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In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

1. Liquid Gold: Pain Doctors Soak Up Profits By Screening Urine For Drugs

With the nation's opioid crisis, urine testing has become a booming business and is especially lucrative for doctors who operate their own labs, a Kaiser Health News investigation finds. And dozens of practitioners have earned "the lion’s share" of their Medicare income exclusively from urine drug screens. (Fred Schulte and Elizabeth Lucas, 11/6)

6. Political Cartoon: 'Sinking Feeling?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Sinking Feeling?'" by Milt Priggee.

Here's today's health policy haiku:

Our Children Continue To Be Slaughtered

Gun rights versus life?
Mental health funding reduced?
Congress MUST change this!

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

7. Health Law Signups, Traffic To Surge In First Few Days Of Open Enrollment

Despite fears that Trump administration's actions to cut the outreach budget for the health law would undermine sign ups, the numbers spiked over last year according to a source who spoke on the condition of anonymity. However, usually signups this early are consumers renewing coverage, not new customers. Meanwhile, insurers are opening their own wallets to make up for the lack of federal marketing for the health law.

The Hill: ObamaCare Signups Surge In Early Days To Set New Record
A record number of people signed up for ObamaCare in the first few days of open enrollment this year compared to the same period in previous years, several sources close to the process told The Hill. The surge in sign-ups, which was confirmed by an administration official, comes despite fears from Democrats that enrollment would fall off due to the Trump administration's cutbacks in outreach and advertising. (Sullivan, 11/6)

The Washington Post: ACA Sign-Ups Spike At Open Enrollment’s Start
More than 200,000 Americans chose a plan on Nov. 1, the day open enrollment began, according to one administration official. That’s more than double the number of consumers who signed up on the first day of enrollment last year. More than 1 million people visited, the official federal website, the official said, which amounts to roughly a 33 percent increase in traffic compared with 2016. These figures capture only a portion of the nation’s overall ACA enrollment, because they encompass states that either use the federal health-care marketplace or rely on its website for their consumers to sign up for coverage. More than a dozen states and the District of Columbia run their own programs and do not use (Eilperin, 11/6)

WBUR: Open Enrollment Is Underway, Amid Attempts To Hobble ACA
It's open enrollment for Americans buying health insurance through the exchanges under the Affordable Care Act. This year's enrollment period has been cut in half, and some consumers may face higher premiums because the Trump administration has discontinued cost-sharing payments that used to subsidize insurance providers for covering low-income customers. (Chakrabarti, 11/6)

Reuters: Insurers Step Up Pitch For Obamacare As Government Slashes Its Effort
President Donald Trump's 90 percent cut to Obamacare advertising has U.S. health insurers in many states digging deeper into their pockets to get the word out about 2018 enrollment, which opened last week. Independence Blue Cross, a health insurer in Pennsylvania, has commissioned a tractor trailer truck to bring insurance consultants out to shopping centers and other neighborhood spots around Philadelphia. (Humer, 11/6)

Modern Healthcare: Trump's Short-Term Insurance Ploy Could Have Long-Term Consequences
Holly Monger seems like an unlikely candidate for short-term health insurance, the type of just-in-case policy known for being cheap and skimpy. She's self-employed, helping clients wade through mountains of medical bills to appeal on their behalf or to educate them about health insurance options. When it came to buying her own plan, the Obamacare public health insurance exchange was too expensive, Monger says. So last year she bought a short-term policy with a roughly $400 monthly premium, less than half the cost of a private plan she looked at. She'll pay the $695 federal tax penalty, too, since her plan doesn't meet the requirements of the Affordable Care Act; it doesn't cover preventive care, for example. (Schorsch, 11/6)

Meanwhile, on the topic of picking employer-based coverage --

The New York Times: Why So Many People Choose The Wrong Health Plans
If you get health insurance from your employer, you have to make decision every year about which coverage to choose. So here is a warning: If you are simply sticking with an old plan with a low deductible, that may well be a wrong and costly choice. ... Because of human quirks, lack of understanding and overly complicated plans, many people are paying more without getting anything extra in return. (Thaler, 11/4)

The New York Times: Which Health Plan Is Cheaper?
Doing a thorough comparison of health care plans is difficult. But there is an imperfect, yet fairly, simple way to check whether a high-deductible plan might qualify for “no-brainer” status, meaning, it enables you to save on health care no matter how often you go to the doctor. Here’s how to do it. (Thaler, 11/4)

8. GOP Lawmakers Don't See Repeal Of Individual Mandate Getting Added To House Version Of Tax Bill

“It hasn’t ever been in the [House] bill,” said one Republican on the Ways and Means Committee. “I expect that it will be added somewhere down the sausage-making venture.” Meanwhile, lawmakers may be considering changes to taxes on health savings accounts.

The Hill: GOP Unlikely To Repeal ObamaCare Mandate In Tax Measure
The House is unlikely to repeal the mandate to buy insurance under ObamaCare as part of its tax-reform bill, GOP sources say, though the issue could return down the road. President Trump and conservative lawmakers are pushing for the individual mandate to be repealed in the bill, but House Ways and Means Committee Chairman Kevin Brady (R-Texas) has expressed worry that the controversial measure would jeopardize the broader tax-reform bill, given the Senate’s failure on health care earlier this year. (Wong and Sullivan, 11/6)

CQ: Republicans Could Target HSAs In Bipartisan Health Tax Deal
Ways and Means Committee Chairman Kevin Brady told reporters Monday night that an emerging bipartisan agreement to delay some medical care taxes could include changes to health savings accounts. “We are working with our Democrats on a bipartisan agreement on the medical device tax and health insurance tax, and perhaps HSAs as well,” the Texas Republican said Monday night. “And we expect that to be part of the discussion on CHIP and teaching health centers and all that." (McIntire, 11/6)

9. Trump Administration Keeping Executive Order To Repeal Individual Mandate In Its Back Pocket

The draft order would broaden the “hardship exemption” that the Obama administration established for those who face extraordinary circumstances.

The Washington Post: White House Seeks To Weaken ACA’s Individual Mandate, With Executive Order As Backup Plan
White House officials have prepared an executive order that would weaken the Affordable Care Act’s requirement that taxpayers demonstrate proof of insurance, according to people briefed on the matter, suggesting they will issue it if congressional Republicans cannot achieve the same goal through the tax reform process. President Trump supports abolishing the insurance requirement, called the individual mandate, but he cannot eliminate it unilaterally because it is enshrined in law. Given that several Republican bills aimed at unraveling the ACA have failed, Trump and his deputies are now seeking other ways to scale back the requirement for health-care coverage. (Eilperin and Sullivan, 11/6)

The Hill: Trump Preparing Executive Order To Scale Back ObamaCare's Individual Mandate: Reports
The White House is reportedly preparing an executive order to weaken ObamaCare’s individual mandate in the event congressional Republicans don’t include the measure in the tax-reform bill. According to the Washington Examiner and The Washington Post, the draft executive order would seek to broaden the “hardship exemptions” to the requirement that taxpayers must demonstrate proof of insurance or pay a fine. (Weixel, 11/6)


10. Maine Voters Set Today To Decide Whether To Expand Medicaid Enrollment

Lawmakers have five times passed bills to expand the state's Medicaid program under the federal health law, but the governor has vetoed the measures.

NPR: Maine Voters Will Decide If They Want More Access To Medicaid
Question 2 asks Maine voters if they want to provide roughly 70,000 Mainers with health care coverage by expanding eligibility of Medicaid, known as MaineCare. It provides health coverage for people living at or near the poverty line. The national battle over Medicaid expansion began with a 2012 U.S. Supreme Court decision that conservatives originally hoped would hobble the Affordable Care Act, President Obama's signature legislative achievement. (Mistler, 11/7)

11. Pa. Officials Delay Shift To Medicaid Managed Care For Some People In Philadelphia

The implementation for elderly and disabled enrollees needing long-term care services is put back a year. In other Medicaid news, Arkansas officials say the wait for federal approval of a new waiver is delaying plans to change eligibility standards, Virginia lawmakers get an estimate of costs for next year, Iowa officials assert that a lawsuit brought by disabled enrollees is now moot and a Republican lawmaker running for governor in Oregon seeks a probe of overpayments.

The Philadelphia Inquirer: Pa. Delays Major Long-Term Care Shift In Philadelphia Area
The Pennsylvania Department of Human Services on Monday delayed the shift to managed Medicaid for long-term services and supports in Southeastern Pennsylvania. The new system, which requires elderly beneficiaries and younger individuals with disabilities to sign up with Medicaid managed-care companies, will start in the Philadelphia region in January 2019, instead of July 2018, “to allow for the deliberate and purposeful implementation” of the program, known as Community Health Choices, in the most populous region of the state. (Brubaker, 11/6)

Arkansas Online: State Medicaid Changes Delayed
With federal approval taking longer than expected, Arkansas officials said Monday, they expect to have to wait until after Jan. 1 to implement state-sought changes to Arkansas' expanded Medicaid program. Amy Webb, a spokesman for the state Department of Human Services, said the department will need 60 days after federal approval is granted to implement the changes, which include moving about 60,000 people off the program by restricting eligibility to people with incomes of up to 100 percent of the poverty level, instead of 138 percent of the poverty level. To start by Jan. 1, as had been planned, the department needed to receive approval from the federal Centers for Medicare and Medicaid Services by Thursday. (Davis, 11/7)

Richmond Times-Dispatch: Medicaid Costs To Rise By $671 Million, But Congress' Inaction On Children's Health Insurance Could Cost State Extra $195 Million
Virginia’s Medicaid program will cost the state an additional $670.6 million over three years, but it could have been worse — and it will be unless Congress acts soon to restore federal funding for children’s health insurance. The new forecast, compiled by the Department of Medical Assistance Services and made public Monday by Gov. Terry McAuliffe’s administration, provides the governor and the General Assembly a clearer road map for reaching the next two-year budget. It will be driven largely by the additional cost of Medicaid, K-12 education and building the state’s cash reserves to hedge against potential economic downturns. (Martz, 11/6)

The Des Moines Register: AmeriHealth's Exit Should Curtail Disabled Residents' Suit Against Iowa, State Lawyers Say
The departure of a controversial Medicaid management company should block a federal lawsuit against Iowa’s human-services director, state lawyers say. The lawsuit was filed in June on behalf of six Iowans with disabilities, who argue that the state’s shift to private management of Medicaid led to illegal cuts to their in-home care services. The plaintiffs say without those services, they could be forced to move into nursing homes, violating their constitutional rights. The lawsuit is being spearheaded by the advocacy group Disability Rights Iowa, which has asked a federal judge to declare the suit a class-action case on behalf of about 15,000 Iowans with disabilities. ... The state lawyers noted in a court filing last week that AmeriHealth oversees Medicaid benefits for all six initial plaintiffs in the Disability Rights Iowa lawsuit. (Leys, 11/6)

The Oregonian: Knute Buehler Calls For Independent Inquiry Into Medicaid Overpayments
Republican gubernatorial candidate Knute Buehler called on Gov. Kate Brown Monday to appoint an independent lawyer to investigate why Oregon overpaid more than $74 million in Medicaid money to health care organizations. Buehler, who is an orthopedic surgeon and lawmaker from Bend, also called for Brown to recoup the money and publicly release all records of her administration's communications about the overpayments. (Borrud, 11/6)

Public Health And Education

12. Mental Illness Becomes Scapegoat After Mass Shootings, But The Truth Is Far More Nuanced, Experts Say

Saying mental illness is to blame for mass violence incidents not only misses the complexities at the root of the motivation, but also besmirches millions of non-violent mentally ill people, experts say in the wake of the Texas shooting which left 26 dead. President Donald Trump said the shooting was a "mental health" problem and not a "guns situation."

The Associated Press: Trump Calls Attackers ‘Deranged’ But Mental Health Link Weak
President Donald Trump called the Texas church shootings gunman “deranged,” the New York bike path attacker “a very sick and deranged person,” and the Las Vegas massacre shooter “a sick, demented man.” It’s a common reaction to mass violence — who in their right mind would commit these senseless crimes? The truth is more nuanced. (Tanner, 11/6)

San Francisco Chronicle: Trump Wrong To Blame Mass Killings On Mental Illness Rather Than Guns, Experts Say
President Trump on Monday attributed the slaughter of 26 people in a Texas church — the nation’s third mass killing in five weeks — to “a mental health problem,” saying it wasn’t a “guns situation.” ...Critics say blaming mass killings on “mental health problems” is not only medically inaccurate, it is politically disingenuous — a “fig leaf,” to make it appear that Trump is doing something about gun violence. (Garofoli, 11/6)

NPR: In Texas And Beyond, Mass Shootings Have Roots In Domestic Violence
In the wake of the massacre at a small-town Texas church on Sunday, many people are asking why. We know that a large portion of the mass shootings in the U.S. in recent years have roots in domestic violence against partners and family members. Depending on how you count, it could be upwards of 50 percent. (Fulton, 11/7)

Los Angeles Times: Gun Injuries In The U.S. Have Become More Severe Since The 1990s, Study Says
If the purpose of a gun is to inflict serious damage to a body, then these weapons have become increasingly effective, new research shows. An analysis of U.S. hospital records shows that gun injuries bad enough to land a victim in the hospital grew more severe over the course of two decades. Wounds involving "serious open fractures" — trauma that pairs a break in the skin with a broken bone — increased by 0.61% per year between 1993 and 2013. Meanwhile, gun injuries classified as "minor" fell by 0.74% per year during the study period. (Kaplan, 11/6)

13. End-Of-Life Guidance For Heart Disease Stuck In The Past When It Used To Kill Quickly

Heart disease has become a chronic condition, but unlike cancer, many doctors don't know how to deal with patients they can no longer help but are still alive. In other public health news: Alzheimer's, diabetes, sleep, vaccines, genetic tests, and more.

Stat: Bipartisan Bill Pushes For The ‘Next Step’ In Solving Alzheimer's
A bipartisan group of four senators on Monday introduced a bill they say would better align Alzheimer’s treatment and prevention strategies with public health approaches for other chronic health conditions, allowing the Centers for Disease Control and Prevention to “create a modern infrastructure for the prevention, treatment, and care of Alzheimer’s and related dementias.” The legislation, authored by Sens. Susan Collins (R-Maine), Catherine Cortez Masto (D-Nev.), Shelley Moore Capito (R-W.Va.), and Tim Kaine (D-Va.), focuses on improving early detection mechanisms, local health program coordination, and data-gathering operations. (Facher, 11/6)

NPR: A Quest: Insulin-Releasing Implant For Type-1 Diabetes
Scientists in California think they may have found a way to transplant insulin-producing cells into diabetic patients who lack those cells — and protect the little insulin-producers from immune rejection. Their system, one of several promising approaches under development, hasn't yet been tested in people. But if it works, it could make living with diabetes much less of a burden. For now, patients with Type-1 diabetes have to regularly test their blood sugar levels, and inject themselves with insulin when it's needed. (Palca, 11/6)

NPR: Sleepless Night Leaves Some Brain Cells As Sluggish As You Feel
When people don't get enough sleep, certain brain cells literally slow down. A study that recorded directly from neurons in the brains of 12 people found that sleep deprivation causes the bursts of electrical activity that brain cells use to communicate to become slower and weaker, a team reports online Monday in Nature Medicine. (Hamilton, 11/6)

The Denver Post: Connecting Moms-To-Be And Doctors Online Can Boost Vaccination Rates, Study Says
Being able to connect with doctors online during pregnancy about vaccine concerns may encourage new mothers to make sure their babies get all the recommended shots, according to a new study in Colorado. Researchers at the Kaiser Permanente Colorado Institute for Health Research found that, when moms-to-be were able to ask questions of doctors and other experts through a specially made website, their children were significantly more likely to be fully vaccinated after six months than if the moms weren’t given the option of online interaction. (Ingold, 11/6)

Stat: FDA Clears The Way For More Consumer Genetic Health Tests To Hit The Market
The floodgates for direct-to-consumer genetic tests are swinging wide open. The Food and Drug Administration plans on loosening many of the regulations surrounding genetic health risk tests, or GHRs, according to a statement Monday from Commissioner Scott Gottlieb. It’s a change of course for the agency, which in 2013 put a freeze on direct-to-consumer marketing of genetic tests for health conditions. Since then, the FDA has generally been approving tests one by one before they hit the market. (Keshavan, 11/6)

Stat: Tiny Human Brain Organoids Implanted Into Rodents, Triggering Ethical Concerns
Minuscule blobs of human brain tissue have come a long way in the four years since scientists in Vienna discovered how to create them from stem cells. The most advanced of these human brain organoids — no bigger than a lentil and, until now, existing only in test tubes — pulse with the kind of electrical activity that animates actual brains. They give birth to new neurons, much like full-blown brains. And they develop the six layers of the human cortex, the region responsible for thought, speech, judgment, and other advanced cognitive functions. (Begley, 11/6)

Kaiser Health News: Beyond Stigma And Bias, Many Transgender People Struggle With Mental Health
Diana Feliz Oliva, a 45-year-old transgender woman who grew up outside Fresno, Calif., remembers being bullied when she was younger and feeling confused about her gender identity. She was depressed and fearful about being found out, and she prayed every night for God to take her while she slept. “I was living in turmoil,” said Oliva, who now works as health program manager in a clinic for transgender people at St. John’s Well Child & Family Center in Los Angeles. “Every morning, I would wake up and I knew I would have to endure another day.” (Gorman, 11/7)


14. Scrutiny Of Opioid Addiction Drug Marketing Intensifies As Sen. Harris Seeks Information From Alkermes

Sen. Kamala Harris (D-Calif.) points to reports that pharmaceutical company Alkermes has attempted to increase sales of Vivitrol -- a monthly shot to treat opioid addiction -- by playing up misconceptions about other medications and trying to limit their availability.

Stat: Harris Calls For Probe Into Alkermes And Its Vivitrol Promotion For Opioid Treatment
A mid a worsening opioid crisis, a U.S. senator has opened a probe into Alkermes and its controversial promotion of the Vivitrol monthly shot for combating opioid addiction. The move comes as Alkermes is scrutinized for aggressive lobbying and marketing. The company has spent heavily on contributions to lawmakers who are trying to mitigate opioid abuse. In state legislatures across the country, the drug maker has pushed bills that favor its treatment over rival medicines. And Alkermes has provided thousands of free doses to encourage usage in jails and prisons. (Silverman and Facher, 11/6)

The Hill: Sen. Harris Seeks Information From Maker Of Opioid Treatment
“According to these reports, Alkermes has targeted much of its promotion for Vivitrol at law enforcement officials and lawmakers, efforts which have included the assignment of sales representatives to judges overseeing drug courts and free shots to inmates leaving jails and prisons,” Harris wrote in a letter Monday to Alkermes’s CEO and chairman, Richard Pops. (Roubein, 11/6)

Sacramento Bee: Kamala Harris Scrutinizes Opioid Treatment Drug Manufacturer
In her letter to Pops, Harris asks the company to provide a list of documents, including: A list of judicial officials and drug courts to which Alkermes has assigned sales representatives; A list all jails or prisons at which Alkermes has provided free Vivitrol shots; Copies of any educational materials provided to law enforcement personnel or judges; Research or data “concerning the superiority of Vivitrol as an opioid addiction treatment.” (Cadei, 11/6)

In other news on the epidemic —

Stateline: For Addicted Doctors, Confidential Treatment That Works
They are among hundreds of physicians from across the country who come to this quiet, pine-shaded retreat 25 miles north of Birmingham, where they can get mental health and addiction treatment without jeopardizing their medical licenses. Bradford [Health Services] addiction treatment regimen isn’t unique — more than a dozen other addiction centers across the country offer similar programs — but when combined with other services offered by state organizations known as physician health programs, it is extraordinarily effective. (Vestal, 11/6)

The Hill: Trump’s Anti-Opioid Advertising Campaign Needs Millions
President Trump’s plan to use a blizzard of advertising to help stem the opioid crisis faces a serious funding challenge. Similar initiatives have been backed by hundreds of millions in federal funding, but it's not clear if — or how soon — the money for Trump’s initiative could come. (Roubein, 11/5)

Miami Herald: To Fight Opioid Crisis, Florida’s Largest Insurer Stops Covering OxyContin
That leftover bottle of painkillers in your medicine cabinet is one of the reasons that Florida’s largest health insurance company will stop covering OxyContin, the brand name prescription opioid, beginning Jan. 1. Instead, the insurer will start covering an alternative opioid that isn’t crushable for injection or snorting, reducing its potential for abuse, the company said Monday. (Chang, 11/6)

15. Valeant Is Selling Female Libido Pill Back To Former Owner, But Is Drug 'Dead In The Water'?

The drug, Addyi, garnered lots of attention and controversy when it was approved by the Food and Drug Administration, but then it flopped.

Stat: Valeant Sells Its Addyi Female Libido Pill To Former Owners, But Will It Ever Catch On?
Will the Addyi female sexual dysfunction pill ever generate any excitement? Two years after betting $1 billion on the drug, Valeant Pharmaceuticals (VRX) has agreed to sell Sprout Pharmaceuticals, which initially won regulatory approval for the drug, back to its shareholders. The deal ends a lawsuit filed against the drug maker by former Sprout shareholders – and Valeant is providing a $25 million loan. (Silverman, 11/6)

Bloomberg: Valeant Gives $1 Billion Female Libido Pill Back To Old Owners
Valeant Pharmaceuticals International Inc. is getting out of the controversial female libido pill business -- but the deal it made in 2015 to buy the drug may continue to haunt its shareholders. In a strange twist, the drugmaker said Monday it will give the pill -- acquired for $1 billion -- back to its original owners for almost nothing. In return, the owners will end a lawsuit alleging Valeant bungled marketing of the drug. (Koons, 11/6)

In other pharmaceutical news —

Politico: Lawmakers Defend 'Unprecedented' Pentagon Health Panel, Which Could Undermine FDA
The Defense Department — and not FDA — would have the power to approve drugs and medical devices under the defense policy bill that's being hammered out by a conference committee, alarming congressional health staff and HHS who say it would undermine medical safety and potentially put soldiers at risk. But the lawmakers backing the bill, including House Armed Services Chairman Mac Thornberry (R-Texas), say the measure is necessary and even overdue. (Diamond, 11/6)


16. Tenet Healthcare Reports Third-Quarter Loss Of $366 Million

The company has implemented new cost controls and 1,300 job cuts. It attributes part of the loss to less volume because of the hurricanes that struck Texas and Florida.

Dallas Morning News: Tenet Healthcare Reports A Quarterly Loss That's 45 Times Higher Than Last Year
Shares of Dallas-based hospital operator Tenet Healthcare continued to dip in after hours trading on Monday as the company reported a third quarter loss of $367 million. That’s about 45 times higher than the loss reported at the same time last year. The company slashed its annual earnings outlook by about $50 million. At $12.65 per share, the ailing health care company’s stock is at a five-year low. (Rice, 11/6)

State Watch

17. State Highlights: The Crackdown On Doctors That Never Materialized; Key West's Sole Community Provider Still Grappling With Aftermath Of Storm

Media outlets report on news from California, D.C., Ohio, Florida, Georgia, Tennessee, Minnesota, Louisiana and Texas.

Los Angeles Times: Why Hasn't California Cracked Down On Anti-Vaccination Doctors?
A year ago, California officials appeared to be coming down hard on doctors and parents who were reluctant to vaccinate children. The state had just implemented one of the strictest vaccination laws in the nation. The medical board was threatening to pull the license of Dr. Robert Sears, a celebrity in the anti-vaccine community. One vaccine skeptic called the case against Sears “a shot across all the doctors’ bows.” (Karlamangla, 11/6)

Modern Healthcare: In The Eye Of The Storm: Hurricane Irma Puts Sole Community Provider In Key West To The Test
More than a month after Hurricane Irma tore through the Florida Keys, Lower Keys Medical Center is still grappling with its aftermath. About 5% of the facility's employees still haven't returned after the storm devastated the Keys and flattened their homes. Another 28 employees lost everything. The majority of those employees are shuffling from one hotel to the next, while Lower Keys Medical does what it can to find them shelter. (Livingston, 11/4)

The Washington Post: Two More Former UMC Employees Criticize Consultants As Contract Vote Looms
Two more high-ranking former employees of the District’s only public hospital stepped forward Monday to criticize the firm running the facility, even as the company’s owner fought back on the eve of a high-stakes D.C. Council vote on whether it should continue to manage United Medical Center. Pamela Lee, the hospital’s former chief operating officer, and Stanley Pierre, its former quality director, said the consulting firm, Veritas of Washington, had taken steps to remove critical safeguards for patients — particularly by understaffing the department that ensures quality of care and compliance with state and federal laws. (Jamison, 11/6)

Kaiser Health News: Ohio’s Drug-Pricing Ballot Question Triggers Voter Confusion
Lawmakers in the nation’s capital have yet to grapple with rising drug costs, but Ohio voters are being asked — in a single ballot-box question next week — to figure out how best to lower the tab the state pays for prescriptions. The Drug Price Relief Act, better known as Ohio Issue 2, has been promoted and pilloried in a dizzying crush of robocalls, TV and radio ads, and direct mailings. (Luthra, 11/7)

Georgia Health News: Survey Finds Georgia Employers Have Health Costs Below Average
Georgia employers’ health care costs are lower than the national average, a recent survey has found. And the survey — done by New York-based Mercer, the world’s largest human resources consulting company — finds that employers in the Peach State offer what are called “consumer-driven health plans’’ at a greater rate than their national counterparts. (Miller, 11/6)

Los Angeles Times: San Diego's Hepatitis A Outbreak Continues To Grow, But More Slowly
Though the case count in San Diego's ongoing hepatitis A outbreak increased again Monday, officials said that the number of new infections continues to slow. In a presentation to the San Diego County Board of Supervisors, Dr. Wilma Wooten, the county's public health officer, showed a chart that indicated there were 31 cases in October, significantly fewer than the 81 reported in September and 94 in August — the largest total of the outbreak so far. (Sisson, 11/6)

The Tennessean: ER Doctor-Owned Urgent Care Clinic To Open In West Nashville
An urgent care clinic owned by local emergency room physicians is on track to open in West Nashville later this month. Physicians Urgent Care will be open seven days a week for people who need treatment for minor issues for which an emergency room trip is not necessary, said Dr. Ty Babcock, managing partner and one of seven physician co-owners. (Fletcher, 11/6)

California Healthline: Breathing Fire: Health Is A Casualty Of Climate-Fueled Blazes
As the deadliest fires in California history swept through leafy neighborhoods here, Kathleen Sarmento fled her home in the dark, drove to an evacuation center and began setting up a medical triage unit. Patients with burns and other severe injuries were dispatched to hospitals. She set about treating many people whose symptoms resulted from exposure to polluted air and heavy smoke. (Upton and Feder Ostrov, 11/7)

New Orleans Times Picayune: In 4 Days, 2 Inmates Hospitalized After New Orleans Jail Stay Have Died
Two inmates died within four days of each other after each was transported to the hospital from an Orleans Parish jail facility, according to the Orleans Parish Sheriff's Office. The deaths do not appear to be related. The sheriff's office earlier on Monday issued a statement saying 27-year-old Evan Sullivan died Sunday (Nov. 5) at a hospital "of apparent natural causes," after he was taken there from the jail. Hours later, The New Orleans Advocate reported a second inmate had died in recent days. The agency then issued a second news release with information about that death. (Lane, 11/6)

Columbus Dispatch: Ohio Teens Now Required To Learn What It Means To Become Organ Donor
As of this academic year, students in high-school health classes across Ohio are being exposed to information about organ donation, thanks to a new state law that requires the education. While such lessons have been available in some schools for years, this is the first time they’re required by the state, said Jenny Hudak, who heads up community education outreach for Lifeline of Ohio. (Viviano, 11/6)

Dallas Morning News: New $25 Million Medical Complex Set For Garland
A Grapevine-based medical real estate company is building a $25 million medical complex in Garland. The North Garland Medical Center will be constructed by New Era Partners at 7217 Telecom Parkway. The 3-story 95,000 square foot of healthcare development space will be built near Bush Turnpike at Lookout Drive and Telecom Parkway. (Brown, 11/6)

Texas Tribune: Buda Voters To Decide Whether To Reintroduce Fluoride To Tap Water
Buda voters on Tuesday will decide whether the Central Texas city should again add fluoride to its water supply. The widespread and decades-old practice of fluoridation — roughly two-thirds of Americans live in communities with fluoridated water supplies — is a federally recognized public health policy meant to curb tooth decay. (Riordan, 11/7)

Editorials And Opinions

18. Perspectives On Gun Violence: Mass Shootings Are Not 'Inevitable'; It Is 'A Mental Health Issue'

In response to the weekend's mass shooting in a small town in Texas, opinion writers offer their ideas on why gun violence continues to plague the United States.

The New York Times: Mass Shootings Don’t Have To Be Inevitable
There is an agonizing predictability to the mass shootings that regularly horrify the nation. The latest, in which 26 churchgoers were shot to death at Sunday worship in Texas, offered all the most cruel and terrifying characteristics. It was carried out by a disturbed individual with easy access to assault weapons adapted from military warfare and marketed in the spurious name of sportsmanship. (11/6)

USA Today: Trump’s Right, This Is A Mental Health Issue
President Trump’s suggestion that the tragedy in Texas is a mental health issue rather than a gun issue deserves more than an arrogant dismissal by gun control proponents. There are roughly 90 million gun owners in the U.S. who responsibly own firearms of all kinds. They didn’t harm anybody on Sunday, and indeed one of those citizens courageously grabbed his own rifle and opened fire on the killer, causing him to drop his rifle and flee the scene. We have tried numerous restrictive gun control measures, and none has lived up to sales pitches about preventing violence. (Alan M. Gottlieb, 11/6)

USA Today: After Texas Shooting, Trump And Politicians Show How Mental They Are
Americans may someday look back in shame at a time when their country was awash in guns, when every few weeks people were slaughtered en masse and when society repeatedly mourned its dead, even as it facilitated their murder with easy access to powerful weapons. ... As shocking as the killings are, equally shocking is that the nation’s political leaders do nothing to stop them. Now, these leaders even want to deny that gun violence has anything to do with … guns. (11/6)

The Washington Post: Yes, President Trump, It’s A Guns Situation
"You never expect something like this,” said one official about Sunday’s mass shooting in the small Texas community of Sutherland Springs. “Unimaginable,” said a man whose parents were among the 26 people killed, along with a pregnant woman, an 18-month-old baby and a 14-year-old girl. Among the awful truths of what happened Sunday morning in a place where no one locks their doors is that gun violence is not unimaginable anywhere in this country. Mass shootings have become commonplace, and shootings far more so: Guns kill more than 30,000 people every year and injure roughly 80,000 more. Just as there was a last time (an outdoor musical festival a little more than a month ago in Las Vegas) and a this time (a rural Texas church), there will surely be a next time unless national lawmakers come to grips with the problem and take meaningful steps to stem the obscene and unfettered access to weapons of war. (11/6)

19. Viewpoints: Advance Directives And Dementia; When Scientific Trials Take Place In Court

A selection of opinions on health care from around the country, including perspectives on the opioid crisis, a Medicare trap for people who choose to work past age 65 and the limits of behavioral economics in medicine.

JAMA: Advance Directives For Dementia
Standard advance directives are often not helpful for patients who develop dementia. Dementia is a unique disease from the standpoint of advance directives. ... Clinicians, perhaps unsure of the goals of care for such patients, often may continue to provide the same care they would have in the absence of dementia, without addressing whether plans should be adjusted. Clinicians and family members often find it easier to continue current treatment paths rather than having conversations about whether such care is what a person with dementia would have wanted. (Barak Gaster, Eric B. Larson and J. Randall Curtis, 11/6)

JAMA Internal Medicine: Scientific Trials—In The Laboratories, Not The Courts
In 2015, one of us published a peer-reviewed study, together with colleagues at the University of California, San Francisco, replicating prior research from the US Food and Drug Administration (FDA) detecting a designer stimulant, β-methylphenylethylamine, in sports, weight loss, and “cognitive function” supplements sold in the United States. The confirmatory study prompted the FDA to take enforcement action against companies selling the stimulant as a dietary ingredient. One of the companies that received an FDA warning letter sued the study’s authors for $200 million in damages for libel, claiming, without supporting scientific evidence, that multiple statements in the article were false. ... The case is just a recent example of using litigation to target scientists. ... When lawsuits target scientists, it does not matter that plaintiffs almost never win. It does not even matter if the case goes to trial. The goal is to intimidate. (Nicolas Bagley, Aaron E. Carroll and Pieter A. Cohen, 11/6)

Detroit Free Press: Without Cash, Trump's Opioid Emergency Declaration Is A Farce Destined To Fail
When I was 14 years old, my older brother Zach overdosed on heroin. It was, not surprisingly, the defining moment of my life; a moment when I came to appreciate the tremendous strength of my family, the vital importance of friends and the overwhelming compassion of my community. Eleven years later, the opioid crisis still feels visceral and raw; I watched my mentor and friend suffer through addiction, I cried endless tears after my time with him was forced into memory, and I’m reminded of him every time I meet new families suffering through the same. I know too well Zach’s struggle and the heartbreak of my family is not unique. In 2006, the year he died, 34,424 others died from an overdose as well. Last year, that agonizing statistic grew to over 64,000. (Connor Goddard, 11/5)

Columbus Dispatch: Medicaid Cuts Threaten Programs That Saved Me
Along with West Virginia, New Hampshire, Kentucky and Rhode Island, Ohio is in the top-five list of states that have the highest rates of drug-overdose deaths. ...Repealing the Affordable Care Act and making deep cuts to Medicaid in the federal budget would take health care away from the more than 1 million Ohioans who got coverage under the ACA. (Phillip Krauss, 11/6)

Chicago Tribune: How To Reduce The Deadly Toll Of Opioids
At the end of the 20th century, Americans were worried about the dangers posed by crack cocaine. They didn’t realize that another drug menace would soon eclipse it. Prescription opioids were gaining favor as a tool against undertreated pain. No one foresaw where this would lead: to an epidemic of opioid overdoses that the nation is only starting to confront with the urgency it warrants. (11/4)

Los Angeles Times: Working Past 65? Beware Of This Medicare Trap That Could Cost You Thousands In Taxes
We can say two things for sure about the American workforce and its health insurance. First, more Americans are working past the traditional retirement age of 65. Second, more are taking advantage of employer insurance plans that include tax-exempt Health Savings Accounts. Add these two facts together, and you end up with a pitfall that could cost unwary American workers as much as $2,700 a year in tax exemptions if they exercise their right to enroll in Medicare at 65. That pitfall exists because of the confusing way HSAs interact with Medicare, and because many big employers fail to help their older employees deal with the potential complexities—or even to know about them. (Michael Hiltzik, 11/6)

The New York Times: Don’t Nudge Me: The Limits Of Behavioral Economics In Medicine
Whenever I talk to physicians about outcomes that are worse than you’d expect, they are quick to point out that noncompliance — when a patient does not follow a course of treatment — is a major problem. Sometimes prescriptions aren’t filled. Other times they are, but patients don’t take the drugs as prescribed. All of this can lead to more than 100,000 deaths a year. (Aaron E. Carroll, 11/6)