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An Arizona county is poised to become an Obamacare ghost town because no insurer wants to sell exchange plans. Aetna’s announcement that it would exit 11 of 15 states where it offers Obamacare plans leaves residents of Pinal County, Ariz., without options for next year, unless regulators scramble to find a carrier to fill the void. Yet they have limited options and little time before plan approval deadlines for 2017 open enrollment. About 9,700 people in Pinal signed up for Obamacare plans this year, according to HHS data. (Pradhan, 8/18)

In an issues brief, the insurance industry association America’s Health Insurance Plans has recently proposed several changes aimed at helping insurers make more profit on the policies sold to individuals and small businesses through the exchanges. ... Insurer recommendations include scrapping a requirement that the oldest – and likely the sickest — customers pay no more than three times the amount in premiums that the youngest policy holders do. ... Another thing insurers would like to change is the ACA minimum medical loss ratio, which caps the revenues insurers can raise from selling policies after claims and certain other expenses are met. (Radelat, 8/19)

Adults who are poor, young, Latino or work at a small business are most likely to be uninsured, according to an analysis released today by the Commonwealth Fund. Groups that were at risk of not having health insurance before the Affordable Care Act was implemented continue to be at a higher risk of not having coverage under the law, the analysis says. (McIntire, 8/18)

Hillary Clinton's campaign sees no reason to put out an update on her health, chief strategist Joel Benenson said Thursday, smacking down Donald Trump's insinuations and calling on the Republican nominee to release medical records comparable to those put out by the Democratic candidate's campaign in July. Trump knows that there is no issue with Clinton's health, Benenson told MSNBC's Andrea Mitchell, remarking that it "must be driving his ego crazy that she's outworking him, outthinking him, connecting better with the American voters about the issues that matter in their life." (Gass, 8/18)

Newt Gingrich dismissed outright as "junk medicine" on Thursday theories about Hillary Clinton's state of health and treatment, after board-certified internist and media personality Drew Pinsky speculated that the Democratic nominee is not receiving a proper level of care. The former speaker of the House and Donald Trump ally responded on "Fox & Friends" after the show played a clip of Pinsky speaking Tuesday on KABC Radio's McIntyre in the Morning. In that segment, Pinsky said he was "gravely concerned" about Clinton's health, noting her doctor's 2015 assessment that showed a "1950 level sort of care" by the evaluation of himself and a colleague. (Gass, 8/18)

Hillary Clinton’s health care plan clearly intends to tackle affordability issues on Obamacare exchanges. Less clear is whether — or how — it deals with the increasingly prominent issue of insurer participation and financial viability in the marketplace. ... While some experts say addressing consumer affordability issues will, in turn, increase insurers’ profitability on exchanges, others say the Democratic nominee’s proposals fall short of addressing the issue. Some even say a public option, which she has proposed, would only make things worse for private plans by pushing premiums artificially lower. (Owens, 8/18)

So far in the 2016 presidential campaign, Medicare and retiree health plans haven’t been near the top of the burning issues’ list. But these important programs still deserve your careful attention when making your choice this fall. ... your options will be significantly influenced by the next president’s intentions for Medicare benefits and its financing, as well as health care plans for retirees under age 65. Let’s look at the positions Hillary Clinton and Donald Trump have staked out, in alphabetical order. (Vernon, 8/18)

The drug industry is quietly troubled over Donald Trump’s tough talk on trade.The Republican presidential nominee has promised to aggressively renegotiate America’s trade deals — and to tear them up if need be. Those pledges are now rankling a biopharmaceutical sector that depends heavily on the deals to protect their intellectual property and, by extension, their entire business model. Provisions in the deals typically require participating nations to adhere to patent protections similar to those in the United States, to give companies relief if there is a delay in granting a patent, and to keep their clinical data confidential. (Scott, 8/18)

A cluster of Zika cases most likely transmitted by local mosquitoes has been identified in Miami Beach, and federal and state officials are considering whether to advise pregnant women to avoid traveling to the city and possibly even all of Miami-Dade County, a health official said Thursday. Such a decision would signal that the potential threat of local Zika transmission had catapulted to a new level. It would no longer be confined to one zone of active local transmission in Miami — the only one identified in the continental United States up to now. (Alvarez and Belluck, 8/18)

If confirmed in Miami Beach, CDC officials likely would issue an updated travel advisory that includes the newly affected area. It was unclear Thursday where the boundaries of such a warning might be. In a statement, Gov. Rick Scott insisted the outbreak remained confined to Wynwood. "We still believe local transmissions are only occurring in an area that is less than one square mile," he said."As we continue to aggressively assess and test people for Zika, we will make every resource available to fight this virus," Scott said. (Dennis, 8/18)

Health officials are likely now to expand that zone, where they have warned the public that mosquito-borne transmission of Zika is occurring, but it wasn’t clear how large the new zone will be, these people said. Deliberations are under way over whether to designate small pockets or one large one, these people said. The news is just what many in Florida have feared—that the outbreak would spread, hurting the state’s tourist-dependent economy, said Susan MacManus, a University of South Florida political-science professor. “The business community is very alarmed and of course, so are health officials,” she said. (McKay, Campos-Flores and Levitz, 8/18)

Health officials now believe the Zika virus is being transmitted by mosquitoes in parts of Miami Beach, a development that is expected to lead to a travel warning for one of the country’s best known travel destinations. Roughly a handful of cases have cropped up that are believed to be linked to that part of the city, a health official who spoke on condition of anonymity told STAT. Late Thursday afternoon health authorities were working to finalize the area that would be covered by a new travel advisory from the Centers for Disease Control and Prevention. (Branswell, 8/18)

State health officials said Wednesday they have found three more Zika cases believed to have been caused by mosquito bites in Miami-Dade County, bringing to 33 the number of locally transmitted cases in South Florida. One of the cases was in a relatively small area of Miami where health officials think active transmissions are occurring, according to information posted on the Florida Department of Health website. (8/18)

When Republicans left town this summer, they abandoned a billion-dollar Zika rescue package that had become mired in partisan infighting. But now some rank-and-file Florida Republicans — who represent scared constituents clamoring for Washington to do something — are pressuring their leaders to get a deal done, no matter what it takes. Rep. Ileana Ros-Lehtinen (R-Fla.) asked Speaker Paul Ryan (R-Wis.) to convene an emergency session of Congress to pass a Zika bill immediately. Rep. Carlos Curbelo (R-Fla.) is worrying that Congress’ lack of action could cripple him in an already tough re-election battle. And a number of Florida Republicans, including Rep. Dennis Ross (R-Fla.), want their party to fully fund President Barack Obama's larger $1.9 billion Zika request. (Bade, 8/19)

Development of a vaccine to combat the Zika virus is on track for at least the next three or four months, despite the bitter congressional standoff over funding a response. But the scientist in charge of the effort said Wednesday the money is likely to dry up in December. Funding for vaccine research at the National Institutes of Health was part of a much broader $1.9 billion request from the Obama administration that's been the subject of much wrangling this year on Capitol Hill. (Lesniewski, 8/18)

The more researchers learn about the Zika virus, the worse it seems. A growing body of research has established that the virus can cause severe birth defects — most notably microcephaly, a condition characterized by an abnormally small head and often incomplete brain development. The virus also has been linked to cases of Guillain-Barre syndrome in adults, a rare autoimmune disorder that can result in paralysis and even death. Now, in a study in mice, researchers have found evidence that suggests adult brain cells critical to learning and memory also might be susceptible to the Zika virus. (Dennis, 8/18)

The authors of the study cautioned that it is difficult to know the extent to which the findings, in mice whose immune systems were weakened, apply to humans, and said they plan further research. But the findings clearly suggest that Zika may not be as benign an infection for adults—or even children—as currently thought, particularly for those with weakened immune systems, they said. Damage to these cells could potentially lead long-term to depression or other cognitive problems, they said. (McKay, 8/18)

The Zika virus, previously thought only to be a big threat to developing babies, might also affect adult brains, researchers reported Thursday. Tests in mice suggest the virus can get to and damage immature brain cells in adults — something that indicates Zika infection may not be as harmless for grown-ups as doctors have believed. It will take much more study to know if human beings infected by Zika are at risk, but the report, published in the journal Cell Stem Cell, adds another disturbing twist to the Zika saga. (Fox, 8/18)

Wanted: Volunteers willing to be infected with the Zika virus for science. It may sound bizarre, but researchers are planning just such a study — this winter, when mosquitoes aren't biting — to help speed development of much-needed Zika vaccines. The quest for a vaccine began less than a year ago as Brazil's massive outbreak revealed that Zika, once dismissed as a nuisance virus, can harm a fetus' brain if a woman is infected during pregnancy. (Neergaard, 8/19)

It’s banned in Europe.Puerto Ricans took to the streets to keep it off their island. But a controversial pesticide is being aerial-sprayed over a Miami-Dade Zika hot zone in a race to kill the virus-carrying aedes aegypti mosquito. And its use is raising concerns about possible health risks posed by long-term exposure to the chemical. (Dimattei, 8/18)

Thirty people have been diagnosed with a rare paralyzing condition caused by Zika virus infection in Puerto Rico, the territory's health department said Thursday. And Centers for Disease Control and Prevention director Dr. Thomas Frieden says he expects even more cases of Guillain-Barre syndrome in Puerto Rico because the virus is infecting so much of the population. "We think there will be as many as 200 additional cases, given the overall number of infections there," Frieden told NBC News. (Fox and Angulo, 8/18)

When Texas officials announced earlier this month they would allow Medicaid to pay for mosquito repellent for low-income pregnant women — a move meant to stop the spread of the Zika virus — health care advocates greeted the news with tempered enthusiasm. They saw it as a tacit endorsement by Republican state leaders of the usefulness of the federal-state insurance program for the poor and disabled in the face of a public health emergency, but they wished the state had gone further. (Walters, 8/19)

As the opioid epidemic surges, Alabama’s toxicologists are testing more blood samples from overdose victims to determine what drugs were in their bodies. But the results of those costly and time-consuming tests are not always ending up on death certificates. More often than not, when overdose victims are found to have multiple drugs in their bodies, coroners simply write “multiple drug toxicity” or “drug overdose” on the death certificate, says Alabama’s forensic science chief Michael Sparks. (Vestal, 8/19)

Contact lenses are so ubiquitous — about 41 million people in the U.S. wear them — that it's easy to forget that they're actual medical devices, with small but real medical risks. An analysis published Thursday by the Centers for Disease Control and Prevention examined 1,075 reports of corneal infections related to contact lens use from the Food and Drug Administration's Medical Device Report database over a decade. To be sure, these were likely the worst of the worst of these types of infection and can't be considered representative of contact lens infections overall. But of those reports, almost 20 percent described a patient with injuries resulting in decreased vision or a corneal scar, or requiring a corneal transplant. (Hobson, 8/18)

Contact lens wearers must be vigilant in taking proper care of their lenses in order to prevent infections, the CDC warns in a new report. About 41 million Americans wear contact lenses. While they are a safe and effective alternative to glasses, contact lenses can lead to serious problems if not handled properly. In fact, the CDC reports that nearly one in five lens-related eye infections reported to a federal database involved a patient who experienced eye damage. (Welch, 8/18)

A study from the consumer genetic-testing company 23andMe and pharmaceutical giant Pfizer has found 15 new DNA regions associated with mutations that could predispose individuals to major depression. The study was huge: Researchers took the DNA of over 75,000 people who reported being clinically diagnosed with depression and compared it with more than 230,000 customers who reported no such diagnosis.The 15 regions in the scrutinized DNA are the first to be linked to major depression in people of European descent. A previous study looking at over 10,000 people of Han Chinese ancestry found two such regions, but those are insignificant in people whose ancestors are from Europe. (Starr, 8/18)

Eight months after striking a $335 million partnership deal, startup CRISPR Therapeutics and Germany’s Bayer AG are taking the wraps off the new company formed to develop drugs using CRISPR’s gene editing technology. The partners are set to announce Friday that they have christened the joint venture Casebia Therapeutics, and plan to move the company early next year into new offices and labs at 610 Main St. in Cambridge, subleasing 33,000 square feet of space at a Pfizer Inc. research complex outside Kendall Square. Casebia’s interim chief executive, Axel Bouchon, said the company will focus on treatments for blood disorders, blindness, and congenital heart disease. (Weisman, 8/19)

A new way to measure how humans age suggests that Latinos withstand life’s wear and tear better than non-Latino Caucasians, and that they may have their Native American ancestors to thank for their longer lives. The new findings offer some insight into a longstanding demographic mystery: that despite having higher rates of inflammation and such chronic diseases as obesity and diabetes, Latinos in the United States have a longer average lifespan than do non-Latino whites. Those findings emerge from an intriguing effort to devise a biological clock — a standard measure of age more revealing than birthdays, walking speed, wrinkled skin or twinkly eyes. (Healy, 8/18)

Park rangers are warning guests not to swim in warm and hot springs in Grand Teton National Park after confirming the presence of a deadly brain-eating amoeba. (8/19)

The FDA began investigating the company after reports of hair loss, balding and rashes. Last month, the agency took the rare step of issuing a safety alert after learning the company had received 21,000 complaints.The company tells CBS News it is cooperating, and its products are safe. (Duncan, 8/18)

When an influential federal panel recommended in 2012 that doctors omit prostate cancer screening from routine health care, it set off a firestorm. Many men and their doctors seem to have heeded the advice, though the long-term implications won't be clear for a while, a new analysis suggests. (McCullough, 8/19)

A federal judge on Thursday definitively blocked a Florida abortion law to prevent state funds from going to organizations that provide abortions — after the administration of Gov. Rick Scott made the unusual decision to drop further legal action. U.S. District Judge Robert Hinkle had placed a temporary hold on the challenged portions of the law hours before the law took effect last June. The sweeping law also was designed to greatly increase inspection requirements for abortion clinics. Planned Parenthood challenged three parts of the law. (Fineout, 8/18)

A Los Angeles pregnancy center that failed to comply with a state law requiring it to provide clients with information about free or low-cost family planning services, prenatal care, contraception and abortions has agreed to cooperate, City Atty. Mike Feuer announced Thursday. After the Pregnancy Counseling Center in Mission Hills missed an Aug. 14 deadline to correct violations, the city attorney’s office moved to file a lawsuit under a state law that bars unfair business practices and carries a possible $2,500 daily penalty. Feuer also informed the center that his office would seek a temporary restraining order to force it to comply.  (Evans, 8/18)

A handful of advocacy groups say they are concerned that clinics at Walgreens in Missouri and Illinois may limit patients’ access to certain types of care and referrals because of the drugstore chain’s relationship with a religiously affiliated health system. Walgreens announced this year that SSM Health, the Creve Coeur-based Catholic health system, would take over the operations of 27 in-store clinics in Missouri and Illinois. (Liss, 8/18)

The battle between the federal government and two area hospital systems will spill back into court Friday, in a case that could alter the Chicago health care landscape in more ways than one. The case, over a potential merger between Advocate Health Care and NorthShore University HealthSystem, could lead to changes in the cost and quality of health care in the Chicago area. Whether those changes would be good or bad depends on which side is doing the talking. (Schencker, 8/18)

Twin Cities nurses have authorized an open-ended strike at five Allina hospitals. The same group of 4,800 union nurses walked off the job for a week in June. Nurse negotiator Angela Becchetti said rank-and-file members overwhelmingly rejected Allina's latest contract offer. ... The Minnesota Nurses Association says Allina's offer is unacceptable because it would force nurses to bear the brunt of premium increases on their union-only health insurance plans. (Benson, 8/19)

Experts from a variety of fields gathered Wednesday at the Statehouse for a mental health symposium spurred by an Emporia hospital’s struggle last year to find a psychiatric care bed for a suicidal patient. House Speaker Pro Tem Peggy Mast, a Republican from Emporia, said she was inspired to convene the symposium after hearing from officials at Newman Regional Health. That hospital nearly lost federal certification after a botched transfer of a patient who was having chest pains and thoughts of suicide. (Marso, 8/18)

A San Diego woman's harrowing account of her aunt's death last month under California's new physician aid-in-dying law suggests that healthcare providers still have a long way to go to make the process work smoothly for terminally ill patients. ... Compassion & Choices, a not-for-profit group that advocates for end-of-life choices and supports the law, has heard of California doctors writing 25 lethal prescriptions so far. The actual number is probably double or triple that, said Kat West, the group's national director of policy and programs. (Meyer, 8/17)

VA staffing shortages in the Corpus Christi area have created monthslong waits for him and many others among the region’s thousands of veterans as they try to see primary care doctors, dentists and other specialists. The VA also issues vouchers so veterans can see private providers that try to help with the patient load, but delayed payments on claims have forced many doctors’ offices to stop seeing veterans. The waits are emblematic of the challenges VA clinics across Texas and the nation continue to face even after series of stories in 2014 exposed systemic problems within the VA. (Rocha, 8/19)

The U.S. Department of Justice has decided to sue Georgia over its segregated “psychoeducational” schools for disabled children. The head of the department’s civil rights division sent a letter to Gov. Nathan Deal and other state officials Monday describing a breakdown in negotiations over the future of the Georgia Network for Educational and Therapeutic Support, or GNETS. “We have determined that we must pursue the United States’ claims in federal court to vindicate the rights of thousands of affected students with behavior-related disabilities across Georgia,” wrote Vanita Gupta, who heads the civil rights division. (Judd, 8/17)

Joyce Gottesfeld remembers the moment on Feb. 10, 2012, when a code blue rippled through Saint Joseph Hospital in Denver — a patient had gone into cardiac arrest. Gottesfeld had just met with expectant mother Cassidy Smith, who was ready to deliver her daughter, before the emergency struck and mobilized dozens of staff members. During labor, Smith suffered a catastrophic amniotic fluid embolism, a rare but serious condition that caused her heart and lungs to stop working and her blood to stop clotting — as well as her fetus’ heart to stop. (Wenzel, 8/18)

A transgender inmate at a Fort Worth federal prison has reportedly been approved to begin hormone treatment, a critical step in the process to transition. Marius Mason is believed to be the the first female-to-male inmate to obtain transition-related medical care after coming into federal custody, according to The Dallas Voice.  (Mervosh, 8/18)

A new study of sports physicals has shown surprisingly high rates of obesity and elevated blood pressure among Philadelphia student athletes. Researchers at Thomas Jefferson University surveying four years of physical exam results for students ages 10 to 20 found obesity and high blood pressure appear to be as much of a problem for active kids as for their peers. The suggestion, the researchers say, is that even participation in athletics was not enough to protect the youngsters from these health concerns. (Giordano, 8/19)

As the number of cases of diarrheal disease in a two-county outbreak has nearly doubled in the past week, some swimming pools have closed and health officials are reaching out to schools and day-care centers to encourage prevention. Cases of cryptosporidiosis linked to area pools, splash pads and a water park — in Columbus and Franklin and Delaware counties — have jumped from 107 a week ago to at least 202. That's more cases than the health departments saw in the past four years combined. Late Thursday, the city of Columbus announced that it will close all of its pools, spray grounds and the Scioto Mile fountains on Friday. (Smola, 8/18)

The walkway leading up to Healthways’ building is dotted with stones memorializing the company’s 35-year history. It needs a new one to mark the next era: Dr. Mehmet Oz and WebMD founder Jeff Arnold want to turn the local health care staple into a leader in digital care. Arnold and Oz, the daytime TV medical personality, came to the firm's Franklin office Wednesday to introduce themselves to the 1,700 Healthways employees who now work for their Atlanta-based company, Sharecare. (Fletcher, 8/18)

Florida’s medical marijuana program took too long to start for the parents of some sick children. ... Gail said Lucie has seizures that can cause her to fall to the ground. She’s broken her collar bone three times, and has a scar on her face from seizing and collapsing. When Gov. Rick Scott approved the use of a non-euphoric strain of medical marijuana in 2014, Gail believed this could help people like her daughter. ... And then, she waited. It’s now been more than two years. (Forchecz, 8/18)

To many people, spring and fall are the prettiest and most pleasant times of the year in the Peach State. But these temperate, transitional seasons have a downside: They often help trigger allergies. The seasonal pollen that causes an uptick in watery eyes and runny noses has been on the rise in recent years, both in Georgia and elsewhere, and researchers and physicians are working hard to determine the cause and take preventive action. (Peters, 8/18)

As part of Florida’s Healthy Babies Initiative, state health officials are looking into several projects to help cut down on the racial disparities in infant mortality. One such project is the Baby Box—very popular in Finland. ... Mike Mason with the Florida Department of Health’s Office of Minority Health adds it also includes supplies and products for the baby. And, the baby box is seen to have helped Finland with its infant mortality rates. (Cordner, 8/18)

More than half of all Americans will have symptoms of a mental disorder at some point in their lives. Yet, persons with these conditions have historically faced limits on health insurance coverage that have restricted their access to treatment, along with shortages of mental health specialists (particularly those who accept insurance) and a treatment system plagued by fragmentation in care delivery. Such fragmentation stems from the historical separation of mental health providers from the rest of the health care system. ... In this report, we will cover issues that surround treatment for mental disorders, including the prevalence of mental disorders, spending trends, the shortage of practicing mental health specialists, efforts to break down the separation between mental health providers and the rest of the health care system. (Haiden A. Huskamp and John K. Iglehart, 8/18)

[Researchers sought to] assess changes in access to care, utilization, and self-reported health among low-income adults [looking at] ... Medicaid expansion in Kentucky and use of Medicaid funds to purchase private insurance for low-income adults in Arkansas (private option), compared with no expansion in Texas. ... In the second year of expansion, Kentucky’s Medicaid program and Arkansas’s private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health. Aside from the type of coverage obtained, outcomes were similar for nearly all other outcomes between the 2 states using alternative approaches to expansion. (Sommers et al., 8/8)

In 2011, the Public Health Accreditation Board launched the national, voluntary public health accreditation program as a strategy to advance the quality and performance of governmental public health departments. As of May 2016, 134 state and local health departments have been accredited. In addition, Florida, in which employees of all 67 local health departments are employees of the state, achieved accreditation for the entire integrated local public health department system in the state. ... A survey of health departments that had been accredited for one year indicates that >90% report experiencing benefits such as stimulation of quality improvement and performance improvement opportunities; increased accountability and transparency; and improved management processes. (Kronstadt et al., 8/12)

Many believe that the answer to issues of cost and access in the US health system lies in telehealth, which increases access to care, alleviates travel costs and burdens, and allows more convenient treatment and chronic condition monitoring. ... The ACA ... implemented telehealth at the federal level through Medicare, in selected circumstances .... telehealth implementation varies from state to state in terms of what services providers will be reimbursed for delivering .... telehealth faces significant obstacles in becoming an accepted and used health care option for individuals, and states and the nation as a whole cannot fully realize the cost savings of telehealth. ... Congress is now considering a nationwide telehealth parity act. The Medicare Telehealth Parity Act is intended to modernize the way Medicare reimburses telehealth services and to expand coverage for Medicare beneficiaries. (Yang, 8/15)

We analyze the 19 states that have not expanded Medicaid. From 2017 to 2026, expansion in these states would increase nominal state costs by less than $60 billion while increasing federal funding by more than $400 billion. Each new state dollar would draw down between $7 and $8 in additional federal dollars. We were not able to estimate offsetting state revenue gains and full state cost savings. Every broad fiscal review conducted in expansion states finds that such offsets are exceeding state cost increases, so expansion is helping overall state budgets. (Dorn and Buettgens, 8/9)

The U.S. and other countries have made dramatic progress in lowering mortality from cardiovascular diseases, which include heart disease and stroke. In the U.S., the mortality rate has fallen from 590 deaths per 100,000 people in 1983 to 253 in 2013. Recently, this has been due in large part to improvements in emergency response for heart attack patients, in addition to medical advances, reduced smoking rates, and improvements in controlling cholesterol and blood pressure. This chart collection explores prevalence, spending, and health outcomes for cardiovascular disease and related conditions. (8/3)

Many Americans will develop health problems as they age and need assistance with everyday activities. Private long-term care insurance could protect them from high out-of-pocket costs if they need paid assistance at home or in nursing or assisted-living facilities. Yet, only 11 percent of adults ages 65 and older had coverage in 2014, including only 25 percent of those worth at least $1 million and who would benefit most from coverage. Various policy reforms could promote long-term care insurance, such as ones that create new incentives for employers to offer coverage through workplace retirement plans on an opt-out basis. (Johnson, 8/2)

Emergency contraception (EC), sometimes referred to as “the morning-after pill,” is a form of backup birth control that can be taken up to several days after unprotected intercourse or contraceptive failure and still prevent a pregnancy. In 1999, Plan B® was the first oral product approved for use in the U.S. as an EC by the Food and Drug Administration (FDA). Since then, more EC products have been approved, and there has been debate over access to EC, particularly over-the-counter availability for teenagers. Many have confused EC with the “abortion pill,” but EC does not cause abortion, since it works by delaying or inhibiting ovulation and will not work if the woman is already pregnant. This fact sheet reviews the methods of EC, known mechanisms of action, women’s awareness of EC, and current national and state policies affecting EC access. (7/25)

While most of the political universe is distracted by the rearranging of deck chairs, a few have noticed that a vital issue is reemerging that could be important come November. Specifically, the issue is the continuing implosion of Obamacare. This week, the health insurer Aetna announced it was quitting Obamacare in 11 states. This is another failure that was predicted by health-care policy experts but willfully ignored by the partisan liberal architects of Obamacare. As with other signs of economic malaise, the Democrats have to pretend it’s not happening and to say that more of the same or incremental tweaks are all we need. Health care is still an economic issue at the heart of family financial decisions. All politics is local; all health care is personal. (Ed Rogers, 8/18)

More than two and half years have gone by since the Affordable Care Act, a.k.a. Obamacare, went fully into effect. Most of the news about health reform since then has been good, defying the dire predictions of right-wing doomsayers. But this week has brought some genuine bad news: The giant insurer Aetna announced that it would be pulling out of many of the “exchanges,” the special insurance markets the law established. This doesn’t mean that the reform is about to collapse. But some real problems are cropping up. They’re problems that would be relatively easy to fix in a normal political system, one in which parties can compromise to make government work. But they won’t get resolved if we elect a clueless president (although he’d turn to terrific people, the best people, for advice, believe me. Not.). And they’ll be difficult to resolve even with a knowledgeable, competent president if she faces scorched-earth opposition from a hostile Congress. (Paul Krugman, 8/19)

Outside the legal challenges it previously faced, the Affordable Care Act has never been as threatened as it is right now. President Barack Obama’s signature law has so destabilized the individual market for insurance that three large companies have announced they are better off not participating in the exchanges. Aetna earlier this week announced it will exit 11 of the 15 states where it has offered plans through ACA exchanges, while UnitedHealthcare plans to exit 30 of its 34 states, and Humana is pulling out of 88 percent of the counties where it offered coverage. (Brian Blase, 8/19)

Health insurance can be a greedy business. When Aetna Inc. announced plans to pull out of HealthCare.gov in Texas and 10 other states, it cited  $200 million in recent losses from Obamacare. But the nation’s third-largest insurer didn’t remind people that it earned $2.4 billion last year, in part because Medicare drove strong results. That means Aetna could handle the growing pains of this emerging segment if it wished. But it’s a free country and a free market, and health care has to deal with the consequences. (Mitchell Schnurman, 8/18)

A physician in our medical group recently complained about the quality-based component of his pay: “I spent 2 1/2 hours last night looking at my compensation statement, and I found 12 patients that shouldn’t have been included [on my list],” he lamented. He’d narrowly missed his payout threshold and was convinced that his recorded quality performance was inaccurate. Such sentiments are new to Swedish Medical Group, a Seattle-based, 1200-provider multispecialty group that is part of Providence St. Joseph Health. In 2015, we began redesigning compensation to include performance on a specialty-specific quality metric in clinicians’ contracts. The process uncovered a latent hunger for compensation strategies that reflect clinicians’ complex impact on health and high-value care. It also revealed a threat to the joy and meaning of practicing medicine — and a potential path forward. (Christopher R. Dale, Michael Myint and Amy L. Compton-Phillips, 8/18)

Before August 21, 1996, it was a huge hassle for most people to see their medical records — if they could see them at all. ... HIPAA basically said that every US resident, with very few exceptions, has the right to see his or her medical records. What HIPAA didn’t do was make it easy to see them. ... The development of electronic medical records made possible a simpler way to share information between doctors and patients. (Janice D. Walker, Catherine L. Annas and Tom Delbanco (8/19)

Policymakers have long been concerned about the adequacy of the U.S. primary care workforce, especially in rural and low-income areas. In an effort to respond to increased demand for primary care services from new private health insurance markets and Medicaid coverage expansions under the Affordable Care Act (ACA), Congress authorized the creation of the Teaching Health Center (THC) Graduate Medical Education (GME) program, a $230-million, 5-year initiative that began in 2011. The program was designed to increase the number of primary care physicians and dentists trained in community-based settings, on the basis of the well-documented principle that doing so will build long-term clinical capacity in those communities. (Marsha Regenstein, Kiki Nocella, Mariellen Malloy Jewers and Fitzhugh Mullan, 8/18)

Seems like every time conservatives make the case for less regulation of business, some well-known company gets caught breaking rules intended to protect consumers, workers or the general public. This time, it’s Woodland Hills insurer Health Net Inc., which was busted for strong-arming employees into keeping quiet about questionable company practices. Health Net agreed to pay a $340,000 penalty this week after the Securities and Exchange Commission determined that the company illegally linked severance payments for hundreds of employees to their agreeing not to seek whistle-blower awards. (David Lazarus, 8/19)

President Obama has until Sept. 15 to choose the seven-member fiscal control board that will be empowered to effectively control the Puerto Rico’s finances and devise a solution to the island’s $70 billion-plus debt crisis. Six of the seven members will come from lists provided by House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. Obama gets to appoint the other, subject to confirmation by the Senate. Given the events of the past few weeks in Puerto Rico, at least one if not all of the members of that board should specialize not in debt or finance, but public health, which at this point is a far bigger danger to the future viability of the commonwealth. (David Dayen, 8/19)

Prescription opioid overdoses killed almost 19,000 people in the United States in 2014. The terrible toll is traceable in large part to excessive prescribing by physicians and dentists. No less an authority than the Centers for Disease Control and Prevention has recently issued guidelines urging health care practitioners to be much more cautious about passing out what the CDC called “dangerous” medications, whose brand names include Vicodin and OxyContin. So how come the New York Times has chosen this moment to announce, on its prestigious front page no less, that some Americans might not be getting their fair share of opioids? (Charles Lane, 8/18)

The Centers for Medicare and Medicaid Services currently makes incentive payments to hospitals based partially on how well they do on patient satisfaction surveys. These surveys ask patients how they feel their pain was controlled and whether providers did everything they could to help with pain. ... Patient satisfaction scores didn’t create the opioid epidemic, nor will removing them solve it. Nonetheless, removing payments for pain control may be an important step because even the perception that financial incentives are tied to pain scores may contribute to opioid prescribing. (Dhruv Khullar and Anupam Jena, 8/18)

“Legal intervention deaths” of civilians — cases in which someone is killed by a law-enforcement or other peace officer while that officer is on duty — and occupational homicides of law-enforcement officers have garnered increasing attention in the United States, owing to numerous recent high-profile incidents. ... Though these killings account for a small percentage of total U.S. homicides, they represent a significant public health burden and can incite further violence in which more people are killed. The most recent events have raised a number of critical questions. Among the first ones we need to answer are these: What is the true magnitude of the problem? And what are the circumstances associated with these events? A public health approach — a comprehensive method for studying and addressing a health problem — can be applied here. (Alex E. Crosby and Bridget Lyons, 8/18)

It has been 52 years since the Surgeon General first issued a warning regarding the long-term health consequences of tobacco use. Due to great strides in smoking prevention and cessation treatments, the United States as a whole is closer to going smoke free than it has ever been. However, one vulnerable population may require additional policymaker attention and resources if it is to realize a decline in smoking rate: those living with mental or behavioral health issues.  (Charles Debnam, 8/18)

The steady decline in smoking rates among U.S. adults that began in the early 1960s has accelerated substantially during the 7 years of the Barack Obama presidency. Since 2009, the prevalence of cigarette smoking in the United States has fallen at a rate of about 0.78 percentage points per year — more than double the rates observed during the administrations of Bill Clinton and George W. Bush. If the current rate of decline were to continue, the prevalence of smoking among U.S. adults would fall from its current level of 15.3% to zero by around 2035. In contrast, at the slower rates of decline observed during the Clinton and Bush years, smoking would not reach zero until approximately 2070 and 2057, respectively. (Michael C. Fiore, 8/17)

In Texas, the state with the most people without health insurance in America, the poor and the uninsured are at least able to go to emergency rooms and receive care once their condition becomes life threatening. It's a wildly inefficient and costly way to treat sick people, leaving aside arguments about basic humaneness. But the emergency room safety net enables defenders of the health care status quo to make the argument that no one is just allowed to die without care in America. (Vernon Loeb, 8/18)

If you live in tight proximity to mental illness — either in your own life or in that of a dearest loved one — you probably have noticed the growing number of heartbreaking, courageous pieces such as the one in yesterday's Washington Post titled: She 'loved life:' A grieving father wrote openly about suicide and mental illness in daughter's obituary. It seems that hardly a week passes these days without a similar story. And no wonder, when you consider the number of Americans fighting through these baffling conditions. (Sharon Grigsby, 8/18)

A federal appeals court gave medical marijuana advocates what seemed like a big win this week with a unanimous ruling that the federal government may not prosecute people who grow and distribute medicinal cannabis if they comply with state laws. The decision affirms a mandate from Congress, which barred the U.S. Department of Justice in 2014 and 2015 from bringing cases against legitimate pot shops in states that have medical marijuana laws. It makes clear that if operators are meticulously following the rules, they shouldn’t have to worry about the feds coming after them. (8/18)