Happy shortest day of the year! But this certainly won’t be the shortest Breeze of the year, because everyone seemed to want to cram about a month’s worth of news into the past five days.
First, a quick programming note before we get started: KHN is closing up shop for a winter break, but the Breeze will be back in your inboxes Jan. 4.
Now buckle up, this week was a wild ride.
“The proverbial dog that caught the car” is the phrase that keeps cropping up about the Texas ruling that deemed that the health law could not stand apart from the individual mandate tax. Republicans have been pounding the “unconstitutional” drum for years, but after the decision (which legal experts on both sides panned) came out, the celebration was … fairly nonexistent.
The thing is, a lot of the health law’s provisions that have survived Republicans’ attempts to chip away at the legislation are wildly popular (so much so that they became a successful battle cry for Democrats in the midterms). Also, millions of Americans (including a wide swath of the GOP’s base) are benefiting from protections that many people don’t even realize are part of the legislation.
On top of that, Republicans are still smarting from the intraparty bruises they left the last time they tried to replace the ACA.
In short, this ruling could be a big ol’ headache that lasts straight up until the 2020 elections.
The Washington Post: Why Republicans (Secretly) Want the ACA to Survive
The Washington Post: Legal Experts Rip Judge’s Rationale for Declaring Obamacare Law Invalid
Politico: Obamacare’s Secret Base: America’s Middle Class
The Texas case also highlights how carefully selecting the particular judge who hears your case has become a strategy that’s being employed by both sides of the aisle.
Few other things in the health law inspire such vitriol in its opponents as the individual mandate. But new enrollment numbers hint that the penalty, despite the angst surrounding it, may have become somewhat superfluous. While the new sign-ups for 2019 coverage did dip slightly (about 4 percent from last year), they were much better than the dire predictions in the weeks leading up to the deadline.
Maybe the mandate was a necessary “stick” in a “carrot-and-stick strategy” that helped steer the health law through its infancy, but those days may be gone, experts say. Now, the “carrots” (subsidies, essential benefits, preexisting conditions protections) seem to be enough to keep consumers around.
The New York Times: Despite Challenges, Health Exchange Enrollment Falls Only Slightly
The Associated Press: Health Law’s Fines Are Not the Big Stick Everybody Thought
An AP investigation paints a grim picture of the conditions at youth detention centers— one that looks a lot like the crowded institutions and orphanages of decades past. The lasting trauma from being held at such places cannot be overstated, experts say. “This is not a perplexing scientific puzzle. This is a moral disaster,” said Dr. Jack Shonkoff in AP’s coverage.
The Associated Press: ‘A Moral Disaster’: AP Reveals Scope of Migrant Kids Program
Several high-profile cases of sexual abuse at the detention facilities have drawn attention to the widespread problem in the system. But it turns out that even when the young people do report the abuse, police are closing the cases often within days, or even hours, sometimes with very little investigation at all.
ProPublica: In Immigrant Children’s Shelters, Sexual Assault Cases Are Open and Shut
Johnson & Johnson has been facing thousands of lawsuits that allege its talc powder causes cancer. The science has always been a little blurry here, and J&J has been adamant that its iconic product is safe. But new memos reveal that the company has known since the ’70s that its powders sometimes tested positive for asbestos.
Reuters: J&J Knew for Decades That Asbestos Lurked in Its Baby Powder
Is the government ready to get into the generic-drug-making business? Well, under a new plan from Sen. Elizabeth Warren (D-Mass.) it would be thrust into that role. Warren wants to create an office that would step in during drug shortages or when only one or two companies produce a certain medication. It’s unclear how much of an impact this legislation would have (ignoring the fact that it would have to get passed at all), because overall generics prices have been going down.
Stat: Sen. Warren’s New Plan to Lower Prices: Have the Government Make Drugs
Letting veterans seek private care is a much-ballyhooed idea by conservatives (and has been championed enthusiastically by President Donald Trump), but the VA Choice Program led to not only longer wait times for veterans but also a higher cost to taxpayers. So, who exactly are the winners in this scenario? Two private companies that secured a cushy government contract to run the program.
ProPublica: The VA’s Private Care Program Gave Companies Billions and Vets Longer Waits
The Veterans Affairs Department’s alarming failures in terms of suicide prevention efforts were detailed this week in a damning report from the Government Accountability Office. Millions that had been budgeted to address the growing crisis have gone unspent, and social media outreach and public service announcement efforts had gone all but dormant in a time when 20 veterans a day still die by suicide.
The New York Times: Suicide Among Veterans Is Rising. But Millions for Outreach Went Unspent by V.A.
Despite all the warning signs, the Drug Enforcement Administration, along with drug distributors, did little to stem the flood of opioids into rural West Virginia during the early days of the epidemic. The 300-plus-page congressional report that blasted the agency for its inaction was the result of an 18-month intensive investigation to figure out why 21 million pain pills were funneled to a small town with the population of 3,200.
Harm-reduction advocates in Maine have come up with a strategy to circumnavigate laws that would impede them from helping people addicted to opioids use the drugs more safely: setting the organization up as a church.
Stat: Recovery Experts Set Up New ‘Religion’ in Maine That May Skirt Drug Laws
And you have to check out this New York Times visual story on how and why people get addicted to opioids, which also contains one of the best quotes to sum up the crisis: “One is too many, and a thousand is never enough.”
The New York Times: Heroin Addiction Explained: How Opioids Hijack the Brain
“Follow the money” is a journalism adage that will rarely let you down. Like with this AP investigation that pulls back the curtain on an organization that represents itself as a champion for Medicare beneficiaries.
The Associated Press: Insurance Giants Bankroll Group That Pushes Private Medicare
Imagine treating health insurance like renting a movie on demand instead of paying for a cable package you almost never use. That radical approach is drawing attention in a landscape that’s hungry for new ideas on reining in health care costs.
The Associated Press: Health Insurance on Demand? Some Are Betting on It
And I’m going to send you into the winter break with a jampacked miscellaneous file, just in case all of that wasn’t enough news:
• A deep dive considers the political paradox of why Republicans, who are the main beneficiaries of government aid (such as Medicaid) are so ardent in their opposition to … government aid.
The New York Times: Where Government Is a Dirty Word, But Its Checks Pay the Bills
• Advocates rejoiced when ballot initiatives to expand Medicaid in three red states found success. But what about that fourth one? What went wrong there? (Hint: They got Big Tobacco involved.)
Stateline: Lone Medicaid Expansion Defeat Offers Lessons for Other States
• A heart-wrenching report finds that when report cards are released on Fridays, child abuse increases nearly fourfold.
The Associated Press: Child Abuse Climbs After Friday Report Cards, Study Says
• When it comes to public health crises, look to West Virginia as the canary in the coalmine. Oftentimes, epidemics, such as obesity and opioids, start here before spreading throughout the country.
The Associated Press: As US Life Expectancy Falls, West Virginia Offers Lessons
• A University of Southern California gynecologist is at the center of the LAPD’s largest-ever single-suspect investigation. If you haven’t been following the case, the Los Angeles Times offers a great overview of where it stands and how it got so bad.
• What we have learned in 2018: Flu shots are great, when hospitals merge patients pay more, teen vaping rates have reached epidemic proportions, and tons more. Check out The New York Times’ look back at lessons from this past year.
The New York Times: What We Learned In 2018: Health And Medicine
And for all you policy wonks out there, check out this Twitter thread on health-related academic papers.
Please have a wonderful and restful last few days of 2018, and I’ll see you guys in the new year!
This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.