All posts by Jason White

Best Reads Of The Week From Brianna Labuskes

Happy Friday! If you’re like me, you’re hooked on the The Golden State Killer case, where investigators used a genealogy website to hunt down their suspect. (And if you’re also a health wonk like me, you’ll want to check out this story on what privacy concerns the investigators’ strategy sparked.)

On to the rest of the best from the week.


Dr. Ronny Jackson’s alleged misconduct (like how he was called “the candy man” and oversaw a hostile workplace) has dominated the headlines. But behind the theatrics of the failed nomination process lies a crucial but leaderless agency — the Department of Veterans Affairs — that’s caught in the midst of a fierce battle over privatization. There has been a recent legacy of turmoil and scandal at the VA, and veterans’ health care is at stake. “This is complete and total chaos after years of complete and total chaos,” said Paul Rieckhoff, with Iraq and Afghanistan Veterans of America.

• The Washington Post: ‘What Makes It Stop?’ Veterans Lament the Ongoing Turmoil Surrounding Trump’s Pick for VA Secretary


Do drug companies see rare-disease patients as human jackpots? A deep dive into the money flow for charities that are, in theory, set up to help those patients pay for expensive drugs reveals that pharma may not be donating to the organizations out of the goodness of their hearts. (Go ahead, feign surprise.)

• The Washington Post: Why Drug Companies See Rare-Disease Patients As Human Jackpots

• USA Today: Drug copay groups: Critical patient charities or fronts for drug makers?

Don’t forget our new KHN patient advocacy group database, “Pre$cription for Power,” which tracks the donations of some of the country’s biggest drugmakers to hundreds of patient groups. It was a resource for the USA Today story and is available for all to use.


Short-term plans are back in the news because the comment period for the proposed extension was Monday. Lots of people in the industry spoke out against them for obvious reasons — they know healthy and young consumers are likely to jump ship to these enticingly cheap plans leaving the population buying individual coverage sicker and older, on the whole. Also, they warn, those young and healthy consumers may well find that the plans don’t offer good coverage if they get sick.

• The Washington Post: Trump Proposal Could Mean Healthy People Save on Insurance While Others Get Priced Out


In the new trend of transparency as a fix for high health prices, the Centers for Medicare & Medicaid Services wants to require hospitals to post their prices online in an easily accessible format for patients. But experts say that while the idea sounds good in theory, it’s not actually going to help most consumers because list prices aren’t what people end up paying. And there’s the big question: Does CMS really have the legal authority to make them do this?

• Modern Healthcare: CMS Proposal for Hospitals to Publish Prices Raises Tricky Issues

• Politico Pro: Legal Barriers Await Medicare’s Price Transparency Work


There was a lot of movement in women’s health this week: The administration is favoring abstinence-focused programs with its teen pregnancy prevention funds; a judge has blocked cuts to Planned Parenthood grants; and an executive order banning Title X funding for Planned Parenthood is apparently in the pipeline for next month.

• The New York Times: Trump Administration Pushes Abstinence in Teen Pregnancy Programs

• The Associated Press: Judge Prevents Trump From Cutting Planned Parenthood Grants

• Modern Healthcare: Trump Could Ban Title X Funding for Planned Parenthood


The research on needle exchanges is crystal-clear. They cut deaths, curb spending and reduce disease without increasing drug use. But in the midst of a raging opioid epidemic, public health leaders just can’t quite convince the public that they’re a good idea.

• The New York Times: Why a City at the Center of the Opioid Crisis Gave Up a Tool to Fight It

And a drug distributor absolves itself of responsibility in the opioid crisis — but, uh, it doesn’t really work that way.

• Bloomberg: McKesson’s Board Clears Itself of Fault on Opioid Oversight


In the miscellaneous file: In Oregon, the criminally insane get better mental health services than people who don’t commit a crime; oncologists wonder if the slimmest chance of a therapy working justifies offering the treatment to terminal patients or if it’s better to keep their mouths shut;  and a reporter offers a heartbreaking look at West Virginia’s long history of broken promises over black lung disease.

• Stateline: What Care for the Criminally Insane Can Teach Us About Mental Health Treatment

• The New York Times: ‘Desperation Oncology’: When Patients Are Dying, Some Cancer Doctors Turn to Immunotherapy

• ProPublica: Covering West Virginia’s Long History of Broken Promises


Have a great weekend! And let me know what you think of this doctor who is pushing the idea of “regifting” kidneys as a way to solve the country’s organ shortage.

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Dissecting The Rhetoric Vs. Reality Of Trump’s Tough Talk On Drug Prices

President Donald Trump has railed against the high price of prescription drugs and famously bemoaned how pharmaceutical companies are “getting away with murder.” Yet, many Americans aren’t seeing a change in what they pay out-of-pocket.

Trump promised a speech on prescription drug prices, and it’s expected anytime.

Here’s a look at the rhetoric thus far versus the results.

You’ll be seeing drug prices falling very substantially in the not-too-distant future, and it’s going to be beautiful.

Trump, March 19, 2018, at Manchester (N.H.) Community College

What’s Happening:

The White House and administration leaders, including Health and Human Services Secretary Alex Azar and Food and Drug Administration Commissioner Scott Gottlieb, say increasing competition is a priority. Gottlieb — whom Trump has called a star — said the FDA has approved a record number of generic drugs and eliminated a backlog in approvals.

The agency is looking for ways to boost price competition for biologics, which are made from natural sources and are among the most expensive drugs on the market. Currently, pharmacists cannot substitute a lower-cost “biosimilar” version when the doctor prescribes a biologic. FDA has proposed “interchangeability” rules that could change the status quo.

The Outlook:

Driving down drug prices through competition may take awhile. That’s because even after gaining FDA approval, generic drugs often have trouble being launched, according to Chip Davis, president of the Association for Accessible Medicines, a trade group for makers of generics and biosimilars. Only three of nine biosimilars approved are available for patients, largely due to patent protections.

We have to get the prices of prescription drugs way down and unravel the tangled web of special interests that are driving prices up for medicine and for really hurting patients.

Trump, Jan. 29, 2018, during Azar’s swearing-in ceremony

What’s Happening:

To say health care is complicated is an understatement. The system that dictates how patients get prescriptions and what they pay includes an array of buyers and payers, such as insurance companies and pharmacy benefit managers. In February, the White House pitched the idea of passing on the discounts and rebates negotiated by PBMs, the financial middlemen between insurers and drugmakers, to seniors who buy drugs through Medicare Part D. This idea, first floated under President Barack Obama’s administration, would mean seniors would pay less out-of-pocket but could also increase premiums if insurers took on added costs.

The Outlook:

Late last year, the administration released a request for public comment on this idea, and pressure is building for the administration to take action. “It’s the one thing you could say that has immediate benefit to consumers,” said John Rother, president of the National Coalition on Health Care. But House Minority Leader Nancy Pelosi said she isn’t convinced much will really change: “At this point, no one is surprised that President Trump has found another reason not to act on prescription drug costs,” Pelosi said in a statement to Kaiser Health News. “While President Trump is making more excuses, Democrats will be discussing real solutions.”

I have directed my administration to make fixing the injustice of high drug prices one of our top priorities for the year. And prices will come down substantially. Watch.

Trump, Jan. 20, 2018, State of the Union address

What’s Happening:

The White House has pitched moving drugs covered under Medicare Part B into the popular Part D program. Part B is the bucket of Medicare that covers drugs that are administered in hospital outpatient settings and doctor’s offices, including expensive chemotherapy and rheumatoid arthritis infusions. Insurers compete for business in Part D and negotiate prices for their members, but there is no such price negotiation in Part B. Total drug spending in the Part B program was about $26 billion in 2015, and the upward trend is ominous.

The Outlook:

While providers and insurers are likely to fight it, there’s no reason the idea wouldn’t work, said Tom Scully, the former Centers for Medicare & Medicaid Services administrator who designed the Medicare prescription drug programs in the early 2000s. He worked closely with HHS’ current leader, Azar, who was then general counsel for HHS. “There’s no reason to have Part B,” said Scully, adding that moving the drugs under Part D would require price negotiation. “If you really want to drive down drug prices, you have to put somebody’s money at risk other than the taxpayers’.”

For Medicare, for Medicaid, we have to get the prices way down, so that’s what we’re going to be talking about.

Trump, Jan. 31, 2017, while holding a listening session with pharmaceutical industry leaders

What’s Happening:

When the White House announced Trump’s forthcoming speech, it also noted that it would coincide with a formal request for information from Health and Human Services on various drug-pricing ideas. The request leaves the door wide open for proposed changes in Medicare and Medicaid. Several experts predict the administration will test payment models through demonstrations under the broad authority of the Center for Medicare & Medicaid Innovation, or CMMI.

The Outlook:

Ideas such as moving drugs to Part D as well as allowing certain states to create drug lists under their Medicaid formularies, as Massachusetts has requested, and other value-based pricing models would be possible under a CMMI demonstration, said Andrea Harris, who leads the health care team at Height Capital Markets. Still, this process could take awhile, and Harris said, “I don’t think anything will meaningfully impact drug-related stocks between now and the midterms [elections].”

Prescription drug prices are out of control. The drug prices have gone through the roof. … The drug companies, frankly, are getting away with murder.”

Trump at Oct. 16, 2017, Cabinet meeting

What’s Happening:

While there has been no direct proposal that would force the pharmaceutical industry to lower the launch price of its drugs, the industry lost a battle last month when Congress reduced how much seniors would pay for prescription drugs in Medicare. It was a rare loss and signaled that the powerful industry may be in a defensive position. And Trump has another card to play with the Federal Trade Commission.

The Outlook:

Trump has nominated Joe Simons, a Washington antitrust lawyer, to lead the FTC. During his nomination hearings in February, he said he’s “very concerned” with price increases for prescription drugs. The agency, which polices anticompetitive behavior, has several vacancies to fill.

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Our new Privacy Manager puts privacy choices at your fingertips

Your privacy is very important. That’s why we have important safeguards in place to protect the information you give us when you visit Medicare.gov. We’ve added a tool that lets you easily control some of the information we may collect from you.

When you visit Medicare.gov, we use common web tools to collect information—things like:

  • What websites you came from
  • What Medicare.gov pages you visit
  • How much time you spend on Medicare.gov
  • What page you’re on when you leave Medicare.gov

We use this information to help us improve Medicare.gov and our outreach to people with Medicare.

You can decide whether you want us to collect this information during your visits to Medicare.gov. Our new Privacy Manager lets you easily adjust your settings to match your comfort level.

To view or change your privacy settings, visit Medicare.gov, and select “Privacy settings” at the bottom of the page. Here’s what it looks like:

Your Privacy Options screengrab

You can choose “on” or “off” for tracking certain types of information about your Medicare.gov visits, like advertising or social media. No matter what you choose, you’ll still have access to everything on Medicare.gov. But, if you choose “off,” we won’t use your visit to:

  • Improve Medicare.gov to make it more useful for visitors
  • Improve our public education and outreach through digital advertising

We’re committed to protecting your privacy. To learn more about how we protect your privacy when you visit Medicare.gov, visit our privacy policy.

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Celebrate Earth Day—Think globally, act locally!

Nearly 200 countries celebrate Earth Day on April 22—a day for encouraging awareness and action for the environment. How can you make your voice heard this year? Let Medicare help! Medicare has several electronic resources to help you manage your health care better.

One great way is to sign up to get your “Medicare & You” handbook electronically. If you have an eReader (like an iPad, Kindle Fire, Surface, or Galaxy Tab) you can download a free digital version to your eReader and take it with you anywhere you go.

Don’t have an eReader? You can still sign up to get a paperless version in a few simple steps. We’ll send you an email in September when the new eHandbook is available. The email will explain that instead of getting a paper copy in your mailbox each October, you’ll get an email linking you to the online version. This online version of the handbook contains all the same information as the printed version. Even better, the handbook information on Medicare.gov is updated regularly, so you can be confident that you have the most up-to-date Medicare information!

Another way is to go paperless and get your “Medicare Summary Notices” electronically (also called “eMSNs”). You can sign up by visiting MyMedicare.gov. If you sign up for eMSNs, we’ll send you an email each month when they’re available in your MyMedicare.gov account. These eMSNs contain the same information as paper MSNs. You won’t get printed copies of your MSNs in the mail if you choose eMSNs.

Sign up today to get your “Medicare & You” information and MSNs electronically, and you’ll be making a difference for the environment. What a great way to make your voice heard and celebrate Earth Day.

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Podcast: KHN’s ‘What The Health?’ Nothing In Health Care Ever Goes Away

Congressional Republicans have struck a decidedly different tone when talking about the Affordable Care Act, and the Democrats have introduced a new Medicare expansion bill.

Meanwhile, states are talking about Medicaid expansion, and a federal court’s ruling on Maryland’s proposal to battle drug price-gouging sends shock waves nationwide. Both chambers of Congress have been busy introducing legislative fixes for the nation’s opioid epidemic with lawmakers promising that legislation will land this spring.

This week’s panelists for KHN’s “What the Health?” are Sarah Jane Tribble of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post.

Among the takeaways from this week’s podcast:

  • In the upcoming election season, the tables may be turned: Democrats likely will spend more on health care ads than Republicans.
  • Democrats think that this congressional campaign season they can effectively target vulnerable Republicans by focusing on the GOP’s support for repealing and replacing the Affordable Care Act.
  • Republicans, on the other hand, predict they have a winning argument with their repeal of the unpopular requirement that people get insurance or pay a penalty. Campaigns likely will also point to the party’s efforts to encourage more flexible — but perhaps less protective — coverage options, such as association and short-term health plans.
  • Two Democratic senators, Jeff Merkley of Oregon and Chris Murphy of Connecticut, introduced a bill this week that would allow individuals who haven’t yet reached 65 and small businesses to buy into the Medicare program. It would also substantially increase subsidies for people buying ACA marketplace plans.
  • Democratic efforts to expand the population that can use Medicare could hit opposition from two key groups: health care providers, such as hospitals and doctors, who object to the lower reimbursement, and seniors, who may be afraid that resources could be stretched too thin.
  • Medicaid expansion advocates in some conservative states seek to follow Maine in getting the issue on the ballot, but those efforts in very conservative states, such as Utah and Idaho, face immense obstacles.
  • Despite a court last week throwing out Maryland’s new law on drug pricing, other states are moving forward on efforts to bring more transparency to what consumers are charged for their prescriptions.
  • Lawmakers are scurrying to push through Congress efforts to help fight the nation’s opioid epidemic. One measure, by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), is expected to be marked up next week. Rep. Greg Walden (R-Ore.), the head of the House Energy and Commerce Committee, says his panel will bring a bill to the floor by Memorial Day.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Joanne Kenen: The New York Times’ “How Profiteers Lure Women Into Often-Unneeded Surgery,” by Matthew Goldstein and Jessica Silver-Greenberg

Margot Sanger-Katz: STAT.com’s “A ‘Breakthrough in Organ Preservation’: Study Shows Keeping Livers Warm Helps Preserve Them for Transplant,” by Eric Boodman

Paige Winfield Cunningham: The Washington Post’s “Science Hinted That Cancer Patients Could Take Less of a $148,000-a-Year Drug. Its Maker Tripled the Price of a Pill,” by Carolyn Y. Johnson

Sarah Jane Tribble: The Washington Post’s “‘One Last Time’: Barbara Bush Had Already Faced a Death More Painful Than Her Own,” by Steve Hendrix

Additional Reading

Sanger-Katz recommended two stories during the opioid discussion. Here are the links to those, too:

Reason’s “America’s War on Pain Pills Is Killing Addicts and Leaving Patients in Agony,” by Jacob Sullum

Harper’s “The Pain Refugees: The Forgotten Victims of America’s Opioid Crisis,” by Brian Goldstone

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher or Google Play.

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New Medicare Perk For Diabetes Prevention Stumbles At Rollout

Several weeks ago, Medicare launched an initiative to prevent seniors and people with serious disabilities from developing Type 2 diabetes, one of the most common and costly medical conditions in the U.S.

But the April 1 rollout of the Medicare Diabetes Prevention Program, a major new benefit that could help millions of people, is getting off to a rocky start, according to interviews with nearly a dozen experts.

In all but a few locations, experts said, Medicare’s new prevention program — a yearlong series of classes about healthy eating, physical activity and behavioral change for people at high risk of developing diabetes — isn’t up and running yet. And there’s no easy way (no phone number or website) to learn where it’s available.

A Medicare spokesman declined to indicate where the diabetes program is currently available, saying only that officials had approved three providers to date.

In a first for Medicare, community organizations such as YMCAs and senior centers will run the program, not doctors and hospitals. But many sites are struggling with Medicare’s contracting requirements and are hesitant to assume demanding administrative responsibilities, said Brenda Schmidt, acting president of the Council for Diabetes Prevention and chief executive officer of Solera Health, a company that assembles provider networks.

Medicare Advantage plans, an alternative to traditional Medicare run by private insurance companies, are now required to offer the Medicare Diabetes Prevention Program to millions of eligible members. But they aren’t doing active outreach because there are so few program sites available.

It’s “too early” to discuss how Medicare Advantage plans will handle implementation given uncertainty about the program’s accessibility, Cathryn Donaldson, director of communications for America’s Health Insurance Plans, said in an email.

Supporters urge patience. While Medicare’s embrace of diabetes prevention is “transformational,” building an infrastructure of community organizations to deliver these services “hasn’t been done before. It’s going to take time,” said Ann Albright, director of the Division of Diabetes Translation at the U.S. Centers for Disease Control and Prevention.

In a written comment, a spokesman for the Centers for Medicare & Medicaid Services said about 50 of more than 400 eligible programs are in the process of submitting applications. An online resource identifying approved programs is under development, and outreach to people with Medicare coverage is “planned for the coming months,” the statement said.

For those who want more timely information, here’s a look at the Medicare Diabetes Prevention Program and why it’s worth waiting for, even if takes awhile for a program to become available near you.

Diabetes and older adults. According to the CDC, at least 23 million people age 65 and older have “prediabetes” — elevated blood sugar levels that put them at heightened risk of developing Type 2 diabetes.

In five years, without intervention, up to one-third of this group will develop Type 2 diabetes — a leading cause of blindness, amputation and kidney disease in older adults, associated with a heightened risk of heart disease, stroke and dementia.

Program eligibility. The Medicare Diabetes Prevention Program is available to older adults and people with serious disabilities with Medicare Part B coverage who have prediabetes — and it’s free for those who qualify.

Once the program becomes available in your area, your doctor can refer you or you can sign up on your own, so long as you have a body mass index of at least 25 (or a BMI of 23, if you’re Asian), you haven’t been previously diagnosed with diabetes, and your blood sugar levels are consistent with prediabetes.

This benefit is available only once to each qualified Medicare beneficiary, so it behooves you to make sure you’re ready for the commitment it entails.

“The purpose of this should be to improve your health and quality of life, long term, not to lose vanity pounds,” said Marlayna Bollinger, executive director of San Diego’s Skinny Gene Project, which works with people at risk of developing diabetes.

Evidence of effectiveness. Medicare is tweaking the National Diabetes Prevention Program, launched by the CDC in 2010. In a much-cited 2002 study published in the New England Journal of Medicine, researchers found that participants in an early version of the CDC program were 58 percent less likely to develop diabetes than a placebo group. For people 60 and older, the reduced risk of developing diabetes was even more striking — 71 percent.

James Combs, 66, weighed 273 pounds when he enrolled in a program offered by Baptist Health in Lexington, Ky., in January 2016. Today, he weighs 210 pounds, no longer takes medication for high blood pressure, and reported “feeling fantastic.” (Combs enrolled before becoming eligible for Medicare, and his private insurance paid for the program.)

Medicare’s model. Small groups of about eight to 20 people meet weekly, for about an hour, 16 times over a six-month period, then once or twice a month for the next six months. Nutritionists, diabetes educators or other coaches use a structured CDC-approved curriculum and foster group discussion and problem-solving.

Participants check their weight at each session and keep daily logs of what they’re eating and their physical activity. The goal is to have participants lose at least 5 percent of their body weight and get 150 minutes of physical activity weekly.

“The objectives are very realistic and that increases the likelihood of success,” said Kathleen Stanley, Baptist Health’s coordinator for diabetes education and prevention.

A four-year pilot program involving nearly 8,000 seniors in 315 locations, sponsored by Medicare and coordinated by YMCA of the USA, found that savings were significant: an estimated $2,650 over the course of 15 months for each participant.

Medicare has also added a second year of monthly sessions, designed to reinforce lessons learned in the first year, for people who meet weight loss targets and regularly attend classes. (Those who don’t aren’t allowed to attend these sessions.)

Medicare will pay up to $670 per participant for the two-year period if programs meet performance standards relating to weight loss and attendance. If not, payments are lower.

For the moment, Medicare doesn’t plan to work with companies such as Omada Health Inc. or Canary Health that offer online versions of CDC’s Diabetes Prevention Program. But advocacy groups are pressing for this alternative to in-person classes.

“Virtual delivery of the diabetes prevention program would be a great option, particularly for seniors in underserved areas,” said Meghan Riley, vice president of federal government affairs for the American Diabetes Association.

Next steps. YMCA of the USA is among several organizations that plan to participate in the Medicare Diabetes Prevention program but are adopting a cautious approach.

“We’re still digging through Medicare rules and regulations and trying to make sure we understand the implications,” said Heather Hodge, the Y’s senior director of evidence-based health interventions.

She said 25 of the Y’s 840 associations were in the process of applying for Medicare certification and that as many as 50 might be offering the Medicare Diabetes Prevention Program by the end of the year. (Each Y association encompasses multiple locations.)

Albright said the CDC was asking state health departments and 10 national organizations, including the American Diabetes Association, the National Alliance for Hispanic Health and Black Women’s Health Imperative, to promote the new Medicare benefit. Once Medicare publishes a list of programs that its officials have approved, CDC will highlight this online, she said.

Angela Forfia, senior manager of prevention at the American Association of Diabetes Educators, suggested that older adults contact their local Area Agency on Aging, local health departments and senior centers in their area and express interest in the Medicare Diabetes Prevention Program.

“If Medicare recipients start to demand and ask for this, you’ll have more organizations step up and sign on to become Medicare suppliers,” she suggested.

Meanwhile, seniors might want to learn if they have prediabetes. (About 9 out of 10 people who do don’t know it.) “Take our risk test and see where you stand,” Albright advised (available at www.doihaveprediabetes.org). “It’s a good conversation starter with your health care professional, who may want to follow up by ordering a blood test.”

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