Overnight Health Care: Watchdog details severe trauma suffered by separated children | Judge approves $70B CVS-Aetna merger | House Dem Caucus chair backs 'Medicare for All'

Overnight Health Care: Watchdog details severe trauma suffered by separated children | Judge approves $70B CVS-Aetna merger | House Dem Caucus chair backs 'Medicare for All'
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Welcome to Overnight Health Care. A top House Democrat endorsed "Medicare for All" legislation today, Michigan banned flavored e-cigarettes, and health advocates want to place Medicaid expansion on the 2020 ballot in Missouri.

We'll start though, with a new report on the mental health of migrant children...


Government watchdog details severe trauma suffered by separated children

A new report from the Department of Health and Human Services' inspector general offered an in-depth look at the mental health trauma suffered by migrant children in HHS custody, and how mental health professionals were caught unprepared by the extent of the issues.

Migrant children separated from their parents through the Trump administration's "zero tolerance" policy experienced more severe mental trauma than children who were not separated, according to the watchdog report.


Separated children "exhibited more fear, feelings of abandonment, and post-traumatic stress" than children who were not separated, the report found. 

The report was based on interviews with about 100 different mental health clinicians across 45 facilities who had regular interactions with children, but did not address the quality of the care the children received.

Beyond zero tolerance: HHS facilities were struggling with the mental health of migrant children in custody before the Trump administration's official policy of family separations took effect, and the policy changes made the existing problems even worse. In many instances, staff were used to treating teenagers, not young children.

After "zero tolerance" was implemented, the proportion of children younger than 12 years old skyrocketed, and the mental health providers said they were not prepared.

Children's trauma: According to the report, some children did not understand why they were being separated and sometimes thought their parents had abandoned them. Mental health staff said some children expressed so much grief and confusion over the separation that they cried inconsolably.

Political response: The administration was forced to rescind "zero tolerance" after massive blowback from the public and Congress, and scrutiny into the lasting impacts continues. In a statement, Rep. Rosa DeLauroRosa Luisa DeLauroTrump HHS official faces firestorm after attacks on scientists Ahead of a coronavirus vaccine, Mexico's drug pricing to have far-reaching impacts on Americans Shutdown politics set to collide with coronavirus aid MORE (D-Conn.), chair of the House subcommittee in charge of HHS appropriations, called the policy "state sanctioned child abuse." 

"Today's OIG reports reinforce what we have known for over a year: that President TrumpDonald John TrumpBiden leads Trump by 36 points nationally among Latinos: poll Trump dismisses climate change role in fires, says Newsom needs to manage forest better Jimmy Kimmel hits Trump for rallies while hosting Emmy Awards MORE's family separation policy was state-sanctioned child abuse. The OIG found that separating kids from their families inflicted unspeakable trauma on them," DeLauro said. "Members of Congress on both sides of the aisle need to recognize the lives President Trump has put at-risk due to his dangerous policies, and we must work to protect children as we appropriate funding for HHS for the next fiscal year."

Read more on the report here.


House Democratic Caucus chairman announces support for Medicare for All

A boost for "Medicare for All" backers: The No. 5 House Democrat is backing their legislation. 

Rep. Hakeem JeffriesHakeem Sekou JeffriesPelosi: House will stay in session until agreement is reached on coronavirus relief Races heat up for House leadership posts Postmaster general earned millions from company with ties to Postal Service: report MORE (D-N.Y.) is the second-highest ranking House Democrat to back Medicare for All, after Rep. Ben Ray Lujan (D-N.M.), who announced his support in June. 

Why it matters: While Lujan is looking to leave the House by running for Senate, Jeffries' backing is important because he is seen as a potential future Speaker of the House once current Speaker Nancy PelosiNancy PelosiAs families deal with coronavirus, new federal dollars should follow the student Sunday shows - Ruth Bader Ginsburg's death dominates Hypocrisy rules on both sides over replacing Justice Ginsburg MORE (D-Calif.) retires.

Caveat: Jeffries is not going all out on Medicare for All. In addition to backing the full-scale Medicare for All bill from Rep. Pramila JayapalPramila JayapalDHS opens probe into allegations at Georgia ICE facility Progressive Caucus co-chair: Whistleblower complaint raises questions about 'entire detention system' Buttigieg, former officials added to Biden's transition team MORE (D-Wash.), Jeffries also announced that he is cosponsoring more moderate approaches, such as a public option bill known as Medicare X. 

Read more here.  


Judge approves CVS-Aetna deal

A federal judge on Wednesday formally approved CVS Health's nearly $70 billion takeover of Aetna, clearing the last hurdle for the mega-deal among health industry powerhouses.

The Justice Department approved the merger last year on the condition that the companies sell Aetna's Medicare drug business to preserve competition, and every state signed off on the merger between one of the country's largest insurers and one of the largest pharmacy benefit managers.

"CVS Health and Aetna have been one company since November 2018, and today's action by the district court makes that 100 percent clear," the company said in a statement. "We remain focused on transforming the consumer health care experience in America."

U.S. District Judge Richard J. Leon, a George W. Bush appointee, initially ordered hearings after he said the Justice Department and the companies acted like his approval was a mere "rubber stamp." The companies had closed the deal just one month after reaching an agreement with federal regulators, which angered Leon.

On Wednesday, Leon officially signed off on the agreement reached between the two companies and federal regulators.

Leon said in his ruling that groups challenging the merger were unable to show that it would result in CVS gaining the ability to steer patients away from their current providers.

The merger was opposed by groups including the American Medical Association (AMA), which urged federal regulators to block the deal because of anti-competitive concerns.

Read more here.


Michigan becomes first state to ban flavored e-cigarettes

Michigan Gov. Gretchen Whitmer (D) on Wednesday made the state the first to ban flavored e-cigarettes amid concerns over the potential health impacts of vaping, particularly among teens.

Whitmer told The Washington Post in an interview that the state health department determined youth vaping is a public health emergency.

Whitmer directed the department to impose the ban effective immediately, according to the Detroit Free Press.

"My number one priority is keeping our kids safe and protecting the health of the people of Michigan," Whitmer said.

The ban will apply to online and retail sales of sweet, fruity, minty and menthol-flavored vaping products, though it will not apply to tobacco-flavored e-cigarettes.

The ban will last six months, with another six months possible following a review. Businesses will have 30 days to comply with the ban.

Why it matters: This could pressure other states to ban flavored e-cigarettes, which is what health groups like the American Lung Association are hoping for absent any strong action from the Food and Drug Administration. 

Context: The FDA in March proposed sales restrictions on flavored e-cigarettes, but the rules haven't been finalized. It would ban the sale of most flavored liquids in stores that don't allow minors or have separate adults-only sections.

But health groups complain the FDA is taking too long to act in the face of a youth vaping crisis. They also argue that proposal doesn't go far enough and want the FDA to ban the sale of flavors entirely. 

Read more on Michigan's action here.


Advocates launch petition to place Medicaid expansion on 2020 ballot in Missouri

Health advocates in Missouri have launched an effort to put Medicaid expansion on the ballot in 2020.

Medicaid expansion could mean coverage for more than 200,000 uninsured Missourians who earn less than $18,000 a year for an individual or $30,000 for a family of three, according to Healthcare for Missouri, the group spearheading the effort. 

The campaign is comprised of hospital groups, physicians, patients and business executives. They need to secure at least 172,000 signatures to qualify to get on the ballot.

Ballot measures for Medicaid expansion have had some success recently. Expansion supporters have circumvented that opposition by making their case directly to voters, who approved initiatives in Utah, Nebraska and Idaho last year. That followed a 2017 success in Maine.

Under ObamaCare, states have the option to expand Medicaid to cover more low-income adults, with the federal government picking up most of the costs.

But 14 states -- most with Republican governors or legislatures -- have decided not to go down that road.

The Healthcare for Missouri campaign is comprised of hospital groups, physicians, patients and business executives. They need to secure at least 172,000 signatures to qualify to get on the ballot.   

The campaign spent the summer exploring whether it was possible to pursue expansion with a ballot initiative before publicly committing on Wednesday. 

Read more about the effort here.


Trump administration awards $1.8 billion in grants to combat opioid crisis 

The grants will help states and local governments provide treatment and recovery services, and better track overdose data. 

The money was appropriated by Congress. 

"My administration is determined to use every resource at our disposal to smash the grip of addiction," President Trump said at an event Wednesday. 

He said his administration has now awarded a total of $9 billion to states and local communities fighting the opioid crisis. 

"Some of these states have done an incredible job once they got the funds and had great results," he said.  


Advocates doubt Trump DEA will ease rules on marijuana research

The Trump administration gave new hope to marijuana researchers when the Drug Enforcement Administration (DEA) appeared to open the door for new applications for federally approved marijuana growers.

While 33 states have legalized marijuana for medicinal purposes, federal research is extremely restricted. The administration's announcement last week that it would expand the number of marijuana growers signaled a positive change after years of agency inaction and delay.

But some cannabis advocates and industry experts said they remain skeptical of the administration's motives and have accused officials of imposing different bureaucratic delays without any intention to act.

For example, the DEA said it first needs to write new regulations in order to evaluate the "unprecedented" number of applications the agency has received but did not say what was wrong with the existing regulations. There was no timeline for when the new regulations would be written, or when the existing applications would get reviewed. 

Back story: Advocates said they have been disappointed in recent years by the Justice Department's unwillingness to act on dozens of applications submitted to grow marijuana for federal research. 

The DEA in 2016 first announced it would consider granting additional licenses for marijuana growers in order to increase the supply of research-grade cannabis. The agency has since received 33 submissions but has not evaluated any of them.

Read more on the controversy here.


Planned Parenthood birth control app to expand to all 50 states by end of 2020

Planned Parenthood says it will expand its telemedicine app to all 50 states by the end of 2020, making it easier for women to access birth control and other prescription drugs without visiting a doctor's office. 

The announcement comes after the Trump administration effectively banned Planned Parenthood from the Title X family planning program, amounting to a funding loss of $60 million a year for the organization. 

"As politicians across the country try to further restrict or block access to reproductive and sexual health care, Planned Parenthood is working every day to increase access to care for all people," Planned Parenthood acting President Alexis McGill Johnson told reporters on Wednesday. 

"We know there is currently a vast, unmet need for sexual and reproductive health care in the U.S."

What this means: This could be particularly helpful if any Planned Parenthood clinics close after losing Title X funding. Some patients that use birth control pills would no longer need to make an in-person appointment for a prescription. 

It's also harder to access birth control in rural areas. About 19.5 million people live in contraception deserts, meaning they lack access to a health center in their county that offers the full range of contraception. 

Read more here.


What we're reading

Pfizer's chessmaster: How a top scientist helped invigorate a lumbering drug giant (Stat)

The scourge of worker wellness programs (The New Republic)

Americans more likely than Swedes to fill prescriptions for opioids after surgery (Kaiser Health News)


State by state

California vaccine bill heads to governor's desk as he asks for late changes (Sacramento Bee)

Oregon reports possible vaping death; would be second in U.S. if confirmed (oregonlive.com

Patients hospitalized in eight Minnesota vaping cases used THC (startribune.com)


From The Hill's opinion page

Social determinants of health -- health care isn't just bugs and bacteria