Massachusetts adopts tough ban on flavored vaping, tobacco products

BOSTON (Reuters) – Massachusetts on Wednesday adopted the country’s toughest ban on the sale of flavored tobacco and vaping products, including menthol cigarettes, in response to a rise in youth vaping and an outbreak of vaping-related serious lung injuries.

FILE PHOTO: A man uses a vape device in this illustration picture, September 19, 2019. REUTERS/Adnan Abidi/Illustration/File Photo

Governor Charlie Baker, a Republican, signed into law legislation passed by the state’s Democrat-controlled legislature earlier this month that also places a 75% excise tax on e-cigarettes.

Several other states have recently adopted emergency bans on the sale of flavored vaping products amid a nationwide outbreak of lung injuries among e-cigarette users and concerns about the growing popularity of the products among high school and middle school students.

Baker’s administration beginning in September had moved to temporarily ban on all vaping product sales. That ban will remain in effect until Dec. 11 while new vaping regulations are adopted in light of the first ban passed by a state legislature.

“We remain committed to doing everything we can to protect the public health,” Baker said during a news conference.

The law was enacted amid public alarm over a mysterious U.S. vaping-related respiratory illness that has sickened nearly 2,300 people and resulted in 47 deaths, according to government officials.

Health officials investigating the lung injuries have identified vitamin E acetate, believed to be used as a cutting agent in illicit vaping products containing marijuana components, as a “chemical of concern” in the outbreak.

The outbreak has coincided with the rising popularity of flavored vaping products among underage users, creating concerns about a new generation of Americans becoming addicted to nicotine products.

More than 27.5% of American high school students use e-cigarettes, up from 20.7% in 2018, according to a recent U.S. government study.

U.S. President Donald Trump’s administration in September said it would unveil a sweeping ban on most e-cigarette and vaping flavors. Concerns about the potential loss of jobs have prompted Trump, a Republican, to revisit the issue.

Baker said states can only do so much to regulate vaping, but “unfortunately it’s becoming increasingly clear the federal government is not going to act decisively.”

The Vapor Technology Association, a vaping industry trade group that unsuccessfully challenged Baker’s earlier vaping sales ban in court, signaled its opposition in a statement issued when the Massachusetts Senate passed the legislative ban.

“Bans don’t work; they never have,” Tony Abboud, the group’s executive director, said.

Reporting by Nate Raymond in Boston; Editing by Bill Berkrot

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Can Air Pollution Take a Toll on Your Memory?

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News Picture: Can Air Pollution Take a Toll on Your Memory?

MONDAY, Nov. 25, 2019 (HealthDay News) — Air pollution may trigger Alzheimer’s-like brain changes and speed memory decline in older adults, a new study suggests.

Previous research has implied that exposure to fine particle air pollution increases the risk of Alzheimer’s disease and other types of dementia, but it wasn’t clear how this type of pollution affects the brain and memory.

“This is the first study to really show, in a statistical model, that air pollution was associated with changes in people’s brains and that those changes were then connected with declines in memory performance,” said researcher Andrew Petkus. He’s an assistant professor of clinical neurology at the University of Southern California’s Keck School of Medicine.

“Our hope is that by better understanding the underlying brain changes caused by air pollution, researchers will be able to develop interventions to help people with or at risk for cognitive decline,” Petkus explained in a university news release.

The study included nearly 1,000 women, aged 73 to 87, who had brain scans five years apart. The researchers also assessed information about where the women lived and environmental data from those locations to estimate the women’s exposure to fine particle pollution.

The results showed that women who were exposed to higher levels of fine particle air pollution had more Alzheimer’s-like changes in brain structure and greater memory declines than those with less exposure to such pollution. But the study only showed an association, and couldn’t prove that air pollution caused brain changes or memory declines.

Alzheimer’s is the sixth leading cause of death in the United States. There’s no cure or treatment.

“This study provides another piece of the Alzheimer’s disease puzzle by identifying some of the brain changes linking air pollution and memory declines. Each research study gets us one step closer to solving the Alzheimer’s disease epidemic,” Petkus said.

Fine particle air pollution — which is inhaled easily, and reaches and accumulates in the brain — has been linked with asthma, heart disease, lung disease and premature death. These tiny air particles come from industrial production, forest fires or vehicles, according to the U.S. Environmental Protection Agency.

The findings were published Nov. 20 in the journal Brain.

— Robert Preidt

MedicalNews
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SOURCE: University of Southern California, news release, Nov. 20, 2019

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Did Joe Biden Overstate Democratic Voters’ Opposition To ‘Medicare For All’?

When the subject of “Medicare for All” came up during the Democratic debate last week, former Vice President Joe Biden claimed that the majority of his party does not favor it.   

“The fact is that right now the vast majority of Democrats do not support Medicare for All,” he said, adding, “It couldn’t pass the United States Senate right now with Democrats. It couldn’t pass the House.”  

This seemed to be a very strong statement, and we weren’t sure that voters’ positions on this issue were as clear-cut as Biden made them out to be, so we asked his campaign where he got the information. 

Public Opinion 

The Biden campaign initially directed us to news coverage of a January 2019 Kaiser Family Foundation tracking poll, which noted that the majority of Americans generally oppose  Medicare for All if they hear arguments that frame the program as requiring Americans to pay more taxes or leading to delays in testing and treatment. (Kaiser Health News is an editorially independent program of the foundation.) 

On the flip side, though, when — in the same poll — Medicare for All was described as guaranteeing health insurance as a right for all Americans, or that it would eliminate health insurance premiums and reduce out-of-pocket costs, the majority favored the national health plan. 

That poll, now nearly a year old, found that when simply asked, 56% said they did favor having “a national health plan, sometimes called Medicare-for-all, where all Americans would get their insurance from a single government plan.”

Those percentages, though, reflected the views of  all Americans, not just Democrats. The same poll broke down respondents’ answers by political party and showed that 81% of Democrats favored creating a national health plan. 

The KFF Health Tracking Poll, done monthly, indicates Democrats’ support for Medicare for All has weakened, but not entirely. Its most recent version, published in November, revealed large majorities of Democrats support a public option (88%), Medicare for All (77%) and a Medicare buy-in (85%).

“The majority of Democrats do support Medicare for All, but Medicare for All is not as popular as public option or a Medicare buy-in,” said Ashley Kirzinger, who is the associate director for public opinion and survey research at KFF. 

Other polls show similar results: support for Medicare for All among Democrats but stronger support for the incremental approaches Biden backs. 

A September NBC News/Wall Street Journal poll, for instance, found 67% of Democrats said they supported adopting Medicare for All. The public option fared better, with 75% of Democrats supporting the proposal. 

“The data … does show majority support among Democratic voters (whether that reaches a “vast majority” depends upon your interpretation), but higher support for a public option,”Jeff Horwitt, senior vice president with Hart Research Associates wrote in an email. Hart Research Associates conducted the NBC/WSJ poll. 

The Biden campaign also directed us to a September KFF Health Tracking Poll that showed that 55% of Democrats prefer a candidate who would build on the existing Affordable Care Act, while 40% of Democrats prefer a candidate who would replace the ACA with Medicare for All. 

And one more from the Biden campaign — a CNN article citing a July CNN and SSRS poll that found almost half (48%) of all respondents who lean Democratic said the national program should not replace private insurance, while 31% said that it should. 

That same CNN/SSRS poll, though, had 85% of respondents who are Democrats or Democratic-leaning independents responding “yes” when asked if the government should provide a national health insurance program for all Americans, even if it would require higher taxes.

The numbers from these various polls seem to communicate a range of opinions among Democrats about Medicare for All. 

Robert Blendon of the Harvard T.H. Chan School of Public Health said he thinks Biden’s statement rings true based on a poll he helped conduct, in partnership with the Commonwealth Fund and The New York Times. 

Rather than asking survey respondents if they favored Medicare for All, the survey asked them to choose among Medicare for All, improving the existing ACA or replacing the ACA with state health plans. 

For registered Democrats, the results were close between two of the proposals: 46% preferred Medicare for All and 45% preferred improving the existing ACA. Only 7% preferred replacing the ACA with state health plans. In this survey, Medicare for All was not preferred by a majority of Democrats. 

But Blendon noted that survey respondents often will say yes to a “one-off question” about whether they support something and that answer can change once they have to choose among options, such as in his organization’s survey. 

“The answer is that Democrats are divided on whether or not they want to build on the ACA or whether they want to do Medicare for All,” he said.  

Congressional Support And Another Context 

Horwitt also made the point that it wasn’t clear in Biden’s statement which group of people he was referencing. 

“I recall hearing the statement in real-time, but in looking now at just the statement from Biden below, it is unclear to me if he is talking about elected Democrats or Democratic voters when he references the “vast majority,” Horwitt wrote via email. 

While the Biden campaign did direct us to public opinion polls, they also pointed out that the Senate and House Medicare for All bills are “only sponsored by a fraction of the members of the respective Democratic caucuses that would be needed to secure passage.”   

The Senate Medicare for All bill, introduced by Sen. Bernie Sanders, has 14 co-sponsors, while the House’s Medicare for All bill, introduced by Rep. Pramila Jayapal, has 118 co-sponsors. (There are currently 233 Democrats in the House and 45 Democrats plus two independents in the Senate.)

Our Ruling 

During the recent presidential primary debates, Biden said: “The fact is that right now the vast majority of Democrats do not support Medicare for All.” Based on a cursory review of polls, this statement appears off-base. After all, most polls find that when Democrats are simply asked if they support Medicare for All, they answer “yes.” 

However, when those same polls dig deeper into this support by asking about the favorability of other Democratic-favored health policies — Medicare for All, the public option or expansions of the Affordable Care Act — or if such a Medicare for All program should replace private insurance, this support becomes weaker. The polls do seem to suggest support among Democrats for the moderate reforms Biden backs. Still, the evidence is lacking to support Biden’s claim that a “vast majority” of Democrats oppose Medicare for All.  

For these reasons, we rate this statement Mostly False. 

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Federal prosecutors open criminal probe of opioid makers, distributors: WSJ

(Reuters) – Federal prosecutors have opened a criminal investigation into whether pharmaceutical companies intentionally allowed opioid painkillers to flood communities, the Wall Street Journal reported on Tuesday, citing people familiar with the matter.

FILE PHOTO: A person holds pharmaceutical tablets and capsules in this picture illustration taken in Ljubljana September 18, 2013.REUTERS/Srdjan Zivulovic

At least six companies have received grand-jury subpoenas from the U.S. attorney’s office in the Eastern District of New York – Teva Pharmaceutical Industries Ltd (TEVA.TA), Mallinckrodt Plc (MNK.N), Johnson & Johnson (JNJ.N) and Amneal Pharmaceuticals Inc (AMRX.N) and distributors AmerisourceBergen Corp (ABC.N) and McKesson Corp (MCK.N), the Journal reported.

Shares of Amneal, Teva and McKesson fell between 3% and 7%, while AmerisourceBergen and Mallinckrodt were down marginally.

The subpoenas were in connection with a Brooklyn federal probe, the Journal reported.

A spokesman for the Brooklyn U.S. attorney’s office declined to comment.

The probe is in early stages and prosecutors are expected to send subpoenas to other companies in the coming months, the report said, citing one of the sources.

The companies did not immediately respond to Reuters’ requests for comment.

Teva, J&J, Amneal and Mallinckrodt disclosed in recent regulatory filings that they received subpoenas from the U.S. attorney’s office in Brooklyn, which the companies generally described as regarding their anti-diversion policies and procedures and distribution of opioid medications.

The companies said it was part of a broader investigation into manufacturers’ and distributors’ monitoring programs and reporting under the Controlled Substances Act.

Teva, Mallinckrodt and J&J also said they had received subpoenas from the New York State Department of Financial Services as part of an industry-wide inquiry into the effect of opioid prescriptions on New York health insurance premiums.

Opioid manufacturers, distributors and pharmacy chains have been defending themselves against thousands of lawsuits by state attorneys general, local governments and class actions accusing them of fueling an addiction crisis.

Opioids have contributed to more than 400,000 deaths since 1997, according to government statistics.

Reporting by Manas Mishra in Bengaluru; Editing by Anil D’Silva and Bill Berkrot

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U.S. life expectancy declining due to more deaths in middle age

(Reuters Health) – After rising for decades, life expectancy in the U.S. decreased for three straight years, driven by higher rates of death among middle aged Americans, a new study suggests.

Midlife all-cause mortality rates were increasing between 2010 and 2017, driven by higher numbers of deaths due to drug overdoses, alcohol abuse, suicides and organ system diseases, such as hypertension and diabetes, according to the report published in JAMA.

“There has been an increase in death rates among working age Americans,” said Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “This is an emergent crisis. And it is a uniquely American problem since it is not seen in other countries. Something about life in America is responsible.”

The rising rates of midlife mortality hit some regions of the country harder than others, Woolf and his coauthor found. Increases were highest in northern New England and the Ohio Valley.

Economic hardship and the resulting despair may be to blame in those regions, Woolf suggested. “While it’s a little difficult to place the blame on despair directly, the living conditions causing despair are leading to other problems,” he explained. “For example if you live in an economically distressed community where income is flat and it’s hard to find jobs, that can lead to chronic stress, which is harmful to health.”

Noting that a pattern of increasing mortality in middle age is not seen in other high income countries, Woolf said this might be because “in other countries there are more support systems for people who fall on hard times. In America, families are left to their own devices to try to get by.”

Data for the study came from the National Center for Health Statistics and the U.S. Mortality Database for 1959 to 2017. The researchers also scoured the medical literature for studies of U.S. life expectancy and mortality trends.

Based on the data, life expectancy had increased by almost 10 years over the course of nearly 6 decades – from 69.9 years to 78.9 years – but had been declining since 2014. And the overall decline was explained by increased mortality among the middle aged.

Death rates among the middle aged weren’t uniform across the country. The largest relative increases in midlife mortality rates occurred in New Hampshire, 23.3%, West Virginia, 23.0%, Ohio, 21.6%, Maine, 20.7%, Vermont, 19.9%, Indiana, 14,8% and Kentucky, 14.7%. Life expectancy actually increased or plateaued in some Western states, the researchers reported.

“The current problems we are seeing are decades in the making,” Woolf said. “We used to have the highest life expectancy in the world. The pace at which life expectancy was increasing in the U.S. started to fall off relative to other countries in the 80s.”

The new findings highlight some distressing trends, said Dr. John Rowe, a professor in Columbia University’s Mailman School of Public Health in New York City.

“It is depressing,” Rowe said, “but I don’t think it’s much of a surprise. We knew the opioid epidemic was taking a major toll with 250,000 who have overdosed and died.”

What’s striking is that the decline in life expectancy isn’t the same for all age groups. “This is really evidence that mortality rates are increasing only in middle age while they’re continuing to decline in children, adolescents and people over 65,” Rowe said, noting that it’s occurring as mortality rates from cancer and stroke are declining.

Part of the problem may be that middle aged people are getting squeezed by health care costs because they are less likely to have coverage than children and people over 65. In fact, another recent study found out-of-pocket costs were more likely to prompt middle aged people to cut back on heart disease medications than people over 65.

SOURCE: bit.ly/2pX1VfU JAMA, online November 26, 2019.

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3 ways to save on Medicare costs

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You may be able to get help paying for your health and prescription drug costs. Even if you aren’t sure you’re eligible, it’s worth learning more about these 3 ways to save on Medicare costs:

  1. Medicaid

If you have limited income and resources, you may qualify for Medicaid—a joint federal and state program that:

  • Helps with medical costs
  • Offers benefits not normally covered by Medicare, like nursing home care and personal care services

    Each state has different rules about eligibility and applying for Medicaid. Call your state Medicaid program to see if you qualify, learn how to apply, and how Medicare works with Medicaid.

  1. Medicare Savings Programs

Medicare has 4 savings programs that may help you pay for your Medicare premiums and other costs:

  1. Qualified Medicare Beneficiary (QMB) Program
  2. Specified Low-Income Medicare Beneficiary (SLMB) Program
  3. Qualifying Individual (QI) Program
  4. Qualified Disabled and Working Individuals (QDWI) Program

To find out if you’re eligible for savings through one of these programs, call your state Medicaid program.

  1. Extra Help

Extra Help is a Medicare program that helps people with limited income or resources pay Medicare prescription drug costs, like premiums, deductibles, and coinsurance. If you apply and qualify for Medicaid or one of the Medicare Savings Programs above, you’ll also get Extra Help with Medicare prescription drug costs automatically. If you don’t automatically qualify for Extra Help, you can apply online at SSA.gov.

Not eligible for any of these programs? Even if you don’t qualify to get help with Medicare costs, choosing the right health and prescription drug coverage can help you save money. Medicare’s Open Enrollment Period is a great time to make any necessary changes. Use our new Medicare Plan Finder to compare Medicare coverage options and find 2020 health and prescription drug plans that meet your unique needs.

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Thermal imaging has potential to assess rheumatoid arthritis

A new study, published today in Scientific Reports, highlights that thermal imaging has the potential to become an important method to assess Rheumatoid Arthritis.

Results of the study, carried out with 82 participants, confirm that both palm and finger temperature increase significantly in patients with Rheumatoid Arthritis (RA).

RA patients were examined by two rheumatologists. A subset of these participants underwent diagnostic ultrasonography by a trained rheumatologist in order to ensure that the recruited participants had no active signs of synovitis in their hands and wrists.

Dr Alfred Gatt, from the University of Malta and a Visiting Fellow at Staffordshire University, was lead author of the report. He explained “We used Flir T630 therma camera and followed the guidelines of the American Thermology Association.

“The results of our study show that the two probability curves intersect at 31.5 for palm temperatures, indicating that individuals whose palm temperatures is less than 31.5 per cent are more likely to be healthy; while those persons whose palm temperature is less than 31.5 are more likely to have Rheumatoid Arthritis. Similarly, for finger temperatures, the two probability curves intersect at 30.3 per cent.”

“While ultrasonography had not detected any significant changes in our study population, thermography flagged a possible ongoing disease process by reporting these higher temperatures”.

“We hypothesize that this temperature difference may be attributed to underlying subclinical disease activity or else that the original inflammatory process may cause irreversible thermal changes that persist after the disease activity has resolved. We will need further studies to substantiate this.”

Dr Gatt added: “Thermal imaging is an emerging technology within medicine and has the potential to become an important clinical tool as disease processes can vary the magnitude and pattern of emitted heat in a person with Rheumatoid Arthritis.”

Associate Professor Cynthia Formosa, also from the University of Malta and Visiting Fellow at Staffordshire University, said:

This is the first study to explore thermographic patterns of patients with Rheumatoid Arthritis comparing them to healthy controls. Our results have clearly shown that an RA hand without active synovitis [the medical term for inflammation of the synovial membrane] exhibits higher temperatures when compared to healthy individuals.”

Professor Nachi Chockalingam, Director of Centre for Biomechanics and Rehabilitation Technologies at Staffordshire University co-authored the study. He added:

Rheumatoid Arthritis affects more than 400,000 adults in the UK which can lead to deformity, disability and cardio-vascular problems. Timely detection of ongoing synovitis in RA is of paramount important to help enable tight disease control. However we know RA can be difficult to diagnose.”

This work showcases our successful collaboration with colleagues in Malta and the potential thermal imaging has in helping practitioners to assess the disease. In addition to making some seminal scientific contributions, our collaborative research work informs our curriculum development and teaching.”

Source:

Staffordshire University

Journal reference:

Gatt, A., et al. (2019) A comparison of thermographic characteristics of the hands and wrists of rheumatoid arthritis patients and healthy controls. Scientific Reports. doi.org/10.1038/s41598-019-53598-0.

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Last-Minute Loophole Could Undermine Texas Law Against Surprise Medical Bills

Drew Calver (center) of Austin, Texas, received a surprise bill of more than $100,000 after a heart attack. His story and others liked it sparked bipartisan legislation in Texas against the practice. He and his wife, Erin, joined President Donald Trump at the White House in May for an event about ending surprise medical billing. (Screenshot from a White House video)

Texas’ bipartisan effort to shield patients from surprise medical bills could be weaker than lawmakers intended when it takes effect Jan. 1.

Earlier this year, lawmakers from both parties came together on legislation to protect people in state-regulated health plans from getting outrageous bills for out-of-network care. The new law, known as Senate Bill 1264, creates an arbitration process for insurers and providers to negotiate fair prices in those cases. The intention of the law is to establish those fair prices without ever involving patients.

But that protection is at risk of becoming “irrelevant,” consumer advocates in Texas say.

“The financial struggle that legislators were trying to remove us from ― trying to protect us from ― patients might be right back in the middle of that situation,” said Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities.

State agencies are writing the rules to implement and enforce the new law. Some of those rules, which will be discussed publicly in early December, will let hospitals and other care providers send patients bills in nonemergency situations, such as scheduled surgeries.

One state agency hashing out how the law will work is the Texas Medical Board, which is run by physicians and regulates other doctors in the state. Pogue said the board has proposed a rule that would expand the use of a narrow exception in the law. SB1264 created an exception for patients who knowingly want to receive nonemergency care from a doctor who is out of their health plan’s network. In those cases, patients would sign a waiver with the expectation of paying those out-of-network costs.

The board’s proposed rule takes that narrow exemption ― intended to be used only when patients want a particular out-of-network doctor ― and instead would require all out-of-network providers in nonemergency situations to give patients that waiver.

In practice, advocates say, the rule could essentially require out-of-network providers — like anesthesiologists and pathologists — to give patients a confusing form that waives their right to the new law’s protection. The form would allow the patients to be balance-billed.

“Now it’s a loophole,” Pogue said. “It’s a loophole in the [law] where legislators wanted to give a protection ― a win-win. And now some patients are going to get a lose-lose.”

According to the Texas Medical Board, the proposed rules “require an out-of-network provider to provide written notice and disclosure to a patient no less than 10 business days prior to the date of a nonemergency procedure.”

“The patient must have five business days to consider whether to accept, and may not agree prior to three business days after the notice was provided,” Jarrett Schneider, a board spokesman, said in a statement. “This allows for a cooling-off period so the patient has adequate time to decide whether to proceed if there are, in fact, out-of-network charges.”

Pogue said the rule also forces patients to choose between “two terrible outcomes” ― either paying more for providers they didn’t choose or forgoing a needed medical procedure.

The proposed rules are expected to be discussed during the board’s meeting early next month and could possibly be adopted at that time.

“It creates a path for any provider that wants to continue to send out-of-network bills [and] continue to balance-bill,” Pogue said. “It creates a pathway where they can do that.”

Schneider maintains that this is not the intent of the proposed rule.

“The Board’s proposed rules do not waive any rights a patient has under Senate Bill 1264 or any statute,” he said in a statement. “The Board has put forward proposed rules that it believes provide patients with enough advance notice to make a reasoned, economic decision in regards to the care they are receiving.”

Jamie Dudensing, CEO of the Texas Association of Health Plans, said in a statement that he believes the proposed rule “misinterprets the law’s intent” and makes surprise-billing protections weaker than they were before the law passed.

“Senate Bill 1264 has been praised as the strongest surprise billing law in the country — now we are in danger of making it almost completely irrelevant,” Dudensing said. “Instead of allowing for rare exceptions to surprise billing protections, the proposed rule would mandate the exception, resulting in patients losing all surprise billing protections in nonemergency situations.”

Blake Hutson, the associate director for the AARP of Texas, said he’s most concerned that the rules are vague about how the waiver would work. He said the state has created a unique exception in an effort to give people more freedom in choosing doctors, but it has come with a lot of confusion.

“Other states that have addressed the surprise medical bill issues haven’t created an exception for nonemergency, out-of-network physicians like we did,” Hutson said.

Among Hutson’s concerns are that the proposed rules do not make it clear that providers should mostly rely on the arbitration process set up under the new law to figure out payments. Instead, it requires them to use the proposed form, which various advocates say is hard to understand.

Hutson said the proposed waiver form also doesn’t make it clear that patients don’t have to sign it. And, he said, there’s no clear process for what happens if patients refuse to sign the waiver. Hutson said the medical board should create a way to ensure people can still receive care even if they refuse to be balance-billed.

“This is totally fixable,” Hutson said.

Advocates say they are worried that many of these concerns won’t be dealt with during the rulemaking process, though, and instead will have to be addressed during the next state legislative session in 2021.

State Sen. Kelly Hancock, a Republican from North Richland Hills, sponsored SB1264. He said “a rulemaking process that does not protect all patients … is not something we will be willing to accept.” Hancock said the intent of the legislation was to protect every Texan with state-regulated health insurance from getting balance-billed by any provider.

“We are trusting the process, but we are also verifying the process to make sure we get the end result we are looking for,” Hancock said. “And, frankly, what I think those who support the legislation voted for.”

State Rep. Tom Oliverson, a Republican from Cypress who co-sponsored the bill, said he’s not as concerned as others about the proposed rules. He said the waiver process included in the bill was supposed to be something that was rarely used and he thinks the board’s final rules will honor that.

Oliverson, who is an anesthesiologist in Texas, said he doesn’t anticipate providers will abuse the waiver system.

“It was designed to be something that was seldom used, but we are not going to let it become a pathway to avoid the law,” Oliverson said. “And if it gets abused, we will come back in 2021 and get rid of it.”

Hancock said it is fairly unusual for bills to go through a rulemaking process this bumpy. He said he thinks this is happening because the stakes for this process are high for many entities who may have been relying on surprise billing as a source of income.

“We have no intentions of seeing the efforts and the intentions of legislators being ignored ― just because associations want to get things their way,” he said.

Pogue said this situation is particularly disheartening because it was a bipartisan effort in Texas, a rare phenomenon.

“I haven’t seen a bill with a scope this big ― that could be this meaningful for the financial security of a family — pass in the 12 years I have been doing this,” Pogue said.

Hutson said SB1264 was “painfully created” and lawmakers took the time to find a compromise with both insurers and providers, which is no easy task.

“There’s a lot of money in health care ― and so the different interests are going to use whatever they can to collect money on the backs of consumers wherever they can, unfortunately,” Hutson said. “It’s frustrating.”

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

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New Roche flu drug can drive resistance in influenza viruses: researchers

CHICAGO (Reuters) – Roche’s influenza treatment Xofluza, a one-dose pill that can clear flu symptoms within days, may cause a mutation of the virus that leads to drug resistance, researchers reported on Monday.

FILE PHOTO: Roche tablets are seen positioned in front of a displayed Roche logo in this photo illustration January 22, 2016. REUTERS/Dado Ruvic/Illustration/File Photo

Results of their study suggest that common flu strains can quickly acquire resistance to the drug. They caution patients who receive it – especially children – should be watched for drug resistance.

The antiviral won U.S. approval last year to treat people 12 and older, and earlier this month was approved for patients at high risk of flu complications.

The Swiss drugmaker is seeking to establish Xofluza, which has a list price of $150, as a more convenient alternative to its older Tamiflu, which is taken twice daily for five days and is facing competition from cheaper generics.

The study published on Monday in Nature Microbiology by researchers at the University of Wisconsin-Madison involved flu samples from an 11-year old boy in Japan diagnosed with the flu last January and treated with the drug, known chemically as baloxavir.

Although he improved initially, the boy’s fever returned, and two days later, his 3-year-old sister was diagnosed with the flu.

The Wisconsin team, led by flu expert Yoshihiro Kawaoka, sequenced DNA of flu samples from the siblings and found the girl’s virus harbored a single mutation resistant to baloxavir.

“It tells you the virus acquired resistance during treatment and transmitted from brother to sister,” Kawaoka said in a statement.

Baloxavir was first licensed in Japan, where developer Shionogi & Co retains marketing rights and has 40% of the antiviral market there.

Kawaoka said prior studies had also found drug resistance, which led him to study resistance in larger groups of patients exposed to H1N1 or H3N2, two common flu strains.

For H1N1, the team tested 74 samples from infected patients before treatment and 22 samples from patients both before and after treatment. They found no mutations in any of the samples before treatment, but 23% of patients carried drug-resistant mutations after treatment.

Tests of H3N2 samples from 40 adults and 101 children found two of the children possessed the mutation. They also studied 16 samples before and after treatment from four adults and 12 children, finding no mutations in adult samples but four in the samples from children.

The team then grew the mutated viruses in the lab and found they were easily transmitted from infected to healthy animals.

Although it is unlikely baloxavir will cause widespread resistance, Kawaoka said it could be a problem when infected patients are in close proximity.

Patients with H1N1 or H3N2 who develop resistance to baloxavir treatment do respond to other virus-fighting drugs, he said.

Reporting by Julie Steenhuysen; Editing by Bill Berkrot

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