- KFF Health News Original Stories 2
- Religious Conservatives’ Ties To Trump Officials Pay Off In AIDS Policies, Funding
- Battle Lines Drawn As Abortion-Rights Activists Leave Their Mark Outside Clinics
- Political Cartoon: 'Rush Of Blood?'
- Capitol Watch 1
- Kavanaugh Tells Sen. Collins That Roe Is 'Settled' Law, But Critics Say He Still Could Vote To Change It
- Veterans' Health Care 1
- Report Finds VA Didn’t Follow Proper Procedures By Denying Veterans' Claims For Sexual Trauma Treatment
- Public Health 2
- Health Advisers Include New Options For Life-Saving Cervical Cancer Screening
- Trump's New Rules On Coal Plants Could Lead To More Premature Deaths, But Several Senators Welcome The Move
- State Watch 5
- Ohio Gov. Kasich Touts Medicaid Report Showing Expansion Cut State's Uninsured Rate By Half
- Mass. Nurses Point Finger At Hospital Execs In Fight Over Nurse Staffing
- Hospital Closures May Accelerate With 8% At Risk, Leaving More Patients Farther From Care
- In Calif., Parents And A Lawmaker Aim For Medical Marijuana To Be Allowed At School, Despite Federal Law
- State Highlights: Texas Study Finds Most Pregnancy-Related Deaths To Be Preventable; Court Revives Autism-Accommodation Lawsuits Regarding Disney Parks In Fla., Calif.
- Prescription Drug Watch 2
- Trump Administration Sends Up Mixed Signals On Drug Pricing, PBM Plans
- Perspectives: CVS Plan Lets Pharma Off Easy; What To Do With Prescription-Drug Middlemen
From KFF Health News - Latest Stories:
KFF Health News Original Stories
Religious Conservatives’ Ties To Trump Officials Pay Off In AIDS Policies, Funding
Shepherd Smith, a strong supporter of abstinence-only sex education for AIDS, has been close to the new director of the CDC for decades. This connection is just one example of the "new in crowd" surrounding the Trump administration, where politics and religion mix. (Marisa Taylor, )
Battle Lines Drawn As Abortion-Rights Activists Leave Their Mark Outside Clinics
Armed with poster board and catchy advertising slogans, abortion-rights activists in California and elsewhere are taking to sidewalks, buses and mobile phone apps to fight a recent U.S. Supreme Court ruling in favor of crisis pregnancy centers. (Ana B. Ibarra, )
Political Cartoon: 'Rush Of Blood?'
KFF Health News provides a fresh take on health policy developments with "Political Cartoon: 'Rush Of Blood?'" by John Cole, The Scranton Times-Tribune.
Here's today's health policy haiku:
TALKING ABOUT HEALTH SYSTEM CHANGE
What do young docs want?
Well… single-payer. But do
They know what that means?
If you have a health policy haiku to share, please Contact Us and let us know if we can include your name. Haikus follow the format of 5-7-5 syllables. We give extra brownie points if you link back to an original story.
Opinions expressed in haikus and cartoons are solely the author's and do not reflect the opinions of KFF Health News or KFF.
Summaries Of The News:
Kavanaugh Tells Sen. Collins That Roe Is 'Settled' Law, But Critics Say He Still Could Vote To Change It
Sen. Chuck Schumer, the Democratic leader, said in his meeting with Brett Kavanaugh, the Supreme Court nominee, that Kavanaugh refused to say whether Roe v. Wade had been settled correctly. "That should send shivers down the spine" of people who support the right to abortion, the New York senator said.
The Washington Post:
Sen. Susan Collins Says Kavanaugh Sees Roe V. Wade As ‘Settled Law’
A Republican senator whose vote could ensure the confirmation of Supreme Court nominee Brett M. Kavanaugh offered an upbeat assessment of their meeting Tuesday, highlighting the judge’s statement that the Roe v. Wade decision legalizing abortion is “settled law.” Sen. Susan Collins (Maine), a centrist who supports abortion rights, appeared to be leaning toward backing President Trump’s nominee after a one-on-one session that lasted more than two hours. Collins said she would announce her decision after confirmation hearings next month. (Viebeck and Pogrund, 8/21)
Collins Says Supreme Court Nominee Kavanaugh Called Roe V. Wade 'Settled Law'
That assurance, made during a Tuesday morning meeting in the Maine senator's office that lasted more than two hours, likely goes a long way toward securing a key vote for Kavanaugh's confirmation. Collins supports abortion rights and made sure to point out she viewed the 1973 decision as "settled law" in her initial reaction to the news that abortion rights swing vote Anthony Kennedy was retiring from the Supreme Court. (Detrow, 8/21)
The New York Times:
Roe Is ‘Settled Law,’ Kavanaugh Tells Collins. Democrats Aren’t Moved.
Democrats immediately pounced on the “settled law” construction, saying it is a standard phrase employed to duck the real question: whether Roe was correctly decided. “Let’s be clear; this is not as simple as Judge Kavanaugh saying that Roe is settled law,” Senator Chuck Schumer of New York, the minority leader, told reporters. “Everything the Supreme Court decides is settled law until it unsettles it. Saying a case is settled law is not the same thing as saying a case was correctly decided.” (Stolberg, 8/21)
Schumer After Meeting With Kavanaugh: Roe V. Wade Is In Jeopardy
Senate Minority Leader Chuck Schumer said he left his 90-minute meeting with Supreme Court nominee Brett Kavanaugh convinced that the conservative jurist could vote to overturn Roe v. Wade if confirmed. Schumer (D-N.Y.) was one of five Democrats who met privately with Kavanaugh on Tuesday afternoon. ... “I asked him if he agreed that Roe v. Wade and Casey v. Planned Parenthood were correctly decided,” Schumer told reporters. “He would not say yes. That should send shivers down the spine of any American who believes in reproductive freedom for women.” (McCaskill, 8/21)
The Wall Street Journal:
Kavanaugh Says Roe V. Wade Is ‘Settled Law,’ GOP Senator Says
Judge Kavanaugh’s comments, as reported by Ms. Collins, echo how other Republican nominees have handled the issue of abortion during confirmation battles. Chief Justice John Roberts said at his 2005 confirmation hearing that Roe v. Wade was precedent and “it is not enough that you may think the prior decision was wrongly decided” to reopen a case. ... Judge Kavanaugh’s record on abortion has been under scrutiny on Capitol Hill. As a judge on the influential U.S. Court of Appeals for the District of Columbia Circuit, Judge Kavanaugh has had no choice but to follow law as settled by the Supreme Court, as lower courts are required to do. At times his opinions suggest that is the only reason he has done so. (Andrews and Tau, 8/21)
Collins: Kavanaugh Sees Roe V. Wade As 'Settled Law'
Collins said she also spoke to Kavanaugh “at length” about Garza v. Hargan, the only abortion case Kavanaugh has rendered a decision on. “We talked about whether he considered Roe to be settled law,” Collins told reporters. ... Collins and Sen. Lisa Murkowski (R-Alaska), who will meet with Kavanaugh later this week, are viewed as possible swing votes on Kavanaugh’s confirmation. Both moderate Republicans are sympathetic to abortion rights. (McCaskill, 8/21)
Collins: Kavanaugh Considers Roe V. Wade 'Settled Law'
Collins is one of the final GOP lawmakers to meet with President Trump’s Supreme Court pick and is widely considered to be a potential swing vote because she’s broken with her party on issues related to health care and abortion. (Carney, 8/21)
Kaiser Health News:
Battle Lines Drawn As Abortion-Rights Activists Leave Their Mark Outside Clinics
Abortion-rights activists in California and beyond have launched or stepped up information campaigns in response to a June U.S. Supreme Court ruling that crisis pregnancy centers cannot be required to tell women about the availability of publicly funded family planning services, including contraception and abortion. Through sidewalk drawings, bus-shelter ads and pop-up messages on mobile devices, these activists seek to spread the word themselves about such services, especially to young, low-income women. They aim to warn them about what they see as incomplete or false information provided by the centers, which are typically affiliated with Christian organizations and seek to persuade women to continue their pregnancies. (Ibarra, 8/22)
On The Campaign Trail, GOP Candidates Struggle To Find Clear Health Care Message
Meanwhile, Sen. Claire McCaskill (D-Mo.) took an opportunity during a Senate hearing to press a Trump administration official on a pending lawsuit challenging the Affordable Care Act's protections for pre-existing conditions. In California, talk about single-payer reform plans are ramping up in the race for governor.
Los Angeles Times:
Once Their Rallying Cry, Obamacare Is Suddenly A Sticky Campaign Issue For Republicans
After failing to deliver on their years-long promise to repeal the Affordable Care Act and faced with the sudden popularity of Obamacare’s consumer protections, GOP candidates across the country are struggling to put together a cohesive message on healthcare. Die-hards still want to repeal the 2010 law, but a growing number of Republicans — particularly those facing tough elections — want to quietly admit defeat and move on to other issues. (Haberkorn, 8/21)
McCaskill Presses Trump Official On Lawsuit Against Pre-Existing Condition Protections
Sen. Claire McCaskill (D-Mo.) pressed a top Trump administration official on Tuesday about a lawsuit challenging ObamaCare’s pre-existing condition protections. McCaskill, who is facing a tough reelection race this year, used a Senate Homeland Security and Governmental Affairs Committee hearing to press the head of the Centers for Medicare and Medicaid Services (CMS) about the lawsuit. (Sullivan, 8/21)
Los Angeles Times:
Gavin Newsom Criticized For Flip-Flopping On California's Most Pressing Issues
Part of the foundation of Newsom’s campaign for governor has been his strong support for establishing a single-payer healthcare system in California ... But former San Francisco County Supervisor Tom Ammiano, author of the ordinance that evolved into Healthy San Francisco, said Newsom “tried to undermine it as best he could” while it was being debated, in part because of concerns over cost to employers in the city. After Healthy San Francisco was approved, Newsom embraced it, Ammiano said. (Willon, 8/20)
Hospital Sleuths Unearth Surprise: Knee Surgery Bills Are 5 Times Its Cost.
Officials at Gundersen Health System in Wisconsin decided that they needed better numbers for the cost of a knee replacement, The Wall Street Journal reports. They were billing more than $50,000 and, after a study, found that the real cost was closer to $10,550. In other health industry news, Bloomberg profiles consumers who are priced out of health insurance, Maryland gets federal approval for a plan to help spread costs and risks across insurers, and Delaware approves an increase for the insurer that sells on the federal health law's marketplace.
The Wall Street Journal:
What Does Knee Surgery Cost? Few Know, And That’s A Problem
For nearly a decade, Gundersen Health System’s hospital in La Crosse, Wis., boosted the price of knee-replacement surgery an average of 3% a year. By 2016, the average list price was more than $50,000, including the surgeon and anesthesiologist. Yet even as administrators raised the price, they had no real idea what it cost to perform the surgery—the most common for hospitals in the U.S. outside of those related to childbirth. ... Prompted by rumblings from Medicare and private insurers over potential changes to payments, Gundersen decided to nail down the numbers. ... The actual cost? $10,550 at most, including the physicians. The list price was five times that amount. (Evans, 8/21)
Priced Out Of Health Insurance, Americans Rig Their Own Safety Nets
The number of people joining so-called health-care sharing ministries—religion-based cost-sharing plans—rose 74 percent from 2014 to 2016, according to the latest Internal Revenue Service data. An alliance for the groups said that more than 1 million people now participate in such programs. Similarly, primary-care clinics like the one Julie Gunther started in 2014 have grown to almost 900 from just a handful in the early 2000s, according to the Direct Primary Care Coalition, a trade group for the clinics. (Tozzi, 8/22)
The Associated Press:
Maryland Lawmakers Say Health Reinsurance Plan OK’d
Maryland lawmakers say a federal waiver has been approved to hold down consumer costs to Maryland’s individual market for insurance in the state’s health care exchange. Sen. Thomas Middleton and Del. Joseline Pena-Melnyk said Tuesday the federal government has approved Maryland’s plan to create a reinsurance plan. The lawmakers, both Democrats, sponsored legislation for the plan. (Witte, 8/21)
U.S. Approves Waiver Allowing Maryland To Lower Obamacare Premium Costs
State officials plan to announce Wednesday that the Trump administration has approved a federal waiver that is expected to stave off increases in health insurance costs for more than 200,000 Marylanders. ... The plan imposes a one-year state tax on insurance companies and uses that revenue to subsidize the most expensive health insurance claims from policies sold through Maryland’s health exchange. By lowering the risk to insurers selling on the individual market, state leaders hope to lower premiums enough to make them affordable next year. (Dresser, 8/21)
Related KHN coverage: States Leverage Federal Funds To Help Insurers Lower Premiums (Findlay, 8/15)
The Associated Press:
Delaware Officials Approve ACA Rate Request
Delaware regulators have approved a 3 percent rate increase for the lone insurer offering coverage under the Affordable Care Act in Delaware. Highmark Blue Cross Blue Shield of Delaware initially sought an average rate increase of 5.7 percent for individual plan coverage next year. The request was revised to 3.7 percent because the initial filing erroneously contained a risk adjustment factor. (8/22)
U.S. Has Lowest Life Expectancy Among High-Income Developed Countries
The report in the British Medical Journal finds 14 industrialized countries have declining life expectancy rates. Much of the problem in the U.S. centers on the opioid epidemic and the resulting deaths among younger adults. In other countries, the declines focused on people over the age of 65.
US Sees Drop In Life Expectancy, Largely Due To Opioid Crisis Among Young Adults
The United States is among 14 high-income countries with declining life expectancy rates, according to new research recently published in the British Medical Journal. The research features findings from two separate observational studies, one pointing to the ongoing opioid crisis in the U.S. as a key contributor to recent declines, and another suggesting the declines in both the U.S. and the United Kingdom transcend the opioid epidemic among diverse populations. (Pirani, 8/21)
Poll: Most Americans Know About Opioid Antidote And Are Willing To Use It
After the surgeon general called for more people to be prepared with naloxone, we decided to ask Americans about their knowledge about the opioid antidote's availability, attitudes toward using it and experience with the medicine in the latest NPR-IBM Watson Health Health Poll. The survey queried more than 3,000 households nationwide in May. We wondered how many people know about naloxone and the fact that someone doesn't have to be a medical professional to administer it. Fifty-nine percent of respondents said they were aware of the antidote and that it could be given by laypeople; 41 percent said they weren't. (Hensley, 8/21)
Amazon's New Hire Brings History Of Introducing Health Professionals To Technology
In other market developments, biotech instrument maker Bionano Genomics goes public and more legal action for Herbalife.
Amazon’s Latest Health Care Hire Brought Technology Into The Clinic
Dr. Maulik Majmudar has spent years toiling on a task Amazon must master to disrupt the nation’s health care industry: getting physicians to incorporate novel technologies into their practices. This week, he announced he is taking a new job with the ecommerce giant following several years incubating new technologies at Massachusetts General Hospital. (Ross, 8/21)
The Wall Street Journal:
Biotech Instrument Maker Bionano Genomics Bucks Trend In $20.6 Million IPO
Bionano Genomics Inc. has gone public in an unusual move for a venture-backed biotech research instrument company, making its Nasdaq debut Tuesday. Drug developers capture the bulk of medical venture-capital dollars, and among health-care startups, they are the most likely to go public. Drug makers also made up the majority of the 29 venture-backed health-care companies that staged initial public offerings in the first half of the year, according to Dow Jones VentureSource. (Gormley, 8/21)
The Associated Press:
Herbalife Distributors Claim In $1B Suit Events Were A Sham
Patricia and Jeff Rodgers figured they did everything right to get rich beyond their wildest dreams selling Herbalife health and personal care products. They attended all of the “Circle of Success” events, brought in new recruits, met their quotas on buying Herbalife goods to sell and even set up a storefront shop. But they didn’t get rich. Instead, Patricia Rodgers estimates the couple lost over $100,000, including about $20,000 spent on attending Herbalife events. Now, the couple and others are suing the multi-level marketing company that sells its products through a network of distributors who recruit more distributors. The potential class-action case could involve more than 100,000 plaintiffs and might mean as much as $1 billion in damages. (Anderson, 8/21)
Report Finds VA Didn’t Follow Proper Procedures By Denying Veterans' Claims For Sexual Trauma Treatment
A top Veterans Affairs official says the agency will review all the denied medical claims dating back to late 2016.
VA Wrongly Denied Hundreds Of Veteran Claims Of Military Sexual Trauma
The Department of Veterans Affairs improperly denied hundreds of military sexual trauma claims in recent years, leaving potentially thousands of veterans suffering from post-traumatic stress disorder without benefits, a VA inspector general investigation found. Last year alone, the investigation found the agency mishandled as many as 1,300 sexual trauma claims. Some 12,000 veterans file for sexual trauma-related PTSD benefits each year. (Slack, 8/21)
The Wall Street Journal:
VA May Have Erred In Rejecting Sexual-Trauma Claims, Report Says
The VA declined to comment beyond its official response to the report. In that response, Paul Lawrence, the top VA official for benefits, concurred with the findings and said the department would review all denied military sexual-trauma claims stretching back to late 2016. He also said the VA would improve training for claims processors and make sure trauma claims are handled by case workers with specialized training. The VA doesn’t expect to complete these fixes until fall of 2019. (Kesling, 8/21)
Health Advisers Include New Options For Life-Saving Cervical Cancer Screening
Because most cervical cancer is caused by the human papillomavirus, the US Preventive Services Task Force says women ages 30-65 now have the choice to get an HPV test every five years, a Pap test every three years or a combination of both tests every five years. Also in women's health news: a bill is being introduced to address the disparity in maternal health outcomes.
For Cervical Cancer Screening, Women Over 30 Can Now Choose The HPV Test Only
Federal health advisors say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force (USPSTF), has expanded its recommendations for this potentially life-saving exam. The new recommendations are published in the latest issue of JAMA. (Harris, 8/21)
New Cervical Cancer Screening Recommendations Include More Options
In the past, the recommendations for women in that age group had suggested a Pap every three years and co-testing every five years. However, for women between 21 and 30, the previous recommendation of only a Pap smear every three years remains in place. That has been a guideline since the introduction of the Pap, also called exfoliative cytology, 75 years ago. (LaMotte, 8/21)
Also on the topic of women's health -
Los Angeles Times:
Maternal Mortality Rates In The U.S. Have Risen Steadily. Sen. Kamala Harris Has A Plan To Change That
Sen. Kamala Harris says she wants to force the medical community to address an uncomfortable reality: Black women in the United States are three to four times more likely than white women to die immediately before or after child birth. The California Democrat plans to introduce a bill Wednesday to provide $30 million in annual grants to train against racial bias and to incentivize healthcare professionals to address the disparity in maternal health outcomes. (Haberkorn, 8/22)
Trump's New Rules On Coal Plants Could Lead To More Premature Deaths, But Several Senators Welcome The Move
Meanwhile, government officials from a collection of more than a dozen states that supported Obama era regulations vow to file court challenges to the administration's changes. Other reports on environmental news include warnings about the health toxins caused by wildfires in the West and improving air quality in Minnesota.
The New York Times:
Cost Of New E.P.A. Coal Rules: Up To 1,400 More Deaths A Year
The Trump administration has hailed its overhaul of federal pollution restrictions on coal-burning power plants as creating new jobs, eliminating burdensome government regulations and ending what President Trump has long described as a “war on coal.” The administration’s own analysis, however, revealed on Tuesday that the new rules could also lead to as many as 1,400 premature deaths annually by 2030 from heart and lung disease, up to 15,000 new cases of upper respiratory problems, a rise in the extremely fine particulate matter that can trigger bronchitis, and tens of thousands of missed school days because of to increased pollution. (Friedman, 8/21)
How Trump’s Rules On Coal-Fired Power Plants Differ From Obama’s
The new EPA proposal, called the Affordable Clean Energy Rule, would give states leeway on whether to limit emissions and by how much, and allow older power plants to operate longer. The proposal, called the Affordable Clean Energy Rule, would replace Obama era regulations. Those rules aggressively pushed for accelerated closures of older coal-fired plants by setting national targets, by reducing carbon dioxide emissions, and encouraging adoption of cleaner energies, such as solar and wind power. (Alcindor, 8/21)
The Associated Press:
US Plan For Coal Power Deregulation Could Cause More Deaths
EPA officials said they could give no firm projections for the health effects of their plan because that will depend on how states regulate power plants within their borders. But models provided by the agency estimate that under the Trump plan, 300 to 1,500 more people would die prematurely each year by 2030, compared to the Obama plan. The models for the Trump plan also project tens of thousands of additional major asthma attacks and hundreds more heart attacks compared with the Obama plan. (Knickmeyer and Borenstein, 8/22)
The Associated Press:
States Blast Trump Administration Coal Plan, Mull Lawsuits
States with a history of fighting air pollution generated by coal-fired power plants on Tuesday criticized a move by President Donald Trump’s administration to scale back federal restrictions on emissions, with some threatening court challenges. Illinois Attorney General Lisa Madigan was among those who pledged to “take legal action to ensure the federal government does its job” to protect the environment and people’s health. ... New York Attorney General Barbara Underwood also vowed to sue the Environmental Protection Agency if the plan is approved. Both are Democrats. (Haigh, 8/21)
Trump Unveils Major Rollback Of Obama's Clean Power Plan
Texas’ Republican leadership cheered the new proposal on Tuesday, which will go through a public comment period and is sure to face legal challenges. “I’m glad to see President Trump remains committed to eliminating job-killing Obama regulations that for years were a wet blanket on the Texas economy,” Republican U.S. Sen. John Cornyn of Texas said in a statement. “By rolling back this rule, Texas and other states will now have the freedom to determine a clean energy plan that works best for them. Pro-growth policies under this Administration continue to boost the Texas economy and benefit Americans across the country.” (Collier, 8/21)
West Coast Smoke: Scientists Warn Of Longer And Harsher Season
Across California and the West, where dozens of large wildfires are burning, public health agencies are urging people to seal off their windows and doors, change filters in air conditioning units and in some places wear masks if they have to go outside for any extended period. Just as the wildfire season is getting longer and more destructive in the West due to climate change and prior forest management, scientists are warning of a lengthening — and worsening — smoke season. The fires themselves have burned hundreds of homes and forced thousands to evacuate. But the smoke, and the unhealthy toxins blowing in with it, will directly affect hundreds of thousands more people. (Siegler, 8/21)
Air Quality Improving, But Smoke Took A Toll On Upper Midwest
The air quality around Minnesota is improving, and state officials are predicting good to moderate air quality for the rest of the week. But it's been a summer of many air quality alerts, and doctors and people who are active outdoors have noticed the effects. (Lebens, 8/22)
Ohio Gov. Kasich Touts Medicaid Report Showing Expansion Cut State's Uninsured Rate By Half
Ohio's Medicaid expansion is among the outgoing governor's signature achievements. He is using this report as well as stories from people who have gained coverage to shore up support for it before he leaves office.
Report Touts Benefits Of Medicaid Expansion
In his final months in office, Gov. John Kasich sought on Tuesday to shore up support for his signature Medicaid expansion, arguing that the health coverage has helped thousands of Ohioans get needed care at a reasonable cost. ...While the federal government pays 63 percent of traditional Medicaid costs, the federal match is 93.5 percent for expansion costs, phasing down to 90 percent in 2021, amid ongoing rumblings that Ohio lawmakers and Washington Republicans could try to dismantle the four-year-old program as financially unsustainable. (Candisky, 8/21)
Ohio Medicaid Expansion Cut Uninsured By Half, Report Finds
Four years after going out on a limb to get Medicaid expansion enacted in Ohio, outgoing Republican Gov. John Kasich is worried about the future of the program. So he is now defending it — through a study and through the stories of people who have benefited from the coverage expansion. (Kasler, 8/21)
Also in the news about Medicaid -
GAO Urges Scrutiny Of Medicaid Managed-Care Organizations
The U.S. comptroller general on Tuesday urged a Senate panel to tighten oversight of Medicaid providers and managed-care plans, and criticized the Obama administration's lax auditing of Medicaid insurers as millions joined the rolls through expansion. Comptroller General Gene Dodaro and CMS Administrator Seema Verma urged lawmakers on the Senate Homeland Security and Governmental Affairs Committee to look at managed care in expansion states, particularly when they cover large swaths of the Medicaid population. Improper Medicaid payments soared to an estimated $37 billion in fiscal 2017, and Dodaro argued that the federal government needs to join forces with state auditors to combat the issue. (Luthi, 8/21)
Mass. Nurses Point Finger At Hospital Execs In Fight Over Nurse Staffing
The fight is headed to the ballot in November. Massachusetts voters will decide whether to impose limits on the number of patients assigned to hospital nurses, a measure that hospital executives oppose. “Hospital executives are the ones who have ignored nurses’ concerns, claiming a lack of resources for safe patient care, while pocketing seven-figure salaries," said Donna Kelly-Williams, president of the Massachusetts Nurses Association.
Nurses Rally For Ballot Initiatives On Staffing, Target Hospital Execs
The Massachusetts Nurses Association, the labor union behind the statewide ballot question to increase nurse staffing in hospitals, slammed hospital executives Tuesday for opposing the measure. The ballot question would set strict limits on the numbers of patients assigned to hospital nurses. (Dayal McCluskey, 8/21)
State House News Service:
At Partners, Nurses Say Hospitals Can Afford Staffing Requirements
Hospitals campaigning against patient limits for nurses are making false claims about their ability to afford patient care limits, according to nurses who traveled to the headquarters of one of the state's largest care providers to make their point on Tuesday. Outside Partners HealthCare in Somerville, nurses from the Massachusetts Nurses Association (MNA), along with members from the Teamsters, drew attention to the facility, estimating its cost at $464 million. (Triunfo, 8/21)
Hospital Closures May Accelerate With 8% At Risk, Leaving More Patients Farther From Care
Currently 30 hospitals a year are shutting down across the U.S., Bloomberg reports. That number could increase, according to a Morgan Stanley analysis, with facilities in rural areas are particularly at risk. More hospital news also comes out of Texas, Minnesota and Denver.
U.S. Hospitals Shut At 30-A-Year Pace, With No End In Sight
Industry M&A may be no savior as the pace of hospital closures, particularly in hard-to-reach rural areas, seems poised to accelerate. Hospitals have been closing at a rate of about 30 a year, according to the American Hospital Association, and patients living far from major cities may be left with even fewer hospital choices as insurers push them toward online providers like Teladoc Inc. and clinics such as CVS Health Corp’s MinuteClinic. (Flanagan, 8/21)
Multnomah County Puts 2 Administrators On Leave Over Handling Of Health Care Complaints
The top administrator of Multnomah County's mental health services is on leave, pending an internal investigation over how his department handled complaints about Portland's psychiatric crisis center and other health care providers. David Hidalgo, director of Mental Health and Addiction Services, was placed on indefinite leave last Wednesday. Joan Rice, the quality manager for the health department, is also on leave. She serves as the de facto clearinghouse for complaints and ultimately decides what to do with them. (Harbarger, 8/21)
Dallas Morning News:
Baylor Health System To Anchor National Push To Improve Medicaid Patient Care
Baylor Scott & White Health, one of the largest nonprofit health systems in Texas, is joining more than a dozen health care providers across the nation to try to reduce the cost and improve the efficiency of caring for Medicaid patients. Called the "Medicaid Transformation Project," the national effort is designed to "transform health care and related social needs" for the more than 67 million Americans who rely on Medicaid for care, according to Avia, a network used by hospitals and health systems that focuses on innovation. The official announcement of the project was expected Wednesday. (Robinson-Jacobs, 8/22)
The Star Tribune:
Allina To Expand Its Twin Cities Retail Clinic Network
After opening two clinics in retail stores this spring, Allina Health System has plans for four more by March as part of a broader effort to make it easier for patients to get quick care for basic ailments. In a financial statement this month, Minneapolis-based Allina disclosed the expansion plans, which will feature clinics inside Hy-Vee grocery stores that treat a limited set of health problems. (Snowbeck, 8/21)
Anschutz Foundation Gives $120M To University Of Colorado Medical Campus
The University of Colorado’s Anschutz Medical Campus on Tuesday announced a $120 million gift that school leaders say will help them recruit more physicians and scientists to the growing Aurora campus. CU officials said the gift, which is the largest private commitment in the medical campus’s history, came from The Anschutz Foundation and its founder and chair, Philip Anschutz. With the pledge, the foundation has invested nearly $300 million in the medical campus since 2000, according to the university. (Seaman, 8/21)
In Calif., Parents And A Lawmaker Aim For Medical Marijuana To Be Allowed At School, Despite Federal Law
Each day, Karina Garcia has to take her son Jojo, a 19-year-old with severe epilepsy, off school grounds to squirt a dose of cannabis oil into his mouth, then return him to school for his special education classes. In Massachusetts, the state Department of Public Health backs away from settling a fight over medical marijuana quality testing. And in Florida, Wells Fargo closes the account of a medical marijuana-supporting candidate.
San Francisco Chronicle/California Healthline:
Medical Pot On School Grounds: Parents, Bay Area Legislator Making The Push
Garcia is among a growing number of parents who are using medical marijuana to treat their sick children, often after pharmaceutical remedies have failed. In recognition of this, California is considering a law that would allow parents to administer the drug at school, a move that could set up a showdown with the federal government, whose laws make it a crime to possess, buy or sell marijuana. (Young, 8/21)
State Refuses To Referee Marijuana Testing Dispute
It was a cornerstone of the pitch for legalizing marijuana in Massachusetts: Mandated laboratory testing would ensure that cannabis products sold in regulated stores are free of pesticides, mold, and other contaminants. Behind the scenes, however, a bitter scientific and business feud has split into two camps the state’s four marijuana testing labs, which currently serve medical dispensaries and will soon join the lucrative recreational market. (Adams, 8/21)
The New York Times:
A Candidate Backed Medical Marijuana. Wells Fargo Closed Her Bank Account.
Wells Fargo isn’t the first bank to close a customer’s account over money that could be related to the sale of marijuana, which is legal in some form in states including Florida but still prohibited by federal law. That conflict has had banks large and small walking a line for more than a decade, since the first states began changing their cannabis laws. Marijuana growers have struggled to open and maintain bank accounts, and dispensaries have relied on cash to do business instead of credit cards. Businesses like construction companies and electricians that provide services to the growers and distributors have also had problems. (Flitter, 8/20)
State Highlights: Texas Study Finds Most Pregnancy-Related Deaths To Be Preventable; Court Revives Autism-Accommodation Lawsuits Regarding Disney Parks In Fla., Calif.
Media outlets also report on other news from Texas, Florida, California, Montana, Missouri, Ohio, Georgia, Wisconsin, Tennessee, Kansas and Nevada.
Texas Study: Most Pregnancy-Related Deaths Avoidable
Most pregnancy-related deaths in Texas in 2012, which saw the highest number of maternal deaths to date, could have been prevented, according to a new state report. The most common causes of pregnancy-related deaths were heart issues, hemorrhaging, and infection. (Chang, 8/21)
Health News Florida:
Autism Accommodation Lawsuits Revived Against Disney
In a detailed, 65-page ruling, a federal appeals court Friday said a trial is needed in a legal battle about whether Disney theme parks have taken adequate steps to meet the needs of customers who have autism and cannot wait long times for rides. ...The appeals court decision came in 30 consolidated cases that involve allegations under the Americans with Disabilities Act and deal with Disney parks in Florida and California. (Saunders, 8/21)
Suicide Rates In Rural America Are Soaring. One Family Is Working To Change That.
The suicide rate in rural America is 45% greater than in large urban areas, according to a study released last fall by the US Centers for Disease Control and Prevention. A more recent CDC report said Montana's suicide rate leads the nation, coming in at nearly twice the national average. A third long-touted CDC study, currently under review, listed farming in the occupational group, along with fishing and forestry, with the highest rate of suicide deaths. (Ravitz, 8/21)
St. Louis Public Radio:
Missouri Asks To Add Addiction Treatment To St. Louis Health Program For Poor, Uninsured
The Missouri Department of Health and Senior Services has asked the federal Centers for Medicare and Medicaid Services to add anti-addiction drugs and services to the Gateway to Better Health program. Substance abuse treatment is an important service to add to Gateway’s short list of benefits, said Robert Freund, CEO of the St. Louis Regional Health Commission, which operates and monitors the program. (Fentem, 8/21)
Ohio State Announces New Office To Replace Troubled Sexual Civility Center
Ohio State University announced Tuesday the creation of a new centralized office to address issues involving sexual misconduct and gender harassment. The school promised in June that it would create a new office by the start of fall semester, after closing its troubled Sexual Civility and Empowerment Center and eliminating four positions. The closure followed an independent review that found the center had failed to properly report and handle some students’ sexual-assault complaints. (Woods, 8/21)
St. Louis Public Radio:
St. Louis Doctors Change Antibiotic Treatment Tactics For Premature Infants To Curb Drug Resistance
Pediatricians are changing how they talk about about antibiotic treatment for preemies, due to the growing threat of drug-resistant organisms and recent research on the long-term effects of early antibiotic exposure. Doctors want to choose antibiotics that are strong enough to treat the infection, but at the same time, they don’t want to apply so much pressure to microbes in the infant’s body that it causes them to develop drug resistance, when bacteria develop the ability to defeat drugs designed to kill them. (Chen, 8/21)
Georgia Health News:
Georgia Tech Teams With ‘Big Data’ Experts To Study Medical Imaging
Last week, the American College of Radiology’s Harvey L. Neiman Health Policy Institute announced a five-year, $3 million research partnership with the Georgia Institute of Technology to establish the Health Economics and Analytics Lab (HEAL), with the Ivan Allen College of Liberal Arts at Georgia Tech. HEAL will apply big data analytics and artificial intelligence to large-scale medical claims databases — focusing on medical imaging — to better understand how health care delivery and payment models affect patients and providers. (Thomas, 8/21)
Lincoln Hills Mental Health Program Gets Upgrade From National Group
Conditions at the state's troubled youth prison are showing signs of improvement with an endorsement from a national group that rates mental health training programs in correctional institutions and elsewhere. The American Psychological Association on Tuesday said the Lincoln Hills School for Boys and Copper Lake School for Girls' psychology internship program was now in good standing and in compliance with industry regulations that govern safety, quality and credibility. (Kyle, 8/21)
Vanderbilt Opening Transgender Health Clinic In Nashville
Vanderbilt University Medical Center will open a new clinic dedicated to transgender patients on Friday, expanding a limited-yet-growing number of options for transgender-tailored health care in Tennessee. The clinic, which is intended as a comprehensive health care provider, will offer primary care, medical specialists, mental health services, hormone therapy and guidance both before and after transition surgery, according to an announcement from the hospital. (Kelman, 8/21)
Fearing Cuts To Healthcare, Some Transgender People In Kansas City Embrace Crowdfunding
Medical expenses are the category most often used on GoFundMe, which is the largest crowdfunding platform. And in recent years, campaigns have snowballed for one particular kind of medical care: gender confirmation surgery. GoFundMe has nearly 5,000 active campaigns for transgender surgery, a number that's doubled since 2014 and includes more than a dozen campaigns in the Kansas City area. The company's website even has a special page to help guide people through the steps of transitioning and their costs. (Smith, 8/22)
Las Vegas Shooting: Doctor Faces Discipline Over Drug Records
A Nevada state licensing board has accused a doctor and his staff of accessing the private prescription drug records of Las Vegas shooter Stephen Paddock before similar details were published by a media outlet. The doctor, Ivan Goldsmith, an internal medicine and weight-loss specialist who owns the Trimcare clinic in Las Vegas, is scheduled to appear before the Nevada State Board of Pharmacy on Sept. 5 to face possible discipline over the disclosure of Paddock's prescription drug records, according to pharmacy board officials. (Alltucker, 8/21)
Trump Administration Sends Up Mixed Signals On Drug Pricing, PBM Plans
News outlets report on stories related to pharmaceutical pricing.
The Trump Administration Can't Decide Whether To Boost PBMs Or Rein Them In
Some days, President Trump vows to eliminate them. But then, there are days when his top health lieutenants promise to empower them. There are even days when they do both. The mixed and muddled signals from the administration are over the increasingly contentious role of the pharmacy benefit managers, or PBMs. Those discordant signals reflect a lack of clarity from Trump and his lieutenants over how best to address one of their top priorities: how to lower prescription drug prices. (Swetlitz, 8/22)
U.S. Health Secretary Says Agency Can Eliminate Drug Rebates
U.S. Health and Human Services Secretary Alex Azar said it was within his agency’s power to eliminate rebates on prescription drug purchases, a key element of the Trump administration’s plan to lower prescription medicine costs. Such rebates are negotiated in the United States by pharmacy benefits managers (PBMs) to lower the cost of medicines for their clients, including large employers and health plans that cover tens of millions of Americans. (Abutaleb, 8/20)
FDA Convenes Working Group On Importing Drugs From Other Countries
A controversial Food and Drug Administration working group has begun discussing how to import drugs from other countries as a way of bringing down prices for American patients, a top Trump administration health official said Monday. “That work group has met and is outlining its plan of action,” Dan Best, senior adviser on drug pricing, said on a phone call with reporters. “As more of that information becomes available, we’ll make it available to the market.” (Swetlitz, 8/20)
China's First Cancer Immunotherapy Will Cost Half Of What It Costs In The U.S.
The blockbuster cancer drug Opdivo will be sold for about $84,000 per year in the Chinese market, before discounts — meaning that China’s first cancer immunotherapy will come at about half the price it costs in the U.S. The price tag for the Bristol-Myers Squibb drug, which is in line with analysts’ expectations, will be an early test of whether the Chinese market can support a coming wave of innovative but pricey medicines. (Robbins, 8/21)
Drugmakers Extend Summer Rally As Markets Regain Footing
Major pharmaceutical companies are partying like it’s 2001. U.S. drugmakers including Pfizer Inc., Eli Lilly & Co., and Merck & Co. are seeing their share prices balloon to the highest levels in more than 16 years as investors rotate in after second-quarter results proved stronger than expected. Impressive earnings paired with waning concerns about potential Trump administration actions on drug pricing could be helping to draw generalist investors in a bit of a “catch up trade,” according to Credit Suisse analyst Vamil Divan. (Lipschultz, 8/20)
Becker's Hospital Review:
These 6 Drugmakers Froze Price Hikes In Response To Trump's Criticism
The pharmaceutical industry is facing increased pressure from President Donald Trump, lawmakers and the public to lower drug prices. In July, President Trump slammed pharma giant Pfizer on Twitter, saying the company should be "ashamed" of the decision to increase the list price of more than 100 drugs and treatments. ... Here is a breakdown of six drugmakers who postponed price hikes or lowered drug prices since the July 9 tweet. (Paavola, 8/20)
WRVO Public Media:
Drug Pricing Experiment Offers Oklahoma Rebate If Drugs Don't Work
This summer, Oklahoma’s Medicaid program was approved for a value-based purchasing program -- a first-in-the-nation drug pricing experiment that hopes to incentivize drug companies to stand behind their product. Jackie Fortier reports on health policy for StateImpact Oklahoma, a collaboration of NPR member stations in Oklahoma that focuses on how government policy affects people’s lives. Fortier spoke to us this August on "Take Care," right before the new drug-pricing model began. She said though there are plenty of skeptics, the new program might do some good for the state and provide an example for other states to follow. (8/19)
Ohio Firing Pharmacy Middlemen That Cost Taxpayers Millions
The Ohio Department of Medicaid is changing the way it pays for prescription drugs, giving the boot to all pharmacy middlemen because they are using "spread pricing," a practice that has cost taxpayers hundreds of millions. Medicaid officials directed the state's five managed care plans Tuesday to terminate contracts with pharmacy benefit managers using the secretive pricing method and move to a more transparent pass-through pricing model effective Jan. 1. (Sullivan and Candisky, 8/14)
Why A Patient Paid A $285 Copay For A $40 Drug
Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March by the University of Southern California’s Schaeffer Center for Health Policy and Economics. USC researchers analyzed 9.5 million prescriptions filled during the first half of 2013. (Thompson, 8/19)
Aimovig Launch Bolsters Hopes For Blockbuster Sales
The first drug approved for migraine prevention since Allergan's Botox, Aimovig offers a new option for the 10 million Americans that Amgen estimates suffer from the debilitating headache condition. ... Perhaps seeking to avoid a similar fate, Amgen and Novartis priced Aimovig at a lower-than-expected $6,900 per year in an effort to win broad coverage for the drug. So far, it seems that approach is paying off. "The response to Aimovig in the marketplace is beyond our expectations," said Anthony Hooper, Amgen's head of global commercial operations, on a second quarter earnings call last month. (Pagliarulo, 8/20)
Perspectives: CVS Plan Lets Pharma Off Easy; What To Do With Prescription-Drug Middlemen
Read recent commentaries about drug-cost issues.
CVS Drug-Price Plan Lets Pharma Off Too Easy
But CVS is hampering itself from the start. Excluding drugs that don’t meet a cost-benefit threshold isn’t a new idea. It’s applied outside of the U.S. with great success — so much so that the strategy is one of the principal reasons other countries pay less for drug prices. Those lower prices come at the cost of reduced access a trade-off that’s difficult to avoid in health care. (Max Nisen, 8/17)
An Economist’s Change Of Heart: It’s Time To Regulate The Prescription-Drug Middlemen
I’ve studied the drug supply chain for years. Like many economists, I saw pharmacy-benefit managers (PBMs) as valuable actors in restraining drug prices, particularly when they went to bat for employer-based health plans. I’ve had a change of heart. While these giant middlemen in the supply chain still drive hard bargains with manufacturers, they are increasingly finding ways to expand their profitability at the expense of employers and patients. Federal regulators need to be empowered to restore order, and soon. (Geoffrey Joyce, 8/20)
Start On A Better Rx Deal For Taxpayers
With what is now known about the way prescription-drug middlemen have profited at the expense of Ohio taxpayers, it’s clear the state’s Medicaid managed-care plans must negotiate better deals with pharmacy benefit managers. The Department of Medicaid is right to put managed-care companies on notice that they are not to continue current contracts beyond Jan. 1. It’s about time. Months of investigation by Dispatch reporters, followed by a state Medicaid-commissioned report, have shown that pharmacy benefit managers, hired to make the Medicaid drug benefit more efficient, have billed taxpayers $223.7 million over and above what they paid pharmacies for the drugs in question. (8/19)
The Wall Street Journal:
A Shot Of Competition For EpiPen
A couple of years ago Washington fell into anaphylactic shock over the high cost of EpiPens, devices that shoot adrenaline into someone having an allergic reaction. But the Trump Administration this week injected some overdue competition into the market that could lower prices for millions of Americans. On Thursday the Food and Drug Administration approved the first generic competitor to Mylan ’s EpiPen. The competing drug is manufactured by the Israeli pharmaceutical company Teva. One might wonder why a simple spring device filled with a cheap medicine didn’t have competitors, even decades after invention. (8/19)
Viewpoints: Improve Benefits, Look Beyond Pregnancies For Ways To Improve Health Of Reproductive Women
Editorial pages focus on these health issues and others.
Maternal Deaths Represent The Canary In The Coal Mine For Women's Health
Recent media reports have coupled a startling set of facts with an equally startling explanation. Women who want to start or grow their families face greater risks during childbirth than their mothers did. Over the last two decades, the number of American women who die each year from a pregnancy- or childbirth-related cause has skyrocketed by more than 50 percent. The risks for black women are more than three times higher than for white or Hispanic women, regardless of income or education. The most common explanation? Hospitals have been failing to protect pregnant women. But as maternal health researchers who have been studying this trend, we believe an essential piece of the story is missing. (Eugene Declercq and Neel Shah, 8/22)
The Washington Post:
Collins Looks Ready To Toss Her Pro-Choice Credentials Out The Window
[Sen. Susan Collins] must think her constituents are very dim, but no one should be shocked that Collins sounds most of the way to “yes” on Kavanaugh’s confirmation. With zero evidence, she’s been saying that arch-conservative Neil M. Gorsuch(!), whom she voted to confirm, would also uphold Roe and thereby protect women’s constitutional rights. Moreover, her own rationale for voting for John G. Roberts Jr. — that he also would uphold Roe — is belied by the chief justice’s own record on the bench. (Jennifer Rubin, 8/21)
The Wall Street Journal:
Kavanaugh And ‘Settled Law’
Brett Kavanaugh continues to make his Senate rounds, and Tuesday’s news was that the Supreme Court nominee reassured Maine Republican Susan Collins on abortion rights. “He said that he agreed with what [Chief] Justice [John] Roberts said at his nomination hearing, in which he said it was settled law,” Ms. Collins told reporters. “We had a very good, thorough discussion.” The High Court’s abortion precedents are a main confirmation concern for Senator Collins, who along with Lisa Murkowski of Alaska is still undecided on Judge Kavanaugh. She says she’s waiting until after the September confirmation hearing, but Tuesday’s meeting sounds like it went a long way to persuading her. (8/21)
The New York Times:
Medical School Should Be Free, But Not For Everyone
Research shows that the burden of medical school debt discourages young doctors from going into types of practices that are poorly paid, like primary care, or working in places where many patients are on Medicaid. As a result, there is a shortage of doctors working in these areas. Over all, we have about the same number of doctors for our population as do Canada, Britain and Japan, but American doctors are more likely to be in highly paid subspecialties — orthopedic surgery and the like — rather than on the front lines. N.Y.U.’s plan was a noble attempt to redress this problem. But the medical school got it wrong. And N.Y.U. can look within — to its own law school, in fact — for a far better solution. (Elisabeth Rosenthal, 8/21)
The Wall Street Journal:
A Free Tuition Education
New York University announced late last week that it will offer free tuition for every current and future student attending its medical school. That’s pretty cool and will save students some $55,000 a year and a lot of debt. But in the spirit of Milton Friedman’s line that there is no such thing as a free lunch, allow us to suggest that every NYU student should have one obligation in return for accepting the gift—read and write an essay on Ken Langone’s autobiography, “I Love Capitalism!” The medical students should at least know where the money for their free tuition will come from. It doesn’t flow from the good intentions of Alexandria Ocasio-Cortez, and it isn’t a product of the Cuban health-care system. (8/20)
The New York Times:
Safe Drinking Water For All
In 2007, the small town of Lanare in California’s Central Valley finally got what it had desperately needed for years — a treatment plant to remove high levels of arsenic in the drinking water. But the victory was short-lived. Just months after the $1.3 million federally funded plant began running, the town was forced to shut it down because it ran out of money to operate and maintain it. More than a decade later, the plant remains closed and Lanare’s tap water is still contaminated — as is the drinking water piped to about a million other Californians around the state. The common barrier to solving the problem is that communities lack access to government financing to run their water treatment systems. (Laurel Firestone and Susana De Anda, 8/21)
Milwaukee Journal Sentinel:
A New Name For The Same Old, Bad Idea: Medicare For All
“Medicare for All” is simply a repackaged attempt to revive an old progressive dream of single-payer health care. Universal government-controlled health care is actually less plausible than President Donald Trump’s dopey plan to build a wall and have Mexico pay for it, yet serious people are still allowed to sing its praises in polite company. (Christian Schneider, 8/21)
San Antonio Press Express:
To Address Mental Health, Reduce Texas’ Uninsured Rate
One of the key challenges in addressing mental health in Texas is that the state has the highest uninsured rate and highest number of uninsured people in the nation. Data provided by the U.S. Department of Health and Human Services in 2016 demonstrates how important health insurance is for getting mental health treatment in Texas. It shows that Texans with health insurance were nearly 50 percent more likely to receive treatment for mental illness or a substance use disorder compared to Texans who lack insurance. The report also confirmed that a huge number of the 1 million Texans without health insurance had experienced mental illness or a substance use disorder during the previous year. (Greg Hansch and Will Francis, 8/21)
Des Moines Register:
Prosecute Gun-Owning Parents When Children Shoot Themselves Or Others
Research shows nearly 2 million American children live in homes with guns that are not stored responsibly. Children gain access to these guns and shoot themselves or others. Everytown For Gun Safety, which is dedicated to reducing gun violence, tracks these incidents. As of Aug. 14, the organization had recorded 124 “unintentional” shootings in 2018 where a person age 17 or under killed or injured themselves or someone else with a gun. The group will likely add the Council Bluffs boy to its database now. These shootings are preventable. (8/21)
St. Louis Post Dispatch:
An Insensitive And Pound-Foolish Health Care Cut
There are times when government has to make hard choices between doing things that are humane and things that are fiscally responsible. But thankfully, those two imperatives sometimes line up. One example is a Missouri program that provides in-home care to thousands of low-income disabled state residents, allowing them to remain in their homes with the assistance of visiting caregivers, instead of having to go into nursing care. They get the crucial independence that comes from living at home; the state gets a cheaper bill than a nursing home would entail. Given all that, why would the Missouri Legislature cut the program by more than $40 million? The cuts, first instituted last year, affect more than 7,800 Missourians, some of whom are now in danger of having to move into nursing homes. This is not only heartless, it’s a classic case of penny-wise/pound-foolish. Lawmakers should restore that funding as soon as possible. (8/21)
Extend Deadline For Medical Pot Licensing
Michigan voters approved medical marijuana a decade ago, and in that time, shops have popped up around the state to fill a clear demand for this alternative medicine. Yet now that the state has stepped in to license sellers, the slow process threatens to unfairly shut down shops and prevent patients from accessing the product. That's wrong, and as a state-imposed deadline looms, the regulatory agency charged with licensing these shops should find a workaround After Sept. 15, medical marijuana facilities that have not yet received a license but are still in the licensing process will be sent into limbo, unable to sell or produce, and will be forced to destroy their plants. If they attempt to remain open past Sept. 15, they will receive a cease-and-desist letter. (8/21)