The conservative Freedom Caucus approved a new version of the American Health Care Act, the Hill reports, but a vote this week is unlikely, especially since many moderate Republicans are skeptical. As currently written, the bill would cause 24 million people to lose health insurance by 2026; cut premium subsidies for low- and middle-income families; phase out the Medicaid expansion; cut more than $800 billion from Medicaid over the next decade; repeal the Prevention and Public Health Fund; allow insurers to charge higher premiums based on pre-existing conditions; increase out-of-pocket costs for older adults; and allow states to opt of requiring that health plans cover Essential Health Benefits. The CBO has said it won’t have a score on the plan this week or next, Politico reports. A new AJPH study found that about 95% of Medicaid enrollees in Ohio would have no insurance option if the repeal of the Affordable Care Act eliminates the Medicaid expansion, Modern Healthcare reports.
Surgeon General Vivek Murthy was dismissed from his post by the Trump administration (his term was originally slated to run until the end of 2018). Dr. Murthy has been an outspoken advocate for addressing the opioid epidemic and gun violence, and has been a strong supporter of the Affordable Care Act, putting him sharply at odds with the Trump administration.
A new study in the Journal Pediatrics finds that the number of children with elevated levels of lead in their blood as of 1999-2000 was 1.2 million, double the CDC’s original reporting. Vox reports, “So how are we failing to account for so many lead-poisoned children? The answer (as well as the solution) is pretty straightforward. We don’t test enough children for lead, and as a result, lead poisoning cases in the US go undetected. If doctors were to test more children and if states were to mandate testing for more at-risk populations, then more children suffering from lead poisoning would get the treatment they so desperately need. It might also mean we’d get more serious about dealing with the threat of lead itself.”
A federal judge this week blocked the Trump administration’s efforts to freeze funding to sanctuary cities. Meanwhile, Mother Jones reports that “Texas is about to become the second state to outlaw sanctuary cities, jurisdictions that refuse to fully comply with federal enforcement of immigration laws,” with lawmakers voting this week to make it a misdemeanor for local law enforcement to not cooperate with federal immigration authorities, with financial penalties for local governments and potential jail time for members of law enforcement who refuse to carry out federal immigration actions.
A National Conference of State Legislatures review showed a surge in bills introduced in 2017 to address Adverse Childhood Experiences (ACEs), according to ACEsTooHigh. The StateNet scan found nearly 40 bills, compared to a handful in 2016. The bills relate to use of ACEs screening tools by providers, training and other resources for schools, and creation of task forces and committees to study and address childhood trauma and its effects.
The Associated Press reports on legislative efforts to transition California’s healthcare system to a single-payer system. “The measure would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally. Private insurers would be barred from covering the same services, essentially eliminating them from the marketplace. Instead, a new state agency would set prices and contract with health care providers such as doctors and hospitals and pay the bills for everyone.… The proposal, promoted by the state's powerful nursing union and two Democratic senators, is a longshot. But supporters hope the time is right to persuade lawmakers in California, where Democrats like to push the boundaries of liberal public policy and are eager to stand up to the Republican president. ‘It is time to say once and for all that health care is a right, not a privilege for those who can afford it,’ said Democratic Sen. Ricardo Lara of Bell Gardens, who wrote the bill along with Democratic Sen. Toni Atkins of San Diego.”
Writing in the New York Times, health economist Austin Frakt makes the case that the savings from crime reductions resulting from treating substance abuse disorders outweighs the cost of those treatments.
The City of Boston is creating “trauma teams” to work with residents of neighborhoods that have experienced crimes, WBUR reports. The teams, which will provide support to crime victims and those who have witnessed crimes, will not only provide immediate care but also connect people with providers who can provide longer-term care.
Patrick Donnelly, a writer in Minnesota, joins a growing number of men sharing their stories of struggles with mental health problems in an effort to encourage others to acknowledge their own challenges and get help. In an article in the Star Tribune, he offers his experiences with anxiety and depression and the social pressures for men to bury their feelings. He writes: “That escapism is a key part of avoidance. Guys like me are supposed to do anything to ignore the nagging, persistent voice that says, ‘This isn’t normal.’ And we’re definitely not supposed to answer to that smaller voice, the one telling us it’s OK to ask for help. It’s OK to confront things that might make us uncomfortable. It’s OK to deal with issues head-on.”
Politico reports that the Trump administration has named Elinore McCance-Katz, previously the chief medical officer at the Substance Abuse and Mental Health Services Administration, as the first HHS assistant secretary for mental health and substance use.
The CDC has launched a video campaign to reduce opioid misuse by encouraging patients to ask questions when their physicians prescribe opioids, according to STAT. The videos will debut in some of the states with the highest rates of overdose deaths—West Virginia, Ohio, Oregon, and Rhode Island.
Buzzfeed looks at the “two epidemics” of overdose deaths in the US. While people in their 50s and older are primarily dying from overdoses of opioid painkillers, heroin is responsible for overdose deaths among people in their 20s.
In other healthcare news, Politico reports the White House said this week it will continue paying Affordable Care Act cost-sharing subsidies, which health plans have said are critical to stabilize the ACA markets. Separately, the Senate Finance Committee will hold a hearing May 9 about the future of the Children's Health Insurance Program. Congress has a Sept. 30 deadline to extend funding for the program, which covers about 5.6 million children. If it’s not extended, states will start to run out of federal funds in October, with most running out between January and March.
Grassroots Change’s Mark Pertschuk co-authored an AJPH piece on the threat of state preemption to public health. It concludes, “With the new federal administration, concerns now exist that state legislation will be preempted by federal law, leaving a potential gap in public health regulation on a national level. Stakeholders across public health fields and disciplines should join together in advocacy, action, research, and education to support and maintain local public health infrastructures and protections.”
Mother Jones reports on the launch of the United for Climate Task Force, a new organization representing marginalized communities facing environmental injustice that includes activists, congressional Democrats, and former EPA staffers.
SPUR covers the passage of Senate Bill 1 in California, a state transportation funding bill passed by the legislature this month that is expected to raise over $5 billion per year, every year, to fund transportation projects (with 10% designated from public transit), a 45% increase over current state funding levels. “What SB1 shows us is a path for how to get something big done for transportation statewide. It required years of compromise, dialogue between hundreds of different interests, strong focus on spending priorities and the best revenue sources, and thinking at a scale that actually solves problems. SB 1 moved the conversation forward on a more sustainable transportation future for Californians, in all senses of the term. We need this pathway. In these times of federal funding uncertainty, we must figure out how to pay for our local and regional transit expansion projects and a statewide rail network — as well as the crucial shift to clean transportation. We also can’t lose sight of the fact that over the next decade we must start thinking about how we transition away from one of SB 1’s funding sources: the gas tax. As we make the much-needed shift to electric vehicles, we will need an ongoing, sustainable revenue source that isn’t reliant on fuel consumption. California’s Road Usage Pilot Program, which will conclude later this year, will lay important groundwork for that “next generation” conversation.”
The Center for Health Journalism’s (CHJ) Slow Medicine columnist Dr. Michael Hochman notes that a “slower, more conservative, less aggressive, more thoughtful approach” to healthcare would yield better patient outcomes and save money. Such an approach would include spending more public health money to address chronic conditions and the environmental factors that lead to them, as well as spending more on injury and suicide prevention. Meanwhile, Permanente Medical Group CEO Dr. Robert Pearl writes for CHJ that our current system relies too much on treatment and we should focus more on prevention.