The Friday Breeze
Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.
Happy Friday! I don’t know about you, but I have been absolutely riveted by the ethics controversy that has sent the scientific community into a shocked-and-appalled, pearl-clutching frenzy this week. I’ll get to that in a second. First, another too-frequent example of the current pitfalls in our health system: A hospital turned down a woman’s heart transplant request because she lacked a secure source of financing for the drugs necessary for the procedure. The hospital’s suggestion for her? Use crowdfunding to raise the $10,000.
Now here’s what you may have missed as we enter that strange lull between holidays (though there certainly wasn’t a dearth of health news).
New guidelines released by the administration on Thursday, among other things, encourage states to flex their creative muscles on how to spend the subsidy money they get under the health law.
Currently, the subsidies are tied to income, and can be used only for insurance that meets federal standards and is purchased through public marketplaces. But the Centers for Medicare & Medicaid Services wants to lift those restrictions and let states do what they will with the pot of money. That could include: allowing the use of subsidies for short-term “junk insurance” plans; offering subsidies as incentive to woo in younger consumers; setting different income limitations; letting people with employer-based plans set up accounts to use the money, etc., etc.
If states acted on these options, that could steer the marketplace toward the geographical disparity that ran rampant before the health law. But it’s doubtful any state would want to take advantage of this offer in the first place. For one, it would be expensive for states to manage the pot of money. Secondly, even if a state received a waiver for the regulations, court challenges likely would follow. That could be more of a headache than it’s worth.
The Washington Post: New Insurance Guidelines Would Undermine Rules of the Affordable Care Act
Modern Healthcare: CMS Allows States to Get Creative With Federal Exchange Funds Under 1332 Waivers
The Friday Breeze
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The lagging numbers for this open-enrollment season are a bit at odds with what experts had seen as a stabilizing, if not quite flourishing, marketplace. While no one is Chicken Little-ing yet (there is still time left to see a boost, and the early weeks of November were busy ones for Americans), health law supporters are concerned that what they see as the administration’s attempts to “sabotage” the Affordable Care Act are coming to fruition.
Politico: Trump May Finally Be Undermining Obamacare
One statistic from the week that experts found “very troubling” was that for the first time in a decade the number of uninsured children rose, despite the improving economy and the low unemployment rate. Rural areas were particularly affected.
Los Angeles Times: Number of Uninsured Children Climbs, Reversing More Than a Decade of Progress, Report Finds
In what is certain to draw fierce pushback from patient advocacy groups and pharma alike, President Donald Trump is expanding Medicare’s negotiating power when certain drug prices rise faster than inflation. The idea has been kicking around for a while as both parties have been trying to come up with the silver bullet for high costs, but the political ramifications are unappetizing. Potentially cutting seniors off from needed drugs — whether it would play out that way or not — has always kept the idea on the back burner.
The New York Times: Trump Moves to Lower Medicare Drug Costs by Relaxing Some Patient Protections
File this under “I’m not sure that’s how it’s supposed to work”: A generic EpiPen is now available. The catch? It’s the exact same price as the one already out there.
The Hill: Generic EpiPen Not Any Cheaper Than Existing Version
FBI background checks were waived for caregivers and mental health workers who were in charge of caring for teens at an immigration detention center in Texas. The revelation ignited outrage, and the Department of Health and Human Services was quick to promise it would fingerprint the employees (officials warned it could take a while, though).
The government also allowed the company who is overseeing the operation of the facility to sidestep mental health requirements — youth shelters generally must have one mental health clinician for every 12 kids, but the contractor was allowed to staff the Texas facility with just one clinician for every 100 children.
The Associated Press: Lawmakers Press for Fingerprinting of Detention Camp Staff
Very quietly, family separations at the border have resumed.
ProPublica: Family Separations Are Still Happening at the Texas Border
Also, Baltimore is suing the Trump administration over its “public charge” policy that lets immigration officials use the acceptance of government aid, such as Medicaid, against those seeking green cards. The lawsuit might be the first of its kind, but it’s doubtful it will be the last.
The Associated Press: Baltimore Sues Trump Administration Over Immigration Policy
It is indicative of just how busy this week was that I haven’t gotten to the (aforementioned) ethics scandal rocking the scientific community yet, but we got here eventually. Chinese scientist He Jiankui dropped a bombshell (unverified and un-peer reviewed) on everyone that he gene-edited human embryos to make designer babies resistant to HIV infections.
This practice crosses an ethical line that many researchers had dug deep, deep, deep in the sand. “Deeply unethical,” “crazy,” “driven by hubris,” were just a few of the reactions from fellow scientists at the shocking news. One consensus that has come out of it, though, seems to be that there’s a crucial need for binding and international guidance on editing human genes. (Oh, and this isn’t over. He says there’s another pregnancy with gene-edited embryos underway.)
Los Angeles Times: Why Geneticists Say It’s Wrong to Edit the DNA of Embryos to Protect Them Against HIV
Stat: He Took a Crash Course in Bioethics, Then Created CRISPR Babies
NPR: Science Summit Denounces Gene-Edited Babies Claim, But Rejects Moratorium
Stat: NIH Director Says There’s Work to Do on Regulating Genome Editing
Medical device policy usually flies a bit under the radar, but it was a hot topic this week. Following a damning report on spinal implants causing severe injury to some patients, the Food and Drug Administration announced that it wants to revamp its (long-criticized and decades-old) approval system.
The Associated Press: FDA Says It Will Overhaul Criticized Medical Device System
And a look at whether the agency’s “first in the world” ambition contributed to a series of high-profile malfunctions.
The Associated Press: At FDA, a New Goal, Then a Push for Speedy Device Reviews
In the miscellaneous file this week:
• The combined suicide and opioid crises are taking a particularly grim toll on the country, sending us into our longest period of generally declining life expectancy since the slice of time that includes a little thing called World War I and the worst flu pandemic in modern history. I’m not going to lie, that’s not a great comparison.
The Associated Press: Suicide, at 50-Year Peak, Pushes Down US Life Expectancy
• A gut-wrenching personal story offers insight into the loved ones left behind in cases of suicides, and how they’re plagued with a forever-unanswerable question of “why”? The entire series is worth a deep read.
USA Today: Suicide: My Mom Took Her Life at The Grand Canyon
• An epidemic of extensive backlog of rape kits languishing on shelves in police departments recently drew a lot of attention. But an even more fundamental and low-profile issue? Those departments that trash them completely before the statute of limitations is up.
CNN: Destroyed: How the Trashing of Rape Kits Failed Victims and Jeopardizes Public Safety
• Johns Hopkins vowed to transform a Florida hospital’s heart surgery unit. Then patients started dying at an alarming rate.
Tampa Bay Times: Heartbroken
• Despite changes in policy, federal prisons are still failing to offer inmates proper mental health care.
The Washington Post/The Marshall Project: Federal Prisons Are Failing Inmates With Mental Health Disorders
As you can tell, it’s a good thing I started drinking coffee (for the first time ever, cue shocked faces) this week! No, I have not been spending my time Googling its health benefits. (OK, I have.) Have a lovely, possibly caffeine-fueled weekend!
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