First Edition: October 24, 2019

Kaiser Health News: A Million-Dollar Marketing Juggernaut Pushes 3D Mammograms
When Dr. Worta McCaskill-Stevens made an appointment for a mammogram last year, she expected a simple breast cancer screening ― not a heavy-handed sales pitch. A receptionist asked if she wanted a free upgrade to a “3D mammogram,” or tomosynthesis. “She said there’s a new approach and it’s much better, and it finds all cancer,” said McCaskill-Stevens, who declined the offer. (Szabo, 10/22)

Kaiser Health News: Compression Garments Can Ease Lymphedema. Covering Costs? Not So Easy.
Every morning, Britta Vander Linden dons compression stockings, a cumbersome process she calls “putting on my legs.” She relies on the garments to stand and walk without intense leg pain and swelling. That’s because Vander Linden, 44, was born with lymphedema. The condition affects the lymphatic system, a network of lymph nodes and vessels that move infection-fighting liquid through the body. (Heredia Rodriguez, 10/23)

Kaiser Health News: For Boomers Reframing Aging, Age-Proofing A Home Won’t Come Cheap
Dennis and Chris Cavner, in their early 70s, are preparing to move less than two blocks away into a 2,720-square-foot, ranch-style house they bought this year. But first a renovation is underway, taking the 45-year-old property all the way back to its studs. When the work is finished, these baby boomers are confident the move will land them in their forever home. “We wanted to find a house that we could live in literally for the rest of our lives,” Dennis Cavner said. “We were looking specifically for a one-story house and one that had a flat lot, to age in place.” (Jayson, 10/21)

Kaiser Health News: For Generation Juul, Nicotine Addiction Happens Fast And Is Hard To Shake
When Will tried his first vape during his sophomore year, he didn’t know what to expect. It was just something he had vaguely heard about at his high school. “I just sort of remember using it a bunch of times, like in a row,” he said. “And there’s this huge buzz-sensation-like head rush. And I just … didn’t really stop.”Will kept vaping nicotine addictively for the next year and a half. He was part of a trend. (Yu, 10/21)

California Healthline: Los Angeles Vape District A Black-Market Gateway
A five-block section of downtown Los Angeles that used to be part of the city’s Toy District has become ground zero for the nation’s counterfeit cannabis trade. While a few remaining stores sell fidget spinners and stuffed animals, the majority are hawking vape cartridges, e-juice flavors, vaporizers and other wholesale smoking and vaping supplies — including knockoffs that originated in China. (De Marco, 10/18)

Kaiser Health News: Washington State Law On Behavioral Care Balances Parental Rights, Teens’ Autonomy
When Ben Packard met with the 16-year-old girl a little over a year ago, she was a patient at Seattle Children’s Hospital, where she’d been admitted after trying to kill herself. Her parents were distraught. “They wanted to know what was going on, and why their kid wanted to die,” said Packard, a mental health therapist on the psychiatric unit who worked with her and her family. But Washington is one of many states that carved out exceptions to the rights of parents to know about or consent to certain types of care their minor children receive, including mental health and drug and alcohol treatment as well as reproductive health services such as birth control and abortion. (Andrews, 10/24)

The New York Times: Obamacare Premiums To Fall And Number Of Insurers To Rise Next Year
Nearly three years into President Trump’s aggressive efforts to undermine the Affordable Care Act, prices for the most popular type of health insurance plan offered through the health law’s federal marketplace will actually drop next year, and the number of insurers offering plans will go up. Administration officials credited Mr. Trump with the resiliency of the law even as they echoed his contempt for it. (Goodnough, 10/22)

The Wall Street Journal: Premiums For ACA Health Plans Are Set To Drop In 2020
Average rates for the most popular, middle-priced plan will fall 4% in 2020 for a 27-year-old buying health insurance on the federal exchange, although premiums will vary widely by location, federal health officials said Tuesday. Rates had also declined 1.5% in 2019, after years of double-digit-percentage premium increases. (Armour, 10/22)

The Associated Press: More Choices And Stable Premiums For 'Obamacare' Next Year 
For now, the Department of Health and Human Services is touting a second consecutive year of positive-sounding numbers. An additional 20 insurers will participate for 2020, expanding consumer choice in many states, officials said. Nearly 70 percent of customers will have three or more insurers from which to pick a plan. (Alonso-Zaldivar, 10/22)

The Washington Post: Rates For The Most Common ACA Health Plans Drop For A Second Year
Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma persisted in tarring the system of individual insurance created under the health-care law as unwieldy, unaffordable for too many and in need of replacement. They also praised President Trump’s guidance for making the law’s insurance exchanges work better. “The president who was supposedly trying to sabotage the law has been better at running it than the guy who wrote the law,” Azar said during a phone briefing for reporters, alluding first to Trump and then to his predecessor, President Barack Obama, who regarded the ACA as one of his main domestic accomplishments. (Goldstein, 10/22)

Politico: Premiums For Popular Obamacare Plans To Drop 4 Percent
Obamacare supporters have said the improving marketplaces are largely a sign of the law's maturing, and that the Trump administration has taken steps to undermine the law. The administration "deserves zero credit" for the law's success, said Protect Our Care, a Democratic-aligned group formed to defend Obamacare. Premiums rose sharply in the first years of Obamacare as insurers adjusted to new rules. Insurers also hiked their rates in Trump's first year amid congressional Republicans’ failed effort to repeal the law and numerous steps taken by the administration seen as undermining the marketplaces. (Goldberg, 10/22)

Modern Healthcare: Verma To Democrats: Some Insurance ‘Better Than No Insurance At All'
CMS Administrator Seema Verma on Wednesday defended the Trump administration's actions on healthcare, telling the U.S. House of Representatives' Energy and Commerce Committee that her agency is trying to provide greater access to care in the face of rising healthcare costs. Verma touted the CMS' efforts on a range of healthcare issues from health IT interoperability to opioid abuse throughout her testimony, but the committee's Democratic members met her with fierce criticism. They said that under the Trump administration, the healthcare system is heading in the wrong direction and that the Affordable Care Act is succeeding "despite" the administration's best efforts to undermine it. (Brady, 10/23)

The Wall Street Journal: Medicare Chief, Congressional Democrats Square Off Over Health Law
The hearing was a rare opportunity for congressional Democrats who have been eager to publicly question Trump administration health officials on White House efforts to roll back the ACA, part of a messaging battle ahead of the 2020 election. Democrats, many of whom will seek re-election by promising to preserve the ACA, say the administration has adopted policies it knew would raise health-care costs and leave more people without coverage. They point to work requirements in Medicaid, the end of billions in payments to insurers that drove up premiums, and the Trump administration’s backing of a GOP-led lawsuit to strike down the ACA. (Armour, 10/23)

The Wall Street Journal: As Court Case Imperils Affordable Care Act, Some States Prepare Contingency Plans
A federal appeals court decision that could strike down the Affordable Care Act as soon as this month has rattled officials in several states who are pursuing legislation to preserve some coverage in the absence of any Trump administration contingency plan. Lawmakers in states including Louisiana, Nevada, New Mexico and California have passed bills or are reviewing action aimed at dealing with the fallout if the ACA is overturned. Many of these lawmakers are also facing re-election campaigns this fall in some of the very states that brought the lawsuit. (Armour, 10/21)

The Associated Press: Anthem 3Q Profit Jumps 23%, Helped By Enrollment Gains 
Anthem's third-quarter profit jumped 23%, and the Blue Cross-Blue Shield insurer raised its 2019 forecast after pulling in more people covered by Medicare Advantage and Medicaid. Anthem also gave investors an initial glimpse into next year's profit expectations. (Murphy, 10/23)

Reuters: Health Insurer Anthem Signals Better-Than-Feared 2020 Earnings, Shares Rise
Anthem said on Wednesday medical costs in its Medicaid business, which manages health plans for low-income Americans, improved in the quarter even as overall costs rose and came in higher than Wall Street targets. "We're very positive about the overall Medicaid environment business going forward," Boudreaux said. The insurer reported third-quarter profit ahead of estimates and raised its full-year earnings forecast, riding on higher sales of its government-backed health plans. (Mathias and Humer, 10/23)

The Associated Press: Consider A Side Of Insurance With Your Health Insurance
Health insurance costs have climbed so high, there's insurance for it. More employers are offering their workers supplemental coverage for expenses that crop up when an unexpected illness or injury hits. These additional policies can help make up for lost wages due to disability leave and pay bills that regular health insurance doesn't cover. (Murphy, 10/23)

Politico: How Warren Could Pay For 'Medicare For All'
Sen. Elizabeth Warren’s pledge to reveal how she'd pay for her "Medicare for All" plan carries big risks, no matter which path she takes. Taxing the wealthy won’t cover the trillions in cost. Raising taxes on the middle class is a political third rail. Other options, like reducing health care benefits or raising payroll taxes are also politically dicey. Small wonder then that the top-tier Democrat — whose motto is that she has a plan for everything — doesn’t have one yet for how to pay for universal health care. (Ollstein, 10/21)

Reuters: Democratic 2020 Hopeful Warren Still Weighing Medicare For All Financing Options
One explanation, according to sources close to Warren’s campaign, is that the U.S. senator from Massachusetts is still considering financing options and at least one under review does not include a middle-class tax hike. “I’ve been working for a long time on this question about what the costs will be and how to pay for it and I’m getting close. It’s just got a little more work that it needs on it before it’s ready,” Warren told reporters in Indianola, Iowa, on Sunday, adding that she will be “ready to put out a plan soon on exactly what the costs will be.” (Becker, 10/21)

The New York Times: Medicaid Covers A Million Fewer Children. Baby Elijah Was One Of Them
The baby’s lips were turning blue from lack of oxygen in the blood when his mother, Kristin Johnson, rushed him to an emergency room here last month. Only after he was admitted to intensive care with a respiratory virus did Ms. Johnson learn that he had been dropped from Medicaid coverage. The 9-month-old, Elijah, had joined a growing number of children around the country with no health insurance, a trend that new Census Bureau data suggests is most pronounced in Texas and a handful of other states. Two of Elijah’s older siblings lost Medicaid coverage two years ago for reasons Ms. Johnson never understood, and she got so stymied trying to prove their eligibility that she gave up. (Goodnough and Sanger-Katz, 10/22)

The Associated Press: Arizona Quietly Suspends Medicaid Work Requirement
Arizona quietly suspended plans to require about 120,000 people to work, volunteer or go to school to receive Medicaid benefits, as courts have taken a dim view of similar mandates in other states. The decision is another setback to efforts by President Donald Trump and his allies in many Republican-led states to put conditions on low-income people seeking taxpayer funded benefits. (Cooper, 10/21)

Politico: Why North Carolina Might Be The Most Innovative Health Care State In America
Two top Obamacare officials spent years in their Washington offices, right next door for a time, thinking about how to fix health care. Then both came to North Carolina, determined to put their ideas to the test in the real world. One runs the state Health and Human Services Department, including Medicaid. The other led the state’s dominant private insurer. Combined, they cover well over 6 million people, more than half the state. Together, they made North Carolina arguably the most innovative state in the country when it comes to improving how health care is delivered and addressing the underlying social and economic drivers, like homelessness, of poor health and high costs. (Kenen, 10/24)

Politico: When Reform Hits Real Life
North Carolina has embarked on an ambitious attempt to shift health care payments so they reward the value of care, not the volume. Working largely through Medicaid and North Carolina’s dominant private health insurer, the state is also addressing social and economic drivers of poor health, like homelessness. Here’s how that’s working in practice for three providers: an urban safety net hospital, a small-town family doctor and a community clinic. (Kenen, 10/24)

ProPublica: How Donald Trump Turned To A Comics Titan To Shape The VA
President Donald Trump personally directed administration officials to report to one of his largest donors, Marvel Entertainment chairman Ike Perlmutter, according to a new book by former Secretary of Veterans Affairs David Shulkin. Starting with Shulkin’s interview for the cabinet post, Trump routinely dialed Perlmutter into meetings and asked if the secretary was keeping Perlmutter informed and happy, Shulkin wrote. Perlmutter would call Shulkin as often as multiple times a day, and White House officials such as Stephen Miller would scold Shulkin for not being in close enough contact with Perlmutter and two of his associates at Mar-a-Lago, Trump’s private club in Florida. (Arnsdorg, 10/22)

USA Today: 'Something Has Changed': People Have Been Vaping For Years But Now They're Dying. Could It Be The Devices?
Dr. Mangala Narasimhan carefully inserted the long, thin probe down Gregory Rodriguez's throat, snaking it past his vocal cords and deep into his damaged lungs. A ventilator breathed for the 22-year-old college student as Narasimhan began sucking out the yellow, jelly-like clots that had nearly killed him. "It really was gross," said Narasimhan, a lung specialist and director of critical care medicine at Northwell Health in New Hyde Park, New York. (Hughes and O'Donnnell, 10/23)

Los Angeles Times: The Recent Vaping Deaths Are Bad. The Long Term Toll Will Be Even Worse
The Centers for Disease Control and Prevention has linked vaping to 1,479 cases of a mysterious lung disease over the last six months. At least 33 people have died since the outbreak began. The illness is marked by chest pain, shortness of breath and vomiting, and it has largely affected young people. The vast majority of cases, almost 80%, involve e-cigarette users younger than 35, and another 15% are younger than 18. (Baumgaertner, Greene and Mukherjee, 10/23)

The New York Times: Marijuana And Vaping: Shadowy Past, Dangerous Present
For years, a divisive debate has raged in the United States over the health consequences of nicotine e-cigarettes. During the same time, vaping of a more contentious substance has been swiftly growing, with scant notice from public health officials. Millions of people now inhale marijuana not from joints or pipes filled with burning leaves but through sleek devices and cartridges filled with flavored cannabis oils. People in the legalized marijuana industry say vaping products now account for 30 percent or more of their business. (Richtel, 10/21)

Bloomberg: Vaping Illness Gives Cigarettes A Second Wind 
Numerous U.S. states have put bans on some types of the products, and federal regulators have also signaled that tighter curbs on vaping are coming soon. If the crackdown endures, tobacco companies will find themselves in an unusual situation in 2020: While the vaping controversy may cloud the future of different cigarette alternatives that they’ve spent billions of dollars to develop, it may also mean their staple products—the cigarettes that made them into globe-spanning behemoths but also left them on the hook for hundreds of billions for smoking-related illnesses—stage a bit of a comeback. (Kary, 10/23)

Stateline: In Opioid Settlements, Suboxone Plays A Leading Role 
In this week’s $260 million settlement between drug companies and two Ohio counties hit hard by the opioid crisis, $25 million worth of the addiction medication known as Suboxone is a big part of the deal. Suboxone would make up a much larger share of a proposed national settlement announced shortly afterward by a bipartisan group of state attorneys general: an estimated $26 billion over 10 years out of a $48 billion overall settlement. (Vestal, 10/23)

Reuters: Teva’s Proposed Opioid Settlement Could Cost Drugmaker Pennies On The Dollar
Teva Pharmaceutical Industries Ltd's proposed $23 billion drug giveaway to settle thousands of U.S. opioid lawsuits will likely cost the company a fraction of that figure due to how it has valued those medicines, according to a Reuters review of pricing data and industry analysts. When Teva announced the value of the donated medicine - a generic version of opioid addiction treatment Suboxone - it based the figure on the drug's list price, which does not account for significant discounts routinely provided by the drugmaker. (Erman and Raymond, 10/23)

The Hill: DEA Unveils New Rule On Opioid Manufacturers After Criticism 
A new policy from the Drug Enforcement Administration (DEA) aims to improve the agency’s quotas of controlled substances, with the intent of preventing manufacturers from overproducing opioids. A proposed rule published Wednesday would further limit excess quantities of medications that might be vulnerable to diversion for illicit distribution and use, the agency said in a statement. (Weixel, 10/23)

Stat: Before Signing Up For Drug Trial, She Wants To Know: Can I Afford It? 
It was an alluring pitch. Patidegib was chemically similar to Erivedge but supposedly safer: By rubbing the stuff on to skin, the thinking went, you could avoid the taste loss, hair loss, and muscle cramps that came when you swallowed it — reactions that kept some from taking the pills. ...To scientists, it’s still an exuberant story of discovery against the odds. To patients like [Kaylene] Sheran, it’s a story tempered with worry: Every side effect, it seems, has been prepared for except financial toxicity. (Boodman, 10/23)

Stat: More New Medicines Had Publicly Supported Research Than You Might Think
As debate grows over the role that taxpayer dollars play in drug discovery, an analysis finds one in four new medicines approved by regulators over the past decade benefited from publicly supported late-stage research or spinoff companies that were created by public sector research institutions. Moreover, drugs that were approved following major public financing were more likely to have won speedier approvals by the Food and Drug Administration. (Silverman, 10/23)

The New York Times: That New Alzheimer’s Drug? Don’t Get Your Hopes Up Yet
Biogen, the drug company, said on Tuesday that it would ask the Food and Drug Administration to approve an experimental drug, aducanumab, to treat people with mild cognitive impairment and the earliest signs of Alzheimer’s disease. About 10 million Americans might qualify for treatment if the drug were approved, according to Michel Vounatsos, the company’s chief executive. Even so, it is not quite time for these patients to celebrate. (Kolata, 10/22)

Stat: 7 Burning Questions After Biogen Resurrected Its Alzheimer's Drug 
Biogen’s aducanumab was the last great hope for treating Alzheimer’s disease through an approach that the leading lights in the field have believed in for 30 years: siccing a lab-made monoclonal antibody on amyloid plaques in the brain. Now that aducanumab is back from the dead, with the company announcing on Tuesday that additional data overturned its earlier conclusion that the drug had no chance of working, the “amyloid hypothesis” also has a new lease on life — and Biogen has a potentially zillion-dollar moneymaker, should the Food and Drug Administration be persuaded. (Begley, 10/23)

The New York Times: New Illinois Abortion Clinic Anticipates Post-Roe World
When it opens just across the river from St. Louis this week, the new Planned Parenthood clinic in Illinois will be one of the largest abortion clinics in the Midwest, set up to serve around 11,000 women a year with various health services, double the capacity of the clinic it is replacing. Its size says as much about the future as the present: With the Supreme Court’s shift to the right, activists on both sides of the abortion divide are adjusting their strategy, anticipating that Roe v. Wade, the 1973 Supreme Court decision that extended federal protections to abortion, might eventually be overturned and that some states would jump at the chance to ban abortions. (Tavernise, 10/22)

The New York Times: Women Should Be Warned Of Breast Implant Hazards, F.D.A. Says
Women considering surgery to receive breast implants should be warned in advance of the risk of serious complications, including fatigue, joint pain and the possibility of a rare type of cancer, the Food and Drug Administration said on Wednesday. Agency officials are urging manufacturers to print a boxed warning on the packaging of the implants, and to provide a checklist spelling out the risks for prospective patients to review before making a decision and putting down a deposit on the surgery. It will be left to doctors to review those risks with women seeking breast implants. (Rabin, 10/23)

The Associated Press: FDA Wants Stronger Warning On Breast Implants About Risks
The agency is also recommending patients complete a checklist to make sure they understand all the possible side effects of the implants, such as scarring, pain, rupture and even a rare form of cancer. "We have heard from many women that they are not fully informed of the risks when considering breast implants," the agency said in a statement detailing the recommendations. (Perrone, 10/23)

The Washington Post: FDA Recommends New Warning For Breast Implants
The FDA’s steps are the latest effort to deal with reports of complications involving devices that have been at the center of sometimes angry debate and legal actions for decades. The devices are used in about 400,000 surgeries in the United States every year, with 75 percent of the women involved getting implants for cosmetic reasons. Most of the rest get them as part of reconstruction after surgery for breast cancer. Over the past few years, patients who say they were harmed by the devices have become increasingly active on social media sites that have enabled tens of thousands of patients to exchange information. (McGinley, 10/23)

The New York Times: When The Menu Turns Raw, Your Gut Microbes Know What To Do
It was a challenge unlike any other the chef-turned-graduate student had faced: Vayu Maini Rekdal had to create a menu where every ingredient could be eaten either raw or cooked. No pickling was allowed, nor fermented toppings like soy sauce or miso. Nothing could be processed in any way, so things like tofu were out. And the more sweet potatoes he could serve up, the better. “It was extremely challenging,” said Mr. Rekdal, a chemistry graduate student at Harvard. (Greenwood, 10/23)

The Associated Press: Is The Stethoscope Dying? High-Tech Rivals Pose A Threat
Two centuries after its invention, the stethoscope — the very symbol of the medical profession — is facing an uncertain prognosis. It is threatened by hand-held devices that are also pressed against the chest but rely on ultrasound technology, artificial intelligence and smartphone apps instead of doctors' ears to help detect leaks, murmurs, abnormal rhythms and other problems in the heart, lungs and elsewhere. Some of these instruments can yield images of the beating heart or create electrocardiogram graphs. (10/23)

Los Angeles Times: By Age 6, Kids Tend To See White Men As More 'Brilliant' Than White Women
Albert Einstein. Benjamin Franklin. Thomas Edison. Steve Jobs. Picture a brilliant person and odds are a white man will come to mind. That idea gets into kids’ heads as early as the age of 6, a new study finds. Researchers who polled more than 200 New York kindergartners and first-graders found that they had already begun to believe that white men are more “brilliant” than white women. (Khan, 10/23)

The New York Times: The Best Time To Take Your Blood Pressure Drugs May Be At Night
Blood pressure medicines may work better if they are taken at night. Spanish researchers randomized 19,084 men and women with diagnoses of high blood pressure, half to take their medicine at bedtime and the other half when they awoke. Over a six-year follow-up, there were 3,246 coronary events — stroke, heart attack, heart failure, angina and others — and 310 deaths from cardiovascular disease. (Bakalar, 10/23)

The New York Times: Black Scientists Held Back By Perceptions Of Their Priorities
Scientific research ideally is colorblind, with merit the only factor in hiring, publishing or the awarding of research grants. But the reality often falls short. Eight years ago, a study published in Science found that black researchers were 10 percentage points less likely than white ones to receive funding from the National Institutes of Health, even after controlling for factors like educational background, previous research awards and publication record. Its authors theorized that the difference might reflect an accumulation of slight advantages over the course of white scientists’ careers. (Goldberg, 10/23)

The New York Times: Deadliest Year For Pedestrians And Cyclists In U.S. Since 1990
More pedestrians and cyclists were killed last year in the United States than in any year since 1990, according to a report released on Tuesday by the National Highway Traffic Safety Administration. Most of the news about traffic safety has been good in recent decades, as vehicle manufacturers have added safety features, drunken driving deaths have fallen and seatbelt use has climbed to nearly 90 percent. But in recent years, pedestrian and cyclist deaths have been a disturbing outlier. (Bogel-Burroughs, 10/22)

The New York Times: Always Removes Female Symbol From Sanitary Pads
In a nod to transgender and nonbinary customers, Procter & Gamble said this week that it was removing the Venus symbol, which has historically been associated with womanhood and the female sex, from the wrappers of Always brand sanitary pads. “For over 35 years Always has championed girls and women, and we will continue to do so,” the company said in a statement. “We’re also committed to diversity and inclusion and are on a continual journey to understand the needs of all of our consumers.” (Murphy, 10/22)

The New York Times: Something In The Way We Move
Each of us appears to have a unique way of moving, a physical “signature” that is ours alone, like our face or fingerprints, according to a remarkable new study of people and their muscles. The study, which used machine learning to find one-of-a-kind patterns in people’s muscular contractions, could have implications for our understanding of health, physical performance, personalized medicine and whether and why people can respond so differently to the same exercise. (Reynolds, 10/23)

The New York Times: Woman Charged With Murder After Claiming Her Daughter Was Terminally Ill
After the Make-a-Wish Foundation was told that Olivia Gant, who was 6, had a terminal illness, it made one of her dreams come true. In 2017, the girl was transformed into a superhero Bat Princess for a day so she could save other princesses from evil villains. A local CBS station in Denver captured a heartwarming scene as Olivia, dressed in a blue Batman mask, shiny purple cape and custom logo, walked through a cheering crowd holding swords above her head and battled with a volunteer dressed as Ursula, Disney’s sea witch from “The Little Mermaid.” Olivia later sang “Part of Your World” with Ariel. (Rueb and Padilla, 10/23)

The Wall Street Journal: Second Round Of Blackouts Begins In California, With More On Horizon
PG&E Corp. on Wednesday began shutting off power to 179,000 customers in 17 California counties, its second major intentional blackout this month meant to head off potential wildfires. The shut-offs began at 2 p.m. local time in the Sierra Nevada foothills and 3 p.m. in some counties north of San Francisco. More were planned for 1 a.m. Thursday in parts of San Mateo County, between San Francisco and San Jose, and Kern County, in the southern part of the state’s Central Valley. (Carlton, 10/24)