Is Zika spreading in Florida? Presented by

The teen birth rate is down, the drug overdose rate is up, and Hillary Clinton is in Miami to talk Zika. But first: Signs that the virus is spreading in Florida.

HOW DID A PALM BEACH COUNTY RESIDENT CONTRACT ZIKA? — The Florida Department of Health is trying to figure out what led to the county's first case of locally transmitted Zika.

Gov. Rick Scott has said that local transmission of Zika has been contained within a one-square-mile area of Miami, with 16 cases linked to mosquitoes in that neighborhood. However, Palm Beach County is more than 40 miles away — and public health experts say that it wouldn't be surprising if Zika has spread, given that more local transmission is likely inevitable. More for Pros.

Burwell to Texas Republicans: We’re doing everything we can. HHS has already allocated all available funding to help Texas’s Zika preparedness efforts, Secretary Sylvia Mathews Burwell wrote to 28 members of Texas’s Republican congressional delegation. Sens. John Cornyn and Ted Cruz led a letter to President Obama last week, asking why HHS hasn’t spent more of its remaining Ebola funds on Zika response.

“As you know, the Department of Health and Human Services is constrained in what it can do since Congress has not yet passed the emergency supplemental bill to provide additional resources requested by President Obama in February,” Burwell wrote on Monday.

“By awarding Texas more than $4 million to support Zika response efforts, CDC has met Texas’s requests for Zika-specific assistance,” she added. “If Texas has additional funding needs, please let us know.” See the letter: http://bit.ly/2bahdmp

On tap today: Hillary Clinton to talk Zika. The Democratic nominee is in Miami today, where she'll meet with providers at Borinquen Health Care Center, which is working to contain the spread of the virus in nearby Wynwood.

Clinton and running mate Tim Kaine on Monday also addressed the need for legislative action on Zika in a Q&A session through Quora. "Congress should return to Washington and immediately provide the emergency funds necessary to fight this disease — either by passing the bipartisan Senate bill or proposing a new solution, free of politics," Clinton wrote. http://bit.ly/2aNPSYh

Scott's critics say his decisions on health care have made things worse. Fighting the Zika virus has become a top priority for Gov. Rick Scott, but Florida’s refusal to expand Medicaid — coupled with his record of cutting money for state health departments and programs — has complicated his message that the federal government is failing the state in addressing the potential crisis.

To Scott’s critics, the governor isn’t being realistic about the cumulative effect of the cuts to the state’s health infrastructure, POLITICO’s Christine Sexton and Marc Caputo report. But Scott and his office have steadfastly rejected criticism that any of the cuts have reduced Florida’s frontline capacity to manage the challenges of the fast-spreading virus: http://politi.co/2baoplB

Moody's on Puerto Rico: Zika could smash economy. The credit-reporting service recently warned that a Zika virus outbreak could adversely affect Puerto Rico's already dire credit outlook, adding to the island's woes.

Moody's said Zika affects one of the island's few economic strengths — tourism — and would serve as a new incentive for Puerto Ricans to move to the mainland, Pro's Colin Wilhelm reports. The leisure and hospitality sector has been the one area of consistent employment growth for Puerto Rico over the last year, with hotel registrations increasing. But the outbreak is a major red flag for the industry.

HEALTH AFFAIRS CHEAT SHEET — The latest issue of Health Affairs is out, and the Pro health care team rounds up some of the most interesting studies.

1. Medicare Advantage plans pay hospitals about 8 percent less than fee-for-service Medicare. That's according to Stanford University researchers, who conclude that about one-third of the difference can be chalked up to Medicare Advantage's narrower networks. See the study.

2. Physicians are less likely to participate in ACOs in poorer communities. University of Pennsylvania researchers found wide variation in ACO participation, but notably less participation in areas where a higher percentage of the population was black, poor, uninsured, disabled or less educated. The findings suggest that ACOs may increase existing disparities by improving care for residents in well-off communities, while residents of vulnerable communities don't see the benefits. See the study.

3. Synchronized refills improve medication compliance. Refiling all of a patient's medication at the same time from the same pharmacy led to an increase in the proportion of patients that were adherent to their medication regime, University of Pennsylvania researchers and Humana conclude. One reason why the study is important: fewer than half of U.S. patients take their drugs as prescribed. See the study.

THIS IS TUESDAY PULSE — Where we've got a big podcast interview this morning, and prepped for it by applying loads of suction cups last night. (Hey, it works for Michael Phelps — though I'm worried I'll look like a sucker.) Send tips and placebos to [email protected] or @ddiamond on Twitter.

With help from Sarah Karlin-Smith (@SarahKarlin).

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

PUBLIC HEALTH

A pair of preliminary reports out from the CDC’s National Center for Health Statistics today offer further evidence that the teen birth rate is plunging while overall drug misuse continues to rise.

Teen births down. The teen birth rate, which is already at an all-time low, fell again from 22.7 births per 1,000 females age 15 to 19 in the first quarter of 2015 to 20.8 births in the first quarter of 2016. See data set.

Drug overdose deaths up. Meanwhile, new data from 2015 suggests that deaths linked to drug overdoses continue to trend up. The age-adjusted death rate for drug overdose rose from 14.4 per 100,000 population for the third quarter of 2014 to 15.8 for the third quarter of 2015. See data set.

OBAMACARE

ICYMI: Harvard study says Medicaid expansion improves access, health. Residents of states that expanded Medicaid reported better access to care and improved self-reported measures of health, according to a JAMA Internal Medicine study. Researchers compared Arkansas and Kentucky — which expanded Medicaid through the ACA — with Texas, an Obamacare holdout. More for Pros.

Urban's math on Medicaid holdout states: $350B in lost federal funds. The Urban Institute analysis, funded by RWJF, concludes that for every $1 a state spends on Medicaid, it would likely draw down between $7 and $8 in net federal funding. All told, the 19 holdout states would see a $27 billion decline in uncompensated care spending over the next decade if they expanded Medicaid. See the study: http://rwjf.ws/2aWSWyY

OPIOIDS

Surgeon General wants to 'Turn the Tide' with new initiative. Surgeon General Vivek Murthy on Monday announced a new website, TurnTheTideRx.org, intended to raise awareness and shed light on proper prescription.

The website includes tools for providers and asks health care professionals to take a pledge to educate themselves on pain management, screen patients for opioid use disorders, and treat addiction as a chronic illness. As of press time, 973 people had signed the virtual pledge.

… Murthy has made reducing opioid misuse a priority of his time in office. “We need to recognize that everyone is potentially at risk,” Murthy told POLITICO's Joanne Kenen in April. “Nobody is protected.”

EYE ON INSURANCE

Mark Cuban on health insurance: 'I'm not happy.' The NBA team owner and reality TV star, who's hinted at political aspirations this election cycle, on Monday tweeted out a link to a Health Affairs blog post about the "3Rs" of health insurance.

It's not the first time Cuban has weighed in on health care issues — the billionaire has riffed extensively about the value of regular, personalized blood testing — but it does appear to be the first time he's shared a Health Affairs article.

… Cuban told his followers that problems in the health insurance market shouldn't be pinned on Obamacare. The price of "insurance goes up and up," he wrote. "You don't see any insurance companies failing do you?" (We guess he's never heard of the Obamacare co-ops.)

Instead, he blamed insurers for bad business strategy. "No question insurance companies mispriced insurance and it's costing us now," Cuban tweeted in follow-up. "I employ a lot of folks. I'm not happy."

WHAT WE'RE READING by Jennifer Haberkorn

Alternative mental health treatments, such as group therapy in which patients are to respond to the voices they hear, are gaining a foothold in psychiatry, The New York Times reports: http://nyti.ms/2aI8NDf

Four Harvard Medical School-affiliated hospitals have implemented new communication systems to allow new residents feel more comfortable bringing questions up the chain of command, the Wall Street Journal reports. http://on.wsj.com/2b2xyLk

“Reference pricing”: Austin Frakt explains how it works, why it’s helped save millions of dollars in California, and what its limits are. http://nyti.ms/2b4NIVS

Arkansas Attorney General Leslie Rutledge says federal law won’t allow the state cannot limit the number of people enrolled in the state’s hybrid Medicaid expansion, according to the Associated Press. http://bit.ly/2aNK2WE

Boston Globe columnist Michael A. Cohen praises Louisiana’s Medicaid expansion and response as proof that “elections have consequences.” http://bit.ly/2avUpzH

In a Bloomberg View opinion piece, Megan McArdle laments who isn’t gaming Obamacare. http://bloom.bg/2bavOAe

Arizona health plans have until today to let the state know if they’ll stop offering plans next year, the Arizona Republic reports. http://bit.ly/2bavkdF

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