Bloomberg: Health Insurance That Doesn’t Cover The Bills Has Flooded The Market Under Trump
Early one Friday morning two years ago, David Diaz woke up his wife, Marisia, and told her he didn’t feel right. He asked her to pray with him. Their son called 911, and within minutes, Marisia was tailing an ambulance down the dirt road away from the couple’s house on the outskirts of Phoenix to a hospital in the city. David had had a massive heart attack. Before being wheeled into surgery, he whispered the PIN for his bank card to Marisia, just in case. But the double-bypass operation was successful, and two weeks later he was discharged. (Faux, Mosendz and Tozzi, 9/17)

In other health insurance news —

NH Times Union: High Cost Of Care: Hospital CEOs Wary Of High-Deductible Health Plans
A few health care executives expressed doubts Tuesday about the latest market-based effort to control health care costs — the high-deductible health care plan. Speaking at a Union Leader symposium about rising health care costs, one hospital executive said the plans — which require patients to pay thousands of dollars up front before insurance kicks in — can become a barrier to care. (Hayward, 9/17)

Cleveland Plain Dealer: While Cheaper Obamacare Options Available For Some Ohioans, Rates Rise For Others
Ohioans with health-insurance coverage on the federal exchange are expected to have lower premiums in 2020, according to the Ohio Department of Insurance.Yet, across the state, only two of the 10 insurance providers with exchange plans, often referred to as Obamacare plans, requested an overall decrease in rates from the federal government, according to federal filings with the Centers for Medicare and Medicaid Services. (Christ, 9/17)

The Washington Post: Trump's Ban On Flavored Vaping Products Took A Well-Connected Industry By Surprise
Juul Labs did everything in the power players’ handbook to cement its status in Washington. The Silicon Valley start-up worked to make friends in the nation’s capital. It hired senior White House officials wired into President Trump and the first family. It sent politically connected officials to the West Wing to extol its products. It spent big on lawmakers in both parties. But last week, the e-cigarette giant along with the rest of the vaping industry, was caught off guard when President Trump decided to take drastic action, banning almost all flavored vaping products. “We can’t have our youth be so affected,” he said in the Oval Office. (McGinley, Satija, Dawsey and Abutaleb, 9/17)

The New York Times: States Rush To Limit Vaping, But Results Remain Uncertain
After a spate of illnesses linked to vaping, states are rushing to push through bans on e-cigarettes for anyone under 21. Governors are calling for prohibitions on flavors like bubble gum, cotton candy and banana split, which critics say are meant to entice young people into trying vaping. And in some states, lawmakers are contemplating raising taxes on vaping products as a way to discourage their use. Yet amid the flood of new measures from state leaders as well as mayors, experts said it was uncertain how much immediate or lasting effect the provisions would have on a broad and growing range of concerns about vaping. (Williams and Del Real, 9/17)

Modern Healthcare: Vaping Fight Likely More Complex Than Anti-Tobacco Efforts
Federal and state authorities quickly took action against non-tobacco vaping flavors after a spate of illnesses related to e-cigarettes, but healthcare providers are concerned about their own role in addressing vaping's dangers. The push to ban certain vaping products comes in light of an outbreak of lung illnesses and deaths associated with e-cigarettes that has racked up more than 380 cases as of Sept. 12, according to the Centers for Disease Control and Prevention. Seven deaths have been confirmed in California, Illinois, Indiana, Kansas, Minnesota and Oregon. (Johnson, 9/17)

Reuters: New York State Ban On Flavored E-Cigarettes Given Final Approval 
New York became the second state to ban flavored e-cigarettes on Tuesday after its Democratic governor called for emergency action in response to concerns about their rising use among teens and a nationwide spate of lung illnesses. Governor Andrew Cuomo on Sunday called for an urgent meeting of the state's Public Health and Health Planning Council to consider the proposed ban. (Dobuzinskis, 9/17)

The Wall Street Journal: New York Bans Sale Of Flavored E-Cigarettes
Members of the state’s Public Health and Health Planning Council approved the ban, arguing it would help stem a rise in e-cigarette use among minors, which they called a public health crisis. Michigan has also banned the sale of flavored e-cigarettes. Some members of the Public Health and Health Planning Council said they were torn about approving the emergency measure, while others said it should have included a ban on menthol e-cigarettes. The ban went into effect immediately and is expected to last 90 days, with the expectation that it will be renewed absent a permanent legislative ban. (West, 9/17)

The Associated Press: Panel Approves Ban On Sale Of Flavored E-Cigs In New York 
New York became the first state to ban the sale of flavored e-cigarettes Tuesday, a move that comes as federal health officials investigate a mysterious surge of severe breathing illnesses linked to vaping. The vote by the state Public Health and Health Planning Council means the prohibition, which covers flavored e-cigarettes and other vaping products except for menthol and tobacco flavors, goes into effect immediately. Retailers will have two weeks to remove merchandise from store shelves. (Hajela and Klepper, 9/17)

The Washington Post: D.C. Bills Would Block E-Cigarette Sales Without A Prescription, Ban Flavored Product
D.C. lawmakers on Tuesday proposed sweeping measures to curb the rise of youth vaping, including a ban on flavored e-cigarettes and requiring a prescription to buy other electronic smoking products. A bill introduced by D.C. Council Member Vincent C. Gray (D-Ward 7) would ban the sale of vaping products at any location that is not a medical marijuana dispensary or a pharmacy. The District would be the first U.S. jurisdiction with such stringent restrictions on e-cigarette sales. (Nirappil, 9/17)

The Associated Press: Vape Maker Overhauls Packaging To Counter Fakes
A short walk from police headquarters in the heart of downtown Los Angeles, a cluster of bustling shops are openly selling packaging and hardware that can be used to produce counterfeit marijuana vapes that have infected California’s cannabis market. Bootleggers eager to profit off unsuspecting consumers are mimicking popular, legal vape brands, pairing replica packaging churned out in Chinese factories with untested, possibly dangerous cannabis oil produced in the state’s vast underground market. (Blood, 9/17)

The Wall Street Journal: Juul’s Sales Halted In China, Days After Launch
E-cigarette maker Juul Labs Inc.’s sales have been halted in China, days after the startup launched its products in the world’s biggest tobacco market. Juul’s sleek vaporizers went on sale early last week online on both JD.com Inc. and Alibaba Group Holding Ltd. BABA 1.09% ’s Tmall, with refill pods in flavors such as mint, Virginia tobacco, mango and cream. But by the end of the week, they had been taken off both ecommerce sites. That left Juul at a loss as to why, according to people familiar with the matter. (Maloney, 9/17)

NPR: Vaping Illness: Questions And Answers About A Mysterious Outbreak
What seems to be causing the illness? The CDC suspects "chemical exposure," but experts have not yet identified a specific agent as the culprit. There is no definitive link to any brand of device, ingredient, flavor or substance. The outbreak has affected users of both THC- and nicotine-containing products, but it is more prevalent among THC vapers than users who self-report using only nicotine products. Because a large number of the patients reported combining nicotine products with THC or CBD products, some researchers are looking into whether the illness may be a result of mixing substances. (Vaughn, 9/18)

WBUR: What We Know About Vaping-Related Lung Illnesses In Mass.
Here in Massachusetts, public health officials have received 38 preliminary reports of cases that could fit the CDC criteria for the newly identified vaping illness. The state Department of Public Health says none of these cases is classified as probable or confirmed at this point. But it's likely most will be, says Dr. Jonathan Winickoff, a pediatrician and researcher at Massachusetts General Hospital — because there is no lab test for the illness, only a description. (Goldberg, 9/17)

Boston Globe: Why The Vaping Lung Crisis Is Exploding Now, According To Boston Doctors
The exploding outbreak, linked to 38 possible cases in Massachusetts, has raised questions about why it’s happening now, when vaping has been popular for years. Officials say the disease has affected people who vaped cannabis, nicotine, or both, and who used both legal and black-market products. (Martin, 9/17)

The Wall Street Journal: Smoking Ban Lights Up Sales At Rare Cigarette-Friendly Bars
At first glance, Karma Lounge looks like any dive bar in Manhattan’s East Village. It has a window box packed with plastic daffodils, a black-painted facade and the usual sidewalk board advertising $5 happy hour beers. The one surprise—a tiny door sign bearing a phrase seldom seen these days: “Smoking Permitted." New York City banned smoking in bars and restaurants back in 2003. But a number of establishments that generated at least 10% of their revenue from tobacco sales got an exemption. Today, just eight remain, all in Manhattan, offering a smoky retreat in an otherwise clean-air town. (Kadet, 9/17)

The New York Times: Trump And California See Same Homeless Problem, But Not The Same Solutions
Open-air heroin use. Sidewalks smeared in human feces. Blocklong homeless camps and people with severe mental illnesses wading through traffic in socks and hospital clothes. You would be forgiven if you thought that those descriptions of California’s urban ills came from the mouth of the state’s biggest detractor, President Trump. After all, as the president jetted off to the Bay Area on Tuesday for a fund-raiser, he took a moment with reporters on Air Force One to fulminate against “people living in our best highways, our best streets, our best entrances to buildings.” (Dougherty, 9/17)

The Washington Post: Trump: Homeless People Hurt The ‘Prestige’ Of Los Angeles, San Francisco
President Trump maligned the problem of homelessness in California as he arrived in the nation’s most populous state Tuesday, arguing that people living on the streets here have ruined the “prestige” of two of the state’s most populous cities and suggesting the possibility of federal action. “We can’t let Los Angeles, San Francisco and numerous other cities destroy themselves by allowing what’s happening,” Trump told reporters aboard Air Force One en route to Silicon Valley, where he hosted a campaign fundraiser to kick off a two-day visit to California. (Rucker and Stein, 9/17)

Los Angeles Times: Trump, In California, Says Homelessness Is Destroying Cities
While aboard Air Force One on Tuesday en route in San Francisco, he said he is considering the creation of an “individual task force” as a possible solution to homelessness, without providing more details. “We can’t let Los Angeles, San Francisco and numerous other cities destroy themselves by allowing what’s happening,” he said, adding that the homelessness crisis is prompting residents of those cities to leave the country. “They can’t believe what’s happening.” (Oreskes, Rust, Shalby and Cosgrove, 9/17)

USA Today: Blaming Shelters And Street Sleeping, Donald Trump Blasts California For Homeless Crisis
In the report, "The State of Homelessness in America," even shelters get some of the blame for increasing the number of people who are homeless. The argument: Some people would be able to find their own housing if they were turned away from shelters. "While shelters play an extremely important role in bringing some people off the streets, it also brings in people who would otherwise be housed, thus increasing total homelessness," the report states. (Woodyard, 9/17)

Los Angeles Times: Is Trump Trying To Make This Historic Building A Homeless Shelter? Locals Are 'Baffled'
A week after hearing about federal officials swinging through a vacant office building close to Los Angeles International Airport, Hawthorne City Manager Arnold Shadbehr is still confused. Shadbehr hasn’t heard from the federal government or anyone else — other than reporters — about the visit to study homelessness in California. The Washington Post last week reported that officials with the administration of President Trump had “secretly” toured the one-time Federal Aviation Administration facility in Hawthorne as part of discussions about turning it into a government-run homeless shelter. (Smith, 9/17)

Politico: As Trump Bemoans California Homelessness, Carson Reassures Locals
California’s homeless crisis came under a federal magnifying glass Tuesday, with President Donald Trump bemoaning conditions in San Francisco and Los Angeles as HUD Secretary Ben Carson downplayed fears of a law enforcement crackdown. As the numbers of people sleeping on California streets have soared — helping to push issues of housing and affordability to the top of the state’s political agenda — Trump has pointed to the growing crisis as evidence of failed leadership in a state that prides itself as a liberal counterweight to the president’s agenda. (White, 9/17)

Modern Healthcare: Judge Tosses CMS' Site-Neutral Pay Policy
A federal judge on Tuesday overturned the CMS rule that cut Medicare payments for some hospital clinic visits, siding with hospitals who sued to prevent the changes. U.S. District Judge Rosemary Collyer in Washington ruled that the Trump administration had exceeded its authority when it expanded the so-called site-neutral pay policy to evaluation and management services at off-campus hospital clinics. The goal was for Medicare to pay the same rate to hospitals as to independent physicians. (Luthi, 9/17)

Modern Healthcare: CMS Overhauls SNF Payment Model
Skilled-nursing providers continue to gear up for a reimbursement overhaul next month, a transition they hope will reward outcome-based care but could also hurt therapy-oriented facilities. The CMS is scrapping the fourth iteration of what’s called the resource-utilization group framework, which primarily bases pay on the volume of therapy services. In its place will be the Patient Driven Payment Model based on acuity and other data-driven characteristics akin to bundled payments. (Kacik, 9/14)

Modern Healthcare: Medicare's Bundled Radiation Therapy Payments Could Impact Quality
Oncology providers have come out against a proposed rule to bundle Medicare payments for radiation therapy, claiming it will put them at excessive financial risk and stifle innovation. Freestanding radiation therapy centers, physician group practices and hospital outpatient departments that provide radiotherapy services for 17 types of cancer in specific parts of the country would be required to accept bundled payments under the proposed rule. The fees would cover some services like CT scans, dose planning and treatment aids over the first 90 days, but it wouldn't pay for the total cost of care provided to Medicare beneficiaries. (Brady, 9/17)

The Associated Press: 'Blood Money'? Purdue Settlement Would Rely On Opioid Sales
The tentative multibillion-dollar settlement with OxyContin maker Purdue Pharma would raise money to help clean up the opioid mess by ... selling more OxyContin. That would amount to blood money, in the opinion of some critics. And it's one reason two dozen states have rejected the deal. (Mulvihill and Galofaro, 9/17)

The Hill: Holdouts Vow To Challenge Purdue Pharma Settlement
States that have not signed on to the deal quickly criticized the settlement, saying that it is not nearly enough to address the opioid crisis and that it will take years before the full terms are realized, if at all. They are gearing up for a fight in bankruptcy court and are expected to try to pursue Purdue’s owners, the Sackler family, for a full accounting. (Weixel, 9/17)

NH Times Union: NH Attorney General Sues Family Behind Purdue Pharma, Joining Other States
The New Hampshire Attorney General’s office has filed a lawsuit against the Sackler family, joining several other state Attorneys General suing the family behind opioid maker Purdue Pharma.Deputy Attorney General Jane E. Young announced the complaint was filed Tuesday in Merrimack County Superior Court. The complaint alleges the Sackler family directed the company to keep promoting opioid painkillers, even in the face of evidence the drugs were harmful. (Albertson-Grove, 9/17)

The Hill: North Carolina Sues Sackler Family Over Opioid Epidemic
North Carolina's attorney general has filed a new lawsuit accusing members of the Sackler family of deliberately ignoring the harms of OxyContin in order to boost the prescription painkiller's sales as well as profits for themselves. In the lawsuit filed Tuesday, North Carolina Attorney General Josh Stein (D) accused eight members of the Sackler family of being the driving forces behind Purdue Pharma and its work to deceptively market and sell OxyContin. (Weixel, 9/17)

Atlanta Journal-Constitution: Georgia Thinks About How It Would Spend Opioid Settlement
OxyContin maker Purdue Pharma made its first appearance in bankruptcy court Tuesday, less than a day after Georgia Attorney General Chris Carr announced in The Atlanta Journal Constitution that the state will join the bankruptcy deal. The company says it could mean $10 billion or more for the states, cities and towns that have sued. Detractors don’t believe that and say it doesn’t do enough. (Hart, 9/17)

The Associated Press: Sackler Money Complicates Donation Policies For Museums
Ask the CEO and president of the Metropolitan Museum of Art whether he’s accepting money from the Sacklers, the billionaire dynasty notorious for its ties to the drug company Purdue Pharma, and the answer is somewhat complicated. For one thing, it depends on which Sackler. “There are people who have the name ‘Sackler’ who have nothing to do with the Purdue Pharma situation,” Daniel H. Weiss says. “If it’s someone tied up with the leadership at Purdue Pharma, we step away.” (Italie, 9/18)

Reuters: Oxycontin Maker Purdue Begins Bankruptcy In Push To Settle Opioid Lawsuits
Oxycontin maker Purdue Pharma LP on Tuesday told a bankruptcy judge it hopes to broaden support for a proposed settlement of 2,600 lawsuits alleging it fueled the U.S. opioid crisis, but opponents of the deal highlighted looming legal battles. A lawyer representing the company told U.S. Bankruptcy Judge Robert Drain in White Plains, New York that the case was an opportunity to end a "chaotic maelstrom" of litigation. (Hals and Raymond, 9/17)

The Associated Press: Purdue Pharma To Stay In Business As Bankruptcy Unfolds
A judge cleared the way Tuesday for OxyContin maker Purdue Pharma to stay in business while it pursues bankruptcy protection and settlement of more than 2,600 lawsuits filed against it in a reckoning over the opioid crisis. At the first court hearing since the Chapter 11 filing late Sunday, Purdue lawyers secured permission for the multibillion-dollar company based in Stamford, Connecticut, to maintain business as usual — paying employees and vendors, supplying pills to distributors, and keeping current on taxes and insurance. (Sisak, 9/17)

In other news on the opioid crisis —

Boston Globe: Settlement Means Nursing Home Company Will Now Accept Opioid-Addicted Patients
The owner of 16 Massachusetts nursing homes has agreed to accept patients being treated for opioid addiction, forgoing a practice that remains common among other nursing homes. In a settlement reached Tuesday with the office of US Attorney Andrew E. Lelling, Athena Health Care Systems agreed to adopt a nondiscrimination policy, provide training to admissions personnel about the rights of disabled people and opioid addiction, and pay a civil penalty of $10,000. (Freyer, 9/17)

The Washington Post: Maryland Opioid Deaths: Decline In First Half 2019
While opioid-related deaths remain at nearly an all-time high in Maryland, preliminary data shows a decline in fatal overdoses for the second straight quarter — the first six-month drop in the last decade. State officials released a preliminary report Tuesday that found that there were 1,060 ­opioid-related deaths in Maryland in the first half of the year, 133 fewer — or an 11 percent decline — than in the first six months of 2018. (Wiggins, 9/17)

The Baltimore Sun: Opioid Overdose Deaths In Maryland Drop For First Half Of The Year
Maryland’s opioid-related deaths dropped during the first half of the year, including those linked to fentanyl, according to new state figures that show a bit of relief from the overdose crisis that is still claiming close to 200 lives a month in the state. There were 1,182 total drug and alcohol-related deaths from January through June, with almost 90% opioid related. That’s down 150 from the 1,332 reported in the first six months of 2018, according to data released Tuesday by the Maryland Department of Health and the state’s Opioid Operational Command Center. (Cohn, 9/17)

The Washington Post: Biden And Sanders Take Fight Over Health Care To Union Workers
Former vice president Joe Biden and Sen. Bernie Sanders (I-Vt.) clashed sharply over health care in separate appearances before union members on Tuesday, intensifying one of the central policy disputes in the Democratic presidential race. Speaking at a forum hosted by the Philadelphia Council of the AFL-CIO, Biden touted his plan to expand the Affordable Care Act with an optional public insurance program. Without naming Sanders and Sen. Elizabeth Warren (D-Mass.), he eagerly criticized the competing proposal they have championed as injurious to organized labor. (Sullivan and Weigel, 9/17)

The Associated Press: Sanders-Biden Feud Ramps Up In Front Of Key Union Audience
Speaking to reporters afterward, the Vermont senator repeatedly called out Biden by his first name, charging that “Joe” has a long record of voting against the interests of the working class. “All I wanted to do today was make it clear that in terms of the needs of working people, I don’t have a record I have to apologize for,” Sanders said. Earlier in the day, Biden took a jab at Sanders by reminding union members that the health care plan championed by the Vermont senator — known as “Medicare for All” — would ultimately force union members from their private insurance plans to a government-backed system. (Peoples, 9/17)

CNN: Sanders And Biden Battle Over Health Care For Union Workers As UAW Strikes
GM revealed that health care benefits for those on strike will soon come to an end, meaning the union will be forced to pick up the tab for COBRA coverage. Sanders, who has faced criticism over how his "Medicare for All" plan would impact unions and their negotiated benefits, argued that if his plan were the law of the land those striking wouldn't have to worry about their coverage. "Here you have a situation with UAW is out on strike. 49,000 workers. I am sure that in that 49,000 there are family members who are seriously ill, and yet the greed of General Motors -- which has the amount of money to pay their CEO something like $21 million a year -- they cut off the health care benefits for those 49,000 workers," Sanders said. (Nobles, 9/17)

Reuters: GM Stops Paying For Health Insurance For Striking Union Workers; Talks Continue
General Motors Co shifted health insurance costs for its striking workers to the United Auto Workers union as its members walked the picket line for the second day on Tuesday. The UAW on Monday launched the first company-wide strike at GM in 12 years, saying negotiations toward a new national agreement covering about 48,000 hourly workers had hit an impasse. (Woolston, 9/17)

Meanwhile, in other election news —

CNBC: Nancy Pelosi: No Need To Reinvent Health Care — Improve Obamacare
Democrats should focus on making improvements to Obamacare instead of trying to reinvent the wheel with “Medicare for All,” House Speaker Nancy Pelosi said Tuesday. “God bless” 2020 Democratic presidential candidates putting forth Medicare for All proposals, Pelosi said in an interview with “Mad Money” host Jim Cramer. “But know what that entails.” (Lovelace, 9/17)

CBS News: Biden Releases New Iowa Digital Health Care Ad Emphasizing Family
Former Vice President Joe Biden's campaign is rolling out a new digital advertisement in Iowa focused on health care, which he continues to make a signature issue of his candidacy. "When it comes to family, it's being there that counts," the narrator says. "Because every moment matters. And every family deserves to have good healthcare from day one. So let's build on Obamacare and finish the job." (Brewster, 9/17)

The Associated Press: Biden's Abortion Shift Tests The Politics Of His Faith
It was one of the first stress tests of Joe Biden's presidential campaign: A sudden reversal of his decades-long support for restricting federal funding of abortions. The move seemed sure to hurt the former vice president with Catholics, particularly those in the Midwest, whose support will be critical to winning the Democratic primary and the general election. But so far, Biden has faced little criticism over his shift on abortion funding relative to other aspects of his record, and polls show that he remains Catholic Democrats' overwhelming favorite in the presidential field. (Schor, 9/17)

The Associated Press: Tennessee Unveils $7.9B Block Grant Proposal For Medicaid 
Tennessee would become the first state in the nation to receive its Medicaid funding in a lump sum under a proposal seeking to drastically overhaul the program that provides health care services to low-income and disabled residents. Nearly four months after Gov. Bill Lee signed off on the idea, state officials released details of the estimated $7.9 billion Medicaid block grant plan Tuesday with the intent of submitting the final product to the federal government in November. (9/17)

Chattanooga Times Free Press: Tennessee Gov. Bill Lee Unveils Controversial $7.9 Billion TennCare Medicaid Block Grant Plan
"We're excited about the prospects, and we think we have crafted a waiver that is going to really mitigate the risk that Tennesseans have [from a block grant] but actually give us an opportunity to benefit from the efficiencies that we have and from the way that we run our program," Lee said during a Monday roundtable with Tennessee reporters. (Sherm, 9/17)

The Washington Post: Tennessee Becomes First State With A Plan To Turn Medicaid Into A Block Grant 
If TennCare, as that state calls its Medicaid program, wins federal approval for its plan, it could embolden other Republican-led states to follow suit. It also almost certainly would ignite litigation over the legality of such a profound change to the country’s largest public insurance program without approval by Congress. Medicaid, originated as part of President Lyndon B. Johnson’s Great Society of the 1960s, is an entitlement program in which the government pays each state a certain percentage of the cost of care for anyone eligible for the health coverage. (Goldstein, 9/17)

CNN: Tennessee Seeks To Be First To Turn Medicaid Into Block Grant Program
Block grants have long been popular with Republicans, who see them as a way to control Medicaid spending. They were part of congressional Republicans' failed attempts to repeal the Affordable Care Act in 2017 and have been included in President Donald Trump's budgets. And the Trump administration, which would need to approve Tennessee's plan, has encouraged states to make historic changes to their Medicaid programs, including adding work requirements. (Luhby, 9/17)

The Wall Street Journal: Tennessee Unveils Draft Plan To Convert Medicaid To Block Grants
Democrats say the initiatives are an attack on safety net programs that would leave more people without health coverage, and advocacy groups could sue if block grants get approved. Republicans say the grants give states more autonomy and direct resources to beneficiaries who are most in need. “We’re pursuing what we believe the Trump administration wants us to pursue,” Republican Tennessee Gov. Bill Lee said in an interview. “Their goal is to give block-grant programs that deliver efficiency and innovation of services. If that happens across the country, the cost of Medicaid is lowered.” (Armour, 9/17)

The Hill: Tennessee Seeks To Become First State To Turn Medicaid Into A Block Grant
Administration officials have drafted a guidance that would make it easier for states to apply for a capped payment or block grants. That document has been under review by the White House Office of Management and Budget for months, but it could be released at any time. The administration has also been quietly trying to sell states on the merits of imposing block grants without congressional approval. Health and Human Services Secretary Alex Azar told lawmakers last spring that he had been having conversations with states interested in the idea. (Weixel, 9/17)

Nashville Tennessean: Tennessee's Medicaid Block Grant: How The Plan Is Supposed To Work
Currently, the federal government provides about $7.5 billion to $8 billion annually to pay for TennCare. This funding increases or decrease as the need grows or shrinks, and the money is theoretically limitless if the state continues to operate TennCare in accordance with federal guidelines. (Kelman, 9/17)

Modern Healthcare: Tennessee Proposes First-Of-Its-Kind Plan To Cap Medicaid Funding
Patient advocates say these requests go far beyond what the HHS secretary can allow. "Most of it is clearly a violation of federal law and not within the secretary's authority to waive," said Hannah Katch of the liberal Center on Budget and Policy Priorities. Representatives of Tennessee's hospital community were cautiously optimistic about the plan — mostly around to the prospect of sharing in the savings the state hopes to reap, but acknowledged they still have to dig into the details. (Luthi, 9/17)

The Hill: Swing-State Voters Oppose 'Surprise' Medical Bill Legislation, Trump Pollster Warns
President Trump’s campaign pollster is warning that swing-state voters oppose a bipartisan bill meant to protect patients from “surprise” medical bills they receive when going out-of-network for emergency care, according to a polling memo obtained exclusively by The Hill. A survey of voters in Michigan, Wisconsin and Pennsylvania conducted by Tony Fabrizio, the president’s campaign pollster, found that a majority of voters in three battleground states believe that health insurers should be on the hook when patients receive “surprise” medical bills for out-of-network emergencies. (Easley, 9/17)

The Hill: House Panel Delays Vote On Surprise Medical Bills Legislation
The House Education and Labor Committee has called off plans to vote on legislation this week to protect patients from "surprise" medical bills because of divisions among lawmakers on the panel, according to House aides and lobbyists. The panel had been planning to hold a markup on legislation to protect patients from getting massive medical bills when they go to the emergency room and one or more doctors treating them turn out to be outside of their insurance network, a problem that lawmakers in both parties say is a top priority. (Sullivan, 9/17)

In other news from Capitol Hill —

The CT Mirror: Blumenthal Sponsors Bill To Try To Block Trump 'Public Charge' Rule
Sen. Richard Blumenthal on Tuesday joined a Democratic colleague on the Senate Judiciary Committee, Sen. Mazie Hirono, D-Hawaii, in introducing legislation that would block the Trump administration’s “public charge” rule.That rule, which will be implemented on Oct. 15, would deny entry or green cards to immigrants based on their use of public assistance programs like food stamps and Medicaid. (Radelat, 9/17)

North Carolina Health News: PFAS Chemical Company Testify To Congress
Near the end of a congressional hearing last week, Congresswoman Debbie Wasserman Schultz grilled executives of the 3M, DuPont and Chemours chemical companies about their willingness to compensate people harmed by fluorinated compounds. The hearing, before a U.S. House subcommittee on environmental oversight and reform, was the third in a series amid pending legislation that aims to better regulate the chemicals, known collectively as per- and polyfluoroalkyl substances or PFAS, nicknamed “forever chemicals” because of their persistence in the environment. (Barnes, 9/18)

The New York Times: America’s Abortion Rate Has Dropped To Its Lowest Ever
Abortion in the United States has decreased to record low levels, a decline that may be driven more by increased access to contraception and fewer women becoming pregnant than by the proliferation of laws restricting abortion in some states, according to new research. “Abortion rates decreased in almost every state and there’s no clear pattern linking these declines to new restrictions,” said Elizabeth Nash, senior state policy manager at the Guttmacher Institute, which issued the findings in a report and policy analysis on Wednesday. (Belluck, 9/18)

The Associated Press: Number Of Abortions In US Falls To Lowest Since 1973
Guttmacher is the only entity that strives to count all abortions in the U.S., making inquiries of individual providers. Federal data compiled by the Centers for Disease Control and Prevention excludes California, Maryland and New Hampshire. The new report illustrates that abortions are decreasing in all parts of the country, whether in Republican-controlled states seeking to restrict abortion access or in Democratic-run states protecting abortion rights. Between 2011 and 2017, abortion rates increased in only five states and the District of Columbia. (9/18)

The Washington Post: The U.S. Abortion Rate Has Fallen To Lowest Levels Since Roe V. Wade -- But State Restrictions Are Not Main Driver
There appears to be no clear pattern between efforts to ban or restrict abortion and the continuing decline in abortion rates, which has been going on for nearly 40 years. The declines were seen across regions and in states that are more supportive of abortion rights as well as those that are more restrictive. “Antiabortion activists are going to try to take credit for this decline, but the facts don’t support their argument,” Rachel Jones, principal research scientist for Guttmacher, which supports abortion rights, said in a call with reporters. (Cha, 9/18)

The Hill: Abortion Rate In U.S. Hits Lowest Point Since Roe V. Wade
Anti-abortion groups have argued in the past that the falling abortion rates can be attributed to changing public perceptions about the procedure. But the report notes that the birth rate in the U.S. has fallen for four consecutive years. More women are also using long-acting reversible contraceptive methods, like IUDs, which are highly effective at preventing pregnancy and can last for several years. Access to birth control has also increased since the passage of ObamaCare, which requires insurers cover contraceptives without out-of-pocket costs. (Hellmann, 9/18)

Los Angeles Times: Abortion Rate In The U.S. Falls To A 46-Year Low, Data Show
Four states that enacted laws requiring clinics to have building and safety standards comparable to hospitals experienced some of the most significant declines in their abortion rate. Between 2011 and 2017, the abortion rate fell by 27% in Arizona and Ohio, by 30% in Texas and by 42% in Virginia. The number of clinics that provide abortion similarly fell in those states. While the Supreme Court ruled in 2016 that those requirements were illegal, the laws still led to the closure of clinics that did not reopen. (Haberkorn, 9/17)

NPR: Abortion Rate Is Falling In Nearly Every State, Report Says
"I don't think there's a clear pattern around why rates are falling," Nash said. "They're going down across the country in nearly every state." Nash said there are exceptions, notably Texas, where laws and regulations have led to clinic closures and abortion rates have declined as a result. In other states, such as Ohio, Nash said the data suggest restrictions and clinic closures have prompted women to go to neighboring states such as Michigan for the procedure. (McCammon, 9/18)

In other news —

CBS News: Violence Against Abortion Clinics, Like Planned Parenthood, Hit A Record High Last Year. Doctors Say It's Getting Worse.
For one of the last abortion doctors in Missouri, harassment, stalking and death threats are a part of regular life. But this year, it's been worse than ever. Colleen McNicholas, the chief medical officer at Planned Parenthood of the St. Louis Region and Southwest Missouri, is one of many providers who told CBS News they've seen an uptick in violence this year, both against themselves and their clinics. They say the increased harassment has coincided with newly enacted state laws restricting legal abortion and polarizing rhetoric surrounding the procedure. (Smith, 9/17)

The Associated Press: Report Of Ant Infestation Pushes VA To Make Changes
An official has been put on leave and others reassigned following a report of a cancer patient bitten more than 100 times by ants at a U.S. Department of Veterans Affairs living center in Georgia. Dr. Richard Stone, the Veterans Health Administration executive in charge, said in a news release Tuesday that the VA's Southeast regional director was placed on administrative leave. (9/17)

Atlanta Journal-Constitution: VA Puts Atlanta Administrator On Leave
The U.S. Department of Veterans Affairs put on leave an Atlanta-based administrator and reassigned the region’s chief medical officer and seven other staff members while it investigates the treatment of a veteran under its care. Joel Marrable’s daughter discovered more than 100 ant bites on her father when she visited him in early September. (Quinn, 9/17)

Military Times: Nine VA Leaders, Staff Placed On Leave Amid Ant-Bite Scandal
VA Secretary Robert Wilkie told Military.com on Tuesday that the department had failed the patient, Air Force veteran Joel Marrable, as well as his family. "[This is] about basic humanity and dignity. I don't care what steps were taken to address the issues. We did not treat a vet with the dignity that he and his family deserved," Wilkie said. (Kime, 9/17)

Stars And Stripes: VA Removes Regional Officials After Veteran Was Bitten By Ants 100 Times In Nursing Home
Sen. Johnny Isakson, R-Ga., said last week that he spoke to VA Secretary Robert Wilkie and expressed outrage about the incident and the VA’s lack of communication after it occurred. Following Tuesday’s announcement of staff disciplinary actions, staff for Isakson, who is chairman of the Senate Veterans’ Affairs Committee, said the senator “believes veterans in Georgia need to be reassured that the VA is doing everything in its power to ensure an incident like this never happens again.” (Thayer, 9/17)

In other VA news —

Kansas City Star: Wichita VA Investigates Doctor Accused Of Botched Surgeries
A surgeon accused of mishandling surgeries in Missouri has been banned from the operating room of the Wichita Veteran Affairs hospital while his work there undergoes a “full review.” The VA’s move comes after The Kansas City Star first reported that urologist Christel Wambi-Kiesse had been accused by Missouri’s medical licensing board of performing robot-assisted surgeries that were beyond his abilities. (Hendricks, 9/17)

The Associated Press: McConnell Says Congress In 'Holding Pattern' On Gun Control
Six weeks after a pair of mass shootings killed more than 30 people, Congress remains "in a holding pattern" on gun control as lawmakers await proposals from the White House, Senate Majority Leader Mitch McConnell said Tuesday. While President Donald Trump has said he would veto a House-passed bill to expand background checks for gun purchases, McConnell said he is hopeful there are other gun-related proposals that Congress can approve and Trump can support. (9/17)

Meanwhile, a Republican in Ohio becomes the latest GOP lawmaker to signal openness to gun regulations —

Columbus Dispatch: GOP Senator Urges Gun Violence Laws: 'I Can No Longer Be On The Sidelines Of Gun Safety'
Joined by two Democrats, Lehner was the lone member of the majority Republican Senate to testify Tuesday in support of five bills designed to reduce the risk of mass shootings and other gun deaths. The Democrat-drafted bills are long shots for passage in the gun-friendly Ohio legislature, where members still await the unveiling of legislation that embodies Republican Gov. Mike DeWine’s gun-safety proposals. Those proposals, too, will face a hard sell in the Republican-ruled General Assembly. (Ludlow, 9/17)

Stat: For Dementia Caregivers, A Place To Share With Strangers — And Be Honest
Barbara Metcalf and Mary Smallwood live 826 miles apart. They’ve never met in person. If not for a chance interaction on Facebook, they would have stayed strangers. But for months, the two women talked nearly every day, swapping stories and venting about their husbands, who both have dementia. Their husbands’ symptoms have manifested in particularly difficult, deeply isolating ways. They blamed their wives for their conditions. They blamed their wives for losing their jobs. They blamed their wives because they couldn’t drive anymore. They accused them of having affairs with the mailman or stealing their money. They urinated all over their houses, leaving the women cleaning for hours. (Thielking, 9/18)

Reuters: Caregivers Of Seriously Ill Spouses Find Life Improves More When The Partner Dies
For caregivers tending to a seriously ill spouse, quality of life may improve to a greater extent if the partner dies than if the partner recovers, a German study suggests. That paradoxical finding - that life becomes more satisfying when sick partners die than when they recover - may arise from the fact that on average, bereaved caregivers in the study had heavier caregiving burdens, with sicker spouses and more hours spent caring for their loved one until the caregiver role ended, said Laura Langner, a sociology researcher at the University of Oxford and Nuffield College in the UK who led the research. (Rapaport, 9/17)

CNN: Global Pandemic Risk Is Growing -- And The World Isn't Ready, WHO Says
The chances of a global pandemic are growing -- and we are all dangerously under prepared, according to the World Health Organization (WHO). In a report published on Wednesday by a panel of international health experts and officials, they pointed to the 1918 influenza pandemic as an example of a global catastrophe. That killed as many as 50 million people -- if a similar contagion happened today, it could kill up to 80 million people and wipe out 5% of the global economy. (Yeung, 9/18)

The New York Times: Almost Everywhere, Fewer Children Are Dying
Two decades ago, nearly 10 million children did not live to see a 5th birthday. By 2017, that number — about 1 in every 16 children — was nearly cut in half, even as the world’s population increased by more than a billion people. The sharp decline in childhood mortality reflects work by governments and international aid groups to fight child poverty and the diseases that are most lethal to poor children: neonatal disorders, pneumonia, diarrhea and malaria. But the results are also highly imbalanced. (Katz, Parlapiano and Sanger-Katz, 9/17)

The Washington Post: ‘Do You Have White Teenage Sons? Listen Up.’ How White Supremacists Are Recruiting Boys Online.
At first, it wasn’t obvious that anything was amiss. Kids are naturally curious about the complicated world around them, so Joanna Schroeder wasn’t surprised when her 11- and 14-year-old boys recently started asking questions about timely topics such as cultural appropriation and transgender rights. But she sensed something off about the way they framed their questions, she says — tinged with a bias that didn’t reflect their family’s progressive values. (Gibson, 9/17)

The Associated Press: Study Finds Air Pollution Reaches Placenta During Pregnancy
A new study suggests when a pregnant woman breathes in air pollution, it can travel beyond her lungs to the placenta that guards her fetus. Pollution composed of tiny particles from car exhaust, factory smokestacks and other sources is dangerous to everyone's health, and during pregnancy it's been linked to premature births and low birth weight. (Neergaard, 9/17)

Medpage Today: Physicians Struggle To Care For Migrants On U.S.-Mexico Border
A 17-year-old girl came into his clinic dizzy, fatigued, and dehydrated, but Carlos Gutierrez, MD, expected that, knowing she'd recently traveled 2,000 miles from Guatemala. He told her to drink plenty of water to stay hydrated. She had just been released from a detention center and the next part of her journey would begin the following day, traveling east to stay with relatives. (Hlavinka, 9/17)

Reuters: U.S. Worker, Food-Safety Advocates Sound Alarm Over New Hog Slaughter Rules
U.S. food safety and the health of plant workers will be at risk from new federal rules that allow meat companies to slaughter hogs as fast as they want and shift the role of government inspectors, food and environmental advocates said on Tuesday. The warnings about the U.S. Department of Agriculture's first update of inspection procedures at hog slaughterhouses in more than 50 years come after several high-profile recalls in the meat sector. (Polansek, 9/17)

The New York Times: Alex Trebek Says He’s In A New Round Of Chemotherapy
Alex Trebek, the longtime host of “Jeopardy!” who announced in March he had Stage 4 pancreatic cancer, revealed on Tuesday that he was undergoing a new round of chemotherapy to treat the disease. Mr. Trebek disclosed the additional treatment in an interview with T.J. Holmes on “Good Morning America.” (Holson, 9/17)

The New York Times: What Can Brain Scans Tell Us About Sex?
Men have a far greater appetite for sex and are more attracted to pornography than women are. This is the timeworn stereotype that science has long reinforced. Alfred Kinsey, America’s first prominent sexologist, published in the late 1940s and early 1950s his survey results confirming that men are aroused more easily and often by sexual imagery than women. It made sense, evolutionary psychologists theorized, that women’s erotic pleasure might be tempered by the potential burdens of pregnancy, birth and child rearing — that they would require a deeper emotional connection with a partner to feel turned on than men, whose primal urge is simply procreation. (Tingley, 9/18)

The New York Times: Women Poop. At Work. Get Over It.
There once was a woman who walked regularly from her office in Midtown Manhattan to a hotel across the street in order to use the restroom, and that woman may have been one of us. That woman had a friend, at another office job, who carried a book of matches and a can of air freshener in her purse — more willing to set off the office fire alarm than leave any hint of odor in a public lavatory. That friend had another friend, at another office job, who repeatedly forced her body to do the deed so quickly — racing from cubicle to bathroom and back, in an effort to deflect attention from what she might be doing in there — that it led to a semi-serious hemorrhoid problem. (Bennett and McCall, 9/17)

The New York Times: Troubled Children’s Hospital May Resume Heart Surgeries
A North Carolina children’s hospital that stopped performing complex heart surgeries in recent months after high death rates were disclosed may now resume the procedures, according to an advisory board that was examining the hospital’s practices. The board noted “significant investment and progress” had been made at North Carolina Children’s Hospital while suggesting areas for improvement, including increasing the number of surgeries performed, a factor associated with better outcomes. (Gabler, 9/17)

Politico: 'We Shall Overcome': California Anti-Vaccine Activists Claim Civil Rights Mantle
A chorus of mostly white women sang the gospel song “We Shall Overcome” in the California State Capitol, an anthem of the civil rights movement. Mothers rallied outside the governor's office and marched through Capitol corridors chanting “No segregation, no discrimination, yes on education for all!" Some wore T-shirts that read “Freedom Keepers." But this wasn't about racial equality. In the nation's most diverse state, protesters opposed to childhood vaccine mandates — many from affluent coastal areas — had co-opted the civil rights mantle from the 1960s, insisting that their plight is comparable to what African Americans have suffered from segregationist policies. (Mays, 9/18)

Reveal: Elderly Often Face Neglect In California Care Homes That Exploit Workers
An investigation by Reveal from The Center for Investigative Reporting found that some operators of senior board-and-care homes that violate labor laws and steal workers’ wages – previously exposed by Reveal – often also endanger or neglect their residents, sometimes with dire consequences. Reveal analyzed thousands of licensing records and hundreds of U.S. Department of Labor cases in California and conducted two dozen interviews with workers, residents and their family members. (Gollan, 9/17)

Boston Globe: ‘It’s The Worst It’s Ever Been’: After Police Crackdown, Unease Grows In The South End
That question has divided this stretch of the South End since police raids, dubbed “Operation Clean Sweep” Aug. 1 and 2, led to the arrest of 34 people and the dispersal of many who congregate here, close to addiction treatment services. The homeless, those struggling with drug use or mental illness, and service providers who work with them say the police crackdown has uprooted an already vulnerable population. But others who live and work in the neighborhood wonder why law enforcement isn’t doing more to curb the rampant drug use, or when City Hall will find a solution to the issues, rather than slapping on another bandage. (Pan, 9/17)

Iowa Public Radio: As Iowa Begins Mental Health Training In Schools, Some Ask If It's Enough
Schools are often on the forefront in spotting mental health issues in children. But historically educators have received little training in this area. In Iowa, legislators have set aside $2 million to expand mental health training in schools. But when nearly a quarter of kids are estimated to have a psychiatric disorder, some people want the state to do more. (Krebs, 9/18)

San Francisco Chronicle: Suit By Transgender Man Initially Refused Surgery Reinstated By Appeals Court
A state appeals court reinstated a transgender patient’s suit against the Catholic hospital chain Dignity Health on Tuesday for refusing to perform transgender surgery, and then allegedly relenting and referring the patient to another hospital only after the story hit the local airwaves. Evan Minton’s claims, if proven, would show that “he was subjected to discrimination” based on gender identity, at least for the three days between the hospital’s rejection and his surgery, said the First District Court of Appeal in San Francisco. (Egelko, 9/17)

CalMatters: Disaster Days: How Megafires, Guns And Other 21st Century Crises Are Disrupting CA Schools
Each year, millions of Californians send their children to public K-12 classrooms, assuming that, from around Labor Day to early summer, there will be one given: A school day on a district’s calendar will mean a day of instruction in school. But that fixed point is changing, according to a CalMatters analysis of public school closures. From massive wildfires to mass shooting threats to dilapidated classrooms, the 21st century is disrupting class at a level that is unprecedented for California’s 6.2 million students. Last year, the state’s public schools closed their doors and sent kids home in what appear to be record numbers, mainly as a result of sweeping natural disasters. It was the third significant spike in four years. (Cano, 9/16)

Columbus Dispatch: Did Ohio Go Around Drugmaker Restrictions On Executions Despite Warnings?
State officials went ahead with executions in recent years even after manufacturers threatened to cut off the supply of their drugs to millions of Ohioans who rely on the state for needed medications, records obtained by The Dispatch show. Going back to at least 2015, drugmakers warned Ohio officials not to use their products in executions. Gov. Mike DeWine and his administration have said some have gone so far as to threaten not to supply Ohio medicine for any use, including in state veterans homes, psychiatric hospitals and prison infirmaries — and for the nearly 3 million residents receiving Medicaid benefits. (Schladen, 9/18)

Boston Globe: Southcoast Health, Blue Cross At Odds Over Payment Rates
Southcoast Health and the state’s largest health insurer are engaged in a contract dispute about how much the hospital system should be paid, threatening to disrupt care for thousands of patients. Southcoast’s chief executive, Keith A. Hovan, took the disagreement public over the weekend, penning a local newspaper opinion piece that accused Blue Cross Blue Shield of Massachusetts of putting revenues before patients. (Dayal McCluskey, 9/17)

San Francisco Chronicle: Protesters Shut Down Commission Meeting As Fight Over SF Mental Health Policies Intensifies
Loud protesters shut down a San Francisco Health Commission meeting Tuesday over the city’s decision to stop admitting patients into a long-term care facility for the mentally ill, and instead turn many of the beds into a temporary respite facility. The protest — which involved about 80 people, including facility staff and patients — came one week after the Department of Public Health told The Chronicle that it decided to stop admitting patients to the Adult Residential Facility on San Francisco General Hospital’s campus due to staff negligence and errors. (Thadani, 9/17)

St. Louis Post Dispatch: ‘Cure Violence’ Program Shouldn’t Be Only Approach To Curbing Violent Crime, Mental Health Official Says
The “Cure Violence” crisis intervention program planned by city leaders should be just one of a wide range of approaches to try to stem violent crime, a city Mental Health Board official told aldermen Tuesday. “I don’t think that one program by itself will address the issues that we have in the city,” said Serena Muhammad, director of strategic initiatives for the tax-supported mental health agency. (Schlinkmann, 9/17)

Georgia Health News: No Delay: Nonprofit Hospitals Must Disclose Financial Data Soon
Georgia’s nonprofit hospitals will still have to disclose extensive financial data by Oct. 1, even though state regulations on this new requirement won’t be finished by then, state officials say. A disclosure law, passed by the General Assembly early this year, requires reporting of executive compensation and the financial holdings of hospitals, among other information. (Miller, 9/17)

MPR: 'FACT' Teams Aim To Keep People With Mental Illness Out Of Jail
When someone is experiencing a mental health crisis, often the only alternatives are jail or an emergency room. Neither of those alternatives is particularly helpful, and sometimes they can make a person’s condition worse. Nationwide, cities and counties are searching for cheaper and more therapeutic options.Some are turning to Forensic Assertive Community Treatment, or FACT, teams — a way to provide a range of support services designed to keep people with serious mental illness out of the hospital and out of the criminal justice system. (Roth, 9/18)

California Healthline: Voices: How Should California Address The Needs Of Its Aging Population?
Demographers, gerontologists and government officials are counting down to 2030.That’s the year America’s youngest baby boomers will reach retirement age. The country already is feeling the effects of an aging population, but its most populous state is bracing for a hard hit as retirement collides with increasing poverty and the high cost of living. (Almendrala and Ibarra, 9/17)

Belleville News-Democrat: Here’s How Much St. Clair County Plans To Tax For Recreational Cannabis Sales
With recreational cannabis sales set to become legal in Illinois in 2020, St. Clair County officials are setting tax rates and eyeing where the new revenue might go. The board voted to set tax rates on recreational sales at a special meeting of the county board Monday night with all attending board members voting in favor of the ordinance. (Mansouri, 9/17)

The Wall Street Journal: The Startup That Manipulated Data To Get A Miracle Drug To Market
The startup had something incredible: a cure for babies with a deadly neurological disease. Last year, the company was snapped up by pharmaceutical giant Novartis AG NVS -2.79% , and by this past May, its drug was the most expensive on the market. In just a few years, the company, AveXis Inc., morphed from a handful of hospital-based researchers into one of the pharmaceutical industry’s most stunning success stories. But in the hurry to fulfill the drug’s promise, AveXis manipulated data that went into the drug’s approval, Novartis and the Food and Drug Administration now say. (Roland, 9/14)

Reuters: U.S. Senators Urge FTC To Scrutinize Multi-Billion Dollar Pharma Mergers
U.S. presidential hopeful Amy Klobuchar on Tuesday led a letter by U.S. senators that urged the Federal Trade Commission (FTC) to closely scrutinize pharma mergers, raising concerns about the potential harm to customers. The U.S. healthcare industry has seen a string of multi-billion dollar deals and consolidation is expected to remain a major theme for the rest of the year. (9/17)

Stat: Wholesale Drug Prices Have Been Falling, And So Have Net Prices
Amid continuing political pressure on drug makers, a new analysis finds that brand-name companies increased their wholesale prices by 3.1% in this year’s second quarter, a smaller boost than the 4.6% hike that occurred during the same time a year ago. Meanwhile, after subtracting certain allowances, net prices fell by 5.8% compared with a 6.1% decline in last year’s second quarter, according to Sector & Sovereign Research, which tracks the pharmaceutical industry. (Silverman, 9/16)

Stat: Medicare Part D Rebates ‘Substantially’ Reduced Drug Spending, But Not Enough To Offset Price Hikes
As controversy continues over prescription drug pricing, a new study finds that Medicare Part D spent $2 billion more for brand-name medicines in 2015 than four years earlier, even though drug makers offered rebates to win favorable coverage from health plans. Specifically, reimbursement to pharmacies for more than 1,500 brand-name medicines rose 19% from 2011 to 2015, while manufacturer rebates offered Medicare Part D plan sponsors increased 4% during that time, according to the Office of Inspector General of the Department of Health and Human Services, which ran the analysis in response to a request from Congress. (Silverman, 9/17)

Modern Healthcare: Medicaid Drug Spending Could Be Cut With New Payment Models
As states continue to see their healthcare budgets rise, some are turning to alternative payment models to control rising prescription drug costs and improve population health, according to a new report. State healthcare budgets increased 7.3% from 2017 to 2018, according to the Duke-Margolis Center for Health Policy. But their attempts to curb the prescription drug costs that contributed to that budget bump are facing some barriers, including operational issues such as a limited ability to collect data about peoples' health outcomes and an absence of proven contracting models. (Brady, 9/17)

Columbus Dispatch: Ohio's Pharmacy Benefit Managers Back In Spotlight Of Medicaid-Oversight Panel
The legislative committee that oversees Ohio’s $28 billion Medicaid program will meet Thursday for the first time this year, and legislators want to know whether the state has made progress in addressing long-standing concerns about pharmacy middlemen profiting off prescription drugs for the poor and disabled. After eight months on the job, Medicaid Director Maureen Corcoran will make her first appearance before the Joint Medicaid Oversight Committee to provide an update that might include the results of a long-awaited report on pharmacy drug pricing. (Candisky, 9/16)

FierceHealthcare: States Mull Value-Based Drug Pricing Models But Face Significant Barriers: Report
States are seeking to try value-based payment models to mitigate high drug costs, but there are plenty of barriers to implementing these programs, according to a new report. Several states have rolled out outcomes-based or population-based models for drug pricing in Medicaid. Louisiana and Washington, for example, operate “Netflix-style” subscription models for hepatitis C drugs. States such as Michigan and Oklahoma are testing outcomes-based approaches.  (Minemyer, 9/16)

NPR: Beyond Insulin: Insurance Rules Can Slow Delivery Of Crucial Diabetes Supplies
In the first three months after getting his Dexcom continuous glucose monitor, Ric Peralta managed to reduce his average blood sugar level by three percentage points. "It took me from not-very-well-managed blood sugar to something that was incredibly well managed," says Peralta, a 46-year-old optician in Whittier, Calif., who was diagnosed with Type 1 diabetes in 2008. Peralta was so enthused that he became a "Dexcom Warrior," a sort of grassroots spokesman for the product. (Sable-Smith, 9/18)

Stat: Martin Shkreli's Firm Is Losing Money — And Its Salesforce Feels Cheated
Phoenixus AG, the drug company founded and controlled by Martin Shkreli, has maintained a low public profile following the backlash over the Daraprim price hike and his federal conviction for securities fraud. While Shkreli has tried to steer Phoenixus’ operations from prison, the company formerly known as Vyera Pharmaceuticals (and Turing Pharmaceuticals before that) continues to lose money due to declining sales, according to financial documents obtained by STAT. (Feuerstein, 9/18)

Stat: FDA To Streamline Some Cancer Therapy Reviews With Canada, Australia
In an effort to speed the process of getting drugs to patients around the world, the Food and Drug Administration and its counterparts in Canada and Australia on Tuesday unveiled a new pilot program that will allow the agencies to review — and potentially greenlight — cancer therapies at the same time. (Joseph, 9/17)

Reuters: With A Backup To The Backup, Insulin Makers Say They're Primed For Brexit
For two men trained as scientists, the bosses of Britain's major insulin providers have had to become experts in ferry schedules, trucking laws and warehouse capacity as they seek to guarantee the supply of life-saving drugs through a chaotic Brexit. With Britain set to leave the European Union within weeks, Pinder Sahota at the world's biggest insulin maker Novo Nordisk, and Sanofi's Hugo Fry have rebuilt operations to withstand the most turbulent of events. (Holton and Sandle, 9/17)

The Wall Street Journal: Louisiana’s Deal For Hepatitis C Drugs May Serve As Model
The crowd at the New Orleans health clinic in late June filled the seats and overflowed into the wings. Louisiana Gov. John Bel Edwards was there, as were employees from Gilead Science ’s affiliate Asegua Therapeutics. They had gathered to launch a plan for the statewide elimination of hepatitis C, which killed more than 17,000 Americans in 2017. The event, however, wasn’t prompted by the discovery of a new cure. Officials were unveiling a new way of paying for an existing therapy. (Alcorn, 9/13)

The Wall Street Journal: Sienna Biopharmaceuticals Files For Bankruptcy
Sienna Biopharmaceuticals Inc. has filed for bankruptcy with plans to find a buyer or investor during its chapter 11 proceedings. The publicly traded drugmaker, whose major investors include Arch Venture Partners, filed its petition Monday in the U.S. Bankruptcy Court in Wilmington, Del. (Yerak, 9/17)

Stat: TV Personality Dr. Oz Is Now On The Board Of A Biotech Company
One biotech company’s newest director has a very familiar face. Dr. Mehmet Oz will be joining the board of directors of PanTheryx, a Colorado-based nutraceutical and biologics company, the company recently announced. Oz, the host of “The Dr. Oz Show,” commands a huge following. He has also drawn sharp criticism for his embrace of alternative medicine and for his “disdain for science and for evidence-based medicine,” as 10 physicians wrote in a 2015 letter to the dean of medicine at Columbia University, where Oz is a faculty member. (Sheridan, 9/17)

CNN: Big Pharma Is Abusing Patents, And It's Hurting Americans
The American patent system has, since our nation's founding, served as a cornerstone of innovation. But the pharmaceutical industry's willingness to undermine this system is having real consequences for American patients. The skyrocketing cost of health care has been fueled by rapidly rising prescription drug prices, which are significantly higher for Americans than patients in other wealthy countries. While some argue that this is just the cost of being a global innovator, it is more complicated than that, and a key source of the problem is the abuse of the patent system. (Garrett Johnson and Wayne T. Brough, 9/13)

The Hill: The Promise And Peril Of Offshoring Prescription Drug Pricing
The president, Congress, and most Americans agree prescription drug prices are too high. After years of drug price growth and relatively little action, 2019 has so far seen an explosion of policy proposals from both parties that could promise some relief. Several of these proposals, including a draft proposal from House Speaker Nancy Pelosi and a regulation and executive order under development by the Trump administration, look to drug prices in other countries to help set prices in the U.S. The straightforward reasoning behind this strategy is that other countries have much lower list prices for drugs than the U.S., and so adopting prices from oversees should lower drug spending here. (Andrew Mulcahy, 9/14)

Stat: Why Didn’t Nonprofits And The NIH Require ‘Reasonable’ Pricing For Zolgensma? That May Happen In France
When a new drug emerges from research largely funded by grants from charities and government agencies, who gets to set the price? In the U.S., that question seems to have been answered — the drug company that makes it. As I’ve learned from a poorly redacted filing with the Securities and Exchange Commission, the answer may be different in France. In May, the FDA approved Zolgensma, a gene therapy for young children with spinal muscular atrophy (SMA). Its maker, Novartis (NVS), set the price at $2.1 million, roughly nine times the median sale price for a home in the U.S. and 33 times the national per capita income. (James Love, 9/18)

Washington Times: Prescription-Drug Price Gouging Must Stop
This week, senators and representatives have returned to Washington, D.C., after a five-week recess. Most congressional members used that time period to criss-cross their state or district, talking to their constituents and hearing directly from them about what needs to be done in Washington. They no doubt heard about immigration concerns, the impact of the trade war and overall frustrations with a lack of action in Washington. And, as I know I have, I’m willing to bet that most of them heard about the skyrocketing cost of prescription drugs as well. (Robert Graham, 9/16)

Honolulu Civil Beat: Hawaii Residents Need Relief From Rx Greed
For decades, Big Pharma has raised drug prices with impunity. Here in Hawaii the average annual cost of brand name prescription drug treatment increased 58% between 2012 and 2017, while the annual income for Hawaii residents increased only 14.8%. Prescription drugs don’t work if patients can’t afford them. (Kealii Lopez, 9/18)

Toledo Blade: Drug Company Probes Must Go Unimpeded
With prescription drug prices spiraling out of control, much work needs to be done to corral the industry and ensure consumers have ready access to medication. But just as important is holding the companies responsible for this price inflation to account and making sure that the public gets the answers it deserves. Earlier this year, 44 states filed a lawsuit against Mylan, Teva Pharmaceutical, and 18 other companies, alleging that the companies “systematically” divvied up the generic drug market to avoid competition, boost prices, and maximize profits. This lawsuit comes on the heels of a congressional inquiry, launched in 2014, into the same matter. (9/17)

The New York Times: Does Anyone Really ‘Love’ Private Health Insurance? 
Twenty minutes after I learned I had Type 1 diabetes — after narrowly avoiding a diabetic coma — a nurse pulled my parents away from my bedside and urged them to call our insurance company immediately. If they didn’t call right away, she warned, insurance would not cover the stay. At that moment — now 10 years ago — my parents had to choose whether to comfort their sick and frightened 14-year-old daughter, or spend hours on the phone with our insurer. Of course, they left me to make those calls, and my nightmarish relationship with the insurance industry began. (Rachel Madley, 9/17)

The Hill: Fixing America's Heath-Care System Is Going To Require Radical Reform: Price Caps
Americans spend more money on health care because prices are higher here than anywhere else in the world. Our system is fraught with waste, our providers (physicians and hospitals) are paid more; and goods like biopharmaceuticals and medical devices are more expensive. On average, U.S. hospital prices are 60 percent higher than countries in Europe and physicians make twice as much as their counterparts in other advanced countries. (Arielle Kane, 9/17)

Axios: Workers Aren't So Sure "Medicare For All" Would Raise Their Wages 
Advocates of a single-payer system may have a hard time persuading workers that their wages would go up if their employer-based health care went away. Why it matters: “Medicare for All” would bring an enormous amount of change to the health system, and the disruption of employer-based insurance is already an important political flashpoint. "For a socialist, you've got a lot more confidence in corporate America than I do,” former Vice President Joe Biden said to Sen. Bernie Sanders at last week’s Democratic debate, in response to Sanders’ assurances that employers would raise wages if they were no longer paying for health benefits. (Drew Altman, 9/17)

Austin American-Statesman: We Need To Get Better At Reaching The Sickest And Poorest Among Us
Every day in communities in Texas and across the country, many people go without the health care that the rest of us take for granted. Individuals in low-income communities, often rural areas or inner cities, face numerous challenges to getting their needs met: longer wait times for appointments, farther distances to providers, difficulty understanding treatment plans for a variety of chronic conditions, and struggling to pay medical and pharmacy costs.In addition, as access to Medicaid and clinic appointments becomes more digitized, ethnic minority communities are often intimidated by expanded choices or skeptical about unfamiliar approaches and fail to connect with these resources. (Miyong Kim, 9/17)

The Hill: Health Care For Veterans Is On The Chopping Block
On July 9, exactly two months ago, three federal judges sitting in a New Orleans courtroom heard a lawsuit seeking to overturn the entire Affordable Care Act. The case was brought by Texas and 17 other states, with the Trump administration lending its support. On the other side were 20 states led by a mix of Democrats and Republicans.  A victory for Texas and its partners would end the ACA’s ban on discrimination against people with pre-existing conditions, a critically important safeguard for those of us with health problems. But other people are also at risk, including one group we cannot afford to fail — veterans in America. (Stan Dorn, 9/17)

The New York Times: Don’t Forget Our Frontline Caregivers In The Opioid Epidemic
America’s opioid epidemic will go down in history alongside the Spanish flu, typhoid, polio and AIDS as one of our worst public health disasters. Between 1999 and 2017, almost 218,000 people in the United States died from overdoses connected to prescription opioids, and almost as many more died from overdoses connected to illicit opioids. Of the 70,000 drug overdose deaths in 2017, two-thirds of them were opioid-connected. Deaths continue at the rate of 130 a day. The impact on our health care system and our hospitals has been staggering. (John Kasich and E. Gordon Gee, 9/17)

The Wall Street Journal: Safe Or Deadly: College Students Debate Vaping
It’s past time to smoke out the hysteria surrounding e-cigarettes. The numbers don’t lie. While seven unfortunate deaths related to e-cigarettes have recently made the headlines, about 150,000 Americans died last year of lung cancer—with tobacco as the major culprit.To vape is to choose the much lesser of two evils. One randomized trial from the U.K. found that vaping was twice as effective as nicotine patches and gum at getting smokers to quit their habit successfully. Even if vaping is somewhat detrimental to lung health—mostly due to modified or illegal cartridges—we allow people to harm their bodies in all kinds of ways. That’s part of the American vision of freedom. (9/17)

St. Louis Post Dispatch: I'm A Gun Lover, But I Can No Longer Remain In The NRA
This decision is based more on the organization’s tactics than its mission. They seem to have decided to defend the Second Amendment solely through vilifying liberals. I wish I could count the number of fundraising phone calls I’ve received whose script started telling me whom to be afraid of, who I needed to fight. The names have changed over the years, but the fear-based marketing has remained amazingly consistent. (Jeremy Grojean, 9/17)

Lexington Herald Leader: Your Second Amendment Right To Own Guns Can’t Outweigh Our Safety 
A recent poll by the PBS NewsHour, NPR and Marist reveals that most Americans support federal legislation requiring background checks (83%) and licenses (72%) to purchase guns and to ban both the purchase of high-capacity ammunition magazines (61%) and semi-automatic assault rifles (57%). Representative Andy Barr recently wrote in the Herald Leader that Republicans are being “falsely accused” of failing to curb gun violence in the U.S., citing some actual or proposed legislation “aimed at preventing violence.” Only one of his items (a ban on “bump stocks’) addresses gun restrictions and none focus on the actions favored overwhelmingly by both Democratic and Republican voters in these polls.So why are many politicians ignoring the wishes of their constituents? (Donald J. Mullineaux, 9/17)

The New York Times: What’s The Right Way To Reverse The Obesity Epidemic?
James Corden drew on his own experience with weight management and stigma over the weekend in a rebuttal to Bill Maher, who, confusing cruelty for wit, declared that “fat shaming doesn’t need to end, it needs to make a comeback.” Mr. Corden responded: “You’re working against your own cause. It’s proven that fat shaming only does one thing: It makes people feel ashamed.” (Spencer Bokat-Kindell, 9/17)

The New York Times: The Abortion Mysticism Of Pete Buttigieg
Pete Buttigieg, the mayor of South Bend, Ind., has made his Christian piety a minor theme of his presidential campaign — quoting Proverbs on the debate stage to critique Republican opposition to a minimum-wage increase, attacking conservative evangelicals over their “porn star presidency” and un-biblical approach to refugees, urging his party to court religious voters and take religion more seriously. (Ross Douthat, 9/17)

Los Angeles Times: Why California Public University Students Should Have On-Campus Access To The 'Abortion Pill'
When Gov. Jerry Brown vetoed the bill last year that would have provided California’s public university students access to medication abortion — widely known as the “abortion pill”— at their on-campus student health centers, he justified it by saying most students lived within five to seven miles of an off-campus abortion provider. He saw the distance as not “unreasonable.” But this reasoning is an oversimplification of the barriers students face in trying to secure abortion services. I’m one of those students who had to travel to an abortion provider off campus, but I attended a private California university. About 500 students a month at the state’s public universities are forced to seek medication abortions off campus. (Jackie Castellanos, 9/18)

Kansas City Star: Missouri Should Scrap Statute Of Limitations For Clergy Abuse
Missouri Attorney General Eric Schmitt has referred the cases of a dozen former Catholic priests accused of sexually abusing minors to prosecutors after a year-long investigation. That potential for justice for any of those so long denied is appreciated, though it’s impossible to say how many of the dozen men will be charged, much less convicted. But charges can’t even be pursued against 46 other ex-clergy because the statute of limitations on the allegations against them has expired.That’s wrong, and it doesn’t have to be this way. (9/18)

San Francisco Chronicle: Newsom On Wrong Side Of Environmental Bill
Gov. Gavin Newsom has signaled that he will veto the most significant environmental protection bill to emerge from the California Legislature this past session: Senate Bill 1, a measure tailored to safeguard the Sacramento-San Joaquin River Delta from water grabs if, as expected, the Trump administration weakens the Endangered Species Act. The governor who fancies himself as a leader of the resistance to Trump administration policies that undermine this state’s laws and violate its values needs to reconsider his position on SB1. (9/16)