Home Trending Monday, December 17, 2018 | Kaiser Health News

Monday, December 17, 2018 | Kaiser Health News


The Associated Press:
Federal Judge Rules Health Care Overhaul Unconstitutional

In a 55-page opinion, U.S. District Judge Reed O’Connor ruled that last year’s tax cut bill knocked the constitutional foundation from under “Obamacare” by eliminating a penalty for not having coverage. The rest of the law cannot be separated from that provision and is therefore invalid, he wrote. Supporters of the law immediately said they would appeal. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans,” said California Attorney General Xavier Becerra, who is leading a coalition of states defending the ACA. (Alonso-Zaldivar, 12/14)

Kaiser Health News:
Judge Strikes Down ACA Putting Law In Legal Peril — Again

It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015. (Rovner, 12/14)

The judge’s ruling, practically speaking, won’t have an immediate impact on the way the health law operates. With enrollment closing on Saturday, the Trump administration said the court decision has “no impact to current coverage or coverage in a 2019 plan.” But the case, seemingly bound for the Supreme Court, now threatens to complicate a wide array of policies and send a shock wave through a marketplace that’s been in upheaval for years.

The New York Times:
What The Obamacare Court Ruling Means For Open Enrollment

Open enrollment was scheduled to end on Saturday in most states, and every year, a surge of people sign up at the last minute. The Centers for Medicare and Medicaid Services sent out an email to millions of Americans on Saturday trying to allay concerns, and HealthCare.gov displayed a red banner alerting people that the court’s decision would not affect open enrollment. “Are you covered yet?” HealthCare.gov tweeted on Saturday. “Hurry!” (Mervosh, 12/16)

The Washington Post:
ACA Ruling Creates New Anxieties For Consumers And The Health-Care Industry

The ruling by a federal judge in Texas striking down the Affordable Care Act has injected a powerful wave of uncertainty about recent changes woven into the U.S. health-care system that touch nearly all Americans and the industry that makes up one-sixth of the economy. The opinion, if upheld on appeal, would upend the health insurance industry, the way doctors and hospitals function, and the ability of millions of Americans to access treatments they need to combat serious diseases. (Goldstein, 12/16)

Ruling Striking Down Obamacare Won’t Affect Health Coverage, Yet 

The White House confirmed that the law remains in effect pending appeal, even as President Donald Trump called the ruling “great news” and suggested Congress start working on a replacement. The ruling has “no impact to current coverage or coverage in a 2019 plan,” Seema Verma, the administrator for the Centers for Medicare and Medicaid Services, tweeted. (Tozzi, 12/17)

Obamacare Ruling Delivers New Shock To Health System

Expanded Medicaid for millions. Penalties for poorly performing hospitals. Even the Trump administration’s own plans to lower drug prices. Those and many other initiatives would all be illegal under a federal judge’s sweeping decision that the entire Affordable Care Act must be struck down — the latest shock to the nation’s health system after a decade of upheavals, including two fights over the ACA that reached the Supreme Court. (Diamond, 12/15)

The Wall Street Journal:
What ACA Ruling May Mean For Millions Of Americans’ Health Coverage

Practically speaking, nothing will happen right away. The judge didn’t immediately block enforcement of the ACA, so it remains in effect for now. The White House on Friday night said the law would stay in place during the appeals stage of the case, a process that could take many months. … It is an open question whether some states may attempt to back away from administering the health law starting next month, once the elimination of the tax penalty goes into effect. If they do, it could spark additional litigation. (Kendall, 12/15)

Health Law Ruling Leaves Consumers Confused

Tim Jost, a professor emeritus at Washington and Lee Law School and an expert on the health law, told CQ on Saturday that the next procedural steps are unclear. A group of Democratic attorneys general that are defending the law will likely soon file an appeal, but because the judge filed a declaratory judgment, rather than an injunction, all parties involved may need to take more time to figure out the next steps. “The main effect right now is just a tremendous amount of confusion,” Jost said. “I think we could possibly lose thousands or tens of thousands of people who need to sign up today.” (McIntire, 12/15)

The Hill:
ObamaCare Signup Period Ends Amid New Uncertainty

ObamaCare’s latest open enrollment period ended Saturday with the future of the law facing uncertainty after a federal judge in Texas struck it down. Sign-ups for ObamaCare plans at healthcare.gov, the federal platform used by 39 states, had already lagged behind previous years, putting enrollment on track to drop for the second year in a row under the Trump administration. (Hellmann, 12/17)

Health Stocks Prepare For Market Jolt After Obamacare Ruling 

U.S. health-care stocks are poised for a potentially ugly trading session Monday as investors weigh in on a judge’s ruling that Obamacare is unconstitutional. A judge sided with Texas late Friday in a lawsuit alleging that Congress’s decision in 2017 to kill a related tax penalty essentially voided the entire Affordable Care Act. While many analysts expect the ruling to be reversed by higher courts, the news adds to volatility in a sector that had barely recovered from political overhangs this year and yet remains the top performing sector in the S&P 500. (Darie, 12/16)

And more on the state impact —

The Baltimore Sun:
What Does Texas Ruling Mean For Obamacare In Maryland? 

After the U.S. Department of Justice said it wouldn’t defend Obamacare in court, [Maryland Attorney General Brian] Frosh filed a case in September. It seeks what’s known as a declaratory judgment saying that Obamacare passes constitutional muster. The Justice Department is seeking to have Frosh’s suit thrown out, arguing that Maryland doesn’t have grounds to bring a case in the first place. Frosh acknowledged that the case was unusual but said it was important that Maryland fight in court. (Duncan, 12/15)

The Star Tribune:
Despite ACA Ruling, Nothing Changes For Minnesota

If you plan to get health insurance through MNsure or have already, nothing changes despite a federal judge’s ruling that the Affordable Care Act is unconstitutional. “Given the recent Texas court case, I wanted to remind Minnesotans that the Affordable Care Act is still the law of the land and that MNsure is open for business,” Gov. Mark Dayton said Saturday in a statement. (Stahl, 12/15)

Atlanta Journal-Constitution:
Georgia AG Carr Touts Obamacare Ruling In Suit Georgia Helped Bring

Reaction in Georgia was swift to a ruling Friday night from a federal judge in Texas striking down the entire Affordable Care Act, also known as Obamacare.Chris Carr, Georgia’s attorney general, said the ruling was just what he and other Republican leaders had argued, when Carr in February added Georgia’s weight behind the lawsuit as one of 20 states challenging the law. (Hart, 12/15)

Had Congress meant to take such radical action as to invalidate the entire law because of one provision, the experts say, it would have said so at the time. “He effectively repealed the entire Affordable Care Act when the 2017 Congress decided not to do so,” Yale law professor Abbe Gluck told The New York Times.

The New York Times:
Health Law Could Be Hard To Knock Down Despite Judge’s Ruling

Could a federal judge in Texas be the catalyst that finally brings down the Affordable Care Act, a law that has withstood countless assaults from Republicans in Congress and two Supreme Court challenges? On the morning after Judge Reed O’Connor’s startling ruling that struck down the landmark health law, legal scholars were doubtful. Lawyers on both sides of previous A.C.A. battles said the reasoning behind this one was badly flawed, notably in its insistence that the entire 2010 law must fall because one of its provisions may have been rendered invalid by the 2017 tax overhaul legislation. Had Congress meant to take such radical action, they said, it would have said so at the time. (Hoffman, Pear and Liptak, 12/15)

The Washington Post:
Legal Experts Rip Judge’s Rationale For Declaring Obamacare Law Invalid

“There’s really no American that’s not affected by this law,” said Yale law professor Abbe Gluck, who filed an amicus brief with other lawyers in the Texas case. The judge’s ruling, she said, flouts settled legal doctrine and places key acts of Congress in reverse order. By ignoring that Congress specifically declined to strike down the ACA in 2017 when it chose to alter only one portion of the bill, she said, the judge decreed that the 2010 Congress, which first passed the law, has more authority than the same legislative body in 2017. “It’s absolutely ludicrous to hold that we do not know whether the 2017 Congress would have wanted the rest of the ACA to exist without an enforceable mandate, because the 2017 Congress did exactly that when it zeroed out the mandate and left the rest of the ACA standing,” Gluck said. “He effectively repealed the entire Affordable Care Act when the 2017 Congress decided not to do so.” (Barrett, 12/15)

The Hill:
Five Takeaways From The Court Decision Striking Down ObamaCare

But where legal experts particularly criticize O’Connor is his next step, where he ruled that because the mandate is unconstitutional, the rest of the Affordable Care Act is also invalid. Experts say that violates the established legal standard that Congress’s intent should be the guide, and in this case it is obvious that Congress intended for the rest of the Affordable Care Act to remain when it repealed only the mandate penalty last year. (Sullivan, 12/15)

Republicans just spent months making campaign promises to retain popular provisions of the health law, such as protections of preexisting conditions coverage. The decision to invalidate those measures in a case pushed by Republican attorneys general ties the party, politically, to a decision undercutting those promises. Meanwhile, President Donald Trump touted the decision, calling it “a great ruling for our country.”

The New York Times:
Ruling Striking Down Obamacare Moves Health Debate To Center Stage

The decision by a federal judge in Texas to strike down all of the Affordable Care Act has thrust the volatile debate over health care onto center stage in a newly divided capital, imperiling the insurance coverage of millions of Americans while delivering a possible policy opening to Democrats. After campaigning vigorously on a pledge to protect patients with pre-existing medical conditions — a promise that helped return them to the House majority they had lost in 2010 — Democrats vowed to move swiftly to defend the law and to safeguard its protections. (Stolberg, Pear and Goodnough, 12/15)

The Associated Press:
Judge’s Ruling On ‘Obamacare’ Poses New Problems For GOP

Republicans, still stinging from their loss of the House in the midterm elections, are facing a fresh political quandary after U.S. District Judge Reed O’Connor said the entire 2010 health law was invalid. Warnings about the Texas lawsuit were part of the political narrative behind Democrats’ electoral gains. Health care was the top issue for about one-fourth of voters in the November election, ahead of immigration and jobs and the economy, according to VoteCast, a nationwide survey for The Associated Press. Those most concerned with health care supported Democrats overwhelmingly. (Alonso-Zaldivar, 12/14)

The Washington Post:
Health-Care Law Ruling Puts Republicans On The Defensive After Campaign Promises

Republicans are under greater pressure to produce an alternative to the law they have ardently opposed since its passage and a means to ensuring affordable health care coverage to some 52 million people with conditions such as diabetes, asthma and cancer. But they are still riven by the divisions that thwarted previous efforts to overhaul the law. (Sullivan, 12/15)

The Wall Street Journal:
Politicians Grapple With Response To Health Law Ruling

Republicans on Sunday said they wanted to maintain the 2010 law’s guarantee of insurance coverage for people with pre-existing conditions. But they also said they continued to oppose most or all of the law, such as its requirement that most people obtain health insurance, the so-called individual mandate. How they might accomplish both goals remained unclear. “There is widespread support for protecting people with pre-existing conditions. There’s also widespread opposition to the individual mandate,’’ said Sen. Susan Collins (R., Maine), speaking on CNN. She said the insurance-purchasing requirement, which is intended to ensure enough healthy people buy policies to make the plans economically viable, was particularly burdensome for low- and middle-income families. (Armour and Peterson, 12/16)

GOP Feels Heat In Wake Of Obamacare Ruling: ‘It’s All The Downsides’

The result is likely to be a split GOP caucus that draws flak from both the right and the left. Republicans who survived the midterm elections by vowing to protect people with pre-existing conditions will find themselves in a particularly tough spot, feeling intense pressure to make good on that pledge. “It’s all the downsides,” a House GOP aide said. “Politically, I don’t think that it helps us at all.” (Demoko and Cancryn, 12/15)

Judge Lobs Political Bomb At Trump By Nullifying Obamacare

“I’m not sure Republicans even know what they’re fighting for right now when it comes to health care,” said David Jolly, a former Republican congressman from Florida who now identifies as an independent. “Opposing Obamacare has become reflexive GOP orthodoxy, but they just spent six months saying they’d protect pre-existing conditions. Hard to square GOP campaign promises with the court victory by GOP attorneys general.” (Kapur, 12/15)

Nashville Tennessean:
Obamacare Unconstitutional? Sen. Alexander Skeptical SCOTUS Will Agree

One day after a federal judge in Texas issued a decision in which he deemed the Affordable Care Act unconstitutional, a key Tennessee lawmaker expressed skepticism that the nation’s high court would concur. In a statement issued Saturday, Sen. Lamar Alexander, who is chairman of the Senate Health Committee, said, “If the U.S. Supreme Court eventually were to agree that Obamacare is unconstitutional — which seems unlikely, however poorly the law was written — I am confident that any new federal law replacing it will continue to protect Americans with pre-existing conditions who buy health insurance.” (Ebert, 12/16)

Trump Hails Judge’s Ruling Against Obamacare As ‘Great’

President Donald Trump on Saturday hailed a court decision against Obamacare as “a great ruling for our country,” while a U.S. government official said the decision by a Texas judge would have no immediate impact on health coverage. (12/15)

The Hill:
Trump Touts Ruling Against ObamaCare: ‘Mitch And Nancy’ Should Pass New Health-Care Law

“Mitch and Nancy, get it done!” Trump added, referring to Senate Majority Leader Mitch McConnell (R-Ky.) and expected incoming House Speaker Nancy Pelosi (D-Calif.). (Axelrod, 12/14)

Senate Minority Leader Chuck Schumer (D-N.Y.) said he will try to force a Senate vote to intervene in the federal case while House Democratic leaders plan to order House counsel to defend the health law as soon as they take control of the chamber next year. Meanwhile, President Barack Obama tried to calm any fears that the decision could ultimately strike down his signature domestic achievement.

Schumer Pushes For Senate Vote On Obamacare Case

The Senate’s top Democrat on Sunday said he plans to push for a vote to intervene in a federal court case over Obamacare after a judge in Texas last week ruled that the landmark health care law is unconstitutional. “We’re going to fight this tooth and nail,” Minority Leader Chuck Schumer of New York said in an interview on NBC’s “Meet the Press.” “And the first thing we’re going to do when we get back there in the Senate is urge, put a vote on the floor, urging an intervention in the case.” (O’Brien and Ollstein, 12/16)

The Washington Post:
Federal Judge In Texas Rules Entire Obama Health-Care Law Is Unconstitutional

House Minority Leader Nancy Pelosi (D-Calif.), who is expected to become speaker next month, issued a statement that said: “When House Democrats take the gavel, the House of Representatives will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act.” (Goldstein, 12/14)

The Wall Street Journal:
Federal Judge Rules Affordable Care Act Is Unconstitutional Without Insurance-Coverage Penalty

Friday’s decision rattled top Democratic politicians, medical groups and health-industry leaders. Some advocacy groups called on Congress to immediately pass legislation protecting coverage for people with pre-existing conditions, and the American Medical Association vowed to work with other organizations in seeking an appeal. “This is a five alarm fire—Republicans just blew up our health care system,” Sen. Chris Murphy (D., Conn.) said in a statement. “The anti-health care zealots in the Republican Party are intentionally ripping health care away from the working poor, increasing costs on seniors, and making insurance harder to afford for people with preexisting conditions.” (Armour and Kendall, 12/15)

The Hill:
Klobuchar Calls ObamaCare Ruling ‘Absurd’

Sen. Amy Klobuchar (D-Minn.) on Sunday called it “absurd” that a Texas judge ruled that the Affordable Care Act is unconstitutional and called on Republicans to work with Democrats to improve the health-care law. “The ruling was absurd. [Supreme Court] Justice [John] Roberts in a conservative court has already ruled that the Affordable Care Act is constitutional,” she said on CBS’s “Face the Nation.” (Burke, 12/16)

The Washington Post:
Obama Hits Out At Republicans After Judge Rules Affordable Care Act Unconstitutional

Obama responded on Saturday by saying in a Facebook post that “Republicans will never stop trying to undo” the health-care law and urging people to continue to get covered under the ACA as the decision makes its way through the courts in what could be a prolonged appeals process. As of early Monday, his Facebook post has received more than 28,000 reactions, and has been liked more than 72,000 times since he also shared it on Twitter. The former president tried to quell any dread that the ruling could ultimately strike down the entirety of his signature health-care law, which is commonly referred to as Obamacare. (Bella, 12/17)

Democrats Vow Rapid Action After Obamacare Tossed By Judge 

Obamacare was struck down by a Texas federal judge in a ruling that casts uncertainty on insurance coverage for millions of U.S. residents, drawing sharp condemnation from some medical professionals and a vow for action by top Democrats. President Donald Trump termed the ruling “a big big victory by a highly respected judge” and an alternative path to the long-time Republican goal of repeal-and-replace. (Korosec and Mehrotra, 12/14)

The Associated Press:
Judge In Health Care Case Had Blocked Other Obama Policies

U.S. District Judge Reed O’Connor, who ruled the Affordable Care Act “invalid” Friday, is no stranger to the conservative resistance to Obama administration policies. O’Connor, 53, is a former state and federal prosecutor who was nominated to the federal bench in 2007 by President George W. Bush. He has been active in the Federalist Society, which describes itself as “a group of conservatives and libertarians interested in the current state of the legal order.” (12/14)

The Associated Press Fact Check:
Trump Floats Fictions About The Border

President Donald Trump’s relationship with the truth tends to be borderline, at best, when it comes to the border. So it was this past week when he made a flurry of false or unsupported statements about immigration. He said, with no evidence, that migrants are plagued with disease. He asserted that Mexico has in effect agreed to pay for his border wall, even as he threatens a partial government shutdown if Congress doesn’t approve billions of dollars to build it. He twisted federal statistics to claim the recent arrest of 10 terrorists who don’t exist. (Woodward and Yen, 12/15)

With reports on the rise of fentanyl’s lethality, even through accidental exposure, people are being prosecuted for endangering the lives of police officers who respond to emergency calls. Experts, however, say that the science behind accidental exposure doesn’t support the extreme measures. Other news from the national drug epidemic includes: secret OxyContin documents, recovery in a small town, naloxone, a massive drug operation and more.

The New York Times:
What Can Make A 911 Call A Felony? Fentanyl At The Scene.

Eric Weil, a gregarious 50-year-old painter who lives in a wooded neighborhood hugging the shores of Lake Winnipesaukee, never suspected he would face felony charges when he called 911 last August. He had agreed to take in a friend’s son who was struggling with addiction, on the condition that no drugs be brought into his house. When Mr. Weil discovered a packet of white powder in the guest bedroom, he called 911. “Somebody’s messed up in my house,” he recalled saying. “He’s on drugs. I don’t know what he’s on. Can we get somebody here?” (Smith, 12/17)

Appeals Court Rules That Secret OxyContin Documents Must Be Released

A Kentucky appeals court on Friday upheld a judge’s ruling ordering the release of secret records about Purdue Pharma’s marketing of the powerful prescription opioid OxyContin, which has been blamed for helping to seed today’s opioid addiction epidemic. The records under seal include a deposition of Richard Sackler, a former president of Purdue and a member of the family that founded and controls the privately held Connecticut company. Other records include marketing strategies and internal emails about them; documents concerning internal analyses of clinical trials; settlement communications from an earlier criminal case regarding the marketing of OxyContin; and information regarding how sales representatives marketed the drug. (Armstrong and Joseph, 12/14)

After A Wake-Up Call, A Small Town Struggles To Recover From Addiction

In September 2016, the town of East Liverpool, Ohio, captured national attention when a photo of a local couple’s overdose went viral. It showed a woman and her boyfriend sprawled comatose in the front seats of a car, while the woman’s 4-year-old grandson sat in the back. The image was originally posted by the local police department. Overnight, East Liverpool, a town of just over 11,000 people, became the face of the opioid crisis enveloping parts of the country. (Brown, 12/15)

Pennsylvania Holds Naloxone Giveaway

David Braithwaite was standing next to his pickup truck Thursday in a parking lot outside the Cumberland County health center in Carlisle, Pa. He’s a chaplain for Carlisle Truck Stop Ministry. His hat even says it. Braithwaite said he and another chaplain minister to truck drivers, homeless people and anyone else who needs help at the truck stop seven days a week. (Sholtis, 12/14)

The New York Times:
Authorities Uncover $8 Million-A-Week Drug Operation In Pennsylvania

It was a typical, single-family house with a landscaped yard and Christmas decorations in a quiet neighborhood in eastern Pennsylvania. But this week investigators, acting on a tip, uncovered a secret in the basement — a drug operation worth an estimated $8 million a week. On Wednesday, prosecutors announced that 11 people were charged with felony drug offenses in the bust, which was believed to be one of the largest in the county. (Hauser, 12/14)

The New York Times:
Tracking The Opioid Epidemic Through The Books That Warned Us

Medical knowledge is evolving at warp speed, spinning out reams of new information into sound bites, articles and more and more new health books to overload your sagging shelves. But if you’re tempted to toss out all the old stuff, better think twice — despite the changes in medical science, some constants endure. The human body still sickens and recovers much the way it always has; our dogged, heartfelt efforts to prevent and relieve pain and suffering are no different than they ever were. Even books published decades or in some cases centuries in the past may still speak clearly to today’s medical issues. (Zuger, 12/17)

Richmond Times-Dispatch:
Opioid Deaths Are Down, But Addiction Continues To Plague Virginia

Even as Virginia expects a slight dip in fatal opioid-related drug overdoses in 2018, deaths caused by cocaine and methamphetamine as well as babies born addicted to drugs are on the rise, indicating a “disease of despair,” according to a report by the state health commissioner. (Balch, 12/14)

The Philadelphia Inquirer:
After Confronting Mental Illness And Addiction, He Wants To Help Others. But One Thing’s Stopping Him.

Last year, 1,481 certified peer specialists were employed in Pennsylvania, according to data the counties report to the Department of Human Services. Across the United States, there are an estimated 25,000 certified mental-health peer support specialists. Though the U.S. Bureau of Labor Statistics doesn’t track the position, it estimates job growth for community health workers in general will increase 16 percent in the coming decade — nearly double the average job growth. (Pattani, 12/17)

Texas Tribune:
What The Medicaid Coverage Gap Means To Texans Without Health Insurance

First, individual states had to agree to expand their Medicaid program, and the federal government offered to pay for 100 percent of states’ Medicaid expansion from 2014 to 2016 — aid that decreased to 90 percent by 2020. But a number of states, including Texas, fought the Obama administration’s mandate to expand Medicaid, and in 2012 the Supreme Court ruled states were not required to comply with the mandate. That left about 638,000 non-elderly Texans in the Medicaid gap as of 2016 — the most among the states that didn’t expand Medicaid, according to the Kaiser Family Foundation. (Allyson Waller, 12/17)

A sweeping investigation examines the quality and effectiveness of care for adult residents who transfer into subsidized apartments under a program called scattered site supported housing. Other news on quality in health care focuses on assisted living facilities and hospitals.

After Years In Institutions, A Road Home Paved With Hunger, Violence And Death

Historically, supported housing was meant as a finish line for those who had demonstrated, under decreasing levels of supervision, that they could live alone. But the court order ushered a wave of adult home residents directly into a system in which people like [Nestor] Bunch were expected, overnight, to be able to care for themselves. Last week, ProPublica and the PBS series Frontline published an investigation, in collaboration with The New York Times, showing how the sudden shift has proven perilous, even deadly, for those who were not ready to live with minimal support. (Sapien and Etheredge, 12/14)

Kaiser Health News:
Assisted Living’s Breakneck Growth Leaves Patient Safety Behind

They found Bonnie Walker’s body floating in a pond behind her assisted living facility in South Carolina. There were puncture wounds on her ear, her temple, her jaw and her cheeks. Her right forearm and her pacemaker were inside one of the alligators that lived in the pond. Like 4 in 10 residents in assisted living facilities, Walker, 90, had dementia. Shortly after midnight one day in July 2016, she slipped out of her facility, Brookdale Charleston, as she had done a few days before. This time, no one noticed her missing for seven hours. (Rau, 12/17)

The Wall Street Journal:
Hotel-Style Hospitality Comes To Hospitals

The friendly touches at a luxury hotel aren’t normally expected at a busy Bronx hospital. But that is exactly what Marcello Khattar of Montefiore Health System is trying to do—put a little of the hotel experience into the health-care setting. Mr. Khattar, 36 years old, is a director of patient experience and customer service at Montefiore, a new role. His charge is to make the hospital experience feel a little warmer, easier and more personal. It is not enough for a patient or family member just to have medical needs met, he says. (West, 12/16)

The Washington Post:
Flu Shot Choices Explained

My kids and I tried something different for our flu shots this year. Instead of making separate visits to my doctor and their pediatrician, we all went to the same place: our local Target, where the in-store clinic offered us each a $5 gift card for getting vaccinated. The visit was convenient: We walked right in without an appointment on a Saturday morning. For the first time, my ­5-year old didn’t scream as the needle went in. And the boys were thrilled to shop for new toys after their shots. (Sohn, 12/15)

Although the Trump administration wants to commit $20 million to develop alternative options to using fetal tissue in research, scientists say it is unique. Other news on public health focuses on CRISPR researcher He Jiankui, an increase in homelessness, low-salt diets, palliative care, second-hand smoke, the Marbug virus, a young Ebola survivor, aftershocks of suicides and more.

There Aren’t Any Good Alternatives To Fetal Tissue Research, Scientists Warn

At an NIH meeting Thursday, Director Francis Collins said that research into alternatives is “scientifically, highly justified,” but also defended the value of fetal tissue research, saying, “There is strong evidence that scientific benefits can come from fetal tissue research, which can be done with an ethical framework.” As part of the Trump administration audit, NIH in September froze the acquisition of new fetal tissue purchases. That has already upset research at an HIV lab in Montana and may soon hamper work in groups studying cancer and eye disease. (Swetlitz, 12/17)

‘CRISPR Babies’ Scientist He Jiankui Rose From Obscurity To Stun The World

In the three weeks since the remarkable announcement about Nana and Lulu, STAT has pieced together the story of the years leading up to that fateful Monday. With details reported for the first time, it describes the many times He [Jiankui] met with and spoke before some of the world’s leading genome-editing experts, the low opinion they had of his research, and the hints he dropped about his grandiose aspirations. It is based on interviews in Hong Kong and with experts on four continents, with scientists and others who have crossed paths with He, as well as on documents and published accounts. He did not reply to requests for an interview. (Begley and Joseph, 12/17)

The Wall Street Journal:
U.S. Homelessness Edges Higher Again After Seven Years Of Declines

Homelessness nudged higher in 2018 for the second consecutive year, as cities struggled to get people off the streets even as many ramped up building and poured millions of dollars into potential solutions. The increase was slight—just 0.3%, according to an annual report to Congress by the Department of Housing and Urban Development to be released Monday. But after seven years of declines, the small rises over the past two years are a troubling reversal at a time when unemployment is at a near 50-year-low and wages are rising. (Kusisto and Malas, 12/17)

The New York Times:
Scant Evidence Behind The Advice About Salt

Despite a number of studies questioning the usefulness of very low-salt diets in the last few years, most major medical organizations continue to recommend them. We would assume that they do so from a strong base of evidence. But with respect to heart failure, there is a shockingly small amount of evidence. (Carroll, 12/17)

The Washington Post:
Palliative Care May Save Money And Ease Suffering

Gordon Surber and Mark Hailey have the same terminal lung disease. Brothers-in-law, they live next door to one another on the Hoopa Valley Indian Reservation in rural Northern California. But they live in different worlds when it comes to health care. Not so long ago, Surber, 57, was a robust man who loved fishing on the Trinity River, racing motocross and feeling his strength return each season when he went back to work in the woods as a logger. Now he can’t lift his baby granddaughter or walk more than a few steps without his oxygen tank. (Underwood, 12/15)

The Philadelphia Inquirer:
Babies, Toddlers At Greater Risk From Second-Hand Smoke Than Previously Thought, Penn State Study Finds

Infants and toddlers in low-income communities may be even more at risk from second- and third-hand smoke exposure than has been believed, according to new federally supported research. In testing that included over 1,200 children, researchers found that up to 15 percent of them had levels of cotinine, a byproduct of the body’s breakdown of nicotine, comparable to what would be found in an adult smoker. (Giordano, 12/14)

The Washington Post:
These Bats Carry The Lethal Marburg Virus, And Scientists Are Tracking Them To Try To Stop Its Spread

By day, some of the most dangerous animals in the world lurk deep inside this cave. Come night, the tiny fruit bats whoosh out, tens of thousands of them at a time, filling the air with their high-pitched chirping before disappearing into the black sky. The bats carry the deadly Marburg virus, as fearsome and mysterious as its cousin Ebola. Scientists know that the virus starts in these animals, and they know that when it spreads to humans it is lethal — Marburg kills up to 9 in 10 of its victims, sometimes within a week. But they don’t know much about what happens in between. (Sun, 12/13)

The Associated Press:
Congo Says Baby Girl Is Youngest Survivor Of Ebola Outbreak

Congo’s Health Ministry says a newborn baby called Benedicte is the youngest survivor of what is now the world’s second-deadliest Ebola outbreak. The ministry posted a photograph of the infant on Twitter this past week showing her surrounded by caregivers who had watched over her 24 hours a day for weeks. (12/16)

Boston Globe:
After Suicides In Acton And Boxborough, A Communion Of Sorrow

There seems no straight line between that pressure and these suicides; no easy way to understand or to respond. Loss by suicide is like no other, and the succession of deaths has left a void at the heart of the two towns, as if they were struck by a meteor. The aftershocks of numbing sadness, pulsing outward in every direction, have spared almost no one. (Arsenault, 12/16)

The Washington Post:
A Human Heart Was Left On A Plane, Revealing How Organs Move Around The Country

A human heart left on a commercial airliner provides a glimpse into the nation’s transplant system, which relies on an obscure network of nonprofit organizations to collect and transport human organs and tissue. The heart traveled in the cargo compartment of a Southwest Airlines flight from Sacramento to Seattle on Sunday. It was supposed to be picked up in Seattle but remained on the plane when the aircraft left for Dallas. There are conflicting accounts of what went wrong, and an investigation is underway. (Kindy and Bernstein, 12/14)

The Washington Post:
A Fitness Fanatic Runs Into An Alarming Ailment That Was Caught In The Nick Of Time

Barry Goldsmith went to great lengths to stay out of the doctor’s office. His belief in the power of exercise — particularly running — to keep him fit and healthy had long been an article of faith. If he wasn’t feeling well Goldsmith would lace up his shoes and “run it off.” The Maryland patent lawyer routinely racked up about 30 miles per week — more when he was training for a marathon or triathlon — interspersed with swimming, cycling and weight training. (Boodman, 12/15)

The Wall Street Journal:
To Expand Access To Emergency Contraception, Some Colleges Try Vending Machines

Some universities are installing vending machines where students can purchase emergency contraception, an effort to remove barriers to and anxiety surrounding products like Plan B. Barnard College in New York said it would soon install a vending machine, months after Columbia University did. Stanford University, Dartmouth College and a few University of California campuses have added vending machines with Plan B or its generic alternative in recent years. Yale University students have pushed for one, and the student council at Miami University in Ohio voted last month in support of selling emergency contraception in campus markets as well. (Korn and West, 12/16)

Boston Globe:
Detecting Pot Use In Drivers Will Be Tricky

In the coming year, police in Massachusetts will likely have to deploy a litany of tests before arresting drivers for being high on marijuana, state officials said Friday. Because there’s no accurate breathalyzer for cannabis use, officers will probably need to use a combination of their observations, roadside assessments, saliva tests, and a 12-step expert evaluation at the police station, said Walpole police Chief John Carmichael, a member of the state’s commission on operating under the influence. (Martin, 12/15)

The Associated Press:
Higher Percentage Of California Pot Passing Safety Tests

A higher percentage of California marijuana products are passing strict safety tests, but the sudden closing of a lab that state authorities found wasn’t correctly checking for pesticides has raised new questions about the system intended to protect the purity and potency of legal cannabis. California broadly legalized marijuana at the start of the year, and mandatory testing began in July 1. During the first two months the failure rate was about 20 percent, but state data collected through November showed improvement — about 14 percent of nearly 24,000 products were blocked from store shelves by tests. (Blood, 12/16)

Obamacare Ruling: Congress Can Save The ACA

For the moment, nothing will change. The ACA will stand while appeals are filed, probably until the case reaches the Supreme Court. The new ruling may well be overthrown, but those who depend on the ACA are left stranded in uncertainty. The timing could hardly be worse. Enrollment in individual insurance is already down this year, and the population of uninsured Americans stands to rise.It’s maddening that the ACA’s legal troubles could be easily resolved. Congress needs only to restore the individual mandate’s tax penalties. Keep in mind, the mandate still exists: Americans are still required to have health insurance. All Congress did last year was set the penalty for failing to comply at zero. (12/16)

The New York Times:
What The Lawless Obamacare Ruling Means

In a shocking legal ruling, a federal judge in Texas wiped Obamacare off the books Friday night. The decision, issued after business hours on the eve of the deadline to enroll for health insurance for 2019, focuses on the so-called individual mandate. Yet it purports to declare the entire law unconstitutional — everything from the Medicaid expansion, the ban on pre-existing conditions, Medicare and pharmaceutical reforms to much, much more. (Jonathan H. Adler and Abbe R. Gluck, 12/15)

The New York Times:
A Partisan Ruling On Obamacare

After sitting on a ruling for months, a federal judge in Texas has given the Trump administration and a group of Republican-led states exactly what they asked for, and then some: the invalidation of the entire Affordable Care Act. Don’t panic. The ruling, issued late on Friday and only one day before the end of the law’s annual open enrollment period, is not a model of constitutional or statutory analysis. It’s instead a predictable exercise in motivated reasoning — drafted by a jurist with a history of ruling against policies and laws advanced by President Barack Obama. (Cristian Farias, 12/15)

USA Today:
Obamacare Ruling Is Latest Republican Boost For Government Health Care

What is the strongest political force driving America toward national health care? No, it’s not Sen. Bernie Sanders and his “Democratic Socialist” minions. It’s the Republican Party. Hang on, don’t Republicans stand foursquare against a government takeover of the entire U.S. health care system? So they say. But the GOP’s pig-headed opposition to less drastic ways to make sure everyone has coverage is stimulating Americans’ appetite for a bigger government role in health care — and it will only be fueled by a federal judge’s ruling Friday night that the Affordable Care Act is unconstitutional. (Will Marshall, 12/16)

The Hill:
Preventing The Next Romaine Lettuce E. Coli Outbreak 

Seven years after Congress passed the 2011 Food Safety Modernization Act (FSMA), the FDA still hasn’t implemented a number of key reforms required by that law. Among other things, the law required the FDA to issue new industry record-keeping rules that mandate traceability, so the agency can quickly trace the source of food-borne illness outbreaks and strong standards to ensure that the water used to irrigate crops is safe and sanitary. (Jean Halloran, 12/14)

U.S. Government Is Asking Industry To Help Identify ‘Emerging Technologies’

In a highly unusual move, the federal Bureau of Industry and Security is asking U.S. industry to help identify emerging technologies that are essential to national security but currently escape the tangle of laws and regulations that govern — and in some cases restrict or prohibit — the sale or transfer of commodities, technology, and technical data to foreign businesses, research institutions, government and private organizations, and individuals who are neither U.S. citizens nor lawful permanent residents. The bureau’s advance notice of proposed rulemaking specifically mentions categories of emerging technology that ought to deeply interest STAT readers: nanobiology, synthetic biology, genomic and genetic engineering, neurotechnology, molecular robotics, neural networks and deep learning, evolution and genetic computation, direct neural interfaces, brain-machine interfaces, and biomaterials. (Zack Hadzismajlovic, 12/17)

The Washington Post:
It’s The Beginning Of The End For The Gun Lobby’s Power

Sometimes, dramatic shifts in American politics go unnoticed. They are buried under other news or dismissed because they represent such a sharp break from long-standing assumptions and expectations. So please open your mind to this: Taken together, the events of 2016 and the results of the 2018 election will be remembered as the beginning of the end of the gun lobby’s power. Supporters of reasonable gun regulation have been so cowed by National Rifle Association propaganda over the past quarter-century that we are reluctant even to imagine such a thing. No matter how many innocents are slaughtered, no matter how many Americans organize, demonstrate and protest, we assume the NRA and its allies will eventually overpower us. (E.J. Dionne, 12/16)

J&J’s Talcum Powder Lawsuits Aren’t Going Away 

Legal issues are a constant of corporate life, especially in health care. That is especially true for Johnson & Johnson, one of the largest and most sprawling health-care companies, with products ranging from baby shampoo to cancer drugs and surgical staples. J&J faces major liability risk from lawsuits over a possible link between asbestos in its talc products and cancer. A Reuters investigation released Friday alleged the company was both aware of and worried about the presence of small amounts of asbestos in its baby powder for decades, but didn’t disclose it. (Max Nisen, 12/14)

‘Outbreak Culture’ Can Derail Effective Responses To Deadly Epidemics

The toxicity that can emerge in outbreak culture isn’t limited to the response to Ebola. We’ve documented the same dysfunctions — and sometimes worse — during other large-scale epidemics. Outbreak culture fueled the stigmatization of groups of people susceptible to AIDS in the 1980s, led to the underreporting of initial cases of severe acute respiratory syndrome (SARS) in China in 2002, and delayed research into the 2006 avian flu outbreak in Indonesia. Outbreak culture also inhibited an adequate response to Zika. (Lara Salahi and Pardis Sabeti, 12/17)


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