First Edition: September 24, 2018

Kaiser Health News: Blood, Sweat And Workplace Wellness: Where To Draw The Line On Incentives 
Workplace wellness programs that offer employees a financial carrot for undergoing health screenings, sticking to exercise regimens or improving their cholesterol levels have long been controversial. Next year, they may become even more contentious. Two recent court rulings have cast uncertainty over what is the appropriate limit for financial incentives that employers can offer workers to participate in programs that require clinical testing or disclosure of personal health data. The dollar amount is subject to debate because it raises questions about when the incentives become so high that employees feel they don’t have a choice about participating. (Appleby, 9/24)

California Healthline: ‘Physicians Of The Mouth’? Dentists Absorb The Medical Billing Drill
On a recent Friday morning, more than 30 dentists and dental staffers gathered in a conference room to learn an arcane new skill: how to bill medical insurers. Pacing back and forth, the Florida dentist leading the two-day course advised the participants to stop thinking of themselves as tooth technicians and reposition themselves as “physicians of the mouth.” (Tuller, 9/21)

The New York Times: Trump Administration Aims To Sharply Restrict New Green Cards For Those On Public Aid
Trump administration officials announced Saturday that immigrants who legally use public benefits like food assistance and Section 8 housing vouchers could be denied green cards under new rules aimed at keeping out people the administration deems a drain on the country. The move could force millions of poor immigrants who rely on public assistance for food and shelter to make a difficult choice between accepting financial help and seeking a green card to live and work legally in the United States. (Shear and Baumgaertner, 9/22)

Reuters: Trump Administration Moves To Restrict Immigrants Who Use Public Benefits
The proposed regulation from the Department of Homeland Security would expand immigration officers' ability to deny visas or legal permanent residency to aspiring immigrants if they have received a range of taxpayer-funded benefits to which they are legally entitled, such as Medicaid, the Medicare Part D low-income subsidy, Section 8 housing vouchers and the Supplemental Nutrition Assistance Program, which is commonly known as food stamps. U.S. immigration law has long required officials to exclude a person likely to become a "public charge" from permanent residence. (Torbati, 9/22)

The Associated Press: US Considers Limit On Green Cards For Immigrants On Benefits
The proposal "will clearly define long-standing law to ensure that those seeking to enter and remain in the United States either temporarily or permanently can support themselves financially and will not be reliant on public benefits," the department said. (Spagat, 9/23)

The Washington Post: Trump Administration Seeks To Limit Access To U.S. For Immigrants Who Use Or Are Likely To Use Public Assistance
The proposal will publish in the Federal Register in the coming weeks, according to DHS, triggering a 60-day public comment period. “After DHS carefully considers public comments received on the proposed rule, DHS plans to issue a final public charge rule that will include an effective date,” the agency said. DHS officials say they are anticipating court challenges to any change. While the proposal does not include tax credits and other health benefits that were under consideration in previous drafts, immigrant advocates have raised concerns that the rule change will force families to forgo help to avoid jeopardizing their immigration status. (Miroff, 9/22)

The Wall Street Journal: Trump Administration Targets Immigrants On Public Assistance
“Building on the traumatic separation of families at the border, the Trump administration has taken another cruel step,” Marielena Hincapié, executive director of the National Immigration Law Center, said Saturday in a statement. “This proposed rule change will similarly result in the separation of families and is just the latest assault on immigrant families.” The proposal would take into account immigrants’ current and past receipt of benefits above a certain threshold but wouldn’t go into effect until the rule is finalized. The rule will be published in the Federal Register in coming weeks. (Armour and Caldwell, 9/23)

The New York Times: One Big Problem With Medicaid Work Requirement: People Are Unaware It Exists
The Trump administration argues that imposing work requirements for Medicaid is an incentive that can help lift people out of poverty. But a test program in Arkansas shows how hard it is merely to inform people about new incentives, let alone get them to act. In the first month that it was possible for people to lose coverage for failing to comply, more than 4,300 people were kicked out of the program for the rest of the year. Thousands more are on track to lose health benefits in the coming months. You lose coverage if you fail to report three times, and the program, in effect for three months, is slowly phasing in more people. (Sanger-Katz, 9/24)

The Hill: Trump Administration To Review Alabama Work Requirements For Medicaid. 
The Trump administration will review Alabama's proposal to require some Medicaid beneficiaries, including parents of young children, work to continue receiving benefits. The proposal would require beneficiaries work or complete other activities for 35 hours a week. Parents of children younger than six would have to work 20 hours a week.  (Hellmann, 9/21)

The Washington Post: Virginia’s Medicaid Work Requirement Won’t Hit Until Long After Program Expands Next Year
Virginia is gearing up to expand Medicaid eligibility to as many as 400,000 residents in January, but requirements that recipients work and pay premiums could lag two years behind, officials said this week. The gap has infuriated Republican state senators who opposed the expansion effort and viewed work requirements as making it slightly less objectionable. (Schneider, 9/22)

Modern Healthcare: Close Governor Races Could Decide Future Of Medicaid
Georgia Democratic gubernatorial nominee Stacey Abrams, whose family was uninsured when she was growing up, says she's running to “expand Medicaid and keep hospital doors open.” Accepting the Affordable Care Act expansion would bring in $3 billion in federal funding a year and cover nearly 500,000 Georgians. She's one of several Democratic gubernatorial candidates making a similar pitch in states that have not extended Medicaid to low-income adults as allowed by the ACA. Others are Andrew Gillum in Florida, Laura Kelly in Kansas, and Janet Mills in Maine. All are locked in tight races against Republicans who strongly oppose expansion. (Meyer, 9/22)

The New York Times: Ruling On Health Care Subsidies Could Prove Costly For Government
A federal court ruled this month that a Montana insurer is entitled to federal compensation for subsidy payments under the Affordable Care Act that President Trump abruptly ended last October, a ruling that could reverberate through insurance markets and cost the government hundreds of millions of dollars. At issue are payments for so-called cost-sharing reductions, discounts that enhance the value of health insurance policies purchased from the Affordable Care Act’s marketplaces by reducing deductibles, co-payments and other out-of-pocket costs for low-income consumers. President Trump ended the payments in October, one of a series of executive actions intended to undo President Barack Obama’s signature domestic achievement. (Pear, 9/22)

The New York Times Fact Checker: Trump Claims To Protect Pre-Existing Health Conditions. That’s Not What The Government Says.
The Justice Department told a federal court in June that it would no longer defend provisions in the Affordable Care Act that protect patients with pre-existing medical conditions. In a brief responding to a lawsuit filed by Texas and 19 other states, the Justice Department called the individual mandate — which requires most Americans to buy insurance or face financial penalties — unconstitutional. Government lawyers argued that protections for pre-existing conditions and other medical issues cannot be separated from the individual mandate, and should also be overturned. (Qiu, 9/21)

Bloomberg: 2018 Democrats Candidates Embrace Obamacare
Democrats used to run away from President Obama’s signature health care law. This year, defending Obamacare from Republican attempts to overturn it is central to the party’s efforts to take back Congress. Democratic candidates are running ads and campaigning on shoring up the Affordable Care Act, not just in reliably blue states, but in traditionally Republican strongholds. Though they might not use the word “Obamacare” itself, Democrats warn against GOP legislation and lawsuits that seek repeal or would block the law’s most popular elements.It’s a far cry from 2010, where fury over Obamacare fueled a Tea Party wave that cost Democrats the House and, four years later, the Senate as well. (Sullivan, 9/20)

The Hill: Trump Hits McCain On ObamaCare Vote
President Trump attacked the late Sen. John McCain (R-Ariz.) at a campaign rally on Friday in Missouri for his vote last year against repealing the Affordable Care Act. “We had it defeated, unfortunately we lost a certain vote, but we lost all the Democrat votes when you think,” he said. McCain's was the deciding vote against the GOP’s push to overhaul former President Obama's signature health-care plan. (Axelrod, 9/21)

The New York Times: Christine Blasey Ford Reaches Deal To Testify At Kavanaugh Hearing
The woman who has accused Judge Brett M. Kavanaugh of sexually assaulting her when they were teenagers has committed to testify before the Senate Judiciary Committee on Thursday, setting up a potentially explosive confrontation unlike any seen in decades with the future of the Supreme Court at stake. (Stolberg and Fandos, 9/23)

The New Yorker: Senate Democrats Investigate A New Allegation Of Sexual Misconduct, From Brett Kavanaugh’s College Years
The claim dates to the 1983-84 academic school year, when Kavanaugh was a freshman at Yale University. The offices of at least four Democratic senators have received information about the allegation, and at least two have begun investigating it. Senior Republican staffers also learned of the allegation last week and, in conversations with The New Yorker, expressed concern about its potential impact on Kavanaugh’s nomination. Soon after, Senate Republicans issued renewed calls to accelerate the timing of a committee vote. (Farrow and Mayer, 9/23)

The Wall Street Journal: Kavanaugh Hearing Set As Accuser Commits To Testifying
On Sunday evening, Sen. Dianne Feinstein of California, the committee’s top Democrat, asked for an immediate postponement of the hearing after new allegations surfaced in an article in the New Yorker. Deborah Ramirez, a college classmate of Judge Kavanaugh, told the magazine that she remembered that Judge Kavanaugh had exposed himself to her at a drunken party when they were at Yale University. Judge Kavanaugh said in a statement Sunday that the alleged incident didn’t happen, and the White House said it stood by the nominee. Judge Kavanaugh said, “This is a smear, plain and simple.” (Peterson, Bykowicz and Nicholas, 9/24)

The Washington Post: Senate Judiciary Panel’s Top Democrat Calls For Delay In Kavanaugh Hearing After New Allegation
In her letter, Feinstein asked “that the newest allegations of sexual misconduct be referred to the FBI for investigation, and that you join our request for the White House to direct the FBI to investigate the allegations of Christine Blasey Ford as well as these new claims.” (Demirjian, Gardner and Kim, 9/23)

Politico: Kavanaugh Confirmation In Renewed Peril After Second Assault Claim
Importantly, Kavanaugh does not yet have the votes to be confirmed and several GOP senators are watching his reaction to the allegations closely. Privately, several Republicans said they were alarmed by the new allegations, but it was not yet clear whether the party will abandon Kavanaugh. The GOP will wait to see the reaction of Sens. Jeff Flake of Arizona, Susan Collins of Maine, Lisa Murkowski of Alaska and Bob Corker of Tennessee to assess whether they can proceed, according to a person familiar with caucus politics. (Everett, Schor and Korecki, 9/23)

Stat: 'Stuff Floating' In Compounded Drugs Prompts FDA To Appeal For More Funding 
The Food and Drug Administration doesn’t have enough funding or staff to properly regulate pharmaceutical compounders, a top agency official said Friday, describing inspections that turned up “stuff floating around” in supposedly sterile shipments. The program doesn’t “have adequate core staffing,” said Janet Woodcock, director of the Center for Drug Evaluation and Research, on Friday, adding that it’s one of the center’s programs that is “suffering the most.” (Swetlitz and Florko, 9/21)

Stat: FDA Orders Pharma Lab To Shut Down In-House Microbrewery 
There’s trouble brewing in the Chicago suburbs, where the FDA has served up another round of warnings to a pharmaceutical laboratory using its space to craft small-batch beer. A recent inspection of Pharmaceutical Laboratories and Consultants Inc., in Addison, Ill., found brewery supplies casually mixed in with equipment used to evaluate over-the-counter drug products. In one instance, the facility had stored a beer fermenter and created a workspace for a brewery employee preparing kegs, all within 10 feet of an area where microbiological material is kept. (Facher, 9/21)

The New York Times: Hurricane Florence Has Gone, But Challenges For The Carolinas Have Just Begun
It will not be easy drying out, fixing up and rethinking whole ways of life in a region drenched and deeply shaken by more than eight trillion gallons of rain. But that is the challenge facing the Carolinas after Hurricane Florence and a wearying week of heroic rescues, hard choices, potential environmental crises — including a dam breach on Friday that allowed coal ash to seep into a river — and a vast response that is still unfolding. (Blinder and Fausset, 9/22)

The Washington Post: Dam Breach Sends Toxic Coal Ash Flowing Into A Major North Carolina River
North Carolina floodwaters continued to inundate a 47-year-old basin of toxic coal ash alongside Duke Energy’s L.V. Sutton power plant on Saturday, sending polluted waters pouring into a man-made lake and then into the Cape Fear River. The rising waters also swamped a 625-megawatt natural gas plant at the site, forcing it to shut down. The water at the plant was at least six inches deep, Duke spokeswoman Paige H. Sheehan said. Video released by state regulators Saturday showed equipment and buildings at the plant poking up from a vast expanse of water. (Dennis, Mufson and Eilperin, 9/22)

The New York Times: What Is Coal Ash And Why Is It Dangerous?
The phrase “coal ash” made headlines this week after a dam on a lake at the site of a power plant in Wilmington, N.C., was breached, allowing the hazardous ash into a river that supplies drinking water to much of the southeastern part of the state. The plant that was shut down, owned by Duke Energy, had been a growing concern since last week after heavy rains associated with Hurricane Florence caused a coal ash landfill at the site to erode, spilling ash onto a roadway. (Mele, 9/21)

The Washington Post: Trump Administration Diverts Nearly A Half-Billion Dollars To Migrant Children In Custody
Federal health officials are reshuffling nearly a half-billion dollars this year to cover the expense of sheltering a record number of migrant children in the department’s custody, according to government documents and officials. In a recent letter to several members of Congress, Health and Human Services Secretary Alex Azar said the department is moving “up to $266 million” to house children from other countries who are on their own, diverting money originally intended for biomedical research, HIV/AIDS services and other health-care purposes. (Goldstein and Moore, 9/21)

The Hill: Health Advocates Decry Funding Transfer Over Migrant Children 
Public health advocates are sounding the alarm over President Trump’s decision to divert nearly $200 million from health programs to fund the detention of unaccompanied migrant children who crossed into the country illegally. The Department of Health and Human Services (HHS) on Wednesday notified Congress that it intends to transfer up to $186 million from elsewhere in the agency to pay for housing a growing number of migrant children. (Weixel, 9/23)

The Washington Post: Parents Face Tougher Rules To Get Immigrant Children Back
Armando Tabora desperately wants to get his teenage daughter out of the government detention facility where she has been for more than three months. He has been stymied at every turn. The Florida landscaping worker took the bold step of going to a government office to submit fingerprints and other documents required for immigrants to get their children out of government custody — and now that information is being shared with deportation agents. He was then told that the woman he rents a room from would also need to submit fingerprints, something she refused to do. He then sought out friends who are here legally to help him out, to no avail. (Salomon and Torrens, 9/22)

Politico: Republicans Cast Opioid Bill As Their Health Care Achievement
Endangered Republicans are running ads defending their achievements on health care — but it’s opioids they are boasting about, not the toxic fight about Obamacare and pre-existing conditions. GOP incumbents in Kentucky, Michigan, New York and Pennsylvania have run advertising recently focused on their efforts to bolster access to treatment, prevent overdoses and stamp out lethal synthetic painkillers like fentanyl. The conservative American Action Network has chipped in $5 million worth of digital and television ads in battleground districts, touting the GOP's commitment to fighting the epidemic. (Demko and Ehley, 9/22)

The Associated Press: Groups Say Medicare Discounts Threatened In Opioids Bill
Consumer and health care groups are scrambling to block what they say is a move by the pharmaceutical industry to commandeer must-pass opioids epidemic legislation as a vehicle for rolling back drugmaker discounts to Medicare beneficiaries with high prescription costs. Republicans said Friday nothing has been decided in behind-the-scenes discussions. But Henry Connelly, a spokesman for House Democratic Leader Nancy Pelosi, called the effort a "Republican attempt to hijack a bipartisan effort on opioids funding to ram through a multibillion-dollar handout to Big Pharma." (9/21)

Stat: Ketamine Clinics Promise Depression Treatment, But Some Stray From The Evidence
Dozens of free-standing clinics have opened across the U.S. in recent years to provide [ketamine] to patients who are desperate for an effective therapy and hopeful ketamine can help. But the investigation found wide-ranging inconsistencies among clinics, from the screening of patients to the dose and frequency of infusions to the coordination with patients’ mental health providers. A number of clinics stray from recommendations issued last year by the American Psychiatric Association. (Thielking, 9/24)

The New York Times: Tiny Device Is A ‘Huge Advance’ For Treatment Of Severe Heart Failure
Almost two million Americans have severe heart failure, and for them even mundane tasks can be extraordinarily difficult. With blood flow impeded throughout their bodies, patients may become breathless simply walking across a room or up stairs. Some must sleep sitting up to avoid gasping for air. Drugs may help to control the symptoms, but the disease takes a relentless course, and most people with severe heart failure do not have long to live. Until now, there has been little doctors can do. (Kolata, 9/23)

The Washington Post: A Hole In The Heart Can Go Unnoticed, Or Sometimes Lead To A Stroke
Everyone is born with a hole in the heart. During pregnancy, this hole allows blood to bypass the fetal lungs — which aren’t yet working — and deliver oxygen to the unborn baby’s heart and brain. The small opening, located between the left and right chambers, usually closes on its own within a few months after birth. But in about 1 in 4 babies, it never does. Most of those babies will be fine, and will live their lives not even knowing it. But for some, the defect can prove dangerous. (Cimons, 9/22)

Stat: Amarin Fish Oil Capsule Shows Dramatic Benefit For Cardiovascular Patients
The biopharma company Amarin is making some heart-medicine history Monday with its proprietary, prescription formulation of fish oil, called Vascepa. In a stunning clinical trial result that upends years of skepticism about the long-term heart benefit of products containing omega-3 fatty acids, Amarin’s Vascepa significantly reduced the risk of deaths, heart attacks, strokes and other serious cardiovascular events compared to a placebo. (Feuerstein, 9/24)

Stat: Can Building A Better Research Mouse Open The Black Box Of Alzheimer’s? 
Drug development for Alzheimer’s disease has been a series of disappointments, with only faint glimmers of hope from pharmaceutical companies or academic labs. What causes the disease is still hotly debated, with the amyloid hypothesis losing believers after each new trial failure. But before those drugs targeting amyloid plaques or tau tangles failed in human trials, they generally succeeded in preclinical studies — specifically, ones done with mice. Right now, about 160 mouse models for Alzheimer’s exist. But none is particularly good, experts say. (Sheridan, 9/24)

The New York Times: The Couple Who Helped Decode Dyslexia
By now, Sally and Bennett Shaywitz might have retired to a life of grandchild-doting and Mediterranean-cruising. Instead, the Shaywitzes — experts in dyslexia at Yale who have been married to each other for 55 years — remain as focused as ever on a research endeavor they began 35 years ago. Sally, 76, and Bennett, 79, both academic physicians, run the Yale Center for Dyslexia and Creativity. (Hafner, 9/21)

The Associated Press: UN: Excessive Drinking Killed Over 3 Million People In 2016
Drinking too much alcohol killed more than 3 million people in 2016, mostly men, the World Health Organization said. The U.N. health agency also warned that current policy responses are not sufficient to reverse trends predicting an increase in consumption over the next 10 years. (9/22)

The Washington Post: Autism Friendly Town In Spam Territory Makes Lives Easier
The tall teenager with the buzz cut opened the museum door, extended a large hand and said cheerily, “Welcome to the Spam Museum.” Samuel Ehret is an official “Spambassador”at the museum, a hot spot for tourists who have a taste for the much-mocked canned meat that has been made here by Hormel Foods for 81 years. Samuel is also autistic, and he got this job because he loves all things Spam — its taste, its history, and especially the museum’s showpiece: a motorcycle that runs on bacon grease. (Nutt, 9/23)

The Washington Post: Organ Transplant Documentary On Nova Reveals Hope As Well As Agony
Today, 20 Americans will die waiting for a donated organ. Meanwhile, the United States’ transplant waiting list — more than 114,000 — will add a name every 10 minutes. Nova’s “Transplanting Hope” tells the story of the people who wait, those who give and those assigned the terrifying privilege of saving lives with transplanted organs. (Blakemore, 9/22)

NPR: Teens, Parents Challenged By Screens When Its Time To Sleep
Within three days of starting high school this year, my ninth-grader could not get into bed before 11 p.m. or wake up by 6 a.m. He complained he couldn't fall asleep but felt foggy during the school day and had to reread lessons a few times at night to finish his homework. And forget morning activities on the weekends — he was in bed. We're not the only family struggling to get restful shut-eye. (Fulton, 9/23)

Los Angeles Times: Cornell Researcher Who Studied What We Eat And Why Will Step Down After Six Studies Are Retracted
A Cornell University professor whose attention-getting studies reported that guests at Super Bowl parties consumed more calories when served snacks from larger bowls and that couch potatoes ate nearly twice as much when watching an action-packed movie than when viewing a PBS talk show will step down from the university at the end of the academic year. Brian Wansink, the longtime director of Cornell’s Food and Brand Lab, submitted his resignation this week after a year-long review concluded that he committed academic misconduct, according to a statement from the university’s provost. (Kaplan, 9/21)

NPR: If Your Chair Hurts Your Back, Blame Technology, Then Try These Hacks
About a hundred years ago, something devious started happening in our homes and offices, in our cars and at restaurants — and our backs have never been the same. For hundreds — even thousands of years — chairs were made of wood. Maybe the seat was covered with cord or cattail leaves, and if you were rich, you could afford some padded upholstery, which began to take off in the 17th and 18th centuries. (Doucleff, 9/24)

The Associated Press: Report: Missouri Landfill Emissions Once Posed Health Risks
Emissions near a troubled St. Louis County landfill once posed health concerns for workers and nearby residents, but the risks have largely disappeared thanks to cleanup efforts, according to a state report released Friday. The report from the Missouri Department of Health and Senior Services is based on air quality data collected near Bridgeton Landfill , which has come under intense scrutiny because a smoldering underground fire burns only a few hundred yards from Cold War-era nuclear waste. (9/21)

The Washington Post: State Agency Rejects Va. School District’s Plan To Arm School Employees
A Virginia school district’s effort to arm teachers and other school employees has encountered a setback after a state agency refused to endorse the district’s plan. The Department of Criminal Justice Services rejected Lee County Superintendent Brian Austin’s application to register as an armed special conservator of the peace, a designation the district hoped would permit school employees to carry firearms in schools. (Truong, 9/23)

The Washington Post: Nurses In D.C.’s 911 Center Are Helping Cut Some Unnecessary Ambulance Runs, But Not Most
D.C. Fire and EMS officials found positive signs in the first 90 days of a $1 million nursing phone line at the 911 call center, but have yet to see big dividends in one of the program’s intended goals: reducing ambulance trips for patients who don’t need them. D.C. Fire Chief Gregory Dean sent a letter to the department this month highlighting early data from the “Right Care, Right Now” program that staffs a triage line at the 911 center with registered nurses. The nurses are there to diagnose callers who appear to have nonlife-threatening maladies or injuries and may not need medics or a fire crew and a trip to the emergency room. (Williams, 9/23)

The Associated Press: Judge: California Child Can Take Cannabis Drug To School
A California kindergartner can keep bringing a cannabis-based drug used for emergency treatment of a rare form of epilepsy to her public school, a judge ruled Friday. The Santa Rosa Press-Democrat reported that a judge sided with the family of 5-year-old Brooke Adams. The Rincon Valley Union School District in Santa Rosa sought to ban the ointment from school grounds because it contains the active ingredient in marijuana. (9/22)

The Associated Press: Georgia Jury Awards $31M Over Boy’s Botched Circumcision
A law firm says a Georgia jury has awarded $31 million to a boy for a botched circumcision he received as a newborn. The Atlanta Journal-Constitution reports the award was handed down Friday in northern Georgia’s Clayton County. A lawsuit filed by the boy’s family says he was 18 days old in October 2013 when part of his penis was severed during a circumcision at Life Cycle Pediatrics in Riverdale. (9/23)