First Edition: October 9, 2017

Kaiser Health News: Overlooked By ACA: Many People Paying Full Price For Insurance ‘Getting Slammed'
Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care. ”Teri Goodrich, of Raleigh, N.C., has the same complaint. “We’re getting slammed. We didn’t budget for this,” she said. Millions of people have gained health insurance because of the federal health law. Millions more have seen their existing coverage improved. (Rovner, 10/9)

Kaiser Health News: 4 Takeaways As HHS Relaxes Rules On Contraception Coverage At Work
Here are some frequently asked questions and answers about the new rules. (Carey and Verdon, 10/6)

Kaiser Health News: Patients, Health Insurers Challenge Iowa’s Privatized Medicaid
Iowa is one of 38 states that radically changed the way it runs Medicaid over the past few years. The state moved about 600,000 people on the government-run health program into care that is managed by for-profit insurance companies. The idea is that the private companies would save the state money, but it has been a rocky transition in Iowa, especially for people like Neal Siegel. (Masters, 10/9)

The New York Times: Trump Administration Rolls Back Birth Control Mandate
The Trump administration on Friday moved to expand the rights of employers to deny women insurance coverage for contraception and issued sweeping guidance on religious freedom that critics said could also erode civil rights protections for lesbian, gay, bisexual and transgender people. The twin actions, by the Department of Health and Human Services and the Justice Department, were meant to carry out a promise issued by President Trump five months ago, when he declared in the Rose Garden that “we will not allow people of faith to be targeted, bullied or silenced anymore.” (Pear, Ruiz and Goodstein, 10/6)

The Washington Post: Trump Administration Narrows Affordable Care Act’s Contraception Mandate
The rules significantly widen the range of employers and insurers that can invoke religious or moral beliefs to avoid the ACA requirement that birth control pills and other contraceptives be covered by insurance as part of preventive care. Administration officials and their allies on the right downplayed the impact of the change on American women, while women’s rights and civil liberties groups portrayed it as a massive, discriminatory act. (Goldstein, Eilperin and Wan, 10/6)

The Associated Press: Birth Control: Trump Expands Opt-Out For Workplace Insurance
The new policy was a long-anticipated revision to Affordable Care Act requirements that most companies cover birth control as preventive care for women, at no additional cost. That Obama-era requirement applies to all FDA-approved methods, including the morning-after pill, which some religious conservatives call an abortion drug, though scientists say it has no effect on women who are already pregnant. (10/6)

Politico: Trump Rolls Back Obamacare Birth Control Mandate
The new policies, which take effect immediately, reignite a fierce battle over one of the health care law's most controversial provisions and quickly drew legal challenges. The requirement to provide FDA-approved contraception at no cost was long opposed by religious groups that heavily favored Trump, and has been wrapped up in litigation for more than five years. (Ehley, 10/6)

NPR: Trump Weakens Requirement That Work-Based Health Policies Cover Birth Control
"This provides an exemption, and it's a limited one," said Roger Severino, director of the HHS Office of Civil Rights. "We should have space for organizations to live out their religious identity and not face discrimination." He said he expects that most companies will continue to provide coverage for birth control and that the changes will only affect a tiny percentage of U.S. women. The new rules are being published Friday in the Federal Register and go into effect immediately. But some health policy analysts say the new rule creates a huge opening that lets any employer claim an exemption, leaving their female workers to pay the full cost of any birth control out of pocket. (Kodjak, 10/6)

The Hill: California Challenges Trump’s Rollback Of Birth Control Mandate 
California Attorney General Xavier Becerra (D) on Friday filed a lawsuit challenging the Trump administration's rollback of an Obama-era policy that required employers include birth control coverage in their health insurance plans. “Donald Trump wants businesses and corporations to control family planning decisions rather than a woman in consultation with her doctor. These anti-women's health regulations prove once again that the Trump administration is willing to trample on people’s rights,” Becerra said in a statement. (Manchester, 10/6)

The Associated Press: White House Plans Order To Expand Health Care Options
The White House is finalizing an executive order that would expand health plans offered by associations to allow individuals to pool together and buy insurance outside their states, a unilateral move that follows failed efforts by Congress to overhaul the health care system. President Donald Trump has long asserted that selling insurance across state lines would trigger competition that brings down premiums for people buying their own policies. Experts say that's not guaranteed, partly because health insurance reflects local medical costs, which vary widely around the country. (Thomas and Alonso-Zaldivar, 10/9)

The Wall Street Journal: Trump To Sign Order Easing Health Plan Rules, Official Says
Mr. Trump will order three agencies, the departments of Health and Human Services, Labor and Treasury, to take steps to make it easier for people to band together and buy insurance through “association health plans,” the official said. Such plans would in some ways be like large employer’s health plans, subject to some restrictions set by the Affordable Care Act, including a ban on lifetime limits. But they would be free of other regulations, including the requirement that insurance plans cover a set package of benefits. These plans are popular with conservatives; some insurers fear that associations would peel off healthier and younger individuals and leave traditional insurance plans to cover sicker and older customers. (Radnofsky, Armour and Mathews, 10/7)

The Wall Street Journal: Trump Executive Order Could Divide The Health Insurance Market
Together, if executed in an expansive way, Mr. Trump’s changes could “cause a bifurcation of the market,” said Cori Uccello, senior health fellow at the American Academy of Actuaries. Insurers that offer plans under the ACA could face new difficulties, but companies also might find opportunities in offering new types of insurance. Mr. Trump’s order, described by a senior administration official, will include broad instructions for federal agencies to loosen rules on health plans that the administration says have driven up premiums and reduced insurance offerings available to people who buy coverage on their own or who work for a small employer. (Radnofsky, Mathews and Armour, 10/8)

The New York Times: Schumer Says He Rebuffed Another Offer From Trump On Health Care
President Trump reached out to the Senate Democratic leader, Chuck Schumer, on Friday to propose yet another effort to repeal and replace the Affordable Care Act, but Mr. Schumer later said he had quickly shot down the offer. Mr. Trump’s phone call, which he announced in a tweet on Saturday morning, was his latest overture to Democrats, after reaching a bipartisan spending deal and forging an unexpected, if tentative, alliance on immigration with Mr. Schumer and the House Democratic leader, Nancy Pelosi. (Landler, 10/7)

The Associated Press: Trump Reaches Out To Democrats In Bid For 'Great' Health Law
Trying to revive health care talks, President Donald Trump said Saturday that he had spoken to the Senate's Democratic leader to gauge whether the minority party was interested in helping pass "great" health legislation. The answer back: Democrats are willing to hear his ideas, but scrapping the Obama health law is a nonstarter. (Thomas, 10/7)

Politico: Trump Vents To Wealthy Donors About Failure To Repeal Obamacare
Trump, appearing at the Greensboro home of Republican Party donor Louis DeJoy, did not pinpoint any lawmakers for criticism, as he has done previously with Arizona Sen. John McCain and Kentucky Sen. Rand Paul, both of whom have balked at getting behind the specific repeal efforts. Trump also chose not to attack Senate Majority Leader Mitch McConnell, another past target of his frustration, the two attendees said. (Isenstadt, 10/8)

The Washington Post: Trump Says He Called Schumer To Broker Deal With Democrats For ‘A Great HealthCare Bill'
"The president wanted to make another run at repeal and replace and I told the president that's off the table," Schumer said in a statement. "If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs." (Rucker, 10/7)

Politico: Democrats Accuse Trump Of ‘Sabotage’ On Obamacare Sign-Ups
Obamacare's first open enrollment season under the Trump administration is expected to be a flop — and even the law's most ardent supporters are worried there's little they can do to change that. With less than a month before sign-up begins, the federal government has gutted outreach and marketing, slashed funding to outside enrollment groups and left state officials in the dark on key details. (Demko and Cancryn, 10/6)

Los Angeles Times: Even Red States Feel Left In The Lurch By The Trump Administration's Management Of Healthcare
As it works to roll back the Affordable Care Act, the Trump administration is letting crucial state health initiatives languish, frustrating a growing number of state leaders, including several from solidly Republican states. Last week, Oklahoma’s health secretary sent a blistering letter to senior administration officials, taking them to task for failing to approve a plan state officials drew up to protect their consumers from large rate hikes. (Levey, 10/6)

The Wall Street Journal: Health-Care Standoff In Washington Raises Stakes Of State-Level Fights
The collapse of the Republican effort to overhaul the health-care system and the resulting standoff in Washington has pushed the fight to the states, where a brewing conflict over Medicaid is shaping up as the next battleground. The Trump administration is expected to rule soon on Kentucky’s push to impose work requirements and other rules on Medicaid enrollees, as other states line up to follow suit. Democrats say that would weaken the program. (Armour, 10/7)

The Hill: Puerto Rico Faces Looming Medicaid Crisis
Puerto Rico is facing an imminent Medicaid funding crisis, putting nearly one million people at risk of losing their health-care coverage. Even before Hurricane Maria caused major damage to the island’s struggling health-care system, the U.S. territory’s Medicaid program barely had enough money left to last through the next year. (Weixel, 10/7)

The Wall Street Journal: Training Ground For Military Trauma Experts: U.S. Gun Violence
As he raced to triage victims of the Las Vegas shooting on the night of Oct. 1, Brandon Snook encountered many familiar wounds. He had seen them in the bodies of U.S. soldiers evacuated from battle in Fallujah, Iraq. Dr. Snook, a surgeon and colonel in the Air Force, is one of several military personnel who pitched in to treat shooting victims at University Medical Center of Southern Nevada. The nearby Nellis Air Force Base supplies the hospital with doctors and nurses aiming to maintain their battlefield skills when they are stateside, where gun violence in some cities provides a steady supply of horrific wounds. (Whalen, 10/9)

The Washington Post: Is The United States One Of Seven Countries That ‘Allow Elective Abortions After 20 Weeks Of Pregnancy?’
There are 59 countries that allow abortion “without restriction as to reason,” or “elective,” or “abortion on demand.” These are countries where the letter of the federal law does not impose specific eligibility requirements for women. The other 139 countries “require some reason to obtain an abortion, ranging from most restrictive (to save the life of the mother or completely prohibited) to least restrictive (socioeconomic grounds) with various reasons in between (e.g., physical health, mental health),” the report says. Only seven of the 59 countries allow elective abortions after 20 weeks, the group found: Canada, China, Netherlands, North Korea, Singapore, the United States and Vietnam. (Lee, 10/9)

Washington Post/Stateline: Pressure Mounts To Lift FDA Restrictions On Off-Label Drugs
When the Food and Drug Administration gives its okay for a new drug to be sold, it specifies the diseases or conditions for which the medicine has been approved. That does not mean doctors can’t prescribe that drug for other ailments. They do. All the time. And it’s perfectly legal. But for decades drugmakers have been barred from promoting their drugs for uses that hadn’t gone through clinical trials. Worried about safety issues, the FDA has prosecuted numerous drugmakers for illegal promotion of off-label uses and extracted billions of dollars in fines and settlements. (Ollove, 10/8)

The New York Times: As Cancer Tears Through Africa, Drug Makers Draw Up A Battle Plan
In a remarkable initiative modeled on the campaign against AIDS in Africa, two major pharmaceutical companies, working with the American Cancer Society, will steeply discount the prices of cancer medicines in Africa. Under the new agreement, the companies — Pfizer, based in New York, and Cipla, based in Mumbai — have promised to charge rock-bottom prices for 16 common chemotherapy drugs. The deal, initially offered to a half-dozen countries, is expected to bring lifesaving treatment to tens of thousands who would otherwise die. (Donald G. McNeil, 10/7)

The Washington Post: Time Sleuths Think Our Body Clock Could Help Crack The Code About Chronic Disease
Commute. Work. Commute. Sleep. Commute. Work. Commute. Sleep. If you think your daily grind’s killing you, you may be right, according to an article by Leslie Kaufman in the September/­October issue of Popular Science. Kaufman examines the work of chronobiologists — scientists who add the element of time to their research on topics such as the neurons that help awaken the human brain and the metabolic processes that occur after a midnight snack. (Blakemore, 10/8)

The New York Times: Researchers Predict A Quarter-Million New Cases Of Breast Cancer In The U.S.
Breast cancer is the most common cancer in American women except for skin cancers. Researchers at the American Cancer Society estimate that there will be 252,710 new cases of invasive breast cancer in women in the United States in 2017. Some 40,610 women will die from the disease. In addition, there will be 63,410 cases this year of carcinoma in situ, abnormal cells that may be an early form of cancer. (Bakalar, 10/6)

NPR: Positive Hospital Marketing Campaigns Have A Painful Downside
Lori Wallace is sitting on a couch with her 11-year-old son and his new pet snake. It's burrowing under his armpit, as if it were afraid. But Wallace says it's not. "If he was terrified, he would be balled up," Wallace says. "See, that is why they are called ball pythons. When they are scared, they turn into a little ball. "Wallace is dying of breast cancer, but a stranger couldn't tell. (Harnett, 10/8)

The New York Times: Is There Any Reason Not To Get A Flu Shot?
Health officials urge all Americans 6 months and older to get an annual flu shot — except for those who have ever had a severe or life-threatening allergic reaction to an influenza vaccine or vaccine component. Individuals who have had severe allergic reactions to a flu vaccine “should not get the vaccine again,” said Dr. Lisa Grohskopf, a medical officer with the Centers for Disease Control and Prevention. (Rabin, 10/6)

The Washington Post: Heart Problems Can Harm Even Dedicated Exercisers
Jason Lathrop was training for a solo backpacking trip in 2015 when he started to feel a creaking sensation in his knees during morning runs near his home in Portland, Ore. Expecting to learn that he’d torn his meniscus or strained a ligament, he went to his doctor, who told him his knees were just fine. Instead, he learned, he had a heart murmur. Six weeks later, the 43-year-old father of two was undergoing open-heart surgery to repair a faulty mitral valve. (Sohn, 10/7)

Reuters: Older Adults May Confide Suicidal Thoughts Especially If They Have Chronic Health Problems Or Depression
More than 1 in 5 older adults who commit suicide disclose their intention to kill themselves before taking their own lives, a study suggests. Overall, 23 percent of suicide victims age 50 or older shared suicidal thoughts with another person in the month before their death, the study found. Disclosure rates were higher among the elderly and more common when people had chronic health problems or suffered from depression. (Rapaport, 10/7)

Los Angeles Times: How San Diego's Hepatitis A Outbreak Became The Worst The U.S. Has Seen In Decades
Experts say San Diego took all the right steps in addressing what is now one of the largest hepatitis A outbreaks the country has seen in decades, but variables unique to the city’s situation contributed to the outbreak. At least 481 people have been infected and 17 have died of the infection since November in San Diego. Another 88 cases have been identified in Santa Cruz and Los Angeles counties, where hepatitis A outbreaks have been declared. (Schroeder, 10/8)

The Associated Press: Maryland Health Officials Held In Contempt To Appeal
Several Maryland health department officials will appeal a Baltimore judge’s decision to hold them in contempt of court in a lawsuit over a shortage of hospital beds for mentally ill defendants. A spokeswoman for the Maryland Attorney General’s Office told The Baltimore Sun on Friday that the decision was made this week but the appeal hasn’t been filed. (10/7)

The Hill: Nursing Home Where 12 Died After Irma Shuts Down 
The Florida nursing home where 12 elderly residents died in the aftermath of Hurricane Irma has shut down and laid off its staff. The Rehabilitation Center at Hollywood Hills, Fla. laid off 245 employees and notified the state of the layoffs on Sept. 20, the Sun Sentinel reported Friday. (Thomsen, 10/7)

The Associated Press: Oklahoma Health Officials Warn Of Dire Budget Consequences
For 66-year-old Richard Boston, an Army veteran who has been disabled for more than 20 years, Oklahoma's Advantage program is a lifeline that allows him to continue living in his modest home in southwest Oklahoma City. The state-funded program provides volunteers who do light housework and run errands. It also gives out medical equipment like a lift chair that allows him to get in and out of the bathtub despite his bad knees and back, the result of a disabling fall he suffered during his career as a truck driver. (10/5)

The Associated Press: Oklahoma Judge Again Overturns Medical Abortion Restriction
An Oklahoma judge has again overturned a state law restricting women's access to drug-induced abortions, according to attorneys for the state and for the groups challenging the law. Oklahoma County District Judge Patricia Parrish on Friday overturned a 2014 state law that banned "off-label" use of medication used for abortions. (10/7)

Los Angeles Times: Hacking Your Health At The New Bulletproof Labs In Santa Monica
The first thing Dave Asprey will tell you about his newly opened Bulletproof Labs in Santa Monica is that it’s not a gym. Rather, he says, it’s the world’s first “human upgrade” facility dedicated exclusively to biohacking, or tweaking your biology for better performance. At first glance, the light-filled space adjacent to his Bulletproof Coffee café on Main Street certainly looks like a gym, with personal trainers standing by and gleaming equipment lined up. (Fulmer, 10/6)