Viewpoints: Repairing Marketplaces After Aetna Leaves; American Diet; Ky. Medicaid Changes

The Hill: Aetna's Extortion Boosts Urgency For ObamaCare Public Option 
Here's one figure to focus on when thinking about Aetna's extortion of the federal government for the Justice Department (DOJ) decision to fight its merger with Humana: $1 billion. That's the amount Aetna will owe Humana if the merger falls through. One billion dollars of health insurance premiums collected from businesses and individuals as part of Aetna's drive to become a bigger near-monopoly and maximize profits. The impact on Americans' access to health be damned. (Richard Kirsch, 8/25)

Modern Healthcare: To Cure ACA Exchange Ills, Why Not Merge The Entire Individual Insurance Market?
The hand-wringing over insurer pullouts and premium spikes in the Affordable Care Act exchanges is growing frantic since Aetna announced last week it would exit from the marketplaces in 11 of the 15 states where it currently sells plans. ... Earlier this week, the prominent health economist Henry Aaron of the Brookings Institution offered what he called “simple way” to reduce the risk of more insurers leaping off the exchange ship. “Make the Obamacare exchange one big marketplace for everyone buying individual health insurance coverage,” he wrote in an op-ed piece in the Washington Post. “Nationwide, this would merge the 12 million people who get their insurance through Obamacare with the roughly 9 million who buy their policies outside the exchanges.” It's an approach that insurers almost certainly would fight. But it's something that state leaders around the country might consider because they could do it on their own without waiting for a deadlocked federal government to act. (Harris Meyer, 8/24)

The New York Times: Can We Talk About Your Weight?
Recently, when attending a medical talk about the connection of unhealthy diets to obesity, heart disease and cancer, I was caught by surprise. “When I want to discuss this issue with patients,” the speaker, a physician, said, “I ask permission.” Permission? I said to myself. Since when do doctors with proven strategies for improving health ask for permission? (Dr. Barron H. Lerner, 8/25)

The Hill: Our Nation’s Top Killer? The Iconic American Diet
Dietary risk factors remain the leading cause of death in our country, but neither candidate has talked about food policy. We know about their personal food preferences, but where do the candidates stand on reforming legislation, like the Supplemental Nutrition Assistance Program (SNAP)? We hear about funding and restrictions, but we don’t hear about transforming the system. What foods are in? Which food-like substances are out? What position will the candidates take? Nobody knows. (Dr. Agustina Saenz, 8/25)

Chicago Tribune: 'Bubble' Laws Protect Patients And Protesters Alike
The U.S. Constitution is silent about dogging — the practice of following people down a sidewalk like a pesky canine in an effort to communicate with them against their will. But Chicago-area anti-abortion activists insist that the First Amendment's guarantee of freedom of speech implicitly gives them a right to dog, and they filed suit in federal court Tuesday in an attempt to overturn a limit on protest activity outside city health care facilities. ... In a rare misfire, the American Civil Liberties Union, which is otherwise a strong proponent of abortion rights, is supporting the anti-abortion protesters, saying the 8-foot privacy bubble "substantially burdens leafleting" on any issue at all outside of hospitals or clinics. Nonsense. The Constitution is not offended by a prohibition on the thrusting of leaflets into unwilling hands. (Eric Zorn, 8/25)

Health Affairs Blog: In Kentucky’s New Medicaid Plan Evidence Takes A Back Seat
On June 22, the Governor of Kentucky unveiled a Medicaid reform plan to replace its highly successful Medicaid expansion. The new Kentucky Medicaid plan is not innovative, instead relying on policies that have been shown to be counterproductive, decreasing coverage and access while increasing the health disparities that affect poor and vulnerable populations. (Roy Grant, 8/25)

Louisville (Ky.) Courier-Journal: Is Medicaid Waiver Good For Ky. Kids?
Kentucky Youth Advocates supports Medicaid expansion in Kentucky because children are more likely to have health insurance when their parents have health insurance, and health insurance is a vital component of access to health care. ... The Bevin administration recently submitted its revised 1115 Medicaid Waiver proposal to the federal Centers for Medicare and Medicaid Services (CMS) for approval. We at Kentucky Youth Advocates appreciate that some of our recommendations were incorporated in the final waiver proposal. ... However, we believe that the 1115 Medicaid Waiver creates several barriers for parents to maintain their health insurance and still have outstanding concerns. (Terry Brooks, 8/25)

Los Angeles Times: Court Ruling Could Mean Death With Indignity For Terminally Ill Californians
In the more than two months since California’s End of Life Option Act took effect, an unknown number of terminally ill patients have signed up for a lethal prescription to take control of their final days. We won’t know exactly how many until the state makes its first annual report next year. Anecdotally, however, about 30 people are known to have requested the lethal prescription since June 9, according to Compassion & Choices, an aid-in-dying advocacy group. But this option may be denied other terminally ill people as soon as Friday, when a legal challenge to the new law comes up for a key court hearing. Riverside County Superior Court Judge Daniel Ottolia is expected to decide whether to put the law on hold until the case is resolved. (8/25)

Des Moines Register: National Bill Puts Needed Focus On Outpatient Mental Health Services
Currently, a person will have to wait nearly two months before seeing a provider and get prescribed medications — even if they are having a medication issue or are in crisis. The lack of available outpatient services has led to people seeking emergency mental health treatment. If outpatient services were more readily available to those in need and could be accessed easier and with less of a wait then some, not all, hospitalizations could be avoided. (Nicole, Lepley, 8/25)

San Francisco Chronicle: Reining In Drug Prices Now Up To Voters With Prop. 61
The opposition to Prop. 61, funded mainly by the drug companies’ lobbying group, has contributed $69.6 million to defeat the measure, according to campaign contributions reported to the secretary of state as of Aug. 5. The proposition’s supporters, which include AARP and the California Nurses Association, have raised about $9.5 million. Supporters say they hope highly publicized cases like EpiPen will spur action. In the nine years since Mylan purchased EpiPen, an epinephrine auto-injector developed in the ’70s and used by millions of Americans, the price spiked more than 400 percent, from $57 per shot to more than $600 for a package of two. But patient groups, including San Francisco’s Project Inform and the Bonnie Addario Lung Cancer Foundation in San Carlos, are concerned Prop. 61 would impede access to needed medications. (Victoria Colliver, 8/25)

Health Affairs Blog: Funerals For Friends: How Public Health In Colorado Handles Growing Prescription Drug Misuse
The opioid painkiller epidemic, leading directly to use of cheaper and even more dangerous heroin, is all too real in every state of the union, [Robert Valuck, an epidemiologist, professor at the University of Colorado Denver] warned his evening audience on the opening night of the Colorado Health Symposium 2016. Valuck elicited audible gasps from the crowd when he offered a math lesson in modern opioid prescribing—enough scripts are now written in the United States each year to give every adult a Vicodin every four hours for an entire month. In Colorado’s rural southern counties, where overdose death rates are climbing at an alarming rate, the destruction is all the more visible, said Freddie Jacquez, executive director of the San Luis Valley Area Health Education Center. “We know these people,” Jacquez said. “We’re going to a lot of funerals.” (Michael Booth, 8/25)

JAMA: Decreasing Unintended Pregnancy: Opportunities Created By The Affordable Care Act
The Affordable Care Act (ACA) increased access without cost to highly effective contraceptive methods, despite a legal challenge that was adjudicated by the Supreme Court, and it may help reduce unintended and teenage pregnancies. ... It is important for health care professionals and public health workers to educate women about the availability without cost of these highly effective methods. Clinicians should offer the full range of contraceptive services to patients who wish to delay or prevent pregnancy and work with them to select an effective and appropriate method. Reducing unintended pregnancy has taken on an increased urgency as the Zika virus has been linked to birth defects and is anticipated to spread to the continental United States. (Jared Fox and Wanda Barfield, 8/23)

The New England Journal of Medicine: Uncertainty In The Era Of Precision Medicine
A National Research Council report on “precision medicine” explains that the term “refers to the tailoring of medical treatment to the individual characteristics of each patient.” ... The new tools for tailoring treatment will demand a greater tolerance of uncertainty and greater facility for calculating and interpreting probabilities than we have been used to as physicians and patients. (David J. Hunter, 8/25)