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Kaiser Health News Original Stories

Summaries Of The News:

Health Law

6. Bolstered By Trump's Support, Conservatives Push To Include Repeal Of Individual Mandate In Tax Bill

However, House Ways and Means Chairman Kevin Brady (R-Texas) warned that mixing health care into an already-complicated tax measure could prompt new opposition and complicate its narrow path in the Senate.

The Associated Press: House GOP Weighs Repeal Of Health Mandate In Tax Bill
Republicans are weighing a repeal of a key tenet of the Obama-era health care law in their tax overhaul as the House's tax-writing committee begins work on shaping the bill. Speaker Paul Ryan said Sunday Republicans are discussing whether their tax plan should include a repeal of the Obama health law's requirement that people have insurance coverage or face a penalty, a step pushed by President Donald Trump but seen by some GOP lawmakers as possibly imperiling a much-needed legislative victory. (11/6)

Politico: Conservatives Push To Repeal Obamacare Mandate In Tax Package
Conservatives are attempting to revive efforts to gut Obamacare’s individual mandate as part of the Republican overhaul of the tax code. But the House's top tax writer, while leaving the door open to a measure President Donald Trump supports, said Friday that such a move would complicate the tax package's prospects, particularly in the Senate. (Demko and Cancryn, 11/3)

CQ: Health Industry Officials Monitoring Tax Bill
Health care industry lobbyists are watching closely to see if tax writers may add a repeal of the requirement to get medical coverage to the House tax bill. A key committee chairman suggested Friday that it is a possibility, as conservatives and the president push for its inclusion. The issue is one of several the industry is monitoring in the bill. House Ways and Means Chairman Kevin Brady, R-Texas, said he expects to release on Monday another version of the bill with substantial changes. He said Friday that tax writers asked congressional scorekeepers for an updated cost estimate of the provision. (McIntire, 11/3)

The Washington Post: They Spent Years Planning To Live With Alzheimer’s Disease. The GOP Tax Bill Threatens Those Plans.
When Diane Thorsen began to show signs at an early age of the Alzheimer’s disease that had stolen her mother’s mind, she and her husband, Richard Davis, were as ready as they could be. They sold their house in California to prepare for the cost of care and moved to Minnesota to live with one of Thorsen’s daughters. Davis planned their finances methodically; once Thorsen’s long-term care insurance ran out, the daunting $98,000 bill for her nursing home would be manageable — because they could deduct medical expenses from their tax bill. (Johnson, 11/4)

7. Shopping Around For Obamacare Coverage: Some Consumers Are Getting 'A Pleasant Surprise,' Others Are Getting Rate Increases And Confusion

News outlets offer the latest on how the sign-up period is working this year for health coverage through the Affordable Care Act marketplaces.

The Denver Post: Why Tens Of Thousands Of Coloradans Choose To Pay A Fine Rather Than Buy Health Insurance
Tens of thousands of Coloradans who could be eligible for free or reduced-cost health insurance instead pay a fine every year for not having insurance at all, according to a new report from a nonpartisan health group. The issue, for many, is the price of insurance. Especially in rural areas of the state, the cost of insurance — even if it is reduced by federal tax subsidies — can still be many times more than the cost of paying the fine, said Joe Hanel, the manager of public policy outreach at the Colorado Health Institute and the report’s author. (Ingold, 11/3)

Concord Monitor: Capital Beat: N.H. Insurance Department Officials Denounce Provider-Mailed Letters
The language is startling: a nearly $400 monthly premium increase for a New Hampshire 2018 health insurance plan over last year’s rates. A letter sent recently by an insurance provider to a New Hampshire resident states that in contrast to the $237 monthly premium the consumer paid in 2017, the cost of that plan next year would shoot to $630 a month if they chose to stay on – despite their federal subsidies. (11/4)

Concord Monitor: After Funding Cuts, N.H. Insurance Navigators Short On Time, Resources
A year ago, Bhagirath Khatiwada had four health insurance navigators on the payroll. His organization, the Manchester-based Building Community in New Hampshire (BCNH), helps sign Granite Staters up for insurance plans on the individual market; the trained navigators play a vital role. But then came a leadership change in the White House – and in health care policy broadly. After the Trump administration made sweeping cuts to outreach and assistance programs for the Affordable Care Act, Khatiwada’s organization saw a 60 percent cut in grant funding. (DeWitt, 11/5)

Capitol Hill Watch

8. CHIP Bill Passes House, But Partisan Strife Over Funding Likely To Cause Headaches In Senate

To pay for the Children's Health Insurance Program, the House bill would charge higher premiums to wealthier Medicare beneficiaries and cut money from the Affordable Care Act's public health fund. Democrats in the Senate are opposed to what they say is just another way to attack the health law.

Roll Call: House Volleys CHIP Measure To Senate
After months of disputes and delays, the House voted Friday to renew funding for the Children’s Health Insurance Program, community health centers and other public health programs. The legislation passed easily, 242-174, although many Democrats opposed the measure due to disagreements over the offsets. ... Advocacy organizations and state officials have been clamoring for Congress to act to extend funding for CHIP, community health centers and a number of other safety net programs. Most still had some money to keep operations going after the Sept. 30 expiration date, but officials are increasingly nervous about running out. In the case of CHIP, federal health officials have been funneling some leftover funds to the states that are in the most dire situations. (Raman, 11/3)

The Hill: House Passes Bill To Fund Children's Insurance Program
The House bill would charge higher premiums to wealthier Medicare beneficiaries, cut money from ObamaCare’s public health fund and shorten the grace period for ObamaCare enrollees who fail to make premium payments. According to an analysis by the left-leaning Center on Budget and Policy Priorities, between 259,000 and 688,000 people could lose their insurance as a result of the shortened grace period. (Weixel, 11/3)

Medicaid

9. N.H. Becomes Latest State To Ask For Federal Approval To Set Work Requirement For Medicaid

Arkansas, Arizona, Indiana, Kentucky, Maine, Utah and Wisconsin are also seeking the new authority for the work mandate for healthy adults. In other Medicaid news, Republican lawmakers in Louisiana blocked managed care contracts, California managed care plans make hefty profits and North Carolina officials begin efforts to revamp the program.

Modern Healthcare: New Hampshire Submits Request For Medicaid Work Requirement
New Hampshire is making a second attempt to impose a work requirement on its Medicaid beneficiaries, asking the Trump administration to approve a request that was denied by the Obama administration. The CMS posted the waiver application on its site Thursday and is accepting comments through Dec. 2. New Hampshire wants to require adults who are unemployed to either work, train for a job, actively search for work or participate in other work-related activities for up to 30 hours per week. ... New Hampshire joins Arkansas, Arizona, Indiana, Kentucky, Maine, Utah and Wisconsin in seeking to impose a work requirement on Medicaid beneficiaries. (Dickson, 11/3)

The Associated Press: $15B In Louisiana Medicaid Contracts Stalled By House GOP
Louisiana House Republican lawmakers Friday blocked high-dollar contract extensions sought by Gov. John Bel Edwards' administration for the managed-care companies that coordinate services for 1.5 million Medicaid patients in Louisiana. The Democratic administration wants to keep the five deals in place for another 23 months beyond their January expiration date. But GOP lawmakers raised concerns about the price tag for the extension: $15.4 billion in federal and state cash. Annually, the deals account for roughly one-quarter of the state's operating budget. (Deslatte, 11/3)

Kaiser Health News: Enriched By The Poor: California Health Insurers Make Billions Through Medicaid
Medicaid is rarely associated with getting rich. The patients are poor, the budgets tight and payments to doctors often paltry. But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds their patient care is subpar. A unit of Centene Corp., the largest Medicaid insurer nationwide, raked in $1.1 billion in profits from 2014 to 2016, according to state data obtained and analyzed by Kaiser Health News. Anthem, another industry giant, turned a profit of $549 million from California’s Medicaid program in the same period. (Terhune and Gorman, 11/3)

Winston-Salem (N.C.) Journal: NC Seeks Input On Medicaid From Providers And Insurers In Reform Initiative
State health officials are taking another step toward reform of the N.C. Medicaid program, this time addressing requirements for physical managed care organizations. In September 2015, the Republican-controlled legislature approved shifting Medicaid from a fee-for-service structure to a managed care structure. ... The Democratic administration of Gov. Roy Cooper revealed in August its proposal for overseeing the approved state Medicaid reform plan. The 77-page plan deals with the Medicaid and the N.C. Health Choice programs. On Friday, DHHS released two requests for information. (Craver, 11/6)

Marketplace

10. Anthem CEO Stepping Down Following Collapse Of Cigna Deal

Chief Executive Joseph R. Swedish will be succeeded by veteran managed-care executive Gail K. Boudreaux, the insurer announces.

The Wall Street Journal: Anthem Confirms Joseph Swedish To Step Down As CEO
Anthem Inc. Chief Executive Joseph R. Swedish will step down, and veteran managed-care executive Gail K. Boudreaux will take over as the insurance giant’s next leader Nov. 20. Ms. Boudreaux will take the titles of chief executive and president, the company said. She will also join Anthem’s board. Mr. Swedish will remain as executive chairman until May 2018 and will be a senior adviser through May 2020. (Wilde Mathews, 11/3)

Reuters: Anthem Names Industry Veteran Gail Boudreaux As New CEO
Swedish will serve as Anthem’s executive chairman and step down from that role in May next year. He will be senior adviser through May 2020, the company said. Swedish orchestrated Anthem’s $54 billion merger proposal to smaller rival Cigna Corp (CI.N) in 2015, which was ultimately scrapped due to regulatory issues. (11/6)

Modern Healthcare: Anthem CEO Joseph Swedish To Retire
Swedish's career in healthcare spans more than four decades. He has worked for Indianapolis-based Anthem, a licensee of the Blue Cross and Blue Shield Association, since 2013 when he replaced Angela Braly as president and CEO. He became chairman in 2015. (Livingston, 11/3)

In other health industry news —

Modern Healthcare: Kaiser Permanente Records Strong Growth In Q3 Operations
Kaiser Permanente reported double-digit increases in operating revenue, operating income and net income in the third quarter of 2017 compared with the year earlier period. Operating revenue for the Oakland, Calif.-based hospital and health plan giant climbed 11.5% to $18.3 billion from the prior-year quarter. In the same period, operating income grew 20.9% to $850 million. (Barr, 11/4)

Public Health And Education

11. Texas Shooting Was 'Mental Health' Problem Not A 'Guns Situation,' Trump Says

“We have a lot of mental health problems in our country, as do other countries," President Donald Trump said of the mass shooting in Texas that left 26 dead.

The Washington Post: Trump Says Texas Shooting Is A Problem Of Mental Health, Not Guns
President Trump declared that the shooting in Sutherland Springs, Tex. that left at least 26 people dead was not “a guns situation,” saying instead he believed that “mental health” was the problem. Trump’s comments came at a news conference in Tokyo, when he was asked about the shooting at a South Texas church and if stricter gun laws were the answer. (Parker, 11/6)

Politico: Trump: Texas Shooting Result Of ‘Deranged Individual,’ ‘Isn’t A Guns Situation’
“This is a mental health problem at the highest level,” the president said during a press conference with Japanese Prime Minister Shinzō Abe when asked what policies he would propose in response to the tragedy. “This was a very deranged individual,” Trump said, adding, “We have a lot of mental health problems in our country, as do other countries. This isn’t a guns situation.” (Restuccia, 11/6)

The New York Times: Gun Death Rate Rose Again In 2016, C.D.C. Says
The rate of gun deaths in the United States rose in 2016 to about 12 per 100,000 people, the Centers for Disease Control and Prevention said in a report released on Friday. That was up from a rate of about 11 for every 100,000 people in 2015, and it reflected the second consecutive year that the mortality rate in that category rose in the United States. (Hauser, 11/4)

12. Drug Overdoses Now Leading Cause Of Death For Americans Under 50

According to the Centers for Disease Control and Prevention, drug overdose rates spiked by 17 percent last year. Meanwhile, China says the U.S. has been too aggressive in pinning blame for the fentanyl flooding into the country.

The New York Times: C.D.C. Reports A Record Jump In Drug Overdose Deaths Last Year
Deaths by drug overdose in the United States surged last year by more than 17 percent over 2015, another sign of the growing addiction crisis caused by opioids, according to a report released Friday by the Centers for Disease Control and Prevention. Preliminary data from the 50 states show that from the fourth quarter of 2015, through the fourth quarter of 2016, the rate of fatal overdoses rose to nearly 20 people per 100,000 from 16.3 per 100,000. (Kaplan, 11/3)

The Wall Street Journal: China Plays Down Role In U.S. Opioid Crisis Ahead Of Trump’s Visit
A Chinese narcotics control official played down China’s role in the distribution of synthetic opioid drugs, though U.S. President Donald Trump has vowed to press the issue at a summit in Beijing next week. Wei Xiaojun, a top officer in the Ministry of Public Security’s Narcotics Control Bureau, told reporters on Friday that Beijing is determined to stem exports of drugs like the opioid fentanyl that are made in China. (Areddy and Dou, 11/3)

In news from the states —

The Denver Post: Here’s How Colorado Is Combating The Prescription Opioid And Heroin Epidemic
A bipartisan panel of lawmakers last week supported a package of six wide-ranging bills designed to prevent and treat the state’s drug overdose crisis, building on five years of work from Gov. John Hickenlooper’s administration to identify holes in the current system. The approach — which, according to experts, puts Colorado in the top tier among states nationwide for its response — has been boosted by a $35 million infusion from the federal government to test solutions to what President Donald Trump has labeled a national public health emergency. (Frank, 11/5)

Denver Post: Denver Heroin Users Could Use Supervised Injection Site If Proposal Passes Multiple Hurdles
In semi-private booths, each with a chair and a mirror, Denver heroin users could shoot up with clean needles, no threat of arrest and under the supervision of staff trained to jump in with a life-saving antidote in case of overdose. It would look more like a medical clinic than a party lounge, with floors and furniture that workers could hose down in the event of vomit or blood spills. Staffers would hand out sterile needles and possibly distilled water, but clients would bring their own drugs to cook and inject. (Brown and Murray, 11/5)

13. On The Hunt For Monkeypox: Tracking A Fatal Virus Before It Spreads Across The Globe

As reports of cases flare across Africa, scientists work hard to understand the deadly virus that has no cure.

The Washington Post: Chasing A Killer
Along a narrow, winding river, a team of American scientists is traveling deep into the Congo rain forest to a village that can be reached only by boat. The scientists are from the Centers for Disease Control and Prevention, and they have embarked on this watery journey to solve a decades-old mystery about a rare and fatal disease: monkeypox. (Sun and Mara, 11/3)

In other news —

14. Americans Are Often Clueless About Their Own Obesity, Survey Finds

And doctors are too busy, to embarrassed or ill-equipped to help them. In other public health news: arthritis, diabetes, genetic tests, the shingles vaccine, sickle cell, and soda.

The New York Times: If You Tear A Knee Ligament, Arthritis Is Likely To Follow In 10 Years
When Jason Lalli tore his left anterior cruciate ligament at age 26, he thought he would be fine as soon as he had his knee repaired. As a soccer player who competed through college and then on recreational teams, he knew that A.C.L. injuries could be debilitating but also that orthopedists could fix them. He figured that he would miss a season, but that he could play and coach the game he loved for the rest of his life. (Kolata, 11/6)

Bloomberg: U.S. Diabetes Patients Are About To Get Some High-Tech Relief
Diabetes devices may be having their iPhone moment. For decades, the daily routine of diabetics involved painful needles, finger-pricking lancets and imprecise glucose meters. Now, manufacturers have begun incorporating the slick and consumer-friendly designs of Silicon Valley, linking to phones and other tech devices. (Rausch, 11/3)

Politico: Politically Connected Cancer Mogul Faces Questions Over His Genetic Tests
Patrick Soon-Shiong, the medical entrepreneur who has expanded his influence in Washington by cultivating close ties to both parties, has struggled to meet analysts’ expectations for sales of his GPS genetic test, the key to his plan to transform cancer treatment by matching patients with tailored drug treatments. At the same time, sales of the GPS test are being boosted by purchases from hospitals and clinics associated with doctors who have financial ties to his network of for-profit and non-profit companies. (Tahir, 11/4)

WBUR: Why Experts Are Excited About The New Shingles Vaccine
This summer, Dr. Ben Kruskal learned firsthand about the famously hellish pain that comes with shingles, the blistering rash that afflicts one in three Americans, usually later in life. "There was a sort of a baseline pain that is not easily described but very, very unpleasant," he said. And "an extreme sensitivity to touch, such that even a very light touch in certain areas of my face was exquisitely painful." Weeks later, "I'm back to normal," he said, "and that is something I'm devoutly grateful for." (Goldberg, 11/3)

San Jose Mercury News: Kids And Soda: It’s Even Worse Than We Thought
Two-thirds of kids drink at least one soda on any given day, according to a recent study from the Centers for Disease Control and Prevention. The bad news is that nearly a quarter of American children aged 12 to 19 have either Type 2 diabetes or prediabetes, according to a 2012 study in the journal Pediatrics. (D'Souza, 11/3)

Veterans' Health Care

15. Koch Group To Launch Massive Campaign To Increase Private Sector's Role In VA Care

But the debate over privatizing VA care is fraught with tension -- from advocates who are concerned civilian hospitals wouldn't be prepared for veterans' unique needs to lawmakers who don't want to see the agency undercut.

The Wall Street Journal: Koch Groups To Mount Hard Press To Expand Private-Sector VA Services
A conservative goal of opening more of the Department of Veterans Affairs’ medical services to the private sector is due to get a push from the well-funded Koch brothers’ network. Brothers Charles and David Koch, whose network is planning to spend hundreds of millions of dollars to advance its conservative agenda across the government and protect vulnerable congressional Republicans, will mobilize several affiliates and subgroups to battle for its vision of the future of the VA, Koch representatives said this week. (Kesling, 11/3)

In other veterans' health care news —

The New York Times: Veterans Groups Push For Medical Marijuana To Treat PTSD
Among critics of the federal prohibition of marijuana — a diverse and bipartisan group that includes both criminal justice reform advocates and Big Alcohol — the American Legion and its allies stand out. For more than a year, the stalwart veterans group has been working to reframe the debate as a question of not only moral and economic imperatives, but also patriotic ones, arguing that access to medical marijuana could ease suffering and reduce suicide rates among soldiers who return from the horrors of war. (Ugwu, 11/3)

Administration News

16. Authorities Release 10-Year-Old Immigrant Girl With Cerebral Palsy

Border Patrol agents had taken the girl into custody following emergency gallbladder surgery and held her at a facility in San Antonio, Texas for unaccompanied immigrant minors.

The Associated Press: Immigrant Girl With Cerebral Palsy Released, Now With Family
U.S. authorities released a 10-year-old immigrant girl with cerebral palsy who had been detained by border agents after surgery because she is in the U.S. without legal permission. The American Civil Liberties Union and U.S. Rep. Joaquin Castro said that Rosa Maria Hernandez was returned to her family Friday. Her parents brought her into the U.S. from Mexico in 2007, when she was a toddler, and they live in the Texas border city of Laredo. (11/4)

Reveal: Detained Immigrant Girl Released But Future Remains Uncertain
Federal immigration authorities released Rosa Maria Hernandez on Friday after more than a week in detention. A lawyer for the girl’s family confirmed to the Corpus Christi Caller-Times she was released to relatives from a San Antonio facility for undocumented minors. While he applauded the child’s release, U.S. Rep. Joaquin Castro noted that her future is uncertain because federal authorities have not determined whether she’ll be able to remain in this country. (Devall, 11/4)

Meanwhile, Justice Department lawyers accuse the American Civil Liberties Union of misleading them about an immigrant teen's abortion —

Politico Pro: HHS seeks Supreme Court Review Of Abortion Case Involving Undocumented Teen
In a petition, HHS alleged that American Civil Liberties Union lawyers rescheduled an abortion for the undocumented 17-year-old soon after the D.C. Court of Appeals ruled in her favor, so it would be earlier than planned. ...HHS is now urging the Supreme Court to vacate the lower court’s ruling against the federal government and assert instead that the federal government has no obligation to facilitate abortions for unaccompanied minors in its custody. (Cancryn, 11/3)

Pharmaceuticals

17. FDA Chief On Regulations: Some Need To Be Re-Regulated. Others 'Sort Of Ignored, Not Followed.'

Food and Drug Administration Commissioner Scott Gottlieb discusses the way his agency can approach old and new rules to achieve its pharmaceutical industry goals. Meanwhile, other news outlets cover the Ohio drug pricing ballot measure and the specter of Amazon's entrance into the marketplace.

Stat: Asked About White House Order, Head Of FDA Says Agency Can ‘Deregulate By Regulating’
Just over nine months after President Trump signed an executive order mandating that each new regulation must be accompanied by suggestions for two regulations to eliminate, the head of one regulatory agency told the public that his agency can accomplish this in what might seem like a paradoxical manner — by creating more regulations. “We actually deregulate by regulating,” Food and Drug Administration Commissioner Scott Gottlieb said at a luncheon. He noted that this was not “some magical construct we’ve adopted … over the last six months” but rather that it was the agency’s normal way of doing business. (Swetlitz, 11/3)

California Healthline: Health Companies Race To Catch UnitedHealth As Amazon Laces Up
As soon as news surfaced last week about the potential merger of CVS Health and Aetna, all eyes turned to the looming threat from Amazon. The online retailer’s flirtation with the pharmacy business is a factor, no doubt. But many industry experts say CVS and Aetna have another huge competitor on their minds: UnitedHealth Group. (Terhune, 11/3)

State Watch

18. State Highlights: Partners HealthCare Urges Workers To Lobby Against Mass. Bill To Regulate Hospital Prices; Va. Health Commissioner OKs Merger Despite FTC Opposition

Media outlets report on news from Massachusetts, Virginia, Tennessee, the District of Columbia, Missouri, Colorado, Minnesota, Florida, Pennsylvania, Michigan and Ohio.

The Boston Globe: Partners HealthCare Asks Workers To Oppose State Health Care Bill
Executives at Partners HealthCare and its largest hospitals are so concerned about a big Massachusetts health care bill that they’re asking employees to lobby against some of the legislation’s provisions. Partners executives sent e-mails to most of the organization’s 73,000 employees Friday, warning about the possible ramifications of the bill now making its way through the Senate. (McClusky, 11/3)

Modern Healthcare: Mountain States, Wellmont Skirt Federal Regulation And Score State Merger Approval
The Virginia state health commissioner recently approved the proposed merger between Mountain States Health Alliance and Wellmont Health System despite the Federal Trade Commission's opposition. Both Tennessee and Virginia approved the organizations' certificate of public advantage, or COPA, which essentially allows them to skirt challenges from federal regulators in favor of 10 years of state oversight while the companies integrate under Ballad Health. COPAs are used to demonstrate that a merger's public benefit outweighs potential anticompetitive consequences. (Kacik, 11/3)

The Washington Post: ‘Veritas Will Be Blamed For This’: Ex-Hospital Official Says Consultants Interfered With Patient Safeguards
The consulting firm running D.C.’s only public hospital came under growing pressure Friday as the hospital’s chief medical officer and a former executive who oversaw quality of care said the firm has disregarded patients’ safety in an effort to preserve a lucrative contract with the District government. Veritas of Washington faced intense criticism at a public hearing by the D.C. Council’s health committee, as Maria Costino, who until several months ago was United Medical Center’s director of quality management and patient safety, said the firm’s employees repeatedly sought to handicap her work. (Jamison, 11/3)

KCUR: Planned Parenthood Loses Second Challenge To New Abortion Law
A federal judge in Kansas City on Friday denied Planned Parenthood’s request to block a Missouri regulation requiring its clinic in Columbia to have a so-called complication plan for medication abortions. The Legislature enacted the requirement this summer after Gov. Eric Greitens called it into special session. Later the Department of Health and Senior Services issued a rule that an OB-GYN had to be on call 24/7 to treat complications from a medication abortion. (Margolies, 11/3)

The Denver Post: Child Health Clinic Treats Kids From Birth To 18
The clinic treats kids from newborns to age 18 — about 27,000 visits a year. It is funded by the Children’s Hospital Colorado Foundation, a past recipient of the Post’s Season to Share campaign. The clinic focuses on disease prevention and health maintenance. Services include hearing and vision screening, nutritional counseling and laboratory testing. Mental health services, including consultations with behavioral health and psychiatry specialists, are also available. (McGhee, 11/5)

Tampa Bay Times: When The Goal Is Getting To The ER Fast And Cheap, Some Choose Ride Sharing Over 911
Ride-sharing drivers in Tampa Bay and beyond are noticing an uptick in rides to and from the emergency room as consumers try to avoid spending what could be thousands of dollars for an ambulance. It’s an updated version of a role long played by cabs. What’s new is that the ride-sharing experience, with its ability to tell people how soon a car will arrive, is seen by many as more nimble and better suited to a spur-of-the-moment decision like rushing to the ER. (Griffin, 11/6)

The Detroit Free Press: Optimal Care Bridges Physical Distance With Chats, Weekly Luncheon For Employees
Nearly everyone on Optimal's staff is a full-time employee with full benefits, which isn't always the case in home health care. Optimal is also fairly unique in the industry for offering its employees annual profit-sharing checks. These checks range in size from several hundreds dollars to several thousand dollars, Murphy-DeOrsey said. The company started focusing in recent years on employees' strengths in annual performance reviews, rather than page after page pointing out weaknesses, said Erik Wilson, Optimal's director of nursing. (Reindl, 11/4)

Columbus Dispatch: Cold And Flu Seasons Call For Stepped-Up Cleaning At Schools, Public Buildings
For agencies across central Ohio, the main strategy against spreading cold and flu is to encourage people to get a flu shot, stay home when they’re sick, wash their hands and contain sneezes. But the people responsible for keeping facilities in tip-top shape say that the work done by custodial staffs is another important step in the battle to prevent illnesses this time of year. (Viviano, 11/5)

Editorials And Opinions

19. Parsing Policies: Tax Reform And The Individual Mandate -- Republicans Could Have It Wrong

Opinion writers offer thoughts on a range of health issues, including how the Affordable Care Act's individual mandate is playing into the current debate regarding tax reform, the ongoing efforts by health law opponents to sabotage Obamacare and a dark view of Medicare for all.

The Wall Street Journal: Tax Reform And ObamaCare
Republicans are looking under every seat cushion to finance tax cuts and the political bribes that Members of Congress are demanding for their votes. One surprising potential “pay for,” believe it or not, would be repealing ObamaCare’s individual mandate. The IRS administers the mandate, which ObamaCare euphemistically dubbed an “individual responsibility payment.” But Chief Justice John Roberts called it a tax to declare it constitutional, so a policy and fiscal nexus exists. (11/5)

RealClear Policy: Republicans Are Wrong About The Individual Mandate
President Trump recently tweeted that GOP tax-writers should include a repeal of the Affordable Care Act’s individual mandate in their tax reform legislation. This is a singularly bad idea that most Republicans are likely to reject. (Senators Tom Cotton and Rand Paul are exceptions, having seconded Trump’s suggestion.) It would be irrational and unproductive at this point to import the fractious political combat associated with health-care reform into tax negotiations that are already loaded with controversies. (James C. Capretta, 11/6)

The New York Times: Obamacare Vs. The Saboteurs
Despite the best efforts of the Trump administration and Republicans in Congress to destroy the Affordable Care Act, the law is not collapsing. And on Wednesday, Americans began signing up for health insurance policies for next year through the online exchanges created by that law. (11/4)

USA Today: Pass The Bipartisan Alexander-Murray Health Care Fix
It’s hard to imagine anything less political than Americans’ everyday interactions with our health care system. Illness and accident don’t distinguish between Democrat and Republican. Neither do rising premiums, pre-existing conditions, or the fear that our loved ones might find themselves without insurance. Like it or not, our basic need for health care is something that unites us. (Mack McLarty and Tom Davis, 11/6)

Helena (Mont,) Independent Record: Budget Cuts Are Not Healthy For Montana
In recent years, how we deliver and receive health care in Montana has been transformed. ... One major reason for this was legislative action in 2015. Until then, far too many Montanans went to work every day with the knowledge that access to health insurance and a doctor or nurse practitioner was beyond their reach. ... Montana’s lawmakers saw what was happening in their communities and delivered a bipartisan compromise to expand Medicaid coverage to these low-income, working families, friends and neighbors. As a result, Montana’s uninsured rate has dropped from a staggering 20 percent in 2013 to 7 percent in 2017, and many rural hospitals struggling under the weight of uncompensated care were thrown a lifeline. (Dick Brown, 11/5)

20. Viewpoints: Alzheimer's Heavy Toll; Missouri Owes Its Blind Citizens

A selection of opinions on health care from around the country.

Louisville Courier-Journal: Alzheimer's Carries Heavy Price For Patient And Caregivers
In American culture, we have long feared aging and death. Other cultures have a different take: They honor and admire the elderly and even celebrate the end of life. For many of us in America, the end of life stage brings sadness, stress and fear. But perhaps we can learn from those other cultures that take a healthier approach. One major factor that influences our perception about aging is the prevalence of Alzheimer’s disease – a condition that impacts more than five million Americans, and is the sixth-leading cause of death in America today. (Mauri Malka, 11/4)

St. Louis Post-Dispatch: Deadbeat State Is Cheating 3,000 Blind Missourians Out Of Millions
Missouri Attorney General Josh Hawley last week said he will appeal a judge’s order that the state catch up with $26.3 million in back payments owed to 3,000 citizens who are totally blind. For financial reasons, as well as reasons of simple compassion, Hawley should rethink the appeal. The state does not dispute that it owes the back payments, which stem from the late 1990s and early 2000s. Four previous appeals over how the payments are calculated have settled the issue. In the latest judgment, made public Oct. 8, Cole County Circuit Judge Patricia Joyce figured the state’s bill at $26.3 million. (11/5)

The Washington Post: Should D.C. Build A New Hospital? Officials Should Be Cautious.
Over the past 10 years, the District has spent $179.7 million on the United Medical Center in Southeast Washington. What it has gotten in return is a perennially troubled hospital that has done little to meet the real health needs of residents in Wards 7 and 8. That experience — along with its calamitous operation of the old D.C. General Hospital — should have taught the city to stay out of the hospital business. Instead, officials are blithely talking about spending as much as $330 million to build a new hospital. (11/5)

St. Louis Post-Dispatch: Veterans Home Scandal Puts Governor On The Defensive
House cleaning to guarantee the safety and care of military veterans in Missouri shouldn’t stop with the St. Louis Veterans Home. It needs to include Larry Kay, head of the Missouri Veterans Commission. Kay hired administrator Rolando Carter, who had a troubled background and is now accused of presiding over a dangerously declining state of care at the home. (11/4)