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First Edition: November 20, 2017

Kaiser Health News - Mon, 11/20/2017 - 6:30am
Categories: Health Care

Shingles: Don’t Let It Get You The Way It Got Me

Kaiser Health News - Mon, 11/20/2017 - 5:00am

Shingles tried to kill me. Like an insidious invading army, the virus that more commonly causes chickenpox in children attacked the right side of my head, leaving me permanently deaf in my right ear. Shingles almost destroyed my voice box, too, and it caused my right eyelid and lower lip to temporarily droop.

It struck out of nowhere. One day I was in Ocean City, Md., enjoying spring break with my family. The next day, I was knocking on my doctor’s door in agony after feeling as though someone was repeatedly jabbing and twisting a butcher knife inside my head. That pain was actually an acute inflammation of the nerve endings in my eardrum.

Now, five years later, having won my wretched battle with the virus, I have some advice for fellow middle-agers: Get the shingles vaccine. Particularly if you’ve reached the big 5-0.

The shingles shot used to be for folks 60 and up. But a new and more effective vaccine targeting the 50-and-older crowd was approved last month by the Food and Drug Administration and recommended by an advisory panel of the Centers for Disease Control and Prevention. It will begin shipping soon to a pharmacy near you.

The old shot, Zostavax (from Merck), made with the live shingles virus, has been recommended for those 60 and older since its approval more than a decade ago. Given in a single dose, it reduces the risk of developing shingles by 51 percent, says the CDC.

The new vaccine, Shingrix (from GlaxoSmithKline), without live virus, targets folks 50 and up, and in clinical trials posted a 98 percent effective rate for one year and 85 percent for two years, the company says. It is given in two doses.

Shingles will strike 1 in 3 Americans during their lifetimes — most between ages 60 and 70. Folks in their 60s get shingles at roughly twice the rate as folks in their 50s, reports the CDC.

The vaccines are your best armor against the disease that has gradually but steadily increased among Americans, primarily because we are living longer. The new vaccine is expensive: about $280 vs. about $220 for the old vaccine. Insurance providers generally cover the cost, but until now, have mostly limited reimbursements to people 60 and up. That is likely to change with the new vaccine being aimed at younger people.

People should get the vaccine whether or not they recall having had chickenpox because more than 99% of Americans age 40 and older have had chickenpox, even if they don’t remember the episode, says the CDC.

Dr. Priya Sampathkumar, an infectious-disease expert and associate professor of medicine at the Mayo Clinic, advises people to seek treatment for any suspicious rash on the face. (Courtesy of Mayo Clinic)

For most people, the first stage of shingles begins as a slightly painful rash with tiny, clear blisters around the chest or belly. This is when early detection and quick action — seeing a doctor and getting on antiviral drugs and oral corticosteroids — may save days of pain and discomfort. Any suspicious rash on the face should be treated as soon as possible because of the risk of shingles attacking the eye or ear, advises Dr. Priya Sampathkumar, an infectious-disease expert and associate professor of medicine at the Mayo Clinic.

The most common complication of shingles is post-herpetic neuralgia (PHN), severe pain in the areas where the shingles rash occurs. About 1 in 5 people with shingles will get PHN, estimates the CDC. The risk of PHN also increases with age.

I was 59 when shingles sucker-punched me. My head felt like someone had just screwed it into an invisible vice. My body felt too weak to be my own. And my brain had a hard time processing any of this.

But I wasn’t the only one caught off-guard. My doctor did not see the telltale rash that typically comes with shingles because it wasn’t visible. I’m a swimmer and that tiny rash was, at that moment, hidden behind ear-plug-induced earwax. The doctor tried but failed to remove the wax, so she was not able to look fully into my ear. She did not suspect the virus and told me to take ibuprofen three times daily and acetaminophen as needed — and to rest. She failed to diagnose my unconventional form of middle-ear-based shingles that strikes only 2 in 1,000 shingles patients.

Shingles is caused by the herpes zoster virus (no relation to genital herpes). After a bout of chickenpox, the virus stays dormant in your body for decades and reappears when your immune system is likely less robust later in life. Stress also may play a role in the onset, although that’s not medically proven, Sampathkumar says.

Shingles continues to affect me five years after my initial outbreak. For one thing, I’m exhausted, both physically and mentally, by 10 p.m. each night. Even worse, I live with a nonstop, high-pitched ringing in my right ear, a condition known as tinnitus, which I’ve taught myself to ignore.

I’ve also learned how to strategically position myself in a room, car or dinner table so I can hear what’s being said. I’ve learned the delicate art of aiming my left ear toward whomever is speaking — kind of like a cop aiming his radar gun at speeding drivers.

Besides the shingles shot, there are other things that people 50 and older can do to fend off an outbreak. Sampathkumar suggests paying close attention to three fundamentals: ample sleep, regular exercise and good nutrition.

That’s worked for me — for now. Doctors say shingles can return, though it’s unlikely.

At 64, I’m doing everything in my power to make sure that first run-in was also my last.

Categories: Health Care

FDA Raids Florida Stores That Consumers Use To Buy Drugs From Canada

Kaiser Health News - Mon, 11/20/2017 - 5:00am

The Food and Drug Administration last month sent criminal investigation agents with search warrants into nine storefronts across Central Florida that help customers order drugs from pharmacies in Canada and overseas at big discounts.

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The agents notified the store owners that importing drugs from foreign countries is illegal and that those helping to “administer” such medicines could face fines or jail time.

None of the stores has closed, but their owners are scared the Trump administration has reversed a long-standing “non-enforcement” policy against the stores. Some of them have been open for nearly 15 years.

“It worries me,” said Bill Hepscher, co-owner of Canadian MedStore, which owns six of the nine storefronts visited by the FDA in late October. His stores are in the Tampa Bay and Orlando areas.

FDA spokeswoman Lyndsay Meyer would not confirm or deny that any investigation was occurring. Nor would she answer whether the FDA has changed its policy.

“The FDA is concerned about the safety risks associated with the importation of unapproved prescription drugs from foreign countries,” she said. “Drug products that come from unknown or foreign sources may be unregulated or subject to less oversight than U.S. requirements. These unknowns put patients’ health at risk.”

In a speech Nov. 14, FDA Commissioner Scott Gottlieb said the agency would be stepping up its work to prevent the importation of drugs into the United States, including tripling the workers at international mail facilities who inspect packages suspected of containing drugs.

Bill Hepscher, co-owner of the Canadian MedStore, outside his Lakeland, Fla., location. Six of the nine stores that federal agents searched last month are owned by Canadian MedStore. (Phil Galewitz/KHN)

Hepscher said the search warrants were for computers, paperwork pertaining to sales of foreign drugs and any drugs themselves. The agents did not remove computers, he said, but they appeared to make copies of files. They also took customers’ paper files and the stores’ financial and bank records.

The storefronts primarily serve seniors who prefer in-person assistance with buying medicines from Canada and other countries, rather than using an internet site. Hepscher said his stores help about 10,000 people a year, and he estimates Florida has about 20 such storefronts.

That’s just a small fraction of the 2 percent of American adults who say they buy drugs from outside the United States — either over the internet or during travels to Canada or overseas.

The Florida stores do not dispense any drugs. Instead, pharmacies in Canada and other countries send the medicine directly to customers’ homes. Consumers need a valid prescription before they can place an order.

Hepscher said he and most other storefronts use only foreign pharmacies certified by the nonprofit company pharmacychecker.com or the Canadian International Pharmacy Association, which verifies the pharmacies as safe. The drugs from foreign pharmacies often are made in the same manufacturing plants around the world as drugs sold in U.S. pharmacies.

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Hepscher said he doesn’t know what prompted the FDA action. He refused to sign a letter the FDA agents left with him acknowledging that he was aware the reimportation practice is illegal.

“We’ve been doing this for 15 years and we are not hiding anything,” he said. “We are not in the shadows.”

Hepscher said he found the timing interesting since President Donald Trump has been promising to help lower the price of drugs for Americans.

Roger Bate, a health economist with the American Enterprise Institute, a conservative think tank, said the crackdown on storefronts could have serious consequences for their customers.

“It’s a shame because this will drive people who are not competent using the Internet to buy from rogue websites,” Bate said.

The idea of allowing Americans to buy drugs from Canada has been pushed by some Republicans and Democrats for years. But it has been bitterly opposed by the pharmaceutical industry, which has cited safety concerns that the drugs might not meet U.S. standards.

Categories: Health Care

Canadians Root For An Underdog U.S. Health Policy Idea

Kaiser Health News - Mon, 11/20/2017 - 5:00am

TORONTO — Ask people in Canada what they make of American health care, and the answer typically falls between bewilderment and outrage.

Canada, after all, prides itself on a health system that guarantees government insurance for everyone. And many Canadians find it baffling that there’s anybody in the United States who can’t afford a visit to the doctor.

So even as Canadians throw shade at the American hodgepodge of public plans, private insurance, deductibles and copays, they hold in high esteem a little-known Affordable Care Act initiative: the federal Center for Medicare & Medicaid Innovation (CMMI).

It was a hot topic on a reporter’s recent visit to Toronto to study the single-payer health care system.

Wonky as it seems, the center’s mission — testing innovations to hold down health care costs while increasing quality — has gotten noticed. Researchers and clinicians talk about its potential to foster experimentation and how it has led the United States to think out of the box regarding payment and reimbursement models.

“It is gaining traction in many circles here,” said Robert Reid, who researches health care quality at the University of Toronto.

“There have been some good efforts … they have tried more things than we have,” agreed Dr. Kaveh Shojania, a Toronto-based internist who studies health care quality and safety.

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Despite the praise emanating from north of the border, the program doesn’t get the same love on the homefront.

Through the ACA, CMMI is armed with $10 billion each decade and sponsors on-the-ground experiments with doctors, health systems and payers. The idea is to devise and implement payment approaches that reward health care quality and efficiency, rather than the number of procedures performed.

Since taking office, though, President Donald Trump has rolled back its reach.

Canada has its own reasons for seeing potential in this sort of systemic test kitchen.

Health care’s growing price tag — and a payment system that doesn’t necessarily reward keeping people healthy — is hardly just an American problem. The vast majority of Canadian doctors are paid through what Americans call the “fee-for-service” model. And Canadian policymakers are also looking for strategies to curb health care costs — which, while greater in the United States, are a big budget here, too.

“The whole world is confronting the same issue, which is, ‘How do you pay and incentivize doctors to keep people out of the hospital and keep them healthy?’” said Ezekiel Emanuel, a former adviser to President Barack Obama who pushed for the center’s initial development. “Different places are looking at how to break out of that system, because everyone knows its perversions. This is one place where … we are in the world among the most innovative groups.”

Emanuel added that he wasn’t surprised to hear of the center’s appeal in Canada. He has received similar feedback from health ministers in Belgium and France, he said.

Even so, U.S. critics say CMMI’s work is a waste of money or a federal overreach.

And, so far, the Trump administration has reduced by half the size of one high-profile Obama administration project that would have bundled payments for hip and knee replacements — so that the hospitals performing those were paid a set amount, rather than for individual services. It also canceled other scheduled “bundling” projects targeting payment for cardiac care and other joint replacements.

CMS Administrator Seema Verma wrote in The Wall Street Journal in September that the Innovation Center was going to begin moving “in a new direction.”

A follow-up “request for information” from the federal government suggested that the center would emphasize cutting health care costs through strategies like market competition, eliminating fraud and helping consumers actually shop for care. It also suggested the Innovation Center would favor smaller-scale projects.

At least for now, it’s hard to interpret what this means, said Jack Hoadley, a health policy analyst at Georgetown University who has previously worked at the Department of Health and Human Services.

Limiting CMMI’s footprint would be problematic, Emanuel argued, while discussing CMMI’s status in the U.S.

The footprint in Canada, though, seems to be growing.

“We definitely looked to it as a model as something we can do. Like look, this happened, and why can’t we do the same thing here?” said Dr. Tara Kiran, a Toronto-based primary care doctor who also researches health care quality.

Categories: Health Care

CBO and JCT Estimates Show Senate Bill Skewed to Top, Harmful to Low- and Middle-Income Americans

Center on Budget and Policy Priorities - Sat, 11/18/2017 - 1:50pm

As we’ve explained, Joint Committee on Taxation (JCT) estimates show that the Senate Finance Committee tax bill provides by far the largest benefits to high-income people and leaves many low- and middle-income households worse off. A new Congressional Budget Office (CBO) analysis provides estimates for the bill’s impact on Medicaid and other federal health spending that’s not included in the earlier JCT estimates.

Combined, the JCT and CBO estimates show just how skewed the Senate bill is when it comes to its full effects on federal taxes and spending. In 2025:

Categories: Benefits, Poverty

In Case You Missed It...

Center on Budget and Policy Priorities - Fri, 11/17/2017 - 5:04pm

This week at CBPP, we focused on federal taxes, the federal budget, health, and food assistance.

Categories: Benefits, Poverty

Roundup: CBPP’s Analyses of the Senate Tax Plan

Center on Budget and Policy Priorities - Fri, 11/17/2017 - 4:45pm

The Senate Finance Committee’s tax bill would overwhelmingly benefit the wealthy and corporations while eventually raising taxes on many low- and middle-income families. We’ve collected our analyses of the bill here.

Commentary: Senate Tax Bill Revisions Make Its Fundamental Tradeoffs — Big Tax Cuts for the Top, Little Gain for Low- and Moderate-Income Families — Even Harsher

Categories: Benefits, Poverty

Harvard Forum: Should Older Politicians And Judges Be Tested For Mental Decline?

CommonHealth (WBUR) - Fri, 11/17/2017 - 4:44pm
Politicians and judges tend to serve well into old age, yet we know that cognitive function tends to decline with age, and some are likely to be impaired. So what to do?
Categories: Health Care

Pic of the Week: The Hamburg Municipal Code of 1497

In Custodia Legis - Fri, 11/17/2017 - 4:21pm

The Law Library of Congress recently had the good fortune to acquire a manuscript of Hamburgisches Stadtrecht von 1497 (The Hamburg Code of Municipal Law). In October 1497, the Senate of Hamburg decided to revise the Hamburg code of law. It proposed that the revision would supersede a number of conflicting state codes that were in circulation among the city’s gentry, causing much confusion and discord. The project was completed on November 24, 1497. This manuscript copy of the original text (composed in Middle Low German and Latin) was likely produced in Northern Germany between the years 1570 and 1573. Additional content was added to it in subsequent years through 1670.

Hamburgisches Stadtrecht of 1497. This copy was made in 1570, after the promulgation of a city ordinance dated May 29, 1570 [Photo by Donna Sokol]

The original manuscript of Hamburgisches Stadtrecht von 1497, of which this item is a copy, is well-known for the illustrations it contains–a remarkable series of 18 miniatures depicting scenes relevant to the legal institutions as well as the incidental details of life in Hamburg in the fifteenth century; it can be found in the Hamburg Staatsarchiv, (Senat, Cl. VII, Litt. L, Nr. 2, vol. 1.). The Library of Congress has in its collections modern reproductions of that manuscript and its famous illustrations here and here. Although not as deluxe as the original manuscript, the present volume nevertheless includes numerous illustrations of high quality and the painted arms of the city of Hamburg.

The painted arms of the city of Hamburg [Photo by Donna Sokol]

This volume contains three separate texts: the Hamburgisches Stadtrecht von 1497, the Lange Rezess von Hamburg (1529) (Long Ordinance) and a List of City Councilors originally composed by Hermann Röver in 1543, which appears in this manuscript with additions that were made through the year 1670.

[Photo by Donna Sokol]

Although many manuscript copies of this work–approximately 50–were previously known to exist, this copy was unknown until its recent appearance on the market. Part of its value stems from its inclusion of later texts, which provide historical evidence for the governance of the city from the end of the fifteenth through the middle of the sixteenth century, a period that includes among other seismic historical events, the Protestant Reformation.

Allegory of responsibility, or a representation of “and they shall be two in one flesh” (Mark 10:8) [Photo by Donna Sokol]

Rare book service is available on weekdays from 9:00 a.m. to 4:00 p.m. Access to rare materials is by appointment and we welcome your inquiries.  For further information, contact me, ndor@loc.gov.

 

The Arbor Consanguinitatis, or the Tree of Consanguinity–a device used for measuring degrees of blood relations for purposes of family law, here depicted growing atop a burial mound as dogs emerge from burrows in the ground [Photo by Donna Sokol]

Categories: Research & Litigation

JCT Estimates: Amended Senate Tax Bill Skewed to Top, Hurts Many Low- and Middle-Income Americans

Center on Budget and Policy Priorities - Fri, 11/17/2017 - 3:42pm

The amended tax bill that Senate Finance Committee Chairman Hatch released on November 14 is even more skewed to the wealthy than the bill he released on November 9.

Categories: Benefits, Poverty

Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices

Kaiser Health News - Fri, 11/17/2017 - 2:22pm

Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.

In a ruling this week, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”

Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling. Use Our Content

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Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable “mistake.”

“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.

Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.

In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks.

Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.

The judge said that in 2015 Melissa Brendt, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.

The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.

In his Nov. 13 ruling against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”

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The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”

The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.

Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”

Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.

As part of his sanctions against Sutter, the judge ordered the health system to examine email backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.

“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.

Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.

“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.

The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.

In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.

Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.

He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.

“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”

The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.

A study published last year found that hospital prices at Sutter and Dignity Health, the two biggest hospital chains in California, were 25 percent higher than at other hospitals around the state. Researchers at the University of Southern California said the giant health systems used their market power to drive up prices — making the average patient admission at both chains nearly $4,000 more expensive.

“Sutter is a pretty extreme case of market power, but health care consolidation has become a really important issue across the country,” said Kathy Hempstead, a health care researcher at the Robert Wood Johnson Foundation. “It’s been on the back burner somewhat because of the debate over the Affordable Care Act, but there is bipartisan interest in tackling this.”

Categories: Health Care

Senate Tax Bill’s Child Tax Credit Increase Provides Only Token Help to Millions of Children in Low-Income Working Families

Center on Budget and Policy Priorities - Fri, 11/17/2017 - 1:19pm

Low-income working families would largely miss out on the increase, just as in the earlier version.

Categories: Benefits, Poverty

Podcast: ‘What The Health?’ Tax Bill Or Health Bill?

Kaiser Health News - Fri, 11/17/2017 - 12:49pm

 

Republican efforts to alter the health law, left for dead in September, came roaring back to life this week as the Senate Finance Committee added a repeal of the “individual mandate” fines for not maintaining health insurance to their tax bill.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Joanne Kenen of Politico and Alice Ollstein of Talking Points Memo discuss the other health implications of the tax bill, as well as the current state of the Affordable Care Act.

Among the takeaways from this week’s podcast:

  • The tax bill debate proves that Republicans’ zeal to repeal the Affordable Care Act is never dead. The new congressional efforts to kill the penalties for the health law’s individual mandate could seriously wound the ACA since the mandate helps drive healthy people to buy insurance.
  • One of the most overlooked consequences of the tax debate is that it could trigger a substantial cut in federal spending on Medicare.
  • A $25,000 MRI? That’s what one family paid to go out of their plan’s network to get the hospital they wanted for the procedure for their 3-year-old. Such choices are again drawing complaints about narrow networks of doctors and hospitals available in some health plans.
  • Although they don’t likely say it in front of cameras, many Democrats are relieved at President Donald Trump’s choice to head the Department of Health and Human Services, former HHS official Alex Azar.
  • Federal officials have given 10 states and four territories extra money to keep their Children’s Health Insurance Programs running but it’s not clear what couch they found the money hidden in.
  • And in remembrance of Uwe Reinhardt, a reminder that he always stressed that a health care debate was about more than money – it was about real people. Email Sign-Up

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Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: Statnews.com’s “This Tennessee insurer doesn’t play by Obamacare’s rules – and the GOP sees it as the future,” by Erin Mershon.

Also: Georgetown University Health Policy Institute’s “What’s Going on in Tennessee? One Possible Reason for Its Affordable Care Act Challenges,” by Kevin Lucia and Sabrina Corlette.

Sarah Kliff: Bloomberg Businessweek’s “How to Make a Fortune on Obamacare,” by Bryan Gruley, Zachary Tracer, and Hannah Recht.

Joanne Kenen: Politico Magazine’s “How Bourbon and Big Data Are Cleaning Up Louisville,” by Arthur Allen.

Alice Ollstein: Talking Points Memo’s “Trump’s Abrupt Policy Shift Fuels Misleading Obamacare Renewal Info,” by Alice Ollstein.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Categories: Health Care

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