First Edition: November 27, 2017

Kaiser Health News: Taken For A Ride? Ambulances Stick Patients With Surprise Bills
One patient got a $3,660 bill for a 4-mile ride. Another was charged $8,460 for a trip from one hospital that could not handle his case to another that could. Still another found herself marooned at an out-of-network hospital, where she’d been taken by ambulance without her consent. These patients all took ambulances in emergencies and got slammed with unexpected bills. Public outrage has erupted over surprise medical bills — generally out-of-network charges that a patient did not expect or could not control — prompting 21 states to pass laws protecting consumers in some situations. (Bailey, 11/27)

Kaiser Health News: Surprise Ambulance Bills: A Consumer’s Guide
What’s a surprise ambulance bill? When the ambulance service that picks you up is out-of-network, your insurer pays what it considers fair. And then — surprise! — the ambulance service sends you a bill for the rest. (Bailey, 11/27)

Kaiser Health News: Marketplace Confusion Opens Door To Questions About Skinny Plans
Consumers coping with the high cost of health insurance are the target market for new plans claiming to be lower-cost alternatives to the Affordable Care Act that fulfill the law’s requirement for health coverage. But experts and regulators warn consumers to be cautious — and are raising red flags about one set of limited benefit plans marketed to individuals for as little as $93 a month. Offered through brokers and online ads, the plans promise to be an “ACA compliant, affordable, integrated solution that help … individuals avoid the penalties under [the health law].” (Appleby, 11/27)

California Healthline: California Winces At Trump’s Turn Back To ‘Bad Old Days’ Of Health Plan Associations
Just a few decades ago, small businesses in California often banded together to buy health insurance on the premise that a bigger pool of enrollees would get them a better deal. California’s dairy farmers did it; so did car dealers and accountants. But after a string of these “association health plans” went belly up, sometimes in the wake of fraud, state lawmakers passed sweeping changes in the 1990s that consigned them to near extinction. (Bartolone, 11/27)

The Washington Post: Enrollment In ACA Health-Care Plans Is Still Running Ahead Of Last Year
The number of Americans signing up for health-care plans under the Affordable Care Act continues to run ahead of last year in states relying on the federal insurance exchange, according to federal figures released Wednesday that span nearly half of an abbreviated enrollment season. Between the start of the current sign-up period on Nov. 1 and Saturday, nearly 2.28 million people chose health-care plans for the coming year — slightly more than during the first four weeks of the ACA enrollment period a year ago, reports from the Centers for Medicare and Medicaid Services show. (Goldstein, 11/22)

Reuters: Sign-Up Pace Slows in Third Week of 2018 Obamacare Enrollment
The pace slowed in the third week of enrollment for 2018 Obamacare individual insurance as nearly 800,000 people signed up through the federal government website HealthCare.gov, down about 75,000 people from the previous week, a U.S. government agency reported on Wednesday. There was an increase, however, in the number of new consumers to the program created by former President Barack Obama, to 220,323 from 208,397 in the previous week, the U.S. Department of Health and Human Services said. (Hummer, 11/22)

Los Angeles Times: Republicans' Latest Plan To Repeal Obamacare's Insurance Requirement Could Wreak Havoc In Some Very Red States
The Senate Republican plan to use tax legislation to repeal the federal requirement that Americans have health coverage threatens to derail insurance markets in conservative, rural swaths of the country, according to a Los Angeles Times data analysis. That could leave consumers in these regions — including most or all of Alaska, Iowa, Missouri, Nebraska, Nevada and Wyoming, as well as parts of many other states — with either no options for coverage or health plans that are prohibitively expensive. (Levey, 11/27)

The New York Times: As Health Care Changes, Insurers, Hospitals And Drugstores Team Up
They seem like odd couples: Aetna, one of the nation’s largest health insurers, is in talks to combine with CVS Health, which manages pharmacy benefits. The Cleveland Clinic, a highly regarded health system, joined forces with an insurance start-up, Oscar Health, to offer individuals a health plan in Ohio. Aetna also has new partnerships with large health systems that include hospitals and doctors’ groups in Northern California and Virginia. (Abelson, 11/26)

The Washington Post: States Prepare To Shut Down Children’s Health Programs If Congress Doesn’t Act
Officials in nearly a dozen states are preparing to notify families that a crucial health insurance program for low-income children is running out of money for the first time since its creation two decades ago, putting coverage for many at risk by the end of the year. Congress missed a Sept. 30 deadline to extend funding for CHIP, as the Children’s Health Insurance Program is known. Nearly 9 million youngsters and 370,000 pregnant women nationwide receive care because of it. (Itkowitz and Somashekhar, 11/23)

The Hill: States Preparing For Children's Health Insurance Program To Run Out Of Funding: Report
Nearly a dozen states are readying for the Children’s Health Insurance Program (CHIP), which provides insurance to low-income children, to run out of funding, according to a report from The Washington Post. Five states are at risk of running out of funding for their individual programs by late December, according to the report. Other states reportedly have enough money to keep their programs afloat for a few more months at least. (Manchester, 11/26)

The New York Times: He Raised Drug Prices At Eli Lilly. Can He Lower Them For The U.S.?
Alex M. Azar II, President Trump’s nominee to lead the Department of Health and Human Services, has expressed concern about the soaring cost of prescription drugs for many consumers. This week, Mr. Azar, a former pharmaceutical executive, is expected to face tough questions at a Senate confirmation hearing over why his own company raised prices. Democratic senators say that, as a top manager at Eli Lilly and Company, he was responsible for steep increases on insulin and other drugs. How he would now tackle that problem as secretary, along with the future of the Affordable Care Act, promises to dominate the hearings. (Pear, 11/26)

The Wall Street Journal: Notre Dame’s Stance On Birth Control Highlights Divide
The University of Notre Dame fought in court for five years to limit the government’s ability to push religiously affiliated employers to offer contraception benefits. Now, the university is voluntarily allowing birth-control benefits, exposing a divide among Catholic institutions. The university’s shift comes as the litigation enters a fresh phase after two U.S. Supreme Court cases and new rules championed by President Donald Trump’s administration. These rules, if implemented, would reverse a requirement set by Mr. Trump’s Democratic predecessor that most employers include birth-control benefits in workers’ health plans. (Radnofsky and Lovett, 11/23)

The New York Times: Texas Abortion Law Is Unconstitutional, Federal Judge Rules
A Texas law restricting the most common form of second-trimester abortion is unconstitutional, a federal judge ruled on Wednesday, saying it would impose an undue burden on women. A lawyer for abortion providers called the decision “a complete victory,” while state officials immediately said they would appeal. Ultimately, the case could make its way to the United States Supreme Court. (Astor, 11/22)

The Associated Press: Federal Judge Blocks Texas Ban Of Common Abortion Procedure
Federal judges have already ruled against past Texas efforts to change the disposal of fetal remains and deny Medicaid funding to abortion provider Planned Parenthood over videos secretly recorded by an anti-abortion group. Last year, the U.S. Supreme Court gutted most of a sweeping, anti-abortion law approved in Texas in 2013 which helped force the closure of more than half of the state's abortion clinics. (11/22)

Wall Street Journal: Amid A Dearth Of Workers, New Hampshire Taps Recovering Addicts For Jobs
At a recruiting event in a sunlit parish hall here, job seekers from sober houses streamed in, looking for opportunities from a range of employers all willing to look beyond gaps in resumes, criminal records and messy pasts. Making the rounds at the “recovery-friendly job fair” was Ben Gale, who said it was tough getting work when he had to explain his history with drugs. “A lot of places look at you very differently,” said the 25-year-old, now sober from a heroin addiction. “A lot of them don’t want to give you a chance.” (Levitz, 11/27)

NPR: The Insurance Company Paid For Opioids, But Not Cold Therapy
As a lifelong racket-sports fanatic, I've dealt with shoulder pain for decades, treating it with bags of frozen peas, physical therapy, cortisone shots and even experimental treatments like platelet-rich plasma. Eventually, however, the soreness prevented me from handling daily-living tasks like pulling a bottle of olive oil off the top shelf of my kitchen or reaching to the back seat of my car to grab my purse. Even low-impact activities such as swimming freestyle hurt a lot. Sleeping also got tougher. After MRI showed two full-thickness rotator-cuff tears, I finally called a surgeon. (Kafka, 11/25)

NPR: Should Hospitals Be Punished For Post-Surgical Patients' Opioid Addiction?
In April this year, Katie Herzog checked into a Boston teaching hospital for what turned out to be a nine-hour-long back surgery. The 68-year-old consulting firm president left the hospital with a prescription for Dilaudid, an opioid used to treat severe pain, and instructions to take two pills every four hours as needed. Herzog took close to the full dose for about two weeks. Then, worried about addiction, she began asking questions. "I said, 'How do I taper off this? I don't want to stay on this drug forever, you know? What do I do?' " Herzog says, recalling conversations with her various providers. She never got a clear answer. (Bebinger, 11/26)

NPR: Telemedicine For Addiction Treatment? Picture Remains Fuzzy
When President Trump declared the opioid epidemic a public health emergency, it came with a regulatory change intended to make it easier for people to get care. Doctors are now allowed to prescribe addiction medicine virtually, without ever seeing the patient in person. In Indiana, this kind of virtual visit has been legal since early 2017. So I called about a dozen addiction specialists in Indiana to find out how it was going. But no one had heard of doctors using telemedicine for opioid addiction treatment until I ran across Dr. Jay Joshi. (Forman, 11/24)

The Associated Press: Maryland Tests Out Part Of Federal Response To Opioid Crisis
A federal initiative to combat the opioid epidemic is being tested in Maryland. The Baltimore Sun reports Maryland, where overdose deaths are surging, is one of seven states approved to allow large residential centers to bill Medicaid for substance abuse treatment. Under the new structure, treatment centers receive reimbursement for each patient rather than a set grant. (11/22)

The New York Times: Why Is This Bacterium Hiding In Human Tumors?
A mysterious bacterium found in up to half of all colon tumors also travels with the cancer as it spreads, researchers reported on Thursday. Whether the bacterium, called Fusobacterium nucleatum, actually plays a role in causing or spurring the growth of cancer is not known. But the new study, published in the journal Science, also shows that an antibiotic that squelches this organism slows the growth of cancer cells in mice. (Kolata, 11/23)

The Washington Post: ‘I Don’t Feel Like I’m A Threat Anymore.’ New HIV Guidelines Are Changing Lives.
Last year, Chris Kimmenez and his wife asked their doctors a simple question. Could Chris, who has been HIV positive since 1989 but keeps the virus in check through medication, transmit it sexually to Paula? They were pretty sure they knew the answer. Married for more than 30 years, they had not always practiced safe sex, but Paula showed no signs of having the virus. Their physicians were less certain. “They had a conversation, and they did some research on it,” Kimmenez said. “They came back to us and said there may still be a risk, but we’re comfortable enough” that unprotected sex is safe. (Bernstein, 11/24)

The Washington Post: From Pills To Psychotherapy, Treating Depression Often Lies In A Gray Zone
Depression afflicts an estimated 16 million Americans every year, many of whom go to their doctors in despair, embarking on an often stressful process about what to do next. These visits may entail filling out forms with screening questions about symptoms such as mood changes and difficulty sleeping. Doctors may ask patients to share intimate details about such issues as marital conflicts and suicidal urges. Some patients may be referred to mental-health specialists for further examination. Once diagnosed with depression, patients frequently face the question: “Are you interested in therapy, medications or both?” (Morris, 11/25)

The New York Times: Why Tobacco Companies Are Paying To Tell You Smoking Kills
The biggest tobacco companies in the United States will start running prime-time television commercials and full-page ads in national newspapers on Sunday — but the campaign is unlikely to spur enthusiasm for their products. “More people,” one ad says, “die every year from smoking than murder, AIDS, suicide, drugs, car crashes, and alcohol, combined.” Another reads: “Cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction.” (Maheshwari, 11/24)

The Washington Post: In The Woods And The Shadows, Street Medicine Treats The Nation’s Homeless
Nurse Laura LaCroix was meeting with one of her many homeless patients in a downtown Dunkin’ Donuts when he mentioned that a buddy was lying in agony in the nearby woods. “You should check on him,” said Pappy, as the older man is known. “But don’t worry, I put him on a tarp, so if he dies, you can just roll him into a hole.” LaCroix called her boss, Brett Feldman, a physician assistant who heads the “street medicine” program at Lehigh Valley Health Network. He rushed out of a meeting, and together the two hiked into the woods. They found Jeff Gibson in a fetal position, vomiting green bile and crying out in pain from being punched in the stomach by another man days earlier. (McGinley, 11/22)

The Washington Post: Hoping To Find Other Patients, He Revealed A Cancer Often Mistaken For ‘Jock Itch’
Stephen Schroeder figured he had little to lose, his growing sense of desperation fueled by the loneliness of his unusual diagnosis. For more than two years, Schroeder had been coping with an extremely rare, invasive cancer called extramammary Paget’s disease (EMPD), which had invaded his scrotum, requiring multiple surgeries. Women account for roughly half of EMPD cases; the cancer, often misdiagnosed as eczema or contact dermatitis, attacks the sweat-producing apocrine glands, including those in the genital and anal areas. (Boodman, 11/25)

NPR: Light Therapy Might Help People With Bipolar Depression
As the months grow colder and darker, many people find themselves somewhat sadder and even depressed. Bright light is sometimes used to help treat the symptoms of seasonal affective disorder, or SAD. Researchers are now testing light therapy to see if it also can help treat depression that's part of bipolar disorder. It's unclear how lack of light might cause the winter blues, although some suggest that the dark days affect the production of serotonin in the skin. (Neighmond, 11/27)

The Washington Post: Pulling Your Hair Or Picking At Skin Can Be Signs Of Serious Disorders
Lucy Harper, 17, a high school junior who lives in College Station, Tex., has been picking at her skin for as long as she can remember. When she was in seventh grade, she also started pulling out her hair. “For a while my skin picking was under the radar, but it was because I was pulling my hair,” she says. “If I wanted my skin to clear up, I’d stop picking and start pulling. If I wanted my hair to grow back, I’d stop pulling and start picking.” (Cimons, 11/26)

NPR: Human Brains Have Evolved Unique 'Feel-Good' Circuits
A brain system involved in everything from addiction to autism appears to have evolved differently in people than in great apes, a team reports Thursday in the journal Science. The system controls the production of dopamine, a chemical messenger that plays a major role in pleasure and rewards. "Humans have evolved a dopamine system that is different than the one in chimpanzees," says Nenad Sestan, an author of the study and a professor of neuroscience at Yale. (Hamilton, 11/23)

The Washington Post: Having Trouble Sleeping? It Is Not Just Because Of Aging.
Many older adults have sleep problems that can be caused by aging. But other issues also contribute to the prevalence of sleep complaints, and they should be discussed and investigated, experts say. A national poll conducted by the University of Michigan and released in October found that almost half of those 65 and older have trouble getting to sleep, and more than a third are taking prescription or over-the-counter sleep aids. (Sadick, 11/26)

NPR: Apps Can Cut Blue Light From Devices, But Do They Help You Sleep?
If you're losing sleep over the blue light coming from your phone, there's an app for that. In fact, there are now lots of apps that promise to improve sleep by filtering out the blue light produced by phones, tablets, computers, and even televisions. But how well do these apps work? (Hamilton, 11/27)

The New York Times: Dog Owners Live Longer
A Swedish study suggests that owning a dog is linked to a reduced risk for cardiovascular disease and death. Researchers used demographic data on 3.4 million Swedes ages 40 to 80. In Sweden, all dogs are registered with the Swedish Board of Agriculture and identified by number with an ear tattoo or a subcutaneous chip. (Bakalar, 11/22)

The Associated Press: Veterans Are Key As Surge Of States OK Medical Pot For PTSD
It was a telling setting for a decision on whether post-traumatic stress disorder patients could use medical marijuana. Against the backdrop of the nation's largest Veterans Day parade, Democratic Gov. Andrew Cuomo announced this month he'd sign legislation making New York the latest in a fast-rising tide of states to OK therapeutic pot as a PTSD treatment, though it's illegal under federal law and doesn't boast extensive, conclusive medical research. (11/26)

The Washington Post: Teenager Dies After Being Found Unresponsive At Behavioral Center In Virginia
Authorities are investigating the death of a teenager who was reported to be unresponsive and not breathing at a behavioral treatment center in Northern Virginia. Officials responded at 3:37 p.m. Sunday to a call at North Spring Behavioral Healthcare on Victory Lane in Leesburg, Va., according to Kraig Troxell, a spokesman for the Loudoun County Sheriff’s Office. ... The teenager was taken to a hospital where he later died. Troxell did not provide the youth’s exact age or other details, citing the ongoing investigation. The cause of death is pending the results of an autopsy. (Silverman, 11/24)