Reuters: Exclusive: White House Preparing Order That Would Cut Drug Prices For Medicare-Sources
U.S. President Donald Trump is considering a sweeping executive order that would cut prices on virtually all branded prescription drugs sold to Medicare and other government programs, according to two industry sources who had discussions with the White House. The order under discussion would be much broader than the Administration's previously disclosed proposal to lower prices on physician administered, or Part B, drugs by tying prices to lower costs in other countries. (Erman and O'Donnell, 7/24)

Politico Pro: Trump, Azar Meet With Pharma Executives At White House
President Donald Trump hosted pharmaceutical executives in the Oval Office today as his administration pursues a deal on drug pricing, four individuals with knowledge of the meeting told POLITICO. Steve Ubl, the CEO of PhRMA, was joined by representatives of Pfizer and Amgen. HHS Secretary Alex Azar and Domestic Policy Council chief Joe Grogan also attended the meeting, as well as House Majority Leader Kevin McCarthy and Rep. Mark Meadows (R-N.C.). (Diamond and Owermohle, 7/24)

Stat: 6 Questions About Lawmakers’ Latest Drug Pricing Plan 
The Senate Finance Committee’s new bipartisan drug pricing package has the potential to change Medicare more dramatically than almost any piece of health care policy in the last 20 years. But with that big of an overhaul comes even bigger questions. The package, which was unveiled Tuesday, fundamentally reworks the complicated scheme used to split Medicare drug costs between the government, patients, insurers, and drug makers. It caps how much Medicare patients can pay out of pocket for drugs each year, and it imposes strict limits on how much drug makers can hike their prices. (Florko, 7/24)

Modern Healthcare: 5 Ways The Senate's Drug-Pricing Bill Would Change Provider Pay
The Senate's major proposal to cut drug prices is roiling Washington's pharma lobbying world, but with the sectors of the U.S. healthcare system so deeply entwined, hospitals and doctors would see some financial changes too, as the package would save more than $100 billion over a decade. Here are five ways the legislation from Senate Finance Chair Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) bleeds into the provider world. (Luthi, 7/24)

The Hill: Azar Calling GOP Senators To Back Grassley Drug Price Plan 
Secretary of Health and Human Services Alex Azar is calling Republican senators to encourage them to vote for a bill to lower drug prices being considered on Thursday in the Senate Finance Committee, according to sources familiar with the matter. The calls from Azar are a sign of the Trump administration’s support for the bipartisan deal between Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), amid blowback from some in the GOP. (Sullivan, 7/24)

Stat: Some Senators Seek To Water Down Drug Pricing Bill In Flood Of Amendments
Lawmakers will wade through more than 100 potential amendments when the Senate Finance Committee takes up its sweeping new drug pricing package on Thursday. Some of the amendments could significantly rework the package, like an amendment from Sens. Pat Toomey (R-Pa.) and Pat Roberts (R-Kan.) that would eliminate the controversial provisions in the bill that would restrict drug makers from raising prices beyond the rate of inflation. A separate amendment from Sen. John Cornyn (R-Texas) would only allow that provision to go into effect if HHS certifies it won’t lead to higher launch prices. (Florko, 7/24)

Des Moines Register: Grassley Prescription Drug Plan Faces Hurdles On Left And Right
U.S. Sen. Chuck Grassley has a warning for fellow Republicans: If they kill his new compromise bill to rein in prescription drug costs, they’re likely to see President Donald Trump back more radical ideas pushed by Democrats. “I assume that if the Republicans can’t accept this moderate position … then something’s going to get done with the president throwing in with (Nancy) Pelosi,” Grassley said in a phone interview Wednesday, referring to the Democratic speaker of the House. (Leys, 7/24)

CQ: Finance Members File Dozens Of Amendments To Drug Price Bill
Senate Finance Committee members filed 110 amendments ahead of Thursday’s markup of a measure to reduce spending on prescription drugs in Medicare and Medicaid, demonstrating the intense interest in a proposal projected to save $100 billion over a decade. It’s unlikely that all of the amendments will be offered, but lawmakers will likely highlight concerns about the bill's impact on the drug industry, doctors and patients. Finance Chairman Charles E. Grassley, R-Iowa, is also expected to release a modified version of the draft released Tuesday that incorporates some changes his colleagues were seeking. (Siddons and Clason, 7/24)

Stat: Medicare Paid For Medicines That Three Other Wealthy Nations Decided Had Little Value 
As the U.S. grapples with rising prices for medicines, a new analysis finds Medicare spent more than $26 billion in recent years on dozens of medicines that were not recommended for coverage in three other wealthy nations because government advisory groups there found the drugs did not have sufficient value to justify the costs. The researchers identified a total of 134 medicines that were approved by the Food and Drug Administration prior to 2016 but were not endorsed by agencies in Australia, Canada, and the U.K. that conduct so-called health technology assessments, according to the study in the Journal of General Internal Medicine. (Silverman, 7/24)

Stat: Duchenne Patients, Backed By ‘Dark Money’ Group, To Debate Drug Prices
Meetings of the Institute for Clinical and Economic Review don’t usually get one’s heart pumping. But a meeting Thursday at the Massachusetts Institute of Technology may prove to be the exception to that rule. Patients Rising Now, an advocacy group that says it promotes transparency in health care and that is a fierce opponent of ICER’s, is expected to face off with the self-professed “watchdog of drug pricing” as it reviews three drugs for Duchenne muscular dystrophy. (Sheridan, 7/24)

Stat: Elizabeth Warren Presses Pfizer For Information On Scott Gottlieb
Sen. Elizabeth Warren is not done with Scott Gottlieb. Already peeved that the former Food and Drug Administration Commissioner joined the Pfizer (PFE) board just weeks after leaving the agency, the Massachusetts Democrat and presidential candidate expressed “disappointment” that Gottlieb refused to resign as she requested earlier this month. And so she is now asking the drug maker to disclose its interactions with Gottlieb and whether it examined the ethical ramifications of making him a director. (Silverman, 7/24)

Stat: Sun Pharma Sales Rep: I Was Fired For Balking At Off-Label Marketing 
A former Sun Pharmaceuticals sales rep has filed a lawsuit claiming he was fired for balking at alleged off-label marketing practices, the latest in a growing number of incidents concerning business practices at one of the world’s largest generic drug makers. In his lawsuit, Damian Frantz contended that company policy prohibiting illegal marketing was ignored and, instead, that a supervisor “expressly directed” him to “do whatever is needed to get” a clinical team to “talk off label” to physicians and health plans, among others. In general, the company sought to “aggressively solicit opportunities to present off-label information to decision-makers about its drugs.” (Silverman, 7/24)

Miami Herald: Jewish Community Helps Aventura Baby Get World’s Most Expensive Drug
A young couple in Aventura was running out of time and praying for a miracle. Their daughter, Eliana Cohen, fast approaching her second birthday, was diagnosed with a rare disease that could keep her from walking, eating and breathing on her own.But her best hope also happened to be the world’s most expensive drug — a $2.1 million treatment called Zolgensma. Without support from insurance, her parents Ariel and Shani Cohen turned to their Jewish community through social media in hopes of covering the staggering cost. The outpouring of support, from South Florida and around the world, proved equally staggering. (Rosa, 7/24)

Kaiser Health News: On A Mission To Help People Control Diabetes — And Save Money On Insulin
In a former church parsonage in Grundy County, Tenn., Karen Wickham ladled out her lentil stew as people arrived for an evening health education class. Wickham and her husband, Steve, are white-haired, semi-retired nurses who have dedicated the last years of their working lives to helping people with Type 2 diabetes control and even reverse the condition with diet and exercise. Wendy Norris is in the group, and she has brought along her father and daughter. Since her diagnosis several years ago, Norris said, her doctor prescribed insulin shots and told her to watch what she ate. (Farmer, 7/25)

The Fiscal Times: Drug Industry Spent A Record Amount On Lobbying In The First Half Of 2019
The Pharmaceutical Research and Manufacturers of America, a leading industry trade group, spent $16.1 million on lobbying in the first six months of the year, up 4% from the $15.5 million it spent in the first half of 2018. PhRMA spent $27.5 million over the full year in 2018, also a record. (Rosenberg, 7/24)

The New York Times: Breast Implants Linked To Rare Cancer Are Recalled Worldwide
Textured breast implants made by Allergan that have been linked to an unusual cancer are being recalled in the United States at the request of the Food and Drug Administration, and will also be recalled globally, the agency announced on Wednesday. The F.D.A. decision, based on an increasing number of cases and deaths from the implant-associated cancer, lags far behind action in Europe, where the Allergan devices were effectively banned late last year. (Grady, 7/24)

The Associated Press: Breast Implant Recalled After Link To More Rare Cancer Cases
The FDA is not recommending women with the implants have them removed because the cancer is so rare, but say they should check with their doctor if they have symptoms, which include pain and swelling. Biocell implants feature a textured surface designed to prevent slippage and to minimize scar tissue. Those models account for just 5 percent of the U.S. market. The vast majority of breast implants used in the U.S. have a smooth surface. (Perrone, 7/24)

The Washington Post: Allergan Said It Acted After Getting New Data On Illnesses And Deaths From The FDA
The FDA said the new data shows that 573 cases worldwide have linked the rare cancer to the implants since the agency began tracking the issue in 2011. The vast majority of those cases involve Allergan products. Thirty-three women have died of what’s known as breast implant-associated anaplastic large cell lymphoma, a cancer of the immune system. Of those fatalities, authorities identified the implant manufacturer in 13 cases — and it was Allergan in all but one. (McGinley, 7/24)

The Wall Street Journal: Allergan Recalls Breast Implants After FDA Cites Lymphoma Link
“While the overall incidence appears to be relatively low, once the evidence indicated the Allergan product was linked to patient harm including deaths, the FDA took action,” Amy Abernethy, the FDA’s principal deputy commissioner, said on a conference call with reporters. “We know that today’s news will be alarming to patients with breast implants.” (Loftus, 7/24)

NPR: Textured Breast Implants Linked To Rare Type Of Cancer Are Recalled
It's not clear whether the texturing is actually responsible for the cancer or is just associated with a higher incidence of the disease. But Maman and others say the surface can interact with the surrounding scar tissue that the body forms as an immune response to the implant. "It's that response that is believed to cause the formation of the lymphoma," Maman said, noting that he only uses smooth, round implants. Given the risks linked to textured implants, he said, "taking them off the market is very prudent and the right approach." (Aubrey and Laidlaw, 7/24)

USA Today: FDA Recalls Allergan Textured Breast Implants Linked To Rare Cancer
Dr. Elisabeth Potter, a plastic surgeon in Austin, Texas, has cared for women with cancer after receiving textured implants. She says the recall is an important step to protect women from the potential risks of textured implants. "It was influenced by folks speaking up when the FDA didn’t act quickly enough," Potter says. "The power is now back in a woman’s hands, and the FDA is backing her up." Potter says women with textured implants should talk with their doctors and monitor for any symptoms such as pain, swelling, redness or anything abnormal. (Alltucker, 7/24)

The Hill: Allergan Recalls Textured Breast Implant Linked To Rare Cancer 
The products have already been banned or recalled from the market in other countries. (Weixel, 7/24)

The Hill: Senate Will Not Vote On Bipartisan Health Costs Bill Before Leaving For August 
The Senate will not vote on a bipartisan measure aimed at lowering health care costs before lawmakers leave Washington for the August recess. Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) said in a joint statement that the Senate “does not have time before the August recess” to consider the bill. (Sullivan, 7/24)

Modern Healthcare: Senate Stalls Vote On Hospital Contract Reforms, Balance Billing
Senate health committee Chair Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) said Wednesday that the Senate "does not have time before the August recess" to consider legislation, although Alexander previously told reporters this week that he hoped for a vote before the recess. Disputes are ongoing over the proposal to ban surprise medical bills with a cap on charges for out-of-network care. "We are engaged in very productive conversations about this legislation with our colleagues in the Senate and the House, and will continue to work during August and into September to move this legislation forward," the senators said. (Luthi, 7/24)

Politico Pro: Senate Won’t Vote On Surprise Billing Package Before August Recess
The timing gives lawmakers and powerful health industry lobbies several weeks to try to influence the legislation, S. 1895 (116), which passed out of the committee in a 20-3 vote last month. The legislation also includes measures on public health, transparency and health IT. (Roubein, 7/24)

Meanwhile —

CQ: Health Care Law Supporters Launch August Tour
An advocacy group that supports the 2010 health care law will launch a national tour next month with the hope of carrying its success from last year's campaigns into the 2020 election cycle. Protect Our Care, a group formed to defend the 2010 health care law (PL 111-148, PL 111-152), plans at least 22 events in August across the country, according to information first shared exclusively with CQ Roll Call. The effort will highlight an issue that helped Democrats win control of the House last year and is likely to be a key issue in next year’s election. (McIntire, 7/25)

The Hill: House Passes Bill Requiring CBP To Enact Safety, Hygiene Standards 
The House passed a Democrat-led bill that would require Customs and Border Protection (CBP) to enact safety and hygiene standards for migrants in their custody in a 233-195 vote on Wednesday. Just one Republican joined Democrats in voting for the measure.  Under the Humanitarian Standards for Individuals in Customs and Border Protection Custody Act — spearheaded by Rep. Raul Ruiz (D-Calif.) — CBP would be required to conduct health screenings, provide emergency care and provide access to medication, translators and emergency transportation for undocumented immigrants.  (Brufke, 7/24)

CQ: HHS To Phase Out Temporary Child Migrant Facilities In 2020
The Department of Health and Human Services plans to have enough permanent facilities to house unaccompanied or separated migrant children by the end of next year to be able to phase out the temporary influx facilities criticized by Democrats and advocates for a lack of oversight. “Just like you, I prefer small, licensed shelters," Lynn Johnson, the assistant secretary of HHS' Administration for Children and Families that oversees care for migrant children, said Wednesday at a House Appropriations Subcommittee hearing. (Misra, 7/24)

Politico Pro: HHS Still Sharing Information About Sponsors Of Migrant Kids
HHS' refugee director told House appropriators Wednesday that the agency is still sharing information about the sponsors of unaccompanied and separated migrant children with immigration enforcement agencies. But Office of Refugee Resettlement Director Jonathan Hayes told the panel that oversees HHS' budget that officials don't disclose the immigration status of any sponsors, and no longer fingerprint parents, grandparents or adult siblings of detained children who come forward as sponsors. (Ollstein, 7/24)

The Washington Post: Opioid Makers Say There’s No Proof They Are Responsible For The Epidemic’s Harms 
Major opioid manufacturers have asked a judge to throw out the first test case of whether they must pay for the nation’s drug crisis, arguing that two Ohio counties cannot prove the drug companies’ actions were responsible for overdose deaths or other harms, newly unsealed court documents show. Lawyers for Purdue Pharma, Mallinckrodt Pharmaceuticals and other drug companies contend that Cuyahoga and Summit counties cannot sufficiently connect the tens of billions of legal painkillers the companies produced to fatalities and addiction. Nor can the counties show that drug company sales calls caused doctors to overprescribe the medications, they said. (Bernstein and Zezima, 7/24)

The Associated Press: No Obligation To The Public, Opioid Distributor Tells Lawyer
An executive at one of the nation’s largest drug distribution companies said under questioning recently that the business has no obligation to the public when it comes to the amount of prescription opioid painkillers it ships. That’s one of the exchanges included in thousands of pages of court documents, including depositions and internal emails, made public this week in lawsuits brought against the pharmaceutical industry over the nation’s deadly opioid crisis. (Hoyer and Mulvihill, 7/24)

The Associated Press: As The Nation's Opioid Crisis Grew, The Pills Got Stronger
In 2012, as the death toll from the nation's opioid crisis mounted, drug companies shipped out enough of the powerful and addictive painkillers for every man, woman and child in the U.S. to have nearly a 20-day supply. In some counties, mostly in Appalachia, it was well over 100 days.An Associated Press analysis of drug distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip. (7/24)

The Washington Post: Opioids In Appalachia: Addiction And Recovery In Painkiller Epidemic
At her very worst, Amber Wood was so desperate for the opioid high she had a dentist pull a tooth — and not even a particularly bad tooth, just one of those molars she didn’t think she’d need as much as she needed a pill. The dentist, she said, gave her a prescription for the opioid painkiller Lortab. She’d been abusing drugs since the age of 13. “None of us said when we went to pre-K, ‘You know what I want to be when I grow up? I want to be a drug addict.’ Nobody thought that. (Achenbach, Koh, Bennett and Mara, 7/24)

News comes out of Massachusetts and Missouri as well —

Boston Globe: Andover Pharmacy Under Investigation For Opioid Dispensing
Attorney General Maura Healey is investigating whether an Andover pharmacy that specializes in workers compensation patients properly dispensed controlled substances, a spokeswoman said Wednesday. The Injured Workers Pharmacy, a national mail-order pharmacy, was recently revealed to be the largest recipient of opioid pills in Massachusetts during 2006 to 2012, in data from the Drug Enforcement Administration. (Freyer, 7/24)

St. Louis Public Radio: Wash U Clinic Offers Expectant Moms With Addiction Drug Treatment, Prenatal Care
The CARE clinic is open half a day each week and is open to all people, insured or not. In addition to prenatal care from high-risk obstetricians, pregnant people receive mental health treatment from psychiatrists and addiction counselors. Most of the women at the clinic receive medication-based treatment such as methadone and buprenorphine, which helps prevent cravings and reduce withdrawal symptoms. (Fentem, 7/25)

The Hill: Sanders Unveils Plan To Address Racial Disparities Among Health Care Professionals 
Sen. Bernie Sanders (I-Vt.) unveiled a plan Wednesday seeking to boost the number of black employees in the health care industry as the White House hopeful works to shore up support in Democratic presidential primary. Sanders's campaign unveiled the plan shortly after he appeared at a presidential forum in Detroit for the NAACP National Convention. The plan would work to train and hire more black health care providers and supplement his “Medicare for All” plan. (Axelrod, 7/24)

The Hill: Sanders Campaign Accuses Biden Of 'Continued Lies' About 'Medicare For All' 
Sen. Bernie Sanders' (I-Vt.) presidential campaign slammed former Vice President Joe Biden on Wednesday for "continued lies" about Medicare for All. "Thank you, Joe Biden, for crediting our campaign for honesty," senior advisor Jeff Weaver said in a statement. "I'm sorry we can't return the favor. Your continued use of the same insurance company scare tactics that were used against the Affordable Care Act is truly disheartening." (Rodrigo, 7/24)

Reuters: Anthem Shares Sink As Cost Concerns Overshadow Earnings Beat
Anthem Inc shares fell as much as 4% on Wednesday after the U.S. health insurer missed Wall Street expectations for a key medical cost gauge as a result of higher costs of selling Medicaid health plans for low-income customers. Anthem reported a 10.2% fall in operating profit from its unit which sells government health plans, in the quarter, saying the decline was driven by continued elevated medical cost trends in Medicaid in some states. (7/24)

The Associated Press: Anthem Tops 2Q Expectations, Shares Slide On Expense Worries
The Blue Cross-Blue Shield insurer said it has added nearly 700,000 Medicaid customers over the past year, but expenses were coming in higher than expected in a handful of states. Chief Financial Officer John Gallina told analysts the issue was "very manageable," and he expected the business's profitability to improve in the second half of the year. He said the populations covered in these states, which he declined to name, had changed slightly since rates were set, and they were seeking rate adjustments. (Murphy, 7/24)

The Wall Street Journal: Anthem Shares Fall Following Earnings Results 
Anthem said the launch process for its new pharmacy-benefits manager, IngenioRx, was moving ahead of expectations, and the company now expects IngenioRx’s results to hit the higher end of its previous projections. The insurer also said it had enrolled a new IngenioRx client, Blue Cross of Idaho, for next year. Anthem has said that it sees fellow Blue Cross Blue Shield insurers as a potentially fertile source of business across various areas. Anthem raised its outlook for multiple 2019 earnings metrics, but tightened its projected medical-loss ratio range to the higher end of its prior suggestion. The company expects an MLR of 86.2% to 86.5%. It had been expecting that ratio to be 86.2% plus or minus 30 basis points. (Wilde Mathews and Prang, 7/24)

Modern Healthcare: CVS, Aetna To Launch Social Care Network
CVS Health is rolling out a network to provide its most vulnerable patients with access to local support for their social care needs. The retail healthcare giant announced on Wednesday it will collaborate with social care coordinator platform provider Unite Us to launch a platform that will allow Medicaid and dual-eligible beneficiaries covered through its insurance arm Aetna to more easily find and access help from social care providers within their communities. (Johnson, 7/24)

Modern Healthcare: Tenet Plans To Spin Off Revenue-Cycle Subsidiary Conifer
After nearly two years of fielding underwhelming offers for its revenue-cycle subsidiary, Tenet Healthcare Corp. has settled on a decidedly different maneuver: It will spin it off as a separate, publicly-traded company. Leaders with Dallas-based Tenet have spent the past 18 months finalizing a deal on Conifer Health Solutions. While CEO Ron Rittenmeyer conceded on an investor call Wednesday that an outright sale would have been the company's first choice, there are several benefits to a tax-free spin off. (Bannow, 7/24)

Bloomberg: Bayer's Other Legal Mess: An Old Liability Many Have Forgotten 
The widening legal nightmare over Roundup weedkillers isn’t the only potential multi-billion-dollar liability Bayer AG inherited last year when it acquired Monsanto Co. While thousands of damage claims over Roundup have grabbed headlines and hogged the attention of investors, the German conglomerate also has become a target of lawsuits by American states and cities trying to clean up toxic PCBs, a widely used fire-resistant chemical compound that the U.S. banned four decades ago. (Feeley and Loh, 7/23)

Modern Healthcare: Trinity Health Sues Anesthesiology Group Amid Insurer Rate Disputes
Trinity Health sued a Michigan anesthesiology group for allegedly compromising operations at a handful of its hospitals amid rate disputes with several insurers. The lawsuit filed in a Michigan federal court Tuesday alleged that Anesthesia Associates of Ann Arbor, which employs more than 100 doctors and is the exclusive provider for six Trinity hospitals, and its parent company, Siromed Physician Services, are terminating contracts with Blue Cross and Blue Shield, Aetna and Priority Health and have sued or are pursuing litigation against those insurers. (Kacik, 7/24)

Modern Healthcare: Advocate Aurora Health Drops Co-CEO Model, Names Jim Skogsbergh CEO
Advocate Aurora Health has pared back its CEO office from two to one, with Jim Skogsbergh emerging as the not-for-profit health system's sole CEO. Newly merged Advocate Aurora's short-lived foray into the co-CEO model lasted just over a year. The Illinois and Wisconsin systems' union became official in April 2018. The health system's announcement Wednesday follows other co-CEO structures, which typically last less than three years. (Bannow and Kacik, 7/24)

Bloomberg: Health Investors Struggle Under Weight Of Washington What-Ifs 
Optimism is in short supply when it comes to health-care stocks as investors can’t see when the sector will recover from an array of regulatory threats. Plagued by concerns about drug pricing and jitters over proposals for a U.S. government-run system, health care has gone from the top-performing group in the S&P 500 Index last year to its worst in 2019. Facing an election in less than 16 months, President Donald Trump may have run out of time in this term to enact meaningful changes affecting the industry, but observers say political questions are still likely to overshadow business fundamentals. (Darie, 7/24)

In other news —

Bloomberg: Health Insurers Sink As Rising Spending Gauge Alarms Investors
Health-insurance stocks sank across the board after Anthem Inc. became the third insurer to report it is paying out a higher percentage of the premiums it takes in to cover patients’ medical claims. Investors watch the so-called medical-loss ratio reported by health insurers closely. The number is a key measure of the companies’ financial health; when the ratio goes up, it can suggest that money is leaving the companies faster than it is arriving. Other issues, such as changes in tax law, can also affect the ratio. (Tozzi, 7/24)

Modern Healthcare: Dermatology Practices Being Bought By Investors Raises Concerns
Private equity firms have acquired nearly 200 dermatology practices across the country over the past six years, raising concerns about how this ownership trend affects quality and costs, according to the most comprehensive study so far tracking these deals. The JAMA Dermatology study found that 17 private equity-backed dermatology management groups rolled up 184 practices from 2012 to 2018, accounting for 381 clinics in at least 30 states. More than a third of the clinics were located in Florida and Texas. (Meyer, 7/24)

Houston Chronicle: Unneeded ER Visits Cost Nation's Healthcare $32 Billion Last Year 
At the heart of the findings are some staggering price differences. For instance, a trip to the emergency room is on average 12 times higher than being treated at a physician's office for common ailments. That translates to $2,032 on average compared to $167. That same trip is also 10 times higher than a visit to urgent care, which on average costs $193. This can be a crucial difference in Texas, where patients continue to be confused between urgent care clinics and the states' hundreds of free-standing emergency rooms, health analysts say. (Deam, 7/24)

U.S. News & World Report: ‘Avoidable’ ER Visits Fuel U.S. Health Care Costs
And while the poor and uninsured may be unable to afford or without access to a primary care doctor, the analysis by the health insurer of its own data and claims found that of 27 million emergency department visits annually by patients with private insurance, two-thirds are "avoidable" and "not an actual emergency." The average cost of such visits for common conditions that could have been remedied through primary care tops $2,000.The problem: an inconvenient and perhaps outdated primary care delivery system that's not always open or accessible when people need immediate treatment. (Williams, 7/22)

In other news on health costs —

Kaiser Health News: First Kidney Failure, Then A $540,842 Bill For Dialysis
For months, Sovereign Valentine had been feeling progressively run-down. The 50-year-old personal trainer, who goes by “Sov,” tried changing his workout and diet to no avail. Finally, one Sunday, he drove himself to the hospital in the small town of Plains, Mont., where his wife, Jessica, happened to be the physician on call. “I couldn’t stop throwing up. I was just toxic.” (Gold, 7/25)

Kaiser Health News: Your Go-To Guide To Decode Medical Bills
In 2018 Kaiser Health News and NPR teamed up to create “Bill of the Month,” a crowdsourced investigative series in which we dissect and explain medical bills you send us. We have received nearly 2,000 submissions of outrageous and confusing medical bills from across the country. Each month we select one bill to thoroughly investigate, often resulting in the bill being resolved soon after the story is published. But what about the large number of Americans who receive surprise medical bills that reporters can’t examine? (7/25)

More Bills Of The Month: Check out KHN's special coverage on surprisingly high medical bills. 

Stateline: Getting Older, Going Broke: Who’s Going To Pay For Long-Term Care? 
Long-term care insurance is, for most of us, prohibitively expensive. Employer-based health insurance doesn’t cover daily, extended care. Medicare pays for only a short stay in a nursing home or a limited amount of care at home. Ninety percent of Americans don’t have long-term care insurance — even though half of all people 65 and over will need such care at some point. Without it, seniors can go bankrupt paying for assisted living, nursing home care or home health care. (Wiltz, 7/25)

The Associated Press: Study: Home-Delivered Meals Could Save Money For Medicare
Medicare could save $1.57 for every dollar spent delivering free healthy meals to frail seniors after a hospitalization, according to a new study that comes as lawmakers look to restrain costs by promoting patients' well-being. The report Thursday from the Bipartisan Policy Center addresses ways that Medicare can do a better job coordinating care for chronically ill patients, who account for most of the program's $650 billion annual cost. (Alonso-Zaldivar, 7/25)

The New York Times: Most High-Risk Men Don’t Take PrEP To Prevent H.I.V.
Among men who are at high risk for H.I.V. infection, only about one in three is taking a drug to prevent transmission of the virus, according to a survey from the Centers for Disease Control and Prevention. The drug, Truvada, is taken daily as part of a preventive strategy called pre-exposure prophylaxis, or PrEP. For the report, published in MMWR, C.D.C. researchers studied 7,873 high-risk men from 20 American cities who were negative for H.I.V. and completed a behavioral survey in 2014 or 2017. (Bilanow, 7/25)

Stat: An AI Expert's Toughest Project: Writing Code To Save His Son's Life 
It was developed as part of an ambitious project funded by the National Institutes of Health to link and make searchable decades worth of biomedical data collected by universities and research labs on genes, proteins, disease symptoms, patient outcomes, drugs, and more. This information is now dispersed among hundreds of databases, in a confusing patchwork of formats and terminology that defies easy analysis. (Ross, 7/25)

Bloomberg: Climate Change May Draw $200 Billion Vaccine Boom, Analyst Says 
Higher temperatures across the globe could expose almost a billion more people to risks for diseases like Zika and Ebola by 2080 and that may be a boon for some drugmakers, Morgan Stanley tells investors. Climate change could spell the rapid spread of infectious diseases and Europe in particular is at risk, analysts led by health-care specialist Matthew Harrison wrote in a note to clients. (Flanagan, 7/24)

NPR: Precision Medicine Research Must Build More Diversity And Trust Says Bioethicist
Precision medicine is the field of dreams for human health — drugs and treatments that would take into account a person's individual DNA configurations, as well as lifestyle and environment, would presumably be better tailored to each person's needs. Still, while the goal of precision medicine is to help everybody, the current research available has a major flaw — it's largely based on the genes of people who are predominantly of white and European descent. (Huang, 7/25)

Bloomberg: J&J Targets Science Behind Thousands Of Baby Powder-Cancer Cases 
Johnson & Johnson, seeking to head off claims by thousands of women that its iconic Baby Powder caused their cancer, took aim at some of the science cited in lawsuits alleging the company’s talc-based products were tainted in the past with asbestos. During a hearing Wednesday, lawyers for the world’s largest maker of health-care products questioned the procedures used by Dr. William Longo, who tested talcum powder for asbestos. J&J hopes a judge will bar Longo from testifying for the women suing the company in cases consolidated in federal court in Trenton, New Jersey. (Feeley, 7/24)

The New York Times: You Are What You Watch? The Social Effects Of TV
Other than sleeping and working, Americans are more likely to watch television than engage in any other activity. A wave of new social science research shows that the quality of shows can influence us in important ways, shaping our thinking and political preferences, even affecting our cognitive ability. In this so-called golden age of television, some critics have pointed out that the best of the form is equivalent to the most enriching novels. (Rothwell, 7/25)

NPR: Robotic Hand Improved To Give User A Sense Of Touch And Better Control
Keven Walgamott, a real estate agent who lost his left hand and part of his arm in an electrical accident in 2002, got emotional when he was able to clasp his hands together and "feel" the space between his thumb and his index finger using a 3D-printed prosthetic hand in 2016. "That was the first time I ever felt anything in my left hand since my amputation," Walgamott says. He got emotional a second time when he was able to grasp his wife's hand and "feel" her touch, this time through a newly designed, experimental prosthetic hand that can be directed with the user's mind. (Torres, 7/24)

Politico Pro: Testimony: Juul Touted Its Products To Ninth Graders, American Indian Tribes
Juul sent representatives into high schools “under the guise of education” and sought partnerships with American Indian tribes to switch people onto its popular e-cigarettes, witnesses testified during a House hearing Wednesday. A Juul official spoke to ninth graders in a New York school last year, showing the children how the products work, calling them “totally safe” and saying FDA would soon state that they were 99 percent safer than traditional tobacco, said Meredith Berkman, co-founder of Parents Against Vaping E-Cigarettes, who testified along with her teenage son and his friend. (Owermohle, 7/24)

The New York Times: Need A Mental Health Day? Some States Give Students The Option
Depression and anxiety. The state of the country. Climate change. Mass shootings. Today’s students are grappling with a variety of issues beyond the classroom. To that end, lawmakers in two states have recently recognized the importance of the mental health of their students by allowing them to take sick days just for that. The measures “empower” children to take care of their mental health, one expert said. (Taylor, 7/24)

Reuters: Former U.S. Pro Football Players May Face Increased Risk Of Heart Rhythm Problem
Former players from the National Football League may face an increased risk of a type of irregular heartbeat that could lead to stroke, a new study suggests. Researchers found that retired NFL players were nearly six times as likely to develop atrial fibrillation as men of the same age in the general population, according to results published in the Journal of the American Heart Association. (7/24)

The Associated Press: Oregon Removes Assisted Suicide Wait For Certain Patients
Legislation allowing certain terminally ill patients to have quicker access to life-ending medications under the state’s first-in-the-nation assisted suicide law has been signed into law, Gov. Kate Brown’s office announced Wednesday. The law allows those with 15 days left to live to bypass a 15-day waiting period required under the Death with Dignity Act, something proponents say will reduce bureaucracy and bring relief to gravely ill people. (Zimmerman, 7/24)

Texas Tribune: Thousands Of Texans Could Lose Food Stamps Under Trump’s New Proposal
The Trump administration is proposing tightened requirements for the Supplemental Nutrition Assistance Program — also known as food stamps — that could end food assistance for more than 3 million Americans and jeopardize assistance for thousands of Texans. The proposed rule would curb states’ abilities to set eligibility requirements for the food assistance program that helps feed millions of Americans each month. (Korte, 7/24)

NH Times Union: NH Hospital Wait List Is Down, Say Reports
According to new reports, the number of adults and children with mental illness waiting to get into New Hampshire Hospital has fallen over the past year, ending the long streak in what had become an out-of-control system. Gov. Chris Sununu, his administration and legislative leaders from both parties celebrated the new, much-lower numbers in contrast to just two years ago when as many as 72 adults and 27 children were left without a bed in the Concord-based program. (Landrigan, 7/24)

The Associated Press: Health System Offers Free DNA Tests For 10,000 Floridians
An operator of hospitals and clinics began offering free DNA testing on Wednesday to 10,000 Floridians in a partnership with a private genomics company. Some biomedical ethicists warn that participants need to realize their data can be used for purposes other than their health care. Researchers at AdventHealth in Orlando said the DNA test screens for an inherited condition that can lead to high cholesterol and heart attacks if left untreated. (7/24)

Des Moines Register: Jerry Foxhoven's Ouster From DHS Preceded Pay-Sharing Pact For Official
Former Iowa Department of Human Services Director Jerry Foxhoven said Wednesday that shortly before Gov. Kim Reynolds ousted him, he objected to having his agency continue to pay an administrator who had transferred to the governor's office. The governor's spokesman said Foxhoven never raised such a concern, and was not asked to sign the pay-shifting agreement for the staffer. The governor asked Foxhoven to resign June 17 as head of the state's largest agency. She has declined to specify why. Her spokesman, Pat Garrett, said Wednesday that the pay-shifting issue was not the reason the governor asked Foxhoven to resign. (Leys and Gruber-Miller, 7/24)

Tampa Bay Times: Mental Health, Weight Management And Substance Abuse Are Top Health Concerns In Hillsborough
Weight management, mental health and substance abuse are among the top health concerns for people living in Hillsborough County, according to a recent countywide survey of residents. Health care professionals and advocates gathered at George M. Steinbrenner Field in Tampa Wednesday morning to discuss those and other findings in the survey, conducted every five years by the Florida Department of Health in Hillsborough County. More than 5,300 people responded as officials sought input from residents with varied ages, locations and backgrounds. (Griffin, 7/24)

The New York Times: Columbine High School Will Not Be Torn Down And Rebuilt
Facing community opposition, a Colorado school district said on Wednesday that it would drop a proposal to tear down Columbine High School, which has been confronting growing threats and thousands of curious trespassers since the 1999 massacre there. In June, the Jefferson County Public Schools in suburban Denver asked for community input on what, to many, was a radical idea to reduce Columbine’s morbid allure. (Healy, 7/24)

MPR: Minnesota Historical Society Offers Support To Dementia Caregivers
The Minnesota Historical Society is something like the state’s memory, preserving the state’s past. The society is also taking on the role of helping Minnesotans whose memories are waning because of dementia. (Cox, 7/25)

MPR: Hmong Farmers, HealthEast Write Prescription For Better Health: Veggie Boxes
Enter the Hmong American Farmers Association and HealthEast. Since 2016, they’ve partnered to provide fresh fruit and vegetable boxes to patients, giving people the opportunity to eat healthier on a regular basis. In turn the Veggie Rx partnership supports local Hmong farmers and helps doctors build stronger relationships with their patients. (Yang, 7/25)

The Baltimore Sun: Johns Hopkins To Study Polio-Like Condition Causing Paralysis In Children In Maryland, Around U.S. 
Researchers at Johns Hopkins Medicine and the University of Alabama at Birmingham will study of a condition that mysteriously began ramping up in 2014 and has caused paralysis in hundreds of children around the world as well as in Maryland. Acute flaccid myelitis has been called polio-like, but doctors don’t know what causes it, though they suspect it’s a rare response to common enteroviruses that normally lead to far more mild infections. (Cohn, 7/24)

San Francisco Chronicle: NIMBYs Beware: Latest Bold SF Plan Asks Every Neighborhood To House The Homeless
On Thursday, the anti-poverty nonprofit Tipping Point Community will debut a new campaign called “All In.” It aims to secure 1,100 new permanent supportive housing units throughout San Francisco within two years. The goal is to add 100 units to each of the city’s 11 supervisorial districts. (Knight, 7/24)

North Carolina Health News: Houses Of God, And Harm Reduction
The North Carolina Council of Churches has been traveling around the state hosting these clergy breakfasts, wherever they’re invited, to discuss the opioid crisis and introduce harm reduction principles to the faith community. Just over 200 people have come to the breakfasts across 12 cities. Established in 1935, the council is comprised of 6,200 congregations and 18 denominations across North Carolina. Their clergy breakfasts are facilitated by Chris Pernell, the coordinator for their program Partners in Health and Wholeness, and Elizabeth Brewington, coordinator of their opioid response program. (Davis, 7/25)

The Star Tribune: Minneapolis' Bright Health Plans To Double Markets Where It Sells Health Plans 
Bright Health, the Minneapolis startup designed for the fast-changing U.S. insurance market, plans to double the number of U.S. markets where it will sell health coverage next year.The company said Wednesday that it plans to expand to 22 markets in 12 states, including offering insurance products for the first time in Chicago, Cleveland and Orlando. (Carson, 7/24)

Pediatrics: Infant Deaths In Sitting Devices
Annually, several hundred infant deaths occur in sitting devices (eg, car safety seats [CSSs] and strollers). Although American Academy of Pediatrics guidelines discourage routine sleeping in sitting devices, little is known about factors associated with deaths in sitting devices. Our objective was to describe factors associated with sleep-related infant deaths in sitting devices. (Liaw et al, 7/1)

JAMA Internal Medicine: Association Between Plant-Based Dietary Patterns And Risk Of Type 2 Diabetes: A Systematic Review And Meta-Analysis
In this systematic review and meta-analysis of prospective observational studies assessing the association between plant-based dietary patterns and risk of type 2 diabetes among adults, higher adherence to plant-based dietary patterns was associated with a lower risk of type 2 diabetes; this association was strengthened when healthy plant-based foods, such as fruits, vegetables, whole grains, legumes, and nuts, were included in the pattern. Findings were broadly consistent in several prespecified subgroups and in sensitivity analyses. (Qian et al, 7/22

Urban Institute: Nine Charts About The Future Of Retirement
Social Security cuts, shrinking employer-sponsored pensions, low savings rates, and longer life spans have raised fears of a looming retirement crisis. But other trends point to better retirement outcomes, such as women’s increased employment and earnings, longer working lives, and economic growth that raises wages. How will these conflicting trends play out? How will the next generations of older Americans fare in retirement relative to those who came before? And what will happen to retirees if Congress cuts Social Security benefits to address the program’s long-term financing gap? (7/23)

The Kaiser Family Foundation: A Look At People Who Have Persistently High Spending On Health Care
Health care spending is highly concentrated, with a small share of people accounting for a large share of expenditures during any year – just 5% of people are responsible for at least half of overall spending. This makes understanding and effectively managing the care for this group vital to improving the quality and efficiency of health care delivery. People with high health care spending are not a homogeneous group: some have very high spending during a short spell of illness, while others have ongoing high spending due to one or more chronic illnesses. (Claxton, Rae and Levitt, 7/22)

The Washington Post: Seema Verma: A Public Option For Health Insurance Is A Terrible Idea
The Affordable Care Act was signed into law nearly a decade ago, significantly expanding the role of the federal government in the U.S. health-care system. It’s telling that many have called for yet another overhaul of health care. This dramatic shift indicates a rare bipartisan consensus that the ACA has failed to achieve its objectives. The question then becomes what comes next. One common proposal is the so-called public option. It would introduce a government-run plan into the commercial health insurance market or, alternatively, allow consumers under age 65 to buy in to traditional Medicare. (CMS Administrator Seema Verman, 7/24)

The Wall Street Journal: Improve, Don’t Repeal, ObamaCare’s Cadillac Tax
There’s one provision of ObamaCare almost everyone wants to repeal. Last week the House voted 419-6 to repeal the so-called Cadillac tax, a 40% excise on high-cost employer-sponsored health insurance. The bill now moves to the Senate. Congress has twice delayed the tax—originally set to take effect in 2018—and weakened it by allowing employers to deduct the levy itself from their profits. But repealing the Cadillac tax is a bad idea. Instead, Congress should modify it to encourage the use of health savings accounts. (Brian Blase, 7/24)

The Washington Post: The Repeal Of The ‘Cadillac Tax’ Showed A Hazard Of Bipartisanship
Acting on the principle “Why put it off until tomorrow when you can do the wrong thing today?,” the House of Representatives last week voted to repeal a tax that is not scheduled to take effect until 2022. The vote against the “Cadillac tax” was 419 to 6, a reminder that “bipartisanship” often is the political class coming together to sacrifice the national interest to its own. Repeal of the promised tax of 40 percent on a portion of the most lavish employer-provided health-care plans would enlarge projected budget deficits by almost $200 billion over a decade. (George F. Will, 7/24)

The Hill: The Cost Of A 'Right' To Health Care Is Liberty
Should America create a broad right to health care? Americans already have a limited right to health care under the Emergency Medical Treatment and Active Labor Act, commonly known as EMTALA. Medicare-participating hospitals must provide emergency screening and stabilizing health care regardless of ability to pay. The leading Democratic presidential candidates support the creation of a broad “right to health care” through “Medicare for All” proposals. (George A. Nation, 7/24)

The New York Times: The Cruelty Of Trump’s Poverty Policy
On Tuesday, the Trump administration announced proposed rules that would cut more than three million people off food assistance. This latest plan confirms what many have long suspected: The only thing unifying its policies on poverty is cruelty. Prior right-ring assaults on the poor at least claimed some semblance of a coherent theme. In contrast, this proposal, and earlier ones, are a grab-bag of mutually inconsistent ideas seemingly selected only to maximize harm. When President Ronald Reagan attacked anti-poverty programs, he claimed to be limiting assistance to the poorest of the poor. He insisted he was protecting a “safety net” for the “truly needy.” To do this, he denied aid to millions of working families. (David A. Super, 7/24)

The Washington Post: Billionaires And Millionaires Against Food Stamps
When Ronald Reagan ran for president in 1976, he liked to badmouth people who received government benefits as undeserving. His prime example: a Chicago fraudster named Linda Taylor, dubbed “the welfare queen” by local tabloids. “Her tax-free cash income alone has been running $150,000 a year,” Reagan proclaimed. This tale set the table for the welfare cutbacks of the 1980s and 1990s, in which millions of poverty-struck people lost access to welfare programs they desperately needed to help them make ends meet. History, as they say, doesn’t repeat, but it sure does rhyme. (Helaine Olen, 7/24)

Stat: Strong Medicine Is Needed To Solve America's Rural Health Crisis
Growing up in the rural community of Fort Kent, Maine (population just shy of 4,000), I watched my parents struggle to find and keep a primary care physician. When I was young, this town in Aroostook, the state’s northernmost county, had a few die-hard general practitioners and surgeons, but as they retired I witnessed firsthand the toll their departure took on patients and families. I started dreaming of becoming a family doctor when I was 12. After medical school, I hoped to practice in a community like Fort Kent, but married a city boy from St. Louis who was tentative about rural life and tall snowbanks, and who wouldn’t go any further north than Connecticut. (Traci Marquis-Eydman, 7/25)

The Hill: The METRIC Act: Drug Price Transparency That The American People Deserve
Between January 2015 to January 2018, the drugs that multiple sclerosis patients rely on have skyrocketed from $60,000 to close to $100,000. In the last decade, the top three insulin manufacturers — Eli Lilly, Novo Nordisk, and Sanofi — have increased the price of insulin by 700 percent in lockstep as 1 in 4 diabetics rations or forgoes this lifesaving medication due to cost. And within this year alone, over 3,400 drugs have already seen price spikes of an average 10.5 percent, representing five times the rate of inflation. The American people are crying out. Prescription drug prices are literally killing them. (Rep. Jan Schakowsky, 7/25)

The New York Times: Living Intimately With Thoughts Of Death
Since my cancer diagnosis, I have lived intimately with thoughts of death. Cancer patients of all ages and stages, as well as people with other ruinous conditions, often experience “a double frame of mind,” as the polemicist Christopher Hitchens once put it. Laboring to survive in the present, we simultaneously imagine our future demise. Of course, feelings and beliefs about mortality range widely. But a number of thinkers have set out to help those who suspect that introspection about this state of mind may be the most important work we can undertake. (Susan Gubar, 7/25)