Modern Healthcare: CMS May Propose Restarting $10B Risk-Adjustment Payments
The CMS may soon restart making billions of dollars in risk-adjustment payments to insurance companies with plans on the individual market via a new rulemaking. The agency on Wednesday sent an interim final rule related to the payments to the White House Office of Management and Budget for review. It's unclear what exactly the rule will do. However, health policy insiders say there are clues in the rule's name: "Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act." (Dickson, 7/19)

Bloomberg: Trump Administration Preparing Fix For Obamacare Risk Payments
An administration official said the rule is an option being considered to resolve the legal dispute that has held up the payments. The rule is labeled as an interim final rule, a status that would allow it to go into effect immediately. It’s titled “Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act.” (Tracer, 7/19)

The Hill: Dems Pressure GOP To Take Legal Action Supporting Pre-Existing Conditions
Senate Democrats are targeting Republicans on health care, urging them to sign on to a resolution that would allow the Senate to intervene in a lawsuit challenging the legality of ObamaCare. The resolution, introduced Thursday, would allow the Office of Senate Legal Counsel to intervene in a case brought by Republican attorneys general that argues ObamaCare is now unconstitutional since Congress repealed the 2010 law's individual mandate last year. (Hellmann, 7/19)

The Hill: House Dems Want Answers On Cuts To ObamaCare Outreach Groups
A pair of House Democrats want answers from the Trump administration about the decision to significantly slash funding for outreach groups that help people enroll in ObamaCare coverage. The funding will be cut from $36 million this year to $10 million in 2019, the Centers for Medicare and Medicaid Services (CMS) said last week. The administration's funding for such outreach had already been slashed last year to well below the $63 million budgeted annually under former President Obama. (Weixel, 7/19)

The Washington Post: House Republicans Target District Over Effort To Prop Up Affordable Care Act
House Republicans passed two measures Thursday that would block the District from requiring that all residents have health insurance, opening a new front in congressional efforts to rein in the city’s government. In addition to measures targeting D.C.’s version of the individual mandate under the Affordable Care Act, lawmakers passed restrictions against using local funding to help low-income women obtain abortions, to commercialize recreational marijuana and to allow terminally ill patients to end their lives. (Portnoy and Jamison, 7/19)

The Hill: Poll: Half Of Americans Find Health Care Harder To Afford This Year
Nearly half of respondents in a new poll said they are now finding it more difficult to afford health care than they were a year ago, according to a poll released Thursday. The Navigator poll found 49 percent of respondents said it’s more difficult to afford prescription drugs, insurance premiums and doctor visits compared to last year. Additionally, 78 percent of those surveyed said they believe the government should be doing more to make health care more affordable. (Samuels, 7/19)

The Fiscal Times: Association Health Care Plans Not Gaining Traction
At NFIB’s 75th anniversary party in June, President Trump announced new rules that make it easier to offer such plans, promising a new option for “low-cost, great health care” for business owners and employees around the country. But it looks like few groups are taking advantage of the new system, Politico reports, and even the NFIB has abandoned long-held intentions to offer a plan for its hundreds of thousands of members. (Rainey, 7/19)

Sacramento Bee: Covered California Premiums Will Rise Average Of 8.7 Percent
Covered California announced Thursday that it expects to increase its health insurance premiums by a statewide average of 8.7 percent in 2019, double what it would have been if Congress had not dropped a tax penalty that encouraged U.S. citizens to maintain health insurance. A state-run health-insurance marketplace, Covered California strives to offer consumers high-quality health insurance at the most affordable prices. (Anderson, 7/19)

San Francisco Chronicle: California Health Insurance Premiums To Rise An Average Of Nearly 9% In 2019
It is the fifth straight year that premiums are rising for such health plans. The increase applies to the 1.1 million lower-income Californians who receive federal financial assistance to buy plans on Covered California, as well as the 1.2 million residents who buy plans without subsidies. (Ho, 7/19)

California Healthline: California’s ACA Rates To Rise 8.7% Next Year
The average increase in California is smaller than the double-digit hikes expected around the nation, due largely to a healthier mix of enrollees and more competition in its marketplace. Still, health insurance prices keep growing faster than wages and general inflation as a result of rising medical costs overall, squeezing many middle-class families who are struggling to pay their household bills.(Terhune and Bartolone, 7/19)

And in other news —

The Star Tribune: UnitedHealthcare Adding One State Health Exchange
Minnetonka-based UnitedHealthcare must sell coverage next year on the health exchange for Massachusetts because it now covers more than 5,000 people in the state via small-employer health plans. The individual and small-group markets are merged in Massachusetts, where state law requires insurers of a certain size to sell on the exchange. (Snowbeck, 7/19)

The Associated Press: Democrats Wrestle With Election-Year Message On Health Care
Cheered on by a handful of activists, liberal House Democrats announced outside the Capitol that they were forming a caucus to push for "Medicare for All" — shorthand for government-financed health care. At the same time Thursday, Democratic senators were introducing a resolution aimed at putting Republicans on the defensive about Trump administration efforts to undermine former President Barack Obama's health care law. (Fram, 7/20)

The Hill: GOP Looks To Blunt Dems’ Attacks On Rising Premiums
House Republicans are trying to blunt Democratic attacks over rising ObamaCare premiums, an issue that’s poised to play a key role in the November midterm elections. The House is planning to vote next week on several GOP-backed health-care measures that supporters say will lower premiums, and passing them could give a boost to some vulnerable Republicans. (Sullivan, 7/19)

WBUR: VA Whistleblowers 10 Times More Likely Than Peers To Receive Disciplinary Action
The U.S. Government Accountability Office's report says VA whistleblowers are far more likely than their colleagues to face discipline or removal after reporting misconduct. It also found that senior VA managers are sometimes not held accountable for substantiated misconduct and that managers accused of wrongdoing sometimes investigate themselves. (Westervelt, 7/19)

Bloomberg: U.S. Soldiers With HIV Say Trump’s New Policy Will Force Them Out
A U.S. soldier asked a federal judge to bar the Trump administration from firing HIV-positive service members from the military under a new “Deploy or Get Out!” policy intended to improve readiness. The policy, announced in February, directs the Pentagon to discharge service members who can’t be deployed outside of the U.S. for more than 12 consecutive months “for any reason.” It takes effect Oct. 1. (Larson, 7/19)

The Hill: Senate To Vote Monday On Trump's VA Nominee
Sen. Johnny Isakson (R-Ga.), the chairman of the Senate Veterans' Affairs Committee, said earlier Thursday that the Senate should vote to confirm Wilkie “without delay.” "It is of utmost importance that any policy changes that impact the future of the department be made by a confirmed VA secretary who can be held accountable by Congress and the American people," Isakson said. (Carney, 7/19)

Politico: McConnell Issues Supreme Court Ultimatum
Mitch McConnell has a warning for Democrats demanding copious documents on Supreme Court nominee Brett Kavanaugh: Be careful what you wish for. The Senate majority leader privately told senior Republicans on Wednesday that if Democrats keep pushing for access to upwards of a million pages in records from President Donald Trump’s high court pick, he’s prepared to let Kavanaugh’s confirmation vote slip until just before November’s midterm elections, according to multiple sources. (Schor and Everett, 7/20)

Politico: Schumer Stalling On Kavanaugh Meeting Deepens White House Rift
Senate Democrats are snubbing Supreme Court nominee Judge Brett Kavanaugh, another salvo in the deepening cold war between President Donald Trump and Minority Leader Chuck Schumer. The politically strategic slight has raised hackles at the White House, which has been reaching out to Senate Democrats to schedule meetings but has found itself rebuffed at every turn. Some Democrats have said they won’t meet with Kavanaugh until Schumer does. Others have more benignly cited scheduling conflicts. (Woellert, 7/19)

The New York Times: What It Takes To Get An Abortion In The Most Restrictive State In The U.S.
With the nomination of Brett Kavanaugh to the Supreme Court, Democrats and abortion rights groups have warned of a threat to Roe v. Wade, the landmark 1973 ruling that made abortion legal nationwide. Already, American women face increasingly different paths to getting an abortion, depending on their state. “It doesn’t make a difference if it’s legal if it’s inaccessible,” said Diane Derzis, owner of Jackson Women’s Health Organization, the only remaining abortion clinic in Mississippi. “And it’s definitely inaccessible to many people.” (Carlsen, Ngu and Simon, 7/20)

The Hill: More Than 400 Bills Aimed At Improving Reproductive Health Have Been Introduced In 2018: Report
More than 400 bills aimed at improving reproductive health have been introduced across 44 states in 2018, according to a new report. The National Institute for Reproductive Health (NIRH) on Monday released a report that found fewer state-level initiatives related to reproductive rights were introduced this year than in 2017, but that overall legislation has continued to skyrocket under President Trump's administration. (Birnbaum, 7/18)

In other women's health news —

San Francisco Chronicle: Gavin Newsom Calls John Cox ‘Extreme’ For Opposing All Abortions
Democrat Gavin Newsom called Republican rival John Cox one of the “most extreme” gubernatorial candidates in decades on the issue of abortion rights as Newsom accepted the endorsement of two pro-choice groups Thursday. Pro-choice advocates are trying to make abortion rights an issue in the November election as the Senate prepares to consider President Trump’s nomination of appeals Judge Brett Kavanaugh to the Supreme Court. (Garofoli, 7/19)

The Washington Post: Cleveland Woman Is Told Embryos Were Destroyed Months After Being Assured They Were Safe
Attorneys suing University Hospitals in Cleveland over the destruction of thousands of eggs and embryos on Thursday called for an independent monitor for the fertility clinic and accused the medical center of undermining the investigation by asking a judge to issue a gag order in the case. Joseph Peiffer, who represents 75 families of the 1,000 families that were impacted by the freezer malfunction in March, said information about the case must continue to be shared freely for the sake of the clients of the clinic. (Cha, 7/19)

ProPublica: Immigrant Shelters Drug Traumatized Teenagers Without Consent
Fleeing an abusive stepfather in El Salvador, Gabriela headed for Oakland, California, where her grandfather had promised to take her in. When the teenager reached the U.S. border in January 2017, she was brought to a federally funded shelter in Texas. Initially, staff described her as receptive and resilient. But as she was shuttled from one Texas shelter to another, she became increasingly depressed. Without consulting her grandfather, or her mother in El Salvador, shelter staff have prescribed numerous medications for her, including two psychotropic drugs whose labels warn of increased suicidal behavior in adolescents, according to court documents. Still languishing in a shelter after 18 months, the 17-year-old doesn’t want to take the medications, but she does anyway, because staff at one facility told her she wouldn’t be released until she is considered psychologically sound. (Chen and Ramirez, 7/20)

And in other news —

The Hill: 364 Children Reunited With Families After Being Separated At Border
The Trump administration said in a court filing Thursday that it has reunited 364 immigrant children between the ages of 5 and 17 that it identified as being separated from their parents at the border, one week before the deadline to complete the reunifications. The administration said last week that it had identified 2,551 immigrant children who had been separated from their families at the border. Officials said Thursday that they have identified 1,606 of the parents, and have interviewed and cleared 848 of them to be reunited with their children, according to the court filing. (Thomsen, 7/19)

Reveal: Contractor Clears Out Phoenix Office Where It Held Immigrant Children
Two Arizona lawmakers also called on the state to immediately investigate whether Virginia-based MVM Inc. is violating state law in keeping children in unlicensed office buildings, with one vowing to sponsor a new state law to halt the practice. MVM has a contract with U.S. Immigration and Customs Enforcement to transport immigrant children to airports and shelters across the nation. (Branstetter, 7/19)

The New York Times: After Flint, Watchdog Urges E.P.A. To Monitor Drinking Water More Closely
The Environmental Protection Agency’s failure to intervene earlier and stop the water crisis in Flint, Mich., exposed a need for wholesale changes to how federal officials monitor drinking water systems, a government watchdog said Thursday. A report from the E.P.A.’s Office of Inspector General said management weaknesses hobbled the agency’s response to the lead and other contaminants that poisoned Flint’s drinking water for more than a year and that federal officials should have taken stronger action to correct repeated blunders by state regulators. (Smith and Friedman, 7/19)

The Associated Press: Flint Water Crisis Prompts Call For More Federal Oversight
In a 74-page report released Thursday, the EPA's inspector general report pointed to "oversight lapses" at the federal, state and local levels in the response to Flint's contaminated drinking water. " While oversight authority is vital, its absence can contribute to a catastrophic situation," the inspector general, Arthur A. Elkins, said in a statement. His office has concluded the EPA was too slow and passive in responding to the Flint crisis. (7/19)

The Washington Post: After Flint Debacle, EPA Must Strengthen Oversight Of Mich. Drinking Water Programs, Watchdog Says
“While oversight authority is vital, its absence can contribute to a catastrophic situation,” EPA Inspector General Arthur A. Elkins Jr. said in releasing the findings, which stated that “while Flint residents were being exposed to lead in drinking water, the federal response was delayed, in part, because the EPA did not establish clear roles and responsibilities, risk assessment procedures, effective communication and proactive oversight tools.” (Dennis, 7/19)

The Wall Street Journal: EPA Report Faults Response To Flint Water Crisis
A spokeswoman for the Michigan Department of Environmental Quality said the water crisis “highlighted the fragile nature of the aging infrastructure throughout the country, as well as a number of ways the federal lead and copper rule needs improvement and/or clarification.” She said that Michigan has “taken a lead role” in updating its lead and copper rule. (Barrett and Maher, 7/19)

Bloomberg: Drug Firms Blame Opioid Crisis On Illicit Websites, Dealers
Two pharmaceutical companies say the real culprits in the opioids epidemic are illegal dealers of the painkillers and want them to be on the hook financially for any damages potentially assessed against drugmakers. Endo International Plc and Mallinckrodt Plc sued a host of convicted drug dealers and Internet sites this week for illegally offering opioids. Among them: RxCash.Biz, which offers misbranded opioids online, an Italian man indicted for of operating so-called pill mills, and a Tennessee resident who’s serving 10 years for possessing fentanyl with an intent to distribute. (Hopkins and Feeley, 7/19)

The Washington Post: Coffee Shop Serves Hope To People Recovering From Addiction
A Pennsylvania town’s newest coffee shop is offering people recovering from opioid addiction a fresh start, one steaming cup of java at a time. Hope & Coffee began serving customers Thursday morning in Tamaqua, a small coal-region town about 85 miles from Philadelphia. In some ways, Hope & Coffee looks like any other hip cafe with its vintage parquet floors, leather sofas, free wi-fi and gourmet coffee beans. But this is coffee with a twist: People in recovery renovated the 1865 Victorian home, built the coffee bar, supply the beans and serve as the nonprofit coffee shop’s managers and baristas. (Rubinkam, 7/19)

NH Times Union: Former Mass. Man Sentenced In Fentanyl Conspiracy Case
A former Lawrence, Mass., man got five years in federal prison for his role in a conspiracy to distribute fentanyl, federal prosecutors said Thursday. Yomar Maldonado, 22, had pleaded guilty last April and after serving his sentence he will be on supervised release for four years. U.S. Attorney Scott W. Murray said Maldonado also faces potential deportation back to Spain after serving his sentence. (7/19)

Stat: The Opportunity 'Is Huge': Why Tech Developers Are Trying To Tackle Mental Health
Here in the technology epicenter of the world, developers are increasingly writing code and launching products to try to disrupt yet another field: mental health. Even as big tech players have conquered the markets in industries like transportation and lodging, they’ve largely steered clear of mental health treatment. Now, however, with an influx of funding, companies are revamping pills with digital sensors, designing virtual reality worlds to treat addiction and other conditions, and building chatbots for interactive therapy. (Robbins, 7/20)

Stat: Scientists Explore New Kind Of Immunotherapy To Treat Autoimmune Diseases
Riding the coattails of CAR-T cancer therapies, scientists have begun to explore a spin-off: using similar immune cells to treat autoimmune diseases such as type 1 diabetes and prevent rejection of transplanted organs. In CAR-T therapies, T cells are extracted from a patient’s blood, reprogrammed to attack cancer cells, and then re-infused into the bloodstream to carry out their new assignment. (Farber, 7/20)

WBUR: Report Warns Of 'Dangerous Complacency' In The Fight Against HIV
Prevention efforts are a different story, and if the world doesn't figure out how to prevent new cases of HIV, stubbornly holding steady at about two million infections a year since 2005, according to a 2016 report in Lancet HIV, a resurgence in the epidemic is possible. That gloomy warning comes from a report by a new Lancet Commission led by the International AIDS Society and published in the July 19 Lancet just days before the start of the 22nd International AIDS Conference on July 22 in Amsterdam. (Brink, 7/19)

Reuters: A Tenth Of U.S. Veteran Coal Miners Have Black Lung Disease: NIOSH
More than 10 percent of America’s coal miners with 25 or more years of experience have black lung disease, the highest rate recorded in roughly two decades, according to a government study released on Thursday that showed cases concentrated heavily in central Appalachia. The study by researchers from the government’s National Institute of Occupational Safety and Health marks the most authoritative evidence to date of a resurgence of the incurable respiratory illness caused by coal dust, which plagued miners in the 1970s but was nearly eradicated by the 1990s. (7/19)

The Associated Press: Gene Tests Can Provide Health Clues -- And Needless Worry
Last year, Katie Burns got a phone call that shows what can happen in medicine when information runs ahead of knowledge. Burns learned that a genetic test of her fetus had turned up an abnormality. It appeared in a gene that, when it fails to work properly, causes heart defects, mental disability and other problems. But nobody knew whether the specific abnormality detected by the test would cause trouble. (7/19)

The New York Times: Parents Aren’t Good Judges Of Their Kids’ Sugar Intake
More than 18 percent of elementary-school-age students in the United States are obese, and no one really knows why. The causes are numerous and tangled. But consuming too much sugar is widely accepted as an important factor. In 2015, the World Health Organization issued a recommendation: Everyone, regardless of age, should restrict his or her sugar intake to less than 10 percent of all calories consumed daily. For young children, that would mean no more than about 45 grams of sugar a day. Of course, few young children are responsible for their own diets or can be expected to capably monitor their sugar consumption. That oversight usually falls to a parent. And a recent study published in the International Journal of Obesity suggests that most of us, alas, are not adept at estimating how much sugar is in some common foodstuffs. (Reynolds, 7/19)

Cleveland Plain Dealer: Can Targeting Race-Based Stress And Healthcare Bias Save Babies' Lives?
Plans to reduce the county's shockingly high rate of black infant mortality and narrow the huge and growing racial divide in infant deaths in our area have started to take shape. With hope to combat racial bias in health care, measure stress levels during pregnancy and interview families who have lost babies, three projects under the umbrella of the city-county infant mortality initiative First Year Cleveland have recently launched or are about to begin. (Zeltner, 7/20)

Bloomberg: Foul Odor Reported From FEMA Trailers Holding Post-Maria Dead
Residents and visitors to one San Juan neighborhood recently noticed an alarming new smell coming from a parking lot near Puerto Rico’s forensic sciences department, raising concerns that it could be the bodies of those who perished in the tumultuous months after Hurricane Maria. "It smelled like dead rat," said Wilfredo Ortega, who occasionally comes to an area restaurant on breaks from his job as a clinical assistant at a nearby hospital. (Rivera and Levin, 7/19)

Kaiser Health News: Long Waits To See Doctors In Puerto Rico, Where Medical Needs Are Great Post-Maria
Physicians are in short supply in Puerto Rico. From 2006 to 2016, the number of doctors on the island declined from 14,000 to 9,000, according the College of Physicians and Surgeons of Puerto Rico. And Hurricane Maria has helped fuel the exodus.Dr. José Cruz, a pediatrician with a practice in Ponce, said the island’s ongoing financial crisis and low payments from health insurers drove many physicians to seek work in the States. (7/20)

The New York Times: Doctors And Health Workers Reflect On Rural America’s Limited Access To Care
Kela Abernathy’s urgent ride to the Missouri hospital where she would give birth to premature twins covered 100 miles, took nearly four hours, and featured one stop at a hospital that couldn’t help because its labor and delivery ward was defunct. In parts of rural America, such lengthy drives to labor and delivery wards are becoming more common, according to an article published Tuesday in The New York Times. (Virella, 7/19)

Boston Globe: Business Groups Raise Alarm Over Bills To Bolster Community Hospitals
At least a dozen business and health care industry groups are sounding alarms about proposals by state lawmakers to raise millions of dollars for struggling community hospitals, warning that the plans would send premiums and other costs soaring. House lawmakers last month approved a bill that would impose more than $330 million in new assessments on insurers and large hospitals, with the money going to community hospitals. (Dayal McCluskey, 7/20)

The Associated Press: California Sues Over Trump Halt To Truck Pollution Rule
California and 14 other states sued the U.S. Environmental Protection Agency Thursday over its decision to suspend an Obama-era rule aimed at limiting pollution from trucks. The July 6 decision by the Trump EPA was illegal and could put thousands of additional highly polluting trucks on the roads, the states and the District of Columbia said in the lawsuit filed in the U.S. Court of Appeals for the District of Columbia Circuit. (7/19)

The Oregonian: Which Oregon Counties Have The Most Smokers?
According to the Centers for Disease Control and Prevention, the share of Oregonians who smoked in 2016 was close to the national average of 17.5%. (Cansler, 7/19)

The CT Mirror: DCF Seeks Independent Review Of Children's Psychiatric Hospital
Connecticut Department of Children and Families Commissioner Joette Katz said on Thursday she is seeking an independent review of the state-run psychiatric facility for children where a pregnant teenager hanged herself last month. ..The 16-year-old girl died just one day before she was supposed to be discharged from the South Campus of the Albert J. Solnit Children’s Center in Middletown and sent to a foster home, according to DCF officials. (Silber, 7/19)

The CT Mirror: Lots Of Plans, But Still No Product For The Health Information Exchange
Nearly 18 months and $5 million later, Connecticut’s fourth attempt to create a statewide Health Information Exchange (HIE) is still in the planning phase. A Health Information Exchange would allow physicians, hospitals and other healthcare providers across the state to share patient medical records. (Werth, 7/19)

Modern Healthcare: UPMC To End In-Network Coverage For Highmark's MA Members By July 2019
The UPMC health system will end its in-network coverage of Highmark Medicare Advantage members on June 30, 2019, according to a recent Pennsylvania Supreme Court ruling that reverses a lower court's order that granted coverage through 2019. Pennsylvania consumers have been caught in the middle of a spat between the state's largest health system and insurer involving the expiration of consent decrees signed five years ago. (Kacik, 7/19)

Health News Florida: Mayaro Virus: Florida’s Next Mosquito-Borne Illness?
There have been no cases of Mayaro virus in Florida yet, but University of Florida’s Barry Alto there could be if it continues to spread from South America. Alto says Florida has the right climate and mosquitos for Mayaro. (Prieur, 7/19)

Milwaukee Journal Sentinel: UW-Madison Study Affirms Trauma Creates Genetic Change That Endures
Trauma endured early in life can ripple directly into a child’s molecular structure and distort their DNA, according to a new study this week from the University of Wisconsin-Madison. The genetic changes leave them biologically more vulnerable in later life to psychiatric afflictions like depression, anxiety, mood disorders and high-risk behavior like drug abuse, the researchers found. (Schmid, 7/19)

Texas Tribune: Texas Health Building Invaded By Mold, Raising Health Concerns
Only one word comes to mind looking at photos that Texas Department of State Health Services employees took of gray, green and brown-hued mold dotting their office furniture: Ew. As of July 10, as many as 127 state workers have been affected by mold in the building, with some finding mold infiltrating their desks, chairs and keyboard hand rests in the Austin State Hospital 636 building. (Evans, 7/19)

The Washington Post: Virginia Resident Dies After Coming Into Contact With A Flesh-Eating Bacteria
A Virginia resident has died from an infection involving a waterborne bacteria that eats flesh. The person came into contact with the flesh-eating Vibrio bacteria. Virginia Department of Health officials weren’t releasing the person’s name or other details about the resident, citing privacy laws. Katherine McCombs, a ­foodborne disease epidemiology program coordinator at the health department, said the person died from a Vibrio infection. She said she couldn’t say when the person died or came into contact with the bacteria. She said it happened in the health department’s eastern region, which includes the Hampton Roads area. (Hedgpeth, 7/19)

Concord (N.H.) Monitor: Pembroke Day Care Surrenders Child Care License Following Inquiry
A Pembroke day care has surrendered its license to operate a child care center following a state investigation in late January. Susan Sennett, the owner of Small Steps Learning Center, gave up her license after a Department of Health and Human Services investigation found a series of violations “jeopardizing the health, safety or welfare of children,” according to department documents. (Dawson, 7/19)

JAMA Internal Medicine: Comparison Of Antibiotic Prescribing In Retail Clinics, Urgent Care Centers, Emergency Departments, And Traditional Ambulatory Care Settings In The United States
Antibiotic use contributes to antibiotic resistance and is associated with adverse events, including Clostridium difficile infections. Antibiotic overuse, especially for viral respiratory infections, is common. Only 60% of outpatient antibiotic prescriptions dispensed in the United States are written in traditional ambulatory care settings (hereinafter “medical offices”) and emergency departments (EDs). Growing markets, including urgent care centers and retail clinics, may contribute to the remaining 40%. Our objective was to compare antibiotic prescribing among urgent care centers, retail clinics, EDs, and medical offices. (Palms et al, 7/16)

Health Affairs: Factors Contributing To Geographic Variation In End-Of-Life Expenditures For Cancer Patients
Health care spending in the months before death varies across geographic areas but is not associated with outcomes. Using data from the prospective multiregional Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, we assessed the extent to which such variation is explained by differences in patients’ sociodemographic factors, clinical factors, and beliefs; physicians’ beliefs; and the availability of services. Among 1,132 patients ages sixty-five and older who were diagnosed with lung or colorectal cancer in 2003–05, had advanced-stage cancer, died before 2013, and were enrolled in fee-for-service Medicare, mean expenditures in the last month of life were $13,663. (Keating et al, 7/9)

Commonwealth Fund: To Understand How Consumers Are Faring In The Individual Health Insurance Markets, Watch The States
Since passage of the Affordable Care Act (ACA), millions of Americans have gained access to comprehensive health coverage, driving the uninsured rate to historic lows. Many people continue to face difficulty affording coverage, however, including those with moderate incomes who nevertheless earn too much to qualify for federal premium subsidies. Though recent developments in Congress and actions by the Trump administration are likely to make it harder for individuals — particularly those who aren’t in perfect health — to afford adequate coverage, some states are taking action to safeguard their residents. (Giovannelli, Lucia and Corlette, 7/18)

The Henry J. Kaiser Family Foundation: Tracking Section 1332 State Innovation Waivers
Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents. As states explore ways to address access and affordability issues in their individual and small group markets, they are increasingly turning to 1332 waivers. (4/16)

JAMA Internal Medicine: Associations Between The Patient Protection And Affordable Care Act Medicaid Primary Care Payment Increase And Physician Participation In Medicaid
The limited duration and design of the payment increase may have dampened its effectiveness. Future efforts to improve access through payment changes or other means can benefit from better understanding of the outcomes of this policy. (Mulcahy, Gracner and Finegold, 7/16)

The Washington Post: Why Health Care Is Making Republicans’ Challenge In November Even Harder
When you’re the party in power, you can take credit for things you may not have had much to do with, such as a strong economy. You might also be blamed for problems you didn’t have much to do with, such as a sudden recession. But can you avoid blame for problems you definitely made worse? When it comes to health care, that’s what Republicans are hoping to pull off this November. As much attention as we all give to the latest outrage from President Trump, polls have repeatedly shown health care to be at or near the top of the public’s agenda when it comes to the midterm elections. Republicans are clearly nervous: They are planning symbolic votes in the House on the same old GOP health-care ideas (health savings accounts!) as a way of dealing with Democratic attacks on the issue. (Paul Waldman, 7/19)

Boston Globe: Trump Declares Victory In War On Poverty In Order To Punish The Poor 
To the long list of lies President Trump thinks he can make true just by repeating them (“The largest audience ever,” “North Korea has agreed to denuclearization,” “I didn’t criticize the prime minister”), we can now add this: “Our war on poverty is largely over, and a success.”That’s the verbatim conclusion of a new study produced by Trump’s Council of Economic Advisors in order to justify new work requirements on Medicaid, public housing, and food stamp recipients. Never mind that 32 percent of all Medicaid dollars go to nursing home patients, and nearly half of food stamp recipients are children — neither population likely to punch a time clock anytime soon. And never mind that able-bodied adults without children already must work for their food stamps. The Trump administration is gunning for federal safety net programs, and if it takes denying the existence of 45 million Americans in poverty to rationalize their disintegration, so be it. (Renée Loth, 7/20)

Charlotte Observer: Another Trump Attack On The Affordable Care Act 
Last week, the Trump administration delivered another major blow to the Affordable Care Act by drastically cutting funding for “navigators” — counselors at nonprofits who help people enroll in health insurance. Next year, total North Carolina navigator funding will drop a jaw-dropping 84 percent, from more than $3 million to $500,000. (By Madison Hardee and Brendan Riley, 7/19)

Deseret News: Rising Health Care Costs Aren't What The Doctor Ordered
A new survey sponsored by the University of Utah Health suggests doctors aren’t to blame for skyrocketing health care costs. Instead, accountability for outsized bills and fees should fall, in large part, with the web of pharmaceutical and insurance companies. Regardless of which side of the health care industry one falls, more transparency and competition must thrive to provide Americans with affordable health care. The survey, done with the help of the New England Journal of Medicine's Catalyst, is a commendable first step in the University of Utah Health’s mission to define the value of health care in America. Finding the true cost of administering care to patients may do much to suppress the rising tide of expensive drugs and procedures. The results of the survey turn a common myth on its head. (7/19)

The New York Times: Want Reliable Medical Information? The Trump Administration Doesn’t 
The National Guideline Clearinghouse is a federal database intended to help doctors answer almost any medical question you can think of: Can this emergency room patient tolerate a procedure that normally requires an empty stomach? Does that patient need a stent? Which antibiotic should this patient be started on? If that sounds like a small matter, it isn’t. The sheer volume of medical information now within a few clicks’ reach can make it difficult, even for doctors, to separate wheat from chaff. Clinical guidelines based on careful consideration and solid impartial research can be difficult to tell apart from those based on weak data, or rooted in a clear conflict of interest (usually a financial stake in whatever treatment they are promoting). The clearinghouse, which not only vets countless sources of medical information but also makes its results easily searchable, is regarded as the most dependable repository of its kind in the world. On Monday, the Department of Health and Human Services took it offline, the latest casualty in an administration determined to eliminate science from the government’s agenda. (7/19)

The Fiscal Times: Consumer Directed Health Plans: A Step In The Right Direction
Recently, the House Ways and Means Subcommittee on Health has been considering ways to expand consumer-directed health plans (CDHPs). These plans — which essentially balance high deductibles with Health Savings Accounts (HSAs) — are a step in the right direction. (Tracy Miller, 7/19)

The Wall Street Journal: An ObamaCare Tax Worth Keeping
House Republicans want to pass a bill delaying ObamaCare’s 40% excise tax on high-cost employer plans—the “Cadillac tax”—by another year, to 2023. GOP hostility to this tax is a mistake. Keeping it would promote market-based health care more than killing it. (James C. Capretta, 7/ 19)

New England Journal of Medicine: The Inevitable Math Behind Entitlement Reform 
At some point, Americans will probably be unwilling to pay higher taxes or increase borrowing to fund public health care programs. But policymakers should have no illusions about how easy it will be to reduce growth in Medicare and Medicaid spending. (Michael E. Chernew and Austin B. Frakt, 7/18)

Stat: Improve Medicare's Annual Wellness Visit To Better Detect Early Dementia
Mind-robbing Alzheimer’s disease, the leading cause of dementia in the United States, usually starts quietly and largely hidden from view. Its manifestations range from mild symptoms such as forgetting important dates and events to requiring round-the-clock care and help with daily living activities such as walking, eating, and bathing. By the time Alzheimer’s is diagnosed, it’s generally too late to do much to halt it. One goal of the Medicare annual wellness visit is to improve the detection of early stages of cognitive impairment, an Alzheimer’s precursor. Yet a study we recently conducted suggests that the wellness visit has fallen short of doing this. We believe the visit would work better if physicians were given more specific guidance on how to detect cognitive impairment, and what steps to take for follow-up diagnostic assessment and care. (Noam Kirson, Urvi Desai and Nicole Fowler, 7/20)

Kansas City Star: Fix Parson’s Veto Of Money For Stroke, Heart Attack Patients
Missouri Gov. Mike Parson has created an unnecessary mess by vetoing money for an obscure but important health program in the state. The state legislature must override the veto in September, or the health of hundreds of Missourians will be at risk. (7/19)

The New York Times: How To Get America On The Mediterranean Diet
In 1953, not long before President Dwight Eisenhower suffered a heart attack in office, the social scientist Leland Allbaugh published “Crete: A Case Study of an Underdeveloped Area.” The landmark analysis of the eating patterns of an isolated Greek population strongly suggested that a calorie-limited diet high in fresh fruits and vegetables, whole grains, and olive oil and low in animal protein, particularly red meat, could lower the risk of heart attacks and strokes, decrease chronic disease and extend life. Medical research over the last half-century has largely borne out this initial finding. Weight-loss fads and eating trends come and go, but the so-called Mediterranean diet has stood fast. “Among all diets,” Dr. Walter Willett of Harvard’s T.H. Chan School of Public Health concluded in an email, “the traditional Mediterranean diet is most strongly supported for delivering long term health and wellbeing.” (Paul Greenberg, 7/19)

Miami Herald: By Investing In Prevention, Obesity Does Not Have To Be Miami’s Destiny
Back in 2013, 67 percent of Miami-Dade adults were overweight or obese, and 13 percent of our teenagers were obese. In response, Miami-Dade worked with the Centers for Disease Control and Prevention to reduce obesity through training childcare staff on nutrition, promoting safe streets and improving healthy meal options in public schools and childcare centers.cUnfortunately new research now suggests that more than half of children in the United States are projected to become obese by age 35, with another study reporting that 37 percent of Floridians are obese. In Miami-Dade, this does not have to be our children’s destiny. (Gabriela Aklepi and Justin Stole, 7/19)

New England Journal of Medicine: The FDA And The Next Wave Of Drug Abuse — Proactive Pharmacovigilance 
In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more appropriate prescribing as a way to limit clinical exposure to opioids, have taken actions to reduce the excess opioids available for abuse, and are working to facilitate development of new therapeutics that can effectively and safely help patients suffering from pain. Going forward, the FDA needs to remain vigilant to recognize shifting trends in the addiction landscape. Taking a systematic approach to monitoring such trends should allow us to intervene promptly and appropriately and protect the public from associated risks. (Douglas C. Throckmorton, Scott Gottlieb and Janet Woodcock, 7/18)

Stat: Doctors Could Prescribe Drugs More Accurately — If They Could Get The Data
We often prescribe new medications that were proven to be effective in rigorous clinical trials and were approved by the Food and Drug Administration only to find that our patients don’t get better. Amazon tells us every day which books would interest us, and Google can chart the fastest routes to our destinations, because these companies have mountains of data on which to base their predictions. We could provide better care for our patients if we had information that would allow us to target treatments to individual patients. But we don’t. Doctors and researchers need clinical trial data to make this happen — and that is hard to come by. (Akbar K. Waljee, Sameer D. Saini and Brahmajee Nallamothu, 7/20)

Detroit News: The Impact Of Artificial Intelligence On Health Care
If there was ever an industry in dire need of increased efficiency, cost containment and improved outcomes, health care tops the list. Despite consuming 18 percent of our nation’s GDP—equal to $3.4 trillion in annual expenditures—it is responsible for nearly 250,000 deaths due to medical errors, poor record keeping and a dismal lack of shared data among doctors about patients in their care. From blockchain technology to surgical robots, medical experts worldwide agree that big data and artificial intelligence (AI) will play a key role in vastly improving health care quality and delivery. Aided by advances in sensor capabilities, computational power and algorithmic ingenuity, the pace of medical innovation is accelerating rapidly. (Noel H. Nevshehir, 7/19)

JAMA: Overprescription In Urgent Care Clinics—The Fast And The Spurious
Despite clear guidelines and extensive educational campaigns aimed at reducing overprescribing of antibiotics, the problem remains. At least 30% of antibiotic prescriptions dispensed in the outpatient setting—80 million prescriptions per year in the United States—are given without an appropriate indication. (Michael A. Incze, Rita F. Redberg and Mitchell H. Katz, 7/16)

The Hill: Lab-Grown Meat Is Coming Down The Pipeline — Who Do You Want Inspecting It?
Since 1906, when Upton Sinclair rattled the country with “The Jungle” and argued for oversight of meat plants, the Agriculture Department has regulated and inspected meat products. Meat products bear a USDA seal that reads “inspected and passed” — and when it comes to “inspected,” USDA means business. In fact, U.S. meat and poultry plants and products are arguably the most regulated and inspected American consumer product. Sound like “spin?” It’s not. (Barry Carpenter, 7/19)

Boston Globe: Mr. Data Goes Missing On Safe Injection Plan 
It’s been clear for some time that Governor Charlie Baker is skeptical of harm reduction centers, where people suffering from substance abuse disorders can inject themselves with illegal drugs under medical supervision, boosting their chance of survival in the case of overdose. But with his misguided rejection of a new proposal by a state Senate committee, which would establish a supervised injection site pilot in Massachusetts, Baker is stepping beyond mere opposition. (7/20)