Raleigh News & Observer: NC Medicaid Holdout Puts Infants At Risk The News&Observer: Giving NC Babies A Better Chance ObamaCare’s image of invincibility is increasingly being exposed as a political illusion, at least for those with permission to be honest about the evidence. Witness the heretofore unknown phenomenon of a “free” entitlement that its beneficiaries can’t afford or don’t want. This month the Health and Human Services Department dramatically discounted its internal estimate of how many people will join the state insurance exchanges in 2016. There are about 9.1 million enrollees today, and the consensus estimate—by the Congressional Budget Office, the Medicare actuary and independent analysts like Rand Corp.—was that participation would surge to some 20 million. But HHS now expects enrollment to grow to between merely 9.4 million and 11.4 million. (10/25) Viewpoints: Health Law Enrollment Lags; Paul Ryan’s Challenge; New Mammography Debate A selection of opinions on health care from around the country. [S]ome Freedom Caucus members consider Ryan … to be dangerously moderate too. Never mind that Mitt Romney chose Ryan as his running mate in 2012 because the congressman had championed bills to slash domestic spending and turn Medicare into a voucher plan. Ultras in the Freedom Caucus distrust Ryan because, as chairman of the House’s tax-writing committee, he made a bipartisan budget deal to keep the government running in 2013. … Tea party organizations are already raising money from supporters with appeals to stop any more Ryanesque budget deals. The GOP presidential campaign will complicate the new speaker’s life too. Already, Sen. Ted Cruz (R-Texas) has demanded that the House include the complete repeal of Obama’s healthcare plan in any budget deal, a reprise of his demand that touched off a 16-day government shutdown in 2013. (Doyle McManus, 10/25) While Republican leaders in Raleigh refuse to expand Medicaid, Dr. Dorothy DeGuzman spends her days in rural Yancey County dealing with the consequences. DeGuzman works for Celo Health Center in Burnsville, a nonprofit, community-owned family practice that serves low-income people in the mountainous county north of Asheville. Most of the center’s patients do not have private health insurance, and their health reflects a lack of access to doctors and preventative programs that would help reduce obesity, hypertension, smoking and substance abuse. The medical care gap shows up most profoundly in the pregnant women DeGuzman sees. (Ned Barnett, 10/24) After decades of inaction, concern about the use of antibiotics in animal agriculture is finally gaining traction, not because of federal regulations or congressional legislation, but because smart people around the nation are listening to consumers and thinking creatively about new ways of doing things. Antibiotic resistance is a serious global problem that is growing worse. (10/25) The New York Times: Shifting Advice On Mammograms The American Cancer Society issued new guidelines last week saying that women with an average risk of breast cancer should start having mammograms at 45, five years later than it had long advocated. This presents yet another wrinkle for women who are trying to make informed decisions about their health care, especially when other respected groups suggest earlier or later ages. (10/26) Over the past three decades, more and more women have opted to get mammograms, which, despite some discomfort and anxiety, provide the best way to detect breast cancer early. The system has worked: In the same period, the rate of breast cancer deaths has been cut by one-third. That can’t be coincidence, and most everyone, including the influential American Cancer Society, agrees that early detection saves lives. (10/25) The significance became clear after I took care of my own red blanket patients: It was a marker of status. At that hospital, patient relations gave them to some C.E.O.s, celebrities and trustees’ friends. Although we weren’t instructed on how to treat the V.I.P. patients, the blanket spoke for itself: “This patient is important.” Today, I work at a hospital in Massachusetts that gives the same white blankets to everyone. Yet I continue to see red blanket patients. Here, they are called “pavilion patients” because they pay extra to stay in private hotel-like rooms on the top floor, which come with gourmet food, plush bath robes and small business centers. (Shoa L. Clarke, 10/26) For a century, the American Cancer Society has held up “early detection” of breast and other cancers as its mantra. Once, that made sense. But over the past few decades, the limitations of this approach have become increasingly apparent to researchers, physicians and other advocacy groups: Early detection may not save lives, and it can lead to unnecessary procedures. Yet the ACS has continued to insist that early detection was still the best way to find and treat the disease …. Why did it take the nation’s most fervent anti-cancer group so long to grapple with new facts? The answer is a reminder that the best way to fight disease is with evidence — and that we should not pay for tests that are not effective, even if they are popular. (Barron H. Lerner, 10/23) The Philadelphia Inquirer: Don’t Let Artificial Caps Stifle Drug Production The Washington Post: Why Did The American Cancer Society Ignore Evidence About Early Detection Until Now? Los Angeles Times: Paul Ryan And The Fight For The GOP’s Soul The Nugent family lost their baby Carlie in 2000, in the Charlotte suburb of Harrisburg. She died from a disease called severe combined immunodeficiency, or SCID, which leaves babies highly vulnerable to infections that can kill them. It’s sometimes called “bubble boy disease” because of a child who lived for 12 years in a plastic, germ-free bubble. A screening test and then a bone marrow transplant to treat the disease can give such babies a tremendous chance at survival. Last week, Gov. Pat McCrory signed a law to test all newborns for SCID. It is the humane and hopeful thing to do, and as McCrory noted, it can save money for the health care system because the diseases that attack those infants with SCID are expensive to treat. (10/25) USA Today: New Mammogram Guidelines Invite Risks: Our View It has been nearly four months since videos surfaced showing Planned Parenthood employees discussing their role in making the organs of aborted fetuses available for medical research. Despite claims by the antiabortion activists who produced the highly edited videos, there has been no evidence of wrongdoing by Planned Parenthood. Nonetheless, the potentially damaging fallout continues, with states moving to yank funding from the women’s health organization and creation of a special committee by House Republicans who want to defund the group. Particularly worrisome is the interest of some states in limiting the use of fetal tissue for medical research. (10/23) The New York Times: Free Mitt Romney! The Obama administration last week offered the outline of a rescue plan to help the island and the 3.5 million American citizens who live there. The plan would impose new oversight on the island’s finances and expand access to government programs like Medicaid and the earned-income tax credit. Crucially, it asks Congress to change the law so that Puerto Rico’s territorial government and its municipalities can seek bankruptcy protection. (10/24) The Washington Post: I’m A Kennedy Who Was Addicted To Painkillers. Obama’s Drug Proposals Worry Me. The Washington Post: Progress On Antibiotics The Washington Post: A Rescue Plan For Puerto Rico The New York Times: Save Puerto Rico Before It Goes Broke But now it’s 2015 in America, and Mr. Romney’s party doesn’t want people who get things done. On the contrary, it actively hates government programs that improve American lives, especially if they help Those People. And this means that Mr. Romney can’t celebrate his signature achievement in public life, the Massachusetts health reform that served as a template for Obamacare. This has to hurt. Indeed, a few days ago Mr. Romney couldn’t help himself: he boasted to the Boston Globe that “Without Romneycare, we wouldn’t have had Obamacare” and that as a result “a lot of people wouldn’t have health insurance.” And it’s true! (Paul Krugman, 10/26) The Washington Post: Defunding Fetal Tissue Research Would Be A Mistake This is shaping up to be another banner year for medical progress. Regulators have already approved 28 new medicines, roughly on last year’s pace of 41 new drug approvals – the most since the Clinton administration. But in future years, the list of medical breakthroughs could prove much shorter. In response to the high cost of certain medications – most notably Turing Pharmaceuticals’ admittedly outrageous 5,000 percent price hike on a generic AIDS drug – political leaders are proposing caps on drug prices. (Wayne Winegarden, 10/26) USA Today: New Mammogram Guideline Balances Risks: Opposing View The New York Times: Hospitals’ Red Blanket Problem Last week, President Obama announced a multipronged effort to address the epidemic of addiction to prescription opiate painkillers in this country. This is long overdue and, unfortunately, like most action on addiction and mental illness, comes after the problem has reached Stage 4 — and is that much harder to treat — when it could have been diagnosed and treated at Stage 1, or perhaps even prevented altogether. (Patrick J. Kennedy, 10/23) The Wall Street Journal: The Decline Of ObamaCare Cancer screening is like searching for needles in a haystack. The needles are the women with breast cancer. The hay is the healthy population. We don’t have a magnet to magically detect the needles. Instead, we sift through each piece of hay: The fewer the needles, the harder they are to find. That’s why we don’t screen women in their 30s. Even though cases of fatal breast cancer exist in this group, they’re very rare. Meanwhile, for women 50 and over, there’s broad consensus about recommended screening. (Ruth Etzioni and Kevin Oeffinger, 10/25) [Treasury Department counselor Antonio Weiss] advocated not only permitting Puerto Rico’s municipalities and public corporations to file for bankruptcy, which would affect about a third of its $73 billion debt, but also extending the bankruptcy option to the commonwealth government itself. He called for a permanent fix to the island’s Medicaid program, which faces crippling uncertainty because of limits on federal assistance unlike those of the 50 states. And to address its lagging labor force participation – a huge drag on economic growth – he proposed creating an Earned Income Tax Credit to encourage low-wage workers’ return to the job market. (10/24) This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.