First Edition: September 8, 2015

Kaiser Health News: Getting The Word Out: Obamacare Is For Native Americans Too
As a member of the Navajo tribe, Rochelle Jake has received free care through the Indian Health Service (IHS) her entire life. ... Recently, though, she felt sharp pains in her side. Her doctor recommended an MRI and other tests she couldn’t get through IHS. To pay for it, he urged her to sign up for private insurance under the Affordable Care Act. ... Tribes, health care advocates and government officials across the nation are trying to enroll as many Native Americans as possible in Obamacare, saying it offers new choices to patients and financial relief for struggling Indian hospitals and clinics. (Gorman, 9/8)

Kaiser Health News: California Passes Bill Delaying Transfer Of Fragile Kids Into Managed Care
California legislators passed a bill postponing a controversial plan that would have shifted tens of thousands of medically fragile children into Medi-Cal managed care plans. ... At issue was the fate of the California Children’s Services program, which serves an estimated 180,000 children younger than 21 with serious medical conditions, including spina bifida, cancer, cystic fibrosis and sickle cell disease. (Ostrov, 9/7)

Kaiser Health News: Readers Ask About Concierge Medicine And Medicare; Insulin Costs And The Doughnut Hole
KHN health columnists answers questions related to coverage in the Medicare program, the federal health insurance program for people who are 65 or older and some who are disabled. (Andrews, 9/8)

Politico: Countdown To Shutdown Begins
Congress returns from its long summer vacation Tuesday to an all-out, three-week sprint to avert a government shutdown – and no apparent plan yet to quell the conservative rebellion over Planned Parenthood that has dramatically increased the odds of a closure. The mad dash – just 10 legislative work days to solve the shutdown crisis, in between major votes on the Iran nuclear deal and the first-ever papal address to a joint session of Congress – presents a major test for Republican leaders in both chambers who vowed to end crisis-driven legislating. (Kim, 9/7)

The New York Times: Prospect Of Another Shutdown Looms As Congress Girds For Fights Over Spending
When Congress returns for business on Tuesday, lawmakers have scheduled a mere 12 legislative days to find a bipartisan compromise to keep the government open, vote on one of the most contentious foreign policy matters in a generation, reconcile the future of funding for Planned Parenthood and roll out the red carpet — and a few thousand folding chairs — to greet Pope Francis. What could go wrong? (Steinhauer, 9/7)

The Washington Post: Defunding Backers May Induce Shutdown
The last thing Republican leaders want is another shutdown quagmire. But a group of conservatives — led by GOP presidential candidate and Texas Sen. Ted Cruz — has vowed to oppose any government spending bill that includes Planned Parenthood funds. That includes a stop-gap spending bill, known as a continuing resolution (CR), that needs to pass before Sept. 30. (Snell, 9/4)

USA Today: Congress Returns To Yet Another Spending Crisis, Fears Of Government Shutdown
Members of Congress return from summer recess facing a Sept. 30 deadline to fund the federal government, a deadline they are certain to miss, as they have each of the past 18 years. The question is: Will the government shut down Oct. 1, or can lawmakers agree to a temporary spending plan while they argue about a longer-term solution? (Singer, 9/7)

The Washington Post: Ted Cruz To Mitch McConnell: Don’t Schedule Legislation To Fund Planned Parenthood
Sen. Ted Cruz (R-Tex.), who is taking a lead role in a campaign to end taxpayer support for Planned Parenthood, will send Senate Majority Leader Mitch McConnell a letter next week urging him not to schedule a vote on or help push legislation that gives federal money to the organization. (Zezima, 9/4)

The Associated Press: Congress Returns To Weighty List Of Unfinished Business
Some tea party lawmakers say they will only back legislation to keep the government open in the new budget year, which begins Oct. 1, if the measure also terminates Planned Parenthood's federal money — even if their battle with Obama over the issue should spiral into a government shutdown. "I'm for doing everything" to halt funds for Planned Parenthood, said Rep. Jim Jordan, R-Ohio. "There is no way they can get taxpayer support." Conservative groups such as Heritage Action are backing the strategy, though establishment anti-abortion organizations aren't throwing their influence behind it. (Taylor and Fram, 9/5)

The Hill: Conservatives Prepare To Make Stand On Planned Parenthood
The make-or-break moment for House conservatives to defund Planned Parenthood is here. Outraged by undercover videos on fetal tissue donation, conservatives are pushing to cut all federal funding for Planned Parenthood as part of legislation that would avert a government shutdown on Oct. 1. ... But with Congress set to return to Washington this week, it remains to be seen whether [Rep. Mick] Mulvaney and his allies can gather enough support to force the hand of leadership. (Marcos, 9/7)

Politico: Boehner's Future As Speaker In Doubt
Something has changed for John Boehner. Figures in his close-knit circle of allies are starting to privately wonder whether he can survive an all-but-certain floor vote this fall to remain speaker of the House. And, for the first time, many top aides and lawmakers in the House do not believe he will run for another term as House leader in 2017. ... consider what he faces this fall: a quixotic but determined fight to defund Planned Parenthood, a potential government shutdown, a deadline to raise the federal debt ceiling or risk default, and a contentious showdown over highway spending. Boehner's aides say they expect a vote to oust him, formally known as a motion to vacate the chair. (Sherman and Bresnahan, 9/8)

Reuters: Planned Parenthood Faces Unexpected Challenge From Obamacare
Many formerly uninsured women who once depended on Planned Parenthood for low-cost access to birth control, abortions and other reproductive healthcare have gotten coverage under President Barack Obama’s healthcare law, making them less reliant on the organization’s 700 clinics. In many states, Planned Parenthood is losing clients as newly insured patients turn to medical providers included in their health plan's networks, according to data provided to Reuters and interviews with more than two dozen of its affiliates. (Mincer, 9/8)

The New York Times: Obama Orders Federal Contractors To Provide Workers Paid Sick Leave
President Obama signed an executive order on Monday requiring federal contractors to provide up to seven days of paid sick leave a year, even as he accused Republican congressional leaders of endangering the economy and Republican presidential candidates of undercutting American workers. ... He also chastised abortion opponents in Congress for threatening to shut down the federal government in an effort to cut off taxpayer financing for Planned Parenthood, saying such a move could damage the economy at a time of global volatility. “A shutdown would be completely irresponsible,” Mr. Obama said. “It would be an unforced error, a fumble on the goal line.” (Baker, 9/7)

The Washington Post: In Boston Speech, Obama Unveils Executive Order For More Paid Sick Leave
President Obama rallied union workers here Monday, unveiling a new executive order that will require federal contractors to offer employees up to seven days of paid sick leave, a move he sought to contrast with Republican economic policies. Obama announced the new directive, which the White House said could benefit more than 300,000 workers, during a Labor Day speech in Boston. It was the latest in the White House’s year-long effort to pressure Congress to approve legislation that would provide similar benefits for millions of private-sector workers. (Nakamura, 9/7)

Politico: Paid Sick Leave: Obama Issues Executive Order
Obama addressed the order during a Labor Day speech at a Boston breakfast and rally, where he also called on Congress to extend paid leave to millions more Americans by passing the Healthy Families Act, which would mandate that all employers with more than 15 employees would have to grant at least seven sick days annually. In addition, Obama pointed to Massachusetts as an example of a state that has passed similar sick leave laws, calling on other cities and states to do the same. (Gass, 9/7)

The New York Times: What Are A Hospital’s Costs? Utah System Is Trying To Learn
Only in the world of medicine would Dr. Vivian Lee’s question have seemed radical. She wanted to know: What do the goods and services provided by the hospital system where she is chief executive actually cost? ... No one on Dr. Lee’s staff at the University of Utah Health Care could say what a minute in an M.R.I. machine or an hour in the operating room actually costs. They chuckled when she asked. But now, thanks to a project Dr. Lee set in motion after that initial query several years ago, the hospital is getting answers, information that is not only saving money but also improving care. (Kolata, 9/7)

The Associated Press: New Medical Coding System Aims To Help Track Quality Of Care
If things are a bit tense in your doctor's office come Oct. 1, some behind-the-scenes red tape could be to blame. That's the day when the nation's physicians and hospitals must start using a massive new coding system to describe your visit on insurance claims so they get paid. Today, U.S. health providers use a system of roughly 14,000 codes to designate a diagnosis, for reimbursement purposes and in medical databases. To get more precise, the updated system has about 68,000 codes, essentially an expanded dictionary to capture more of the details from a patient's chart. (Neergaard, 9/7)

The Washington Post: One Female Veteran’s Epic Quest For A ‘Foot That Fits’
Every morning for more than two years, retired Army Sgt. Brenda Reed had the infuriating chore of screwing on what she calls her “man foot.” The prosthesis was given to her by the Department of Veterans Affairs after her left leg was amputated in 2013 .... She pleaded with VA officials for “a foot that fits, a female foot,” only to be told repeatedly that the agency doesn’t carry that kind of customized prosthesis .... a health-care system that for generations catered almost exclusively to men has been slow to recognize that the 2.3 million female veterans represent the fastest-growing population turning to the agency. (Wax-Thibodeaux, 9/5)

The New York Times: Premature Babies Study And Judge’s Ruling Raise Debate Over Consent
Two years ago, researchers in a clinical trial involving oxygen levels for the tiniest premature babies were accused by a federal watchdog agency of not properly disclosing the risks to families who participated. What followed was extensive public scrutiny of the trial, called Support, and soul-searching in the research community about how best to obtain informed consent from participants. Some families sued, arguing that their babies suffered serious injuries as a result of their treatment. But last month, a federal judge threw out the suit .... Last week, the editors of a prestigious medical journal wrote that the decision showed that the trial was solid to begin with. ... But some bioethicists disagreed. (Tavernise, 9/7)

The Associated Press: Across Much Of US, A Serious Shortage Of Psychiatrists
It is an irony that troubles health care providers and policymakers nationwide: Even as public awareness of mental illness increases, a shortage of psychiatrists worsens. In vast swaths of America, patients face lengthy drives to reach the nearest psychiatrist, if they can even find one willing to see them. Some states are promoting wider use of long-distance telepsychiatry to fill the gaps in care. In Texas, which faces a severe shortage, lawmakers recently voted to pay the student loans of psychiatrists willing to work in underserved areas. (Crary, 9/7)

USA Today: Doctors Urged To Screen Teens For Major Depression
Doctors should screen teenagers for major depression, a federal advisory group said Monday, but only if their young patients have access to mental health professionals who can diagnose them, provide treatment and monitor their progress. That’s a big “if.” Mental health services are in short supply for anyone, but especially teens, said Jeffrey Lieberman, a professor and chairman of psychiatry at the Columbia University College of Physicians and Surgeons in New York. (Szabo, 9/7)

USA Today: Aetna CEO Got Summer's First Merger Agreement, Raised Minimum Wage And More
The CEO who pulled off the first major insurance company merger agreement of the summer also achieved what many executives might think impossible: He raised his company's minimum wage, announced plans to up its contribution to workers' health care and watched the stock soar by nearly 30% since January. But Aetna's Mark Bertolini is used to defying expectations. (O'Donnell, 9/7)

The New York Times: Doctors’ Association Sees Harm In Insurance Mergers
In a new study to be released on Tuesday, the American Medical Association says that most insurance markets in the United States are dominated by a few companies and would become even more concentrated with a plan by Anthem to acquire Cigna and a proposal by Aetna to buy Humana. The American Hospital Association raised similar concerns last week in a letter to the Justice Department that said the proposed Aetna-Humana deal “threatens serious and widespread competitive harm” to Medicare beneficiaries because it would reduce options in the market for private Medicare Advantage plans. (Pear, 9/8)

The Wall Street Journal: New Push For Meningitis B Vaccines On College Campuses
As the fall semester gets under way, some U.S. colleges and universities are offering students new vaccines against a bug responsible for recent campus outbreaks of a rare but life-threatening form of meningitis. Academic institutions are taking a range of approaches, from simply making the shots available at student health centers to anyone who is interested, to holding vaccine clinics on campus that students are required to attend. (Loftus, 9/7)

The New York Times: New Type Of Drug-Free Labels For Meat Has U.S.D.A. Blessing
As meat companies scramble to eliminate antibiotics from their products to address consumer and regulatory concerns, the federal Agriculture Department has quietly opened a new front in the debate over the use of drugs in the livestock and poultry industries. In the next few months, consumers will start seeing the phrase “produced without ractopamine” on packages of Organic Buttercroft Bacon from Tendergrass Farms, a company that markets “natural” and organic meats. Ractopamine hydrochloride is among a class of drugs called beta-agonists, which are used to add muscle weight to animals in the weeks before slaughter. (Strom, 9/4)

The New York Times: Food Industry Enlisted Academics In G.M.O. Lobbying War, Emails Show
Corporations have poured money into universities to fund research for decades, but now, the debate over bioengineered foods has escalated into a billion-dollar food industry war. Companies like Monsanto are squaring off against major organic firms like Stonyfield Farm, the yogurt company, and both sides have aggressively recruited academic researchers, emails obtained through open records laws show. (Lipton, 9/5)

The Washington Post: In Maryland, Gambling Addiction Is Growing, But Treatment Options Are Not
Michael Rosen listens to the wreckage that the $1 billion gambling industry has wrought in Maryland. He listens to the man, $400,000 in debt, whose wife threw him out of the house and told him he couldn’t see his kids again unless he gave up gambling. He listens to the gambler who went on a three-day blackjack binge without sleeping and rarely eating. ... Rosen, who helps manage the state’s increasingly busy 1-800-GAMBLER help line, commiserates with the desperate and directs many to Gamblers Anonymous meetings. But he can’t suggest any free treatment programs because Maryland, one of the country’s most concentrated casino markets, doesn’t offer any. (Heim, 9/7)

The Washington Post: How America’s Love Affair With Caffeine Has Sparked A Crisis Of Overdoses — And What The FDA Is Trying To Do About It
Today, caffeine comes in all shapes and formulations -- Red Bull and Monster energy drinks, "Stay Awake" pills, Jolt gum. The most potent form, the pure powdered kind that's meant for people to mix into their food, is sold in bulk in bags or canisters that can cost as little as $10 per pound. A single teaspoon can be packed with as much caffeine as 28 cups of regular coffee. The new products have led to an alarming public health development in recent years that was unheard of in the many previous decades that people enjoyed caffeine: a rash of thousands of overdoses and reports of addiction and withdrawal. ... The Food and Drug Administration has been so alarmed that it's mounted an aggressive effort to warn consumers about the risks of caffeine products and to take manufacturers to task for the way they are marketed. (Cha, 9/2)

The Washington Post: Researchers Are Trying Again To Help You Take Your Medicine
[P]hysicians, pharmacists and researchers have been frustrated for decades at patients’ inability to follow such simple instructions and remain on their medication regimens. Twenty to 30 percent of prescriptions are never filled, according to research published in the journal Annals of Internal Medicine, and half of all people do not follow their drug instructions, even when that is critical to keeping them alive. ... A wide variety of attempted solutions — including free medicine — haven’t helped much. But with the Obama administration keen to control medical costs and improve the quality of health care, a round of experiments funded by the Affordable Care Act is winding to a close. They offer hope of progress against one of medicine’s most in­trac­table problems. (Bernstein, 9/5)

The New York Times: Flicker Of Hope For Children With Rare And Devastating Disease
Once a year, Crystal and Jonathan Bedford drive 1,000 miles from their home in Texas to rural Alabama, their three children in tow. Beside a wooded lake, they huddle with other families whose children have the same extremely rare genetic disorder that their 5-year-old daughter, Marley, has. The disease, rhizomelic chondrodysplasia punctata, is a painful form of dwarfism, usually accompanied by severe intellectual disability and respiratory problems. There is no cure, and children with RCDP, as it is known, rarely survive into adolescence. ... But this year was different. A biotech executive from Canada had come to discuss a potential treatment being developed by his company and the possibility that the children could be part of a clinical trial next year. It seemed too good to be true. (Goodnough, 9/6)

The Washington Post: Family Carves Out Its Own Path In Fight Against 4-Year-Old’s Rare Disease
Arturito [Estopiñan] was 1 when he was diagnosed with a disease caused by a disruption in the mitochondria, a part of the cell that supports growth. Only 83 such cases have ever been recorded. Doctors told his parents, Arturo and Olga, that there was no treatment and that he would die soon. ... Today, Arturito is enduring with the help of an experimental drug that only a handful of people in the world are taking. ... The Estopiñans’ experience illustrates how families struggle to find help fighting diseases that don’t attract a huge amount of research or specialized funding. It also shows how determined parents can forge a path for other families encountering similar obstacles. (Gebelhoff, 9/7)

The New York Times: On The Trail Of A Mentally Ill Brother, Lost In Brooklyn
Ever since they were children, Aukejshia Boyce-Gaskins made sure to look out for her younger half brother, Birshon Daley. Their mother, addicted to crack cocaine, dumped them with their great-grandmother when Ms. Boyce-Gaskins was 10 and her brother was 2. Ms. Boyce-Gaskins helped raise Mr. Daley in a small town in Georgia, even taking him in after she graduated from high school. Eventually, she sent him to live with his father in Brooklyn. But then came his diagnosis of paranoid schizophrenia. His father died. Almost three years ago, he disappeared. (Barker, 9/5)

The Associated Press: Infants’ Whooping Cough Source Likely Siblings, Study Finds
Infants are more likely to catch whooping cough from their siblings than their moms, says a study with implications for how to protect them. Previously, moms were considered the more common source of infection. The change is probably due in part to an increased frequency of whooping cough among school-aged children, the study of government data suggests. (Tanner, 9/6)

The New York Times: Pertussis Passed To Newborns From Siblings
A new study has found that siblings, not mothers, are now the most common source of pertussis infection in newborns. Infants can be given the DTaP vaccine (it also protects against tetanus and diphtheria) starting at 2 months, and the schedule calls for four more shots periodically through ages 4 to 6. (Bakalar, 9/7)

The Washington Post: Your Gynecologist Had To Start Somewhere. You Can Thank These Actors Later.
For her next lesson, the teacher, a petite, dark-haired woman named Anna C. Sosa, shrugs off her red robe, kicks her striped socks into the footrests and steels herself for yet another potentially disastrous pelvic exam. ... Sosa is a gynecological teaching associate, and she holds one of modern medicine’s most awkward jobs, using her body to guide med students through some of its most delicate, dreaded exams. Every week, she lies back for dozens of the next medical generation’s first pelvic and breast screenings, steering gloved fingers through the mysteries of her own anatomy and relaying the in-depth feedback they’ll need out in the wild. (Harwell, 9/3)