How measles detectives work to contain an outbreak

[Original UPDATED on June 11]

On any given day, more than 4,000 people pass through the library at California State University-Los Angeles. On April 11, one of them had measles. The building has only one entrance, which means that anyone who entered or exited the library within two hours of that person’s visit potentially was exposed to one of the most contagious diseases on Earth. It’s the stuff of public health nightmares: Everyone at the library between 11 a.m. and 3 p.m. that day had to be identified, warned and possibly quarantined. Measles is so contagious that up to 90% of people close to an infected person who are not protected by a vaccine or previous case of the disease will become infected.

Are surprises ahead for legislation to curb surprise medical bills?

Surprise medical bills — those unexpected and often pricey bills patients face when they get care from a doctor or hospital that isn’t in their insurance network — are the health care problem du jour in Washington, with congressional lawmakers from both sides of the aisle and the White House calling for action. These policymakers agree on the need to take patients out of the middle of the fight over charges, but crafting a legislative solution will not be easy. A hearing of the House Ways and Means health subcommittee Tuesday, for example, quickly devolved into finger-pointing as providers’ and insurers’ testimony showed how much they don’t see eye to eye. “I’m disappointed that all participants that are going to be here from critical sectors of our economy could not come to find a way to work together to protect patients from these huge surprise bills,” Rep. Devin Nunes (R-Calif.), the ranking Republican on the subcommittee, said in his opening statement. As Congress weighs how to address the problem, here’s a guide to the bills and what to watch.

How Obamacare, Medicare and ‘Medicare For All’ muddy the campaign trail

The health care debate has Democrats on Capitol Hill and the presidential campaign trail facing renewed pressure to make clear where they stand: Are they for “Medicare for All”? Or will they take up the push to protect the Affordable Care Act? Obamacare advocates have found a powerful ally in House Speaker Nancy Pelosi, who in a recent “60 Minutes” appearance said that concentrating on the health law is preferable to Medicare for All. She argued that since the ACA’s “benefits are better” than those of the existing Medicare program, implementing Medicare for All would mean changing major provisions of current Medicare, which covers people 65 and up as well as those with disabilities. This talking point — one Pelosi has used before — seems tailor-made for the party’s establishment.

A big hearing for ‘Medicare-For-All’ — in a small room

The first congressional hearing on a “Medicare-for-all” bill in at least a decade took place Tuesday, but without the usual phalanx of T-shirted supporters — or even the presidential candidates — who have been pushing the bill. That’s because the hearing took place not at one of three major committees that oversee health policy in the House, but in the ornate — and comparatively miniature — hearing room of the House Rules Committee. That panel’s primary role is to set the terms for House floor debates, and its hearing room can seat about 50 people in the audience, compared with hundreds in the larger rooms of the Capitol complex’s office buildings. Also, members of the public cannot easily access the room on the third floor of the Capitol as they can the House office buildings across the street. That arrangement was no accident — the Rules Committee is often called the “Speaker’s Committee” because it is so closely aligned with the speaker’s goals and is more heavily populated with members of the majority party than the usual committee breakdowns.

Planned Parenthood’s ‘Risky strategy’ to update its image

PROVIDENCE, R.I. — The Trump administration is pushing ahead with its reproductive health agenda. It has rolled out changes to the Title X program, which funds family planning services for low-income people, that are designed to have a chilling effect on organizations that provide abortions or include this option in counseling. It also has nominated federal judges widely believed to support state-level abortion restrictions. Against that backdrop, Planned Parenthood, known as a staunch defender of abortion rights, is working to recast its public image. Under its president, Dr. Leana Wen, who took office in November, the nation’s largest reproductive health provider is highlighting the breadth of care it provides — treating depression, screening for cancer and diabetes, and taking on complex health problems like soaring maternal mortality rates.

The Blame Game: Everyone and no one is raising insulin prices

A casual observer of Wednesday’s House Energy and Commerce subcommittee hearing might think insulin prices just go up by themselves. After all, the key industry executives filed opening statements to the congressional panel outlining patient-assistance programs, coupons and discounts — a range of price reductions that might make one think this life-or-death diabetes medication is easily affordable to the patients who need it. In fact, the price of insulin nearly doubled from 2012 to 2016 alone, triggering national headlines about the resulting hardships — sometimes deadly — suffered by people with the Type I-version of the condition who are left to ration insulin because it is too expensive for them to use as prescribed. The three drug manufacturers that make insulin — Eli Lilly, Novo Nordisk and Sanofi — joined three pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — to testify before the Oversight and Investigations panel at its second hearing probing the corporate maneuvers behind the skyrocketing costs. Pharmacy benefit managers, or PBMs, are the go-between companies that negotiate with drugmakers on which medicines will make insurance plans’ lists of covered drugs and how much insurers’ plans will pay for them.

Democrats fight back against lawsuit threatening health law

Among the first things Democrats did after officially taking control of the House was to express support for efforts to appeal a Texas district court decision declaring the Affordable Care Act unconstitutional.

Overshadowed by opioids, meth is back and hospitalizations surge

The number of people hospitalized because of amphetamine use is skyrocketing in the United States, but the resurgence of the drug largely has been overshadowed by the nation’s intense focus on opioids. Amphetamine-related hospitalizations jumped by about 245 percent from 2008 to 2015, according to a recent study in the Journal of the American Medical Association. That dwarfs the rise in hospitalizations from other drugs, such as opioids, which were up by about 46 percent. The most significant increases were in Western states. The surge in hospitalizations and deaths due to amphetamines “is just totally off the radar,” said Jane Maxwell, an addiction researcher.

High stakes, entrenched interests and the Trump rollback of environmental regs

Since his days on the campaign trail, President Donald Trump has promised to roll back environmental regulations, boost the use of coal and pull out of the Paris climate agreement — and he’s moving toward doing all those things. He has pushed ahead with such action even as a report by the United Nations’ Intergovernmental Panel on Climate Change released in October concluded that without much stronger measures to reduce the use of fossil fuels, a warming planet will witness the spread of tropical diseases, water shortages and crop die-offs affecting millions of people. Supporters of the administration’s changes — some of whom are skeptical of accepted science — say the administration’s moves will save money, produce jobs and give more power to states. But critics say new strictures on scientific research and efforts to overturn standards for protecting air, water and worker safety could have long-term, widespread effects that would upend hard-won gains in environmental and public health. The Trump administration’s many environmental proposals vary widely in target and reach.

In swing districts, Republicans may pay for having tried to reverse the health law

EDGEWATER PARK, N.J. — Not long ago many voters knew little about Tom MacArthur. A low-key moderate Republican congressman in a district that twice went for Barack Obama, he burnished his reputation as the guy who worked with Democrats to help rebuild in the years after Hurricane Sandy. Now, as he wages a bitter fight for re-election to a seat he won by 20 percentage points just two years ago, even some of his supporters have turned virulently against him. The reason? His new reputation as the turncoat whose legislation almost repealed the Affordable Care Act.