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Monthly Archives: January 2018

Congressional Brinksmanship Over Children’s Coverage Scars Families

In a pitched partisan battle, lawmakers took more than three months to fund the Children’s Health Insurance Program while families that depend on that insurance waited nervously. In Medicaid news, a Virginia legislative committee moves toward seeking a work requirement for non-disabled adults getting Medicaid benefits. News outlets also report on developments in New Hampshire, Delaware, Montana, New Mexico and Indiana.

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CMS Sees Sharp Drop-Off In Number Of Doctors Opting Out Of Medicare

One theory for the decrease is that MACRA ended the need for providers to renew opt-out affidavits every two years; now opt-outs can be indefinite, and providers must ask to rejoin the program. Meanwhile, health providers are excited about hints that Medicare may change its policy on medical consultations that start over the phone.

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First Edition: January 31, 2018

Today’s early morning highlights from the major news organizations.

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As Marijuana Laws Relax, Doctors Say Pregnant Women Shouldn’t Partake

Two-year-old Maverick Hawkins sits on a red, plastic car in his grandmother’s living room in the picturesque town of Nevada City, Calif., in the foothills of the Sierra Nevada. His playpal Delilah Smith, a fellow 2-year-old, snacks on hummus and cashews and delights over the sounds of her Princess Peppa Pig stuffie.

It’s playtime for the kids of the provocatively named Facebook group “Pot smoking moms who cuss sometimes.”

Maverick’s mother, Jenna Sauter, started the group after he was born. “I was a new mom, a young mom — I was 22 — and I was just feeling really lonely in the house, taking care of him,” she said. She wanted to reach out to other mothers but didnât want to hide her marijuana use.

“I wanted friends who I could be open with,” Sauter said. “Like, I enjoy going to the river and I like to maybe smoke a joint at the river.”

There are nearly 2,600 members now in the Facebook group. Marijuana, which became legal for recreational use in California this month, is seen by many group members as an all-natural and seemingly harmless remedy for everything from morning sickness to postpartum depression.

Delilah Smithâs mom, Andria, is 21 and a week away from her due date with her second child. She took umbrage when an emergency room physician recently suggested she take âhalf a Norco”— a pill akin to Vicodin, an opioid-based painkiller — for her excruciating back pain.

Smith was disdainful. “She was like, ‘We know more about Norco and blah, blah, blah and what it can do to you, but we don’t that much about marijuana,’” Smith said.

“I was like, ‘Test me!’ I was like, ‘Observe me. My kid could count to 10 before she was even 2 by herself, and I smoked pot throughout my whole pregnancy. She’s not stupid! There is no third eye growing.’”

The number of women in the United States who use marijuana during pregnancy has been difficult to gauge, partly because some women are reluctant to tell their doctors; at least 24 states consider substance use during pregnancy a form of child abuse, so divulging such information can have serious consequences.

Still, a number ofstudies nationally suggest there’s been a sharp jump in pot use among pregnant women. Younger mothers, especially, were reported using marijuana during pregnancy.

Andria Smith and Sauter both told their doctors of their marijuana use, and after they gave birth, their babies were tested for signs of marijuana’s chief active ingredient, THC.

Because their babies tested positive, Sauter and Smith were visited at home by county social service workers, who gave the women information about the effects of marijuana use during pregnancy and breastfeeding.

Researchers say psychoactive compounds in marijuana easily cross the placenta, exposing the fetus to perhaps 10 percent of the THC — tetrahydrocannabinol that the mother receives, and higher concentrations if the mom uses pot repeatedly.

Dr. Dana Gossett, a research obstetrician and gynecologist at the University of California-San Francisco who also treats patients, said studies have shown marijuana increases the risk of stillbirth or adversely affects how a babys brain develops.

Gossett cited some research that suggests children exposed to marijuana while growing in the womb can have poorer performance on visual-motor coordination — tasks like catching a ball or solving visual problems like puzzles.

And studies also show, she said, these kids may have behavioral problems at higher rates than other children by age 14, and are at greater risk for initiating marijuana use.

“That is biologically plausible,â Gossett said, “because the effects of THC in the brain may actually prime that child for addictive behavior, not just to marijuana but to alcohol as well.”

There has been little research on the effects of THC passed to a baby via breastfeeding. But because there isn’t enough evidence to determine the risk, the American College of Obstetricians and Gynecologists (ACOG) discourages marijuana use during pregnancy, and warns breastfeeding moms to avoid eating or smoking marijuana or inhaling its secondhand smoke — since some amount of THC, just like alcohol, can pass into the baby that way.

To Smith’s point that her daughter, Delilah, is just as smart as her peers, studies do show that, in general, children exposed to marijuana in utero don’t score worse on reading or mathematics as they get older.

Jenna Sauter said many parents she knows are uncertain if they can get in trouble using pot now in California. (Sarah Varney/KHN)

Sauter said she and her friends don’t smoke near their children, nor do they spend their days stoned to oblivion.

“It’s not like being totally out of it,” Sauter said. “I’m completely aware of my surroundings. I’m watching my kid, watching my friends’ kids. I’m hanging out. You totally know what’s going on.”

Sauter said many parents she knows are uncertain if they can get in trouble using pot now in California. Indeed, child protection laws in most states remain at odds with liberal marijuana laws. Some moms on the Facebook page will not go to the doctor — even when they’re sick.

“They don’t want to get tested,” Sauter said. “And that’s dangerous. We should be able to be open about it. Because if something does go wrong, we’ve got to know.

ACOG does not endorse mandatory testing for THC in pregnant women or newborn babies — out of concern that women could be jailed or have their babies taken from them. Instead, the organization urges obstetricians to ask pregnant women about drug use during prenatal visits, counseling these patients against substance use and helping them alleviate their nausea, back pain or postpartum depression with medications deemed safe by federal drug regulators.

But with recreational cannabis now legal in at least eight states and the District of Columbia, physicians like Gossett are worried that newborns and young children, whose brains are rapidly developing, constructing billions of neural connections, will come to know the world in an altered state.

“They’re learning what things look like and how things move and how to respond to the world,” Gossett said. Marijuana’s psychotropic effects, she added, will change “a child’s ability to interpret the world around him.”

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Expert Advice For The Corporate Titans Taking On Health Care

An announcement Tuesday by three of the nation’s corporate titans — Amazon, Berkshire Hathaway and JPMorgan Chase & Co. — that they are joining forces to address the high costs of employee health care has stirred the health policy pot. It immediately sent shock waves through the health sector of the stock market and reinvigorated talk about health care technology, value and quality.

Though details regarding the undertaking are thin, the companies said in a release that their partnership’s intent is to improve employee satisfaction and hold down costs by bringing “their scale and complementary expertise to this long-term effort.”

They plan to create an independent company, “free from profit-making incentives and constraints,” to focus on “technology solutions.”

Berkshire Hathaway CEO Warren Buffett described health care costs as “a hungry tapeworm on the American economy,” and Amazon founder and CEO Jeff Bezos said the partnership was “open-eyed about the degree of difficulty” ahead. Jamie Dimon, chairman and CEO of JPMorgan, said the results could benefit the employees of these companies and possibly all Americans.

But what does all of this mean and how can it be successful when so many other initiatives have fallen short? KHN asked a variety of health policy experts their thoughts on this venture, and what advice they would offer these CEOs as they go forward. Some of the advice has been edited for clarity and length.


Tom Miller, resident fellow, American Enterprise Institute (Courtesy of Tom Miller)

Tom Miller, resident fellow, American Enterprise Institute:

“It’s great that someone theoretically with resources would try to build a better mousetrap. But itâs been difficult to do, and part of it is regulatory and competitive barriers are well-constructed in the health care sphere, which tend to make it less receptive or subject to competitive pressures.

“I welcome any new capital trying to disrupt health care. … The incumbents are comfortable and could use disruption. If Amazon has an idea, and is willing to put some money behind it, that’s wonderful. What they are willing to do other than fly low-cost providers for home visits in drones — I don’t know. They’d probably have to miniaturize them, wouldn’t they?


Stan Dorn, senior fellow, Families USA (Courtesy of Stan Dorn)

Stan Dorn, senior fellow, Families USA:

“Number one, look at prices. America doesn’t use more health care than European countries, but we pay a lot more and that’s because of prices more than anything else. Look at hospital prices and prescription drug prices. I would also say, look to eliminate middlemen operating in darkness. I’m thinking in particular of pharmacy benefit managers. Often, the supply chain is hidden and complex, and every step along the way the middlemen are taking their share, and it winds up costing a huge amount of money.”


Bob Kocher, partner, Venrock (Courtesy of Bob Kocher)

Bob Kocher, partner, Venrock:

“It has been said that health care is complicated. One thing that is not complicated is that the way to save money is to focus on the sickest patients. And that’s the only thing that has proven to work in great primary care. I hope Amazon realizes this early and does not think that [its smart digital assistant] Alexa and apps are going to make us healthier and save any money.

“It would sure be nice if they invest in a ‘post-CPT-ICD-10-and-many-bills-per-visit’ world where we know prices, can easily know what is known about quality and experience, and have same-day service.”


Tracy Watts, senior partner, Mercer (Courtesy of Tracy Watts)

Tracy Watts, senior partner, Mercer:

“Everyone thinks millennials want to do everything on their phones. But that’s not necessarily the case.

“[There was a recent] survey about this €” specifically, millennials are the most interested in new health care offerings, but it wasn’t as much high-tech as it is convenience they are interested in â same-day appointments with a family doctor, guaranteed appointments with specialists, home visits, a wider array of services available at retail clinics. That was kind of an ‘aha’ — this kind of convenience and high-touch experience is what they’re looking for. And when you think of ‘health care of the future,’ that’s not what comes to mind.”


John Rother, president and CEO, National Coalition on Health Care (Courtesy of John Rother)

John Rother, president and CEO, National Coalition on Health Care:

“Health care is complex and expensive, so the aim should always be simplicity and affordability. Three keys to success: manage chronic conditions recognizing the life context of the patient, emphasize primary care-based medical homes and aggressively negotiate prescription drug costs.”


Suzanne Delbanco, executive director, Catalyst for Payment Reform (Courtesy of Suzanne Delbanco)

Suzanne Delbanco, executive director, Catalyst for Payment Reform:

“The biggest driver of health care costs is prices. Those are being driven up by health care providers who have consolidated and will continue to consolidate and amass more market power.

“It sounds like they [the companies] are limiting the use of health plans, but if they’re going to get into that business, they’re going to come up with the same challenges health plans face. What would be really innovative would be to build some provider systems from the ground up where they can truly get a handle on the actual costs and eliminate the market power that drives the prices up, and they can have control over their prices.”


Brian Marcotte, president and CEO, National Business Group on Health (Courtesy of Brian Marcotte)

Brian Marcotte, president and CEO, National Business Group on Health:

“They recognize this is [a] long-term play to get involved in this. I’d have to say, this industry is ripe for disruption.

“I think we know technology will continue to play an increasing role in how consumers access and receive health care. We’ve also learned most consumers do not touch the health care delivery system with enough frequency to ever be a sophisticated consumer. What’s intriguing about this partnership is Amazon for many consumers has become part of their day-to-day world, part of their routine. It’s intriguing to consider the possibilities of integrating health care into consumer routine.

“And I think that therein lies the opportunity. Employers offer a lot of resources to their employees to help them maximize their experience, and their No. 1 challenge is engagement.”


Joseph Antos, health economist, American Enterprise Institute (Courtesy of Joseph Antos)

Joseph Antos, health economist, American Enterprise Institute:

“My first suggestion is to look at what other employers have done (some unsuccessfully) and consider how to adapt those ideas for the three companies and more broadly. Change incentives for providers. Change incentives for consumers. Work on ways to reduce the effects of market consolidation. The bottom line: Don’t keep doing what we are doing now. I don’t see that these three companies have enough presence in health markets to pull this off anytime soon, but perhaps this should be viewed as the private-sector version of the Affordable Care Act’s Innovation Center — except, this time, there may be some new ideas to test.”


Ceci Connolly, president and CEO, Alliance of Community Health Plans (Courtesy of Ceci Connolly)

Ceci Connolly, president and CEO, Alliance of Community Health Plans:

œWe know that 5 percent of any population consumes 50 percent of the health care dollar. I would encourage this group to focus on how to better serve those individuals who need help managing multiple chronic conditions.”


David Lansky, CEO, Pacific Business Group on Health (Courtesy of David Lansky)

David Lansky, CEO, Pacific Business Group on Health:

“The incumbent providers of services to our members are not doing as much as we need done for affordability and quality. So, we are pleased to see them go down this path. We don’t know what piece of the puzzle they will tackle.

“We know well-intended efforts over the years haven’t added up to material impact on cost and quality. I would suspect they are looking at doing something broader, more disruptive than initiatives we have tried before.

“I think across the board they have the opportunity to set high standards for the health system in whatever platform they use. These companies have a history of raising the bar. Potentially, it could be a help to all of us.”

Staff writers Julie Appleby, Rachel Bluth, Jenny Gold, Jay Hancock, Shefali Luthra, Jordan Rau, Julie Rovner and Chad Terhune contributed to this report.

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Viewpoints: Long-Term Care Insurance Faces A ‘Daunting Challenge’; Do Prisoners Deserve Pricey Cures?

Opinion writers from around the country express views on a range of health issues.

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Parsing Policies: Pros And Cons Of Medicaid Changes; The Toll Of Rising Medicare Out-Of-Pocket Costs

Editorial pages feature thoughts on health policy topics.

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State Highlights: Hospital Board’s Vote To Close Delivery Room Broke D.C. Law; Minn. Task Force Calls For ‘Dramatic’ Reforms To Prevent Elder Abuse

Media outlets report on news from Minnesota, Kansas, Maryland, Wisconsin, Florida, Louisiana, Georgia and Oregon.

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Judge Rules Texas’ Fetal Tissue Burial Law ‘Lacks Merit,’ Issues Temporary Block On Legislation

U.S. District Judge David Ezra said the state did not show how the measure has a public health purpose.

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Fitness App Might Be Unfit For Use: Sensitive Military Sites In Iraq And Syria Are Exposed

The U.S. military is reviewing its policies for the use of wireless trackers, like the popular Strava fitness app, after maps were posted online showing where service members and aid workers run and bike. In other health and technology news: online forums are flagging suspicious research and a messaging system for young teens gets a red light.

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