an alphabet soup of plans, coverage choices, premium levels and enrollment rules. The New York Times recently invited readers to submit their questions about Medicare. Today, we’re responding to some of the most frequent ones. (Miller, 11/1)

USA Today: Medicare Open Enrollment: Use These Tips To Save On Your Next Plan
About 60 million Medicare recipients have the chance to change their coverage during the health care service’s annual open enrollment season, which opened on October 15 and closes on December 7. But research indicates fewer than 4 in 10 seniors review their Medicare plan each year to find the best deal. That means millions of Medicare recipients may be making a costly mistake: The program’s open enrollment period represents the only time of the year when seniors can tweak their drug coverage, says Diane Omdahl, the chief executive and founder of 65 Inc., which provides fee-based Medicare advice to seniors. Skipping the process, or rushing through it, can mean losing out on savings or choosing a plan that doesn’t cover your prescriptions, she adds. (Picchi, 10/31)

The Associated Press: Measles Saps Kids' Ability To Fight Other Germs
Measles has a stealth side effect: New research shows it erases much of the immune system's memory of how to fight other germs, so children recover only to be left more vulnerable to bugs like flu or strep. Scientists dubbed the startling findings "immune amnesia." The body can rebuild those defenses — but it could take years. And with measles on the rise, "it should be a scary phenomenon," said Dr. Michael Mina of Harvard's school of public health, lead author of research published Thursday in the journal Science. (Neergaard, 10/31)

The New York Times: Measles Can Cause ‘Immune Amnesia,’ Increasing Risk Of Other Infections
The weakened immunity leaves a child vulnerable for several years to other dangerous infections like flu and pneumonia. The damage occurs because the virus kills cells that make antibodies, which are crucial to fighting off infections. Scientists call the effect “immune amnesia.” During childhood, as colds, flu, stomach bugs and other illnesses come and go, the immune system forms something akin to a memory that it uses to attack those germs if they try to invade again. The measles virus erases that memory, leaving the patient prone to catching the diseases all over again. (Grady, 10/31)

The Washington Post: Measles Virus Infection Destroys Immune System Memory, Increasing Vulnerability To Other Diseases
The discoveries have enormous and immediate public health implications, researchers and clinicians said, and underscore more than ever the importance of measles vaccination. In recent years, anti-vaccine misinformation has been one reason vaccination rates have plummeted and global measles cases have surged. This year, the United States has had 1,250 cases of measles, the most since 1992. (Sun, 10/31)

Stat: How Measles Infections Can Wipe Away Immunity To Other Diseases
Dr. Michael Mina, first author of the Harvard paper, said the phenomenon bears some similarities to the one that takes place after HIV infection. HIV also infects immune system cells. “If you took the first 10 years of somebody having HIV and you squished that into a few weeks, that’s the kind of memory damage and immune damage you get from measles,” Mina, an assistant professor of epidemiology at Harvard’s T.H. Chan School of Public Health, told STAT. (Branswell, 10/31)

Los Angeles Times: Measles Infection Causes ‘Immune Amnesia,’ Leaving Kids Vulnerable To Other Illnesses
“The measles virus is like a car accident for your immune system,” said Harvard University geneticist Stephen Elledge,the senior author of the Science study. An unvaccinated child who weathers the measles may emerge only slightly the worse from such a crash. Or he might sustain an injury from which it takes months or years to recover. (Healy, 10/31)

NPR: Measles Virus May Wipe Out Immune Protection For Other Diseases
Previous evidence for immune amnesia has been based on mathematical models and population-level studies according to Dr. Michael Mina, assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health and the primary author of the study released this week in Science. The new studies are the first to show "any of the real biology that helps explain the population-level effects," he says. (Vaughn, 10/31)

The New York Times: New Threats Put Wildfire Fighters’ Health On The Line
As fires spread across Northern California last year, Capt. Matt Alba and Strike Team 2253A found themselves wading through a smoldering jungle of plastic and metal in search of bodies. As they worked through charred auto shops and trailers, Mr. Alba kept thinking about the poisons they were kicking up, and that they did not have a single mask or hazmat suit among them. Wildfire fighting had changed. (Turkewitz, 10/31)

The Associated Press: Fires, Smoke Disrupt Halloween Fun For Many California Kids
For tens of thousands of children in California, the biggest monsters this Halloween are wildfires that have thrown trick-or-treating into disarray. Nancy Metzger-Carter and her family have been in a San Francisco hotel since Saturday when a blaze in Sonoma County wine country forced them to evacuate their home in the small community of Graton. (Tang, 10/31)

The Associated Press: Dying Winds Bring Relief After Weeks Of California Wildfires
The winds subsided in virtually all parts of the state Thursday and forecasters anticipated at least a week of calm weather, though there was no rain in the forecast that would reduce the threat of fall fires. However, winds lingered in some mountainous areas and they were blamed for driving a new wildfire that threatened homes Thursday night north of Los Angeles. (Melley and Chea, 10/31)

Los Angeles Times: Maria Fire In Ventura County Explodes To 7,400 Acres, Threatening Somis And Saticoy
A brush fire exploded in Ventura County Thursday night, quickly consuming more than 7,400 acres and burning structures. The blaze, which has been dubbed the Maria fire, broke out atop South Mountain, just south of Santa Paula, and was moving toward the small agricultural towns of Somis and Saticoy. At least two stuctures have been lost, and 1,800 are threatened. (Wigglesworth and Lin, 11/1)

Stat: Giving Vouchers To Pharma To Develop Antibiotics Could Be Costly
One approach federal lawmakers have used to jumpstart certain types of drug development has been to offer vouchers to companies that can later be redeemed when seeking approval for yet another medicine. But a new analysis suggests the notion may not be worth the cost if it were used to entice drug makers to develop much-needed antibiotics. Citing a bill proposed last year to offer vouchers for new antibiotics, the researchers calculated the idea would have cost an extra $4.5 billion in spending on medicines over a 10-year period, had the legislation taken effect in 2007. (Silverman, 10/31)

Reuters: Health Insurer Cigna Quarterly Profit Soars 75%
Cigna Corp reported a 75% rise in quarterly profit on Thursday, benefiting from its acquisition of Express Scripts pharmacy benefits business last year. The health insurer, which in December closed its $52 billion acquisition of pharmacy benefits manager Express Scripts, said shareholders' net income rose to $1.35 billion, or $3.57 per share, in the third quarter ended Sept. 30, from $772 million, or $3.14 per share, a year earlier. (10/31)

The New York Times: A Gender Divide On Microaggressions In Medicine
“Is this seat taken?” I heard a student ask another student, who was holding a seat in the front row of a class I was about to teach. “Yep — that one’s taken!” He laughingly gestured to his lap. “Want to sit here instead?” he asked softly. She paused and looked at him silently for a split second before walking away and taking a seat at the back of the class. Not wanting to start the first day of the course on a negative note, I said nothing. I should have. (Periyakoil, 10/31)

The Associated Press: WeWork’s Ex-CEO Faces New Pregnancy Discrimination Complaint
A former top aide to WeWork co-founder Adam Neumann has filed a federal discrimination complaint against him, saying she was demoted for becoming pregnant, subjected to derisive comments and ultimately fired for raising concerns. The complaint seeks class action status against WeWork, alleging a pattern of discrimination against women at the office-sharing company. (Olson, 10/31)

The New York Times: Studies Yield ‘Impressive’ Results In Fight Against Cystic Fibrosis
A pair of new studies report “impressive” benefits from a drug therapy for cystic fibrosis, a deadly and devastating disease that affects tens of thousands of people worldwide, the director of the National Institutes of Health wrote in an editorial published in The New England Journal of Medicine on Thursday. “These findings indicate that it may soon be possible to offer safe and effective molecularly targeted therapies to 90 percent of persons with cystic fibrosis,” wrote the director, Dr. Francis S. Collins, who led the team that in 1989 identified the gene that causes the genetic disease affecting the lungs and digestive system. (Chokshi, 10/31)

The Washington Post: New Cystic Fibrosis Drug Trikafta Could Make Deadly Disease Manageable
A new cystic fibrosis therapy dramatically improved patients’ lung function and showed clear signs of targeting the genetic root of the disease, instead of just alleviating symptoms — a breakthrough so long-sought that many doctors and patients are moved to tears when talking about it. The data, being unveiled Thursday at a national conference in Tennessee and simultaneously published in two leading medical journals, was so persuasive that the Food and Drug Administration last week approved the three-drug combination, called Trikafta — five months ahead of the agency’s deadline. (Johnson, 10/31)

The Associated Press: Science Says: How Daylight Saving Time Affects Health
Office workers bemoan driving home in the dark. Night owls relish the chance to sleep in. As clocks tick toward the end of daylight saving time, many sleep scientists and circadian biologists are pushing for a permanent ban because of potential ill effects on human health. Losing an hour of afternoon daylight sounds like a gloomy preview for the dark winter months, and at least one study found an increase in people seeking help for depression after turning the clocks back to standard time in November — in Scandinavia. (10/31)

Los Angeles Times: Wake Up! Here's Why You Shouldn't Grab That Extra Hour Of Sleep This Weekend
Someone already drowsy or irritable during the day shouldn’t take this weekend’s time change as a license to sleep in or go to bed later, he said, because they’re only shifting their poor sleep habits. Such an abrupt change — even just an hour — can wreak havoc on our circadian rhythms, the 24-hour cycles of living beings that determine sleeping and feeding patterns, and can be affected by stimuli including sunlight and temperature. (Carney, 10/31)

NPR: Sleep And Alzheimer's: Cerebrospinal Fluid Washes Away Toxins
The brain waves generated during deep sleep appear to trigger a cleaning system in the brain that protects it against Alzheimer's and other neurodegenerative diseases. Electrical signals known as slow waves appear just before a pulse of fluid washes through the brain, presumably removing toxins associated with Alzheimer's, researchers reported Thursday in the journal Science. (Hamilton, 10/31)

The New York Times: Should I Take Fish Oil?
In 1971, a team of Danish researchers found that an Inuit population in Greenland had lower cholesterol levels and incidence of heart disease than Danes and Inuits who lived in Denmark. A theory arose: The indigenous people’s high marine-fat diet gave them heart protections. Since then, fish oil and omega-3 fatty acids — the health-boosting star component of fish oil — have been the subject of tens of thousands of papers exploring their health benefits. (Martin, 11/1)

The Associated Press: Louisiana Couple Sentenced For Abusing Caged Autistic Woman
A husband and wife in Louisiana have each been sentenced to 28 years in federal prison for horrific abuses of a young autistic woman who at times was forced to live in an outdoor cage. The sentences for Terry Knope II and Raylaine Knope had been expected since their guilty pleas to federal charges in May. They had received similar state court sentences in Tangipahoa Parish. (10/31)

The Wall Street Journal: New York City Council Reviews Expanding Primary-Care Services
A New York City Council committee on Thursday reviewed whether the city is doing enough to provide primary care through its public hospital system. The City Council held the oversight hearing because it is pushing legislation that would create a health-access program that includes a “medical home” for primary-care services in every community district. The medical home could be one of the public NYC Health + Hospitals facilities, or a Federally Qualified Health Center, or FQHC. (West, 10/31)

The Wall Street Journal: Meet The New York City Marathon Runners Who Finish Last
On most weekends, Dave Fraser leaves his house at 6 a.m. to begin his marathon training. Starting from his home in Canarsie, Brooklyn, the 52-year-old pushes himself in a wheelchair across the borough, then across the Brooklyn Bridge and through Manhattan, where he culminates his workout with a couple of laps of Central Park. Afterward, he hops on an express bus back home. (Blint-Welsh, 10/31)