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Defenders of a Texas law that restricts abortion clinics say its main purpose is to protect women's health. So far, however, it has mainly undermined their safety. Since 2013, when the law began requiring that clinic doctors have admitting privileges at local hospitals, the number of clinics providing abortion services in Texas has fallen by more than half, from 42 to 18. There's no proof that this in any way "elevated" care, as Ken Paxton, the state's attorney general, claims. But many women in the state -- an estimated 100,000 to 240,000 -- have since tried to end a pregnancy on their own, according to research at the University of Texas. (11/18)

Medicaid is the healthcare family's poor relation. It's taken for granted. Its quality is widely derided, even as it's typically saddled with the lowest provider reimbursement rates of any government health program. Republican governors and legislatures refused to accept the central role it was given as the insurance plan for their poorest constituents (though that's been changing). So here's a shocker: Children on Medicaid receive very good care — in many respects better than those on private insurance. (Michael Hiltzik, 11/18)

While [Vermont Sen. Bernie] Sanders has supported the Affordable Care Act, or Obamacare, he has described the legislation as merely a first step toward guaranteeing that every American has health insurance. He has said that creating a single-payer system, similar to the schemes that now operate in countries such as France and Taiwan, would achieve that goal. Such a large expansion of government programs would inevitably require raising trillions of dollars in new revenue. ... In the past, Sanders has proposed financing a single-payer scheme with a payroll tax that would affect everybody, including the middle class. On Monday, that possibility drew a sharp attack from Brian Fallon, Clinton’s chief campaign spokesman. (Jonathan Cohn, 11/17)

Another of Obamacare’s insurers is going under. This time, it’s Health Republic of New York, an insurer that made waves in 2014 for offering some of the lowest-cost insurance plans on New York’s exchange. The non-profit, which had been hemorrhaging money since year one, will shut down by the end of November, taking $265 million in federally-subsidized loans with it. Health Republic is a textbook example of failure in government management, with lessons that should guide future reforms. (Yevgeniy Feyman, 11/19)

Last year, we encouraged returning Obamacare customers to shop around for a better deal. This year, a lot of people will have no choice. In markets throughout the country, the plan in the most popular category that was least expensive this year will not be offered next year. That means that some people who took our advice and shopped for a bargain will need to shop again, even if they’re happy with their plan. (Amanda Cox and Margot Sanger-Katz, 11/18)

We face a critical challenge of keeping our rural hospitals open and thriving. The threats to these hospitals are numerous and include sequestration cuts, the constant threat of shrinking reimbursement rates, geographic areas that serve lower patient volumes than their urban counterparts and a population with unique health challenges that can often be more costly. ... To help Virginia’s rural hospitals remain open and continue to serve those in need, Governor McAuliffe and I continue to work to expand access to health care. Expanding access increases the opportunities for citizens across the commonwealth to get needed health insurance, and allows our state system to reimburse hospitals that care for those citizens not currently covered. (Virginia Secretary of Health and Human Services William Hazel, 11/18)

When is a “best price” anything but?Medicaid regulations require that drug companies charge the state-federal health program for the poor the lowest or “best” price that they negotiate with any other buyer. In theory, the best-price requirement protects taxpayers from price-gouging. With the federal and state governments spending about $20 billion annually on drugs for Medicaid patients, such protection seems valuable. n practice, the Medicaid Drug Rebate Program contributes significantly to a dysfunctional pricing process that undermines competition and inflates drug costs. (Dana Goldman, 11/17)

When should a doctor betray a patient’s confidence? This week the Supreme Court of the State of Washington heard arguments on this question in a case that has profound implications for the doctor-patient relationship. In the case, Volk v. DeMeerleer, a psychiatrist, Howard Ashby, was sued after a patient of his, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before killing himself. (Mr. DeMeerleer also stabbed another son, who survived.) The estate of the victims, Rebecca and Phillip Schiering, took legal action, arguing that Dr. Ashby was liable because he had not warned the Schierings. A lower court ruled in Dr. Ashby’s favor on the grounds that Mr. DeMeerleer, who had occasionally voiced homicidal fantasies, had made no specific threats toward the Schierings during his treatment. (Sandeep Jauhar, 11/19)

The latest results from the National Health and Nutrition Examination Survey, an authoritative federal source, is that the country’s obesity rate hasn’t budged over the course of this decade, despite unprecedented attention and public health campaigns devoted to the issue. The rate stood at nearly 35 percent in 2011 and 2012. The latest figures, for 2013 and 2014, peg the rate at nearly 38 percent. The 3-percentage-point increase from the previous results is not statistically significant — but the 6-point increase from 2003 and 2004 is. (11/18)

Many of our elected leaders beat the drums of patriotism when they send our troops to fight their wars but then refuse to fund vital programs to support them when they return home. Here in North Carolina, Gov. Pat McCrory and the GOP-controlled General Assembly have turned their backs on N.C. veterans who would be eligible for Medicaid expansion funding. In fact, a study by the Robert Wood Johnson Foundation and the Urban Institute concluded that at least 23,300 North Carolina veterans would be eligible for Medicaid if the program were expanded. Refusing to accept those funds, already paid for by N.C. tax dollars, means many veterans in need of vital physical and mental health care services must go without. (Douglas H. Ryder, 11/18)

For many Americans, the holiday season is one of the few times each year they can spend time with their parents and other older relatives. That makes it an ideal time to find out if older loved ones need assistance in any areas of their lives, such as personal care, home maintenance, physical problems, finances and transportation, according to AgeOptions, the Area Agency on Aging of suburban Cook County. Some changes, such as appearance, reflexes and physical or mental health, may be obvious. Others may require looking into the refrigerator, financial records and other aspects of the older person's life. Keep in mind that issues may be connected, such as when physical limitations or lack of transportation make it difficult to shop, cook, clean or visit friends. (11/17)

About 2 months ago, the media was full of news stories about a study called the Systolic Blood Pressure Intervention Trial (SPRINT). This media attention wasn’t because of the publication of a peer-reviewed article. It was because the National Institutes of Health held a media briefing about ending the trial early. ... Although this was certainly good news and the results would be of interest to many, I was concerned, as were many others, about how the announcement was made. At this point, the trial’s results had not been fully analyzed by the study team. More importantly, their meaning and context had not yet been subject to peer review. We live in an age in which the barriers to information dissemination are disappearing. This does not mean, however, that all information should be disseminated immediately. Peer review exists for a reason. (Aaron Carroll, 11/18)

[T]here is reason to be concerned about the decline in prostate cancer screening and prostate cancer incidence reported [in JAMA]. Certainly, physicians have been overly aggressive in their approach to prostate cancer screening and treatment during the past 2 decades, but the pendulum may be swinging back the other way. It is time to accept that prostate cancer screening is not an “all-or-none” proposition and to accelerate development of personalized screening strategies that are tailored to a man’s individual risk and preferences. By doing this, it should be possible to reach some consensus around this vexing problem. (David F. Penson, 11/17)