�鶹Ů��

President Barack Obama said “a handful of people” would take a hit from hefty health-insurance premium increases due to kick in next year, and that all of those people had previously been uninsured, in remarks that downplayed problems with his signature health law as it takes on greater prominence in the final days before the election. Data from the Department of Health and Human Services puts that handful as high as 8.4 million – between almost seven million people who buy coverage directly from insurers, and another 1.5 million who use HealthCare.gov or a state equivalent but don’t meet income criteria for a tax credit. Others say the handful may be even higher. (Radnofsky, 11/3)

While the Affordable Care Act has pushed the uninsured rate in the U.S. near a record low, a Commonwealth Fund study this year found that about four in 10 adults in ACA plans aren’t confident they could afford care if they got sick. Affordability has become a major issue in the presidential campaign. Donald Trump, the Republican candidate, has pointed to rising premiums as a sign that the ACA doesn’t work, and promised to repeal it. Hillary Clinton, the Democratic candidate, has pledged to fix the law, in part by boosting subsidies to buy insurance. Any major changes would need action by Congress. (Tracer and Doherty, 11/4)

With a string of comeback wins, the Federal Trade Commission has proved it's still capable of foiling healthcare consolidation it deems out of bounds—even though most of the deals it fights these days are wrapped in the flag of reform. A federal appeals court on Nov. 1 handed the FTC a big victory Oct. 31 when it revived its effort to challenge a proposed merger of Advocate Health Care and NorthShore University HealthSystem in Chicago's northern suburbs. And last month the agency won its appeal to temporarily block the union of Penn State Hershey (Pa.) Medical Center with PinnacleHealth System, which prompted them to abandon their plans. (Castellucci, 11/4)

New data show that 16.4 million people have gained health insurance since ObamaCare’s main coverage provisions went into effect in 2013. The survey from the Centers for Disease Control and Prevention (CDC) finds that the uninsured rate is near a record low, at 8.9 percent, just slightly higher than the 8.6 percent record in the first quarter of this year. In 2013, it was 14.4 percent. (Sullivan, 11/3)

There were roughly 28 million uninsured Americans during the first six months of this year, a significant change from the 48 million consumers who lacked coverage at the time of the enactment of the Affordable Care Act in 2010. Government-subsidized health insurance policies for low and middle-income people, along with an expansion of the Medicaid program in more than half of the states, have helped more than 20 million uninsured people obtain coverage. But as the politically embattled program begins its fourth year of operation in January, Obamacare has been rocked by skyrocketing premiums, high deductibles and an alarming number of major insurers including Aetna and UnitedHealthcare deciding to pull out of the market after incurring tens of millions of dollars in losses. (Pianin, 11/3)

Advocates and opponents are gearing up for a life or death battle over a problematic Affordable Care Act in 2017, and the idea of a government option in health insurance is gaining some traction among Democratic legislators. ... A public option would involve a government-run health plan that would compete with private options offered on the health law’s exchanges. It would be different from a so-called single-payer system under which a government-run national health insurance program would cover everyone. (Armour, 11/3)

The Affordable Care Act was a major point of contention when U.S. Sen. Ron Johnson ran against then-Sen. Russ Feingold six years ago, and it's front and center again with their rematch coming up Tuesday. Johnson, a Republican who was elected to the Senate partly because of his opposition to the health insurance reform law, remains one of its most steadfast critics. Feingold, a Democrat who voted for the law, continues to support it. But with the law now in its sixth year, few opponents talk of returning to the status quo that existed before it was implemented, and few supporters suggest it has worked out exactly as planned. (Boulton, 11/3)

The sign-up period for 2017 Obamacare health plans began this week, but leaders of Connecticut’s health insurance exchange are eyeing the need for significant changes in the following year to ensure that the marketplace remains viable. ... Two of the four insurers that sold plans through Access Health this year are not offering exchange plans for 2017, and the head of one of the remaining insurers, Anthem, indicated Wednesday that the company might consider leaving exchanges across the country in 2018 without improvements in “the pricing and regulatory environment.” (Levin Becker, 11/4)

President Obama on Thursday mocked Republicans, saying they do not even have “a hint” of a plan to replace ObamaCare, despite vowing to repeal it. “They don’t even have a pretense of a plan,” Obama said at a campaign rally for Democratic presidential nominee Hillary Clinton in Miami, Fla. “They don’t even have a semblance of a plan. There’s not even a hint of a plan.” Obama touted that the law has expanded coverage to 20 million people who did not have it before. (Sullivan, 11/3)

President Obama on Thursday slammed Republicans for advocating for the repeal of the Affordable Care Act, and for doing so without an alternative health plan. “They want to repeal because, ideologically, they’re opposed to the idea of helping these 20 million people get health insurance,” Obama said in Miami at a Hillary Clinton campaign event. “It’s not like — they don’t even have a pretense of a plan. They don’t even have a semblance of a plan. There’s not even a hint of a plan.” Obama has been defending the Affordable Care Act, his signature domestic policy achievement, in recent weeks, touting the number of people who have gained health insurance coverage under the law. (McIntire, 11/3)

President Barack Obama today mocked Donald Trump’s call to repeal Obamacare, dismissing the Republican nominee’s stance on the president’s signature health care law as stubborn obstruction and claiming Trump has “not even a hint of a plan” of what to do afterward. Campaigning for Hillary Clinton in Miami, Obama lit into Republicans, accusing them of fostering needless gridlock in Washington, as he did Wednesday in North Carolina. Today, he went on a riff about Obamacare, hitting congressional Republicans for repeatedly voting to repeal the 2010 law and then poked at Trump, who at a recent press conference called for a special session of Congress to “repeal and replace” it amid premium increases. (Conway, 11/3)

Cigna Corp. said profit fell in its latest quarter as its government business dragged on results. The government segment’s issues included medical costs in Cigna’s small Medicaid business, particularly in Texas and Illinois. Cigna also faced expenses related to a Centers for Medicare and Medicaid Services audit of its Medicare plans. (Hufford, 11/3)

Cigna Corp. third quarter profits were down compared to a year ago as costs to reform its Medicare Advantage and Medicare drug prescription programs were a drag on results. ... Cigna has been under sanctions from federal regulators since late January. The Centers for Medicare and Medicaid Services said Cigna had widespread and systemic failures that prevented seniors from accessing medical services and prescription drugs. It said that the ways Cigna operated in restricting access to drugs and services created "a serious threat to enrollees' health and safety." (Lee, 11/3)

The health insurer Cigna is planning for a loss on the Obamacare market next year, its CEO said Thursday. “We are going to expect to see some revenue growth but we are continuing to plan for a loss,” CEO David Cordani said on the company’s third quarter earnings call. The insurer’s strategy to slowly expand into the new marketplace created by the Affordable Care Act has “proven to be more right than wrong,” he said, noting that was unfortunate. (McIntire, 11/3)

Are you suffering from election stress disorder? It seems like everyone I know has it. Last week my kindergartner woke up at 5 a.m. with nightmares about “two people running for president.” One friend wrote on Facebook that she is barely sleeping at all and now fills the pre-dawn hours canning fruit. I’ve heard reports of chest pains and short-term Xanax prescriptions within my circle as Nov. 8 draws near. (Netburn, 11/4)

More than half of Americans are experiencing election-related stress comparable to that often attributed to work, money, or the economy, the American Psychological Association has said. And while the good news is the presidential contest will end next week, the bad news is that because of the ferocity of the campaign, the mental damage may linger. And for some groups, it may get even worse—depending on who wins...The hope is that once this election is over, and the constant barrage of negativity via television, radio, and mobile phone ends, things may return to some semblance of normal. But not everyone is so optimistic.  (Shanker, 11/4)

In an election season in which the presidential campaign “issues” have ranged from “hot mics” to emails, some down-ballot campaign ads highlight a wonky, far less racy topic: a tax on medical devices. Really? Why? (Appleby, 11/4)

If Colorado voters pass a first-in-the-nation statewide universal health care proposal this year, a typical elderly couple on Social Security and Medicare would save nearly $2,000 per year, according to the proponents’ campaign. Or they would end up paying nearly $1,800 extra per year, a separate analysis finds. Or perhaps they might pay more than that, opponents of the measure warn. When it comes to Amendment 69, the universal health care measure known as ColoradoCare, the simplest question — How much would I pay? — is fraught with disagreement. That’s because many of the decisions that would determine exactly what ColoradoCare would look like, what it would cover and even how much it would ultimately cost individuals wouldn’t be made until after it is passed — including some decisions that would be made by people not in Colorado. (Ingold, 11/3)

It is now just as likely for middle school students to die from suicide as from traffic accidents. That grim fact was published on Thursday by the Centers for Disease Control and Prevention. They found that in 2014, the most recent year for which data is available, the suicide rate for children ages 10 to 14 had caught up to their death rate for traffic accidents. (Tavernise, 11/3)

Being worried sick is more than just a figure of speech. It’s also a medical fact: Anxiety has been associated with everything from migraines to tumor metastases. But doctors thought that anxiety about health could be an exception. Obsessing about obesity might inspire you to exercise more, and stressing about lung cancer could get you off cigarettes. Or it might just stress you out — and potentially increase your risk of poor cardiovascular health, as researchers found in some 7,000 Norwegians. In a study, published Thursday in the BMJ, the authors reported that health anxiety — what physicians until recently called hypochondriasis — increased the patients’ risk of heart disease by 73 percent. (Boodman, 11/3)

As a doctor who worked at one of Boston's busiest hospitals, Vivek Murthy is no stranger to life-and-death situations. But it's still a minor political miracle that he survived a battle with the NRA — a yearlong standoff over Murthy's comments about gun violence had threatened to derail his nomination for surgeon general before he was eventually confirmed in 2014. The bruising confirmation fight has made Murthy wary of misspeaking, but two years into the job, it hasn't changed his mind on guns. (Diamond, 11/3)

Attention smokers: For every year that you continue your pack-a-day habit, the DNA in every cell in your lungs acquires about 150 new mutations. Some of those mutations may be harmless, but the more there are, the greater the risk that one or more of them will wind up causing cancer. (Kaplan, 11/3)

Kevin Turner, a high-profile professional football player who was thought to have died of ALS, was actually afflicted with the degenerative brain disorder chronic traumatic encephalopathy, according to results of his autopsy presented Thursday. The findings are the “best circumstantial evidence we will ever get that this ALS-type of motor neuron disease is caused by CTE,” said Dr. Ann McKee of the Boston University CTE Center at a press conference Thursday. That’s not to say that every case of ALS is actually CTE, but rather than CTE in certain parts of the brain can cause symptoms similar to ALS, and may be misdiagnosed. (Swetlitz, 11/3)

The link between ALS and CTE has been known for years — NFL players face a quadruple risk of getting ALS — but [Ann] McKee said [Kevin] Turner's brain offers the best evidence yet of the connection... Of 90 brain-bank specimens examined so far, she said, 17 have been found to have both CTE and signs of ALS. The bank — run jointly by the Department of Veterans Affairs, Boston University School of Medicine and the Concussion Legacy Foundation — has received more than 380 brain donations so far. Turner had been a prominent plaintiff in the major concussion lawsuit brought by former players against the NFL. (Goldberg, 11/3)

The birth defects caused by Zika have been described in heartbreaking detail as the virus has spread to more than 45 countries, infecting hundreds of thousands of people, including tens of thousands of pregnant women. Now researchers have concluded that a Zika infection during pregnancy is linked to a distinct pattern of birth defects that they are officially calling congenital Zika syndrome. (Sun, 11/3)

Researchers wanted to know more about the associations between the amount of sleep students get, how sleepy they are in the daytime and a brain function known as self-regulation — the ability to control emotions, cognitive functions and behavior. Night owls tend to have the hardest time with self-regulation, the researchers found. These students have more memory problems, are more impulsive, and get irritated and frustrated more easily. (Stein, 11/3)

The first Death Cafe was held in London in September 2011 to de-stigmatize talking about death over cake and conversation. This isn't a funeral home pitching their business. Topics range from grieving and funeral practices to end of life care and advance directives. Lizzy Miles is a hospice worker who organized the first death cafe in the United States four years ago in Columbus, Ohio. (Miller, 11/3)

A Harvard University study shows [Elsie] Young is not the only one to feel the effects of faith physically and emotionally. The study, published this year and led by epidemiology professor Tyler VanderWeele, found that women who attended religious services had a longer, healthier life. The more services attended, the study found, the better a woman’s chance of delaying death and the higher the odds of avoiding depression, suicide, smoking and other ailments. (King, 11/4)

A new estimate of the health impact of soda taxes in Mexico sheds some light on what’s at stake in ballot measures coming to a vote in three Bay-area cities and Boulder, Colo. next week. In cases of heart disease and diabetes averted, the model suggests that, in Mexico, those levies are on track to save close to a billion dollars and powerfully improve lives. After a tandem run-up in consumption of sugar-sweetened beverages and obesity, Mexico has become one of the fattest countries on Earth. In 2014, it adopted a 10% excise tax on the sale of sugary drinks. (Healy, 11/3)

Can public health officials force Americans to break their soda habit? The answer may come soon from the University of California, San Francisco, a health sciences center that has more than 24,000 employees on its sprawling campus. Last year, U.C.S.F. removed sugar-sweetened beverages from every store, food truck and vending machine on its campus. Even popular fast-food chains on the campus, like Subway and Panda Express, have stopped selling Sprite, Coca-Cola and their sugary brethren at the university’s request. (O'Connor, 11/3)

Voters in four U.S. cities will decide on Tuesday whether they would like to tax sugary drinks, the latest in a series of such measures as officials and nutritionists seeks ways to address obesity, diabetes and other health epidemics. The following are some cities and states around the United States that have taxes or are considering imposing them for soft drinks, sugary beverages and sellers of sodas. (Prentice, 11/4)

On Wednesday, Oct. 12, 6-year-old Jonathan Daniel Ramirez Porter woke up with a fever. His mother, Marijo De Guzman, decided to keep him home from kindergarten in Ferndale, Wash., a small town less than an hour south of the Canadian border. Instead of getting better, Daniel complained of a severe headache the next day. By Saturday, Oct. 15, he was stumbling and drooling, unable to keep food in his mouth or to speak clearly. (Hurley, 11/3)

Researchers developing drugs against polio and other polio-like viruses say those drugs could potentially be effective against a mysterious, polio-like condition called acute flaccid myelitis (AFM). The Centers for Disease Control and Prevention has confirmed 89 cases of the paralyzing disease in the United States through September. A 6-year-old boy suspected of having AFM died in Seattle on Sunday, the first death believed to be caused by the disease. (Hurley, 11/3)

The Ebola virus mutated to more effectively infiltrate human cells during the West African outbreak that killed more than 11,300 people between 2013 and 2016. That's the finding of two teams of virologists in studies published Thursday in the journal Cell. The scientists identified a mutation that changed the part of the virus that fits into receptors on the exterior of the host cell. (Kaplan, 11/3)

The Ebola virus that went on a deadly three-year rampage in West Africa before it was smothered earlier this year was on the move in more ways than one. Two new studies show that, in the course of the West African epidemic, the Ebola virus underwent evolutionary changes that made it more deadly and easier to spread from human to human. (Healy, 11/3)

The researchers do not yet understand exactly how it works, but several lines of evidence suggest it helped expand the scope of the epidemic. One alarming finding: Patients infected with the mutated version of Ebola were significantly more likely to die. “It’s hard to escape the conclusion that it’s an adaptation to the human host,” said Dr. Jeremy Luban, a virologist at the University of Massachusetts Medical School and an author of one of the new studies. (Zimmer, 11/3)

Ryan Ainsworth and Grant Seaver, both 13, were students at Treasure Mountain Junior High School in Park City, Utah. They were best friends who shared the hobbies of adventurous Utah teenagers — spending afternoon on skis, dirt bikes or skateboards. Relatives spoke of their bright and beautiful smiles. “Grant was a happy boy,” as Lisa Sippel described her nephew to Utah’s Fox 13, “who lived every minute of his short life to the fullest.” In September, the young teens died within 48 hours of each other. (Guarino, 11/4)

Baltimore-area school systems are stocking their health suites with naloxone, the heroin overdose drug, and training nurses to administer it.Use of naloxone has become commonplace for paramedics, police officers and family members of addicts as the number of opioid-related deaths has increased dramatically in Maryland and across the country. ... Anne Arundel County schools began stocking naloxone — also known by the brand name Narcan — in school health rooms last spring. Baltimore County and Carroll County started programs this school year. (Wood, 11/3)

Last year, the Texas legislature approved a $350 million cut in Medicaid reimbursement rates to early childhood intervention therapists and providers. The cuts, made to help balance a billion dollars in property tax relief, affect the most vulnerable Texas children — those born extremely prematurely or with Down syndrome or other genetic conditions that put them at risk for developmental delay. For months, providers of in-home physical, speech and occupational therapies have continued to serve children who have disabilities, despite mounting financial losses. Now some have had to shut their doors, curtail services or halt their home-visit programs, leaving many children without treatments their parents feel are crucial to the kids' well-being. (Goodwyn, 11/3)

A public letter by the head of the Kansas Department for Aging and Disability Services praising KanCare’s effect on Kansans with disabilities has drawn a string of rebuttals from people who provide disability services. Tim Keck’s letter was published Oct. 24 by the Wichita Eagle editorial page. In it, the interim KDADS secretary said KanCare — the state’s move to privatize Medicaid under the administration of three insurance companies — has improved the lives of Kansans with disabilities and that the state’s safety net is strong. (Marso, 11/3)

Medicaid Commissioner Stephanie Azar urged lawmakers not to abandon a plan to change to a system of managed patient care, a sweeping change that might be in jeopardy because of uncertain funding. The Legislature's contract review committee today temporarily blocked an $8.3 million, one-year contract renewal with a consulting firm that is helping Medicaid with the transition to regional care organizations, or RCOs. (Cason, 11/3)

The Department of Vermont Health Access has started reallocating $4 million in Medicaid money from academic medical centers to family doctors. The department reduced what it pays the University of Vermont Medical Center by $2.9 million, what it pays Dartmouth-Hitchcock Medical Center by $1 million, and what it pays out-of-state academic medical centers by $100,000. ... Lawmakers say the Legislature approved the $4 million transfer after defeating a proposal from Gov. Peter Shumlin to raise $17 million from a new tax on independent doctors and dentists and then put $4.8 million of that money toward increased reimbursements. (Mansfield, 11/3)

The Louisiana Department of Health and the state's Medicaid program are in one of the strongest financial positions in six years, after the state opted to expand Medicaid through the federal Affordable Care Act, a new report shows. LDH's fiscal forecast report predicts that, because of the infusion of federal dollars tied to Medicaid, the department will end the budget cycle next June with a modest $2.85 million surplus, after facing deficits in five of the previous six years. (Crisp, 11/3)

At least 17 states have changed procedures so their Medicaid health care programs for the poor will pay hospitals to insert the implants at the most opportune moment — when women are already at the hospital having a baby. That often is the only opportunity that many of them have for a face-to-face discussion with doctors about the best methods of birth control. It’s also the occasion to do something about it. (Ollove, 11/4)

San Francisco Bay Area companies say Sutter Health is strong-arming them into a contract that would help the hospital system secure its power over prices and potentially raise the cost of medical care for their employees in the future. Dozens of companies have received a letter, via their insurance administrators, asking them to waive their rights to sue Sutter. If they don't, a fact sheet included in the letter says, the companies' employees who get care through Sutter's network of hospitals, doctors and medical services will no longer have access to discounted in-network prices. (Dembosky, 11/4)

Later this month, [David] Kalin heads to Havana with a delegation of more than a dozen health professionals from throughout the nation, including at least six from the Tampa Bay area. They will meet with counterparts to learn more about Cuba's medical industry and discuss potential collaborations — an initiative made possible by the White House move in December 2014 toward normalization of relations between the two nations after five decades of isolation. (Guzzo, 11/3)

Though the benefits of hospitalized patients getting out of bed and moving around has been known for decades, most hospitals keep young patients in pediatric intensive care units under heavy sedation for fear they might dislodge a breathing tube or IV line, or injure themselves. Sedation also was thought to reduce the fear and anxiety children experience when hospitalized. Newer studies have debunked such notions and linked hospital sedation to weakness, and higher risks of post traumatic stress disorder and delirium in all patients. (Wells, 11/3)

For Dr. David Chang, a vascular surgeon from Cupertino whose office is in Los Gatos, innovation is a way of life. With more than 10 patents to his name over the course of 16 years of professional practice experience, Chang’s biggest achievement to date is the development of a minimally invasive technique to treat blockages in the carotid artery at risk of causing a stroke. The procedure, which Chang calls “transcarotid artery revascularization,” or TCAR, replaces a technique previously used by surgeons known as “transfemoral carotid angioplasty.” (Sarwari, 11/3)

State medical authorities revoked the medical license of an “integrative medicine” doctor Thursday for his role in the death of a college student from untreated cancer. Bad advice from Dr. Kenneth Woliner of Boca Raton was responsible for the student’s decision to forgo chemotherapy, said the Florida Board of Medicine at a meeting in Jacksonville. Woliner said he will seek a court stay of the board’s decision while he appeals it through the court system. Courts usually grant stays in such cases. (Benk, 11/4)

Two Florida-based Sanford Burnham trustees have resigned from their posts, the Orlando Sentinel has learned... The Sentinel reported last month a months-long investigation by the University of Florida cleared Dr. Bernie Machen, former UF president and trustee board chair, of having a potential conflict of interest in chairing the Sanford Burnham trustee board while the institute was working to hand off its operations to UF. (Miller, 11/3)

The Columbus city prosecutor has charged former Ohio State Dental Board executive director Lili Reitz with leaking confidential information in an investigation into a MetroHealth System executive now facing federal prosecution. Reitz is the fifth person charged in an FBI probe into Edward Hills and dentists affiliated with MetroHealth. Charging documents say Reitz, 51, of Dublin gave former dental board member Hills the identity, home address and email address of a person who made an anonymous complaint about him to the dental board. (Heisig, 11/3)

In the days after Halloween, leftover candy seems to linger indefinitely. It shows up in office break rooms and on receptionists’ desks, tempting passers-by to dig into the big plastic bowl just one more time. Local dentists are encouraging another tradition. They’re encouraging patients and others in the community to skip the extra Snickers and bring it to their office instead, where people will receive $1 for every collected pound of candy. (Caiola, 11/3)

The results for nearly half of all clinical trials conducted by big drug makers during the last decade have not been published, and one company — Ranbaxy Laboratories — has not published findings for any of the nearly three dozen trials conducted in the past 10 years, according to a new online tool. The tool was launched Thursday by AllTrials, a consortium of researchers and medical journals that has been pushing the pharmaceutical industry to do a better job of disclosing clinical trial data. This is an important, but also contentious, issue because without access to such data, independent researchers are unable to verify results that can lead to improved treatments, better health care, and lower costs. (Silverman, 11/3)

The National Institutes of Health will require applicants for federal research funding to submit a plan outlining how data gleaned from a potential project will be shared with the public, Director Francis Collins told CQ Roll Call. This move is part of a larger push from President Barack Obama’s administration to make information gathered from government-backed studies more public. (Williams, 11/3)

Of 2.6 million total deaths in the United States in 2014, 2.1 million were among Medicare beneficiaries. Although Medicare spent significantly more on care for people at the end of life who died in 2014 ($34 529 per person) than for other beneficiaries that year ($9121 per person), the share of total Medicare spending for people at the end of life decreased from 18.6% to 13.5% between 2000 and 2014. Medicare spending for people at the end of life also decreased with age. Hospice use among Medicare beneficiaries at the end of life increased between 2000 and 2014 to nearly half (46%) of all beneficiaries. Medicare spending on hospice also increased during that period, from $2.3 billion to $10.4 billion. (Griffin et al., 11/1)

In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014. ... Of 111 patients included ... 81 (73%) were emergent vs 30 (27%) elective admissions. Only 15 (14%) had an advance directive. Of the 81 (73%) patients placed on comfort care, 31 (38%) had care withheld or withdrawn despite available medical options, 15 (19%) had an advance directive, and 28 (25%) had a palliative care consultation. ... Palliative care consultations may be underused at the end of life. A large percentage of patients were transitioned to comfort measures despite available treatment, yet few presented with advance directives. (Wilson et al., 11/2)

Even after full implementation of the ACA coverage expansions, an estimated 28 million to 31 million people will remain uninsured and will continue to rely on the safety net for care. Hence, for some safety-net providers, the expansion in coverage may not be sufficient to offset reductions in federal payments for uncompensated care. ... The concentration of uninsured or high-risk patients with costly or complex conditions who are cared for by safety-net providers could increase as newly insured persons seek other sites of care. ... In addition to expanding health coverage, the ACA included a variety of provisions to advance health care payment reform. ... studies of all three programs have shown that safety-net hospitals face a higher risk of being penalized through reductions in payments than other hospitals. (Chokshi, Chang and Wilson, 11/3)

In March 2016, the American Academy of Pediatrics (AAP) released the first-ever policy statement on poverty, calling for pediatricians to screen and address poverty and related social determinants of health (SDH). ... Notably, poverty has grown by 66% in suburban communities over the past decade, double the rate in cities. ... Low-income suburbanites confront challenges distinct to this setting. The first is the lack of access to safety net services. Food pantries and other resources are often less available .... Second is the relative lack of public transportation. ... The AAP recommends that pediatricians identify families in need, connect families to resources, and coordinate with community partners. Doing so in suburban practices may require approaches that differ from urban practices. (Palakshappa and Fiks, 11/1)

[M]illions of people — 28 million nonelderly people as of the end of 2015 — remain without coverage. ... Over half (57%) of the ... uninsured are outside the reach of the ACA either because their state did not expand Medicaid, they are subject to immigrant eligibility restrictions, or their income makes them ineligible for financial assistance. The remainder are eligible for assistance under the law but may still struggle with affordability and knowledge of options and require targeted outreach to help them gain coverage. For both eligible and ineligible remaining uninsured people, health care needs persist regardless of insurance status, underscoring the importance of safety net providers and community health clinics to serve this population. (Garfield et al., 11/1)

Fewer U.S. men got prostate biopsies and surgery after new recommendations steered most men away from routine prostate cancer screening, researchers reported Wednesday. Their findings add to a growing body of research that's adding to the debate about prostate cancer screening and often leaving men and their doctors more confused than informed. ... The latest report, published in the Journal of the American Medical Association's JAMA Surgery, shows the new guidelines have indeed cut back on the number of procedures that men are undergoing. (Fox, 11/2)

Did you not get enough sleep last night? You may find yourself overeating today. That’s the conclusion investigators came to after reviewing data on 172 participants in 11 sleep studies. (Bakalar, 11/2)

A risk-based gun removal law enacted in Connecticut in 1999, which allows police to temporarily seize firearms from people thought to be at risk of harming themselves or others, has prevented an estimated 72 suicide deaths, a new analysis suggests. (King, 11/2)

In a growing number of states, Medicaid directors have come to believe they could save money by housing the homeless. The federal government is providing money to find out if they're right. There's good reason to think this is an experiment worth trying. The idea arose from two developments. First, Obamacare's drastic expansion of eligibility for Medicaid coverage has raised the number of homeless people who sign up. These beneficiaries often suffer from unmanaged illnesses, which lead to higher health-care costs and put a strain on Medicaid budgets. Second, in recent years, policy makers have come to better understand how the way people live affects their medical needs. (11/3)

Anthem Inc. is threatening to leave the Obamacare exchanges. But in fact, this is huge news, because Anthem runs the Blue Cross/Blue Shield organizations in 14 states. And though Anthem doesn't appear to be the sole company offering exchange coverage in any of those states, the Blues are generally the backbone of the exchanges. Where others have quailed, the Blues have by and large stuck with Obamacare. If they pull out, then it’s likely that we’ll see more counties, and possibly entire states, with no Obamacare policies on offer. (Megan McArdle, 11/3)

In early 2009, the drafters of the Affordable Care Act (ACA) agreed that as part of their insurance coverage Americans should have access to clinical preventive services without cost sharing. To avert demands for services of unclear effectiveness, they proposed that health plans should, at minimum, cover services with an A or B grade from the U.S. Preventive Services Task Force (USPSTF), a federally sponsored expert panel known for making careful assessments grounded in rigorous scientific analysis. For advocates of evidence-based medicine, this provision represented a singular achievement. But the USPSTF’s transition from arbiter of evidence to full-fledged policy authority has provoked sharp debate. (David Merritt Johns and Ronald Bayer, 11/3)

Gov. Terry Branstad’s unpopular privatization of Medicaid is turning out to be an even bigger train wreck than anticipated. Since he handed over administration of the government program to for-profit insurers on April 1, numerous Iowans have been denied health services, providers have closed their doors and seniors have lost in-home care. The governor has ignored or dismissed these complaints. Yet when the managed care companies collecting hundreds of millions of public dollars for “administration” started grumbling, Branstad snapped to attention. (11/3)

The Centers for Medicare and Medicaid Services (CMS) efforts to eliminate fraud and abuse are necessary to protect program integrity, which is the practice of a majority of caregivers in our industry. Florida –– more specifically, South Florida –– is the epicenter of home health fraud. To combat this, CMS in 2013 imposed a three-year moratorium on new Medicare agencies in Miami-Dade County, a two-year moratorium in Broward County (Fort Lauderdale), and a six-month moratorium statewide. As a result, honest providers cannot currently expand their home health businesses across our ever-growing state, and beneficiaries have fewer choices as to which agency cares for them. (Kyle Simon, 11/4)

Although physicians are rationally aware when uncertainty exists, the culture of medicine evinces a deep-rooted unwillingness to acknowledge and embrace it. Embodied in our teaching, our case-based learning curricula, and our research is the notion that we must unify a constellation of signs, symptoms, and test results into a solution. ... The unintended consequence — an obsession with finding the right answer, at the risk of oversimplifying the richly iterative and evolutionary nature of clinical reasoning — is the very antithesis of humanistic, individualized patient-centered care. (Arabella L. Simpkin and Richard M. Schwartzstein, 11/3)

In 2010, the department of health in Victoria, Australia, announced the construction of a 500-bed hospital without bricks and mortar. This “virtual hospital” has 33,000 admissions each year, accounting for almost 5% of all acute care bed-days in the state of Victoria and adding much-needed hospital-bed capacity. The Australian health system has since expanded this program to reduce the strain on available hospital beds in other regions as well, while avoiding capital expenditures and preserving the quality of care. What incredible technological advance permitted achievement of these impressive results? Home visits. Intensive home health care services as an alternative to hospitalization are becoming a standard option in many health systems around the world. (Luis Ticona and Kevin A. Schulman, 11/3)

Last week, DNA sleuthing disproved a widely held belief about the HIV/AIDS epidemic: that one person single-handedly brought the illness across the Atlantic to North America. That man, a gay flight attendant named Gaetan Dugas, was mistakenly identified as “Patient Zero” by journalists in the 1980s. Not long after his name became public, the crisis had a villain: In a screaming headline, the New York Post called Dugas “The Man Who Gave Us AIDS,” while the National Review deemed him “the Columbus of AIDS.” ... The scientific findings, published last Wednesday in the journal Nature, went beyond the clearing of one person’s reputation. They also shed light on society’s often irrational way of blaming people for getting sick. (Faye Flam, 11/3)

The National Institutes of Health Clinical Center (NIHCC) has a long and storied list of accomplishments. Many practices begun at the NIHCC on the basis of NIH research have become the standard of care worldwide, and in many ways, it’s a hospital like no other. Like other hospitals, however, it is susceptible to competing priorities that can lead to lapses that compromise patient safety. Recent events at the center provide important lessons for health professionals and leaders everywhere. (Tejal K. Gandhi, 11/3)

Impeccable research has proved that because children’s circadian rhythms are much different than those of adults, having them go to school so early each morning – some as early as 7 a.m. – damages their ability to learn. Yes, in theory, they could have gone to bed earlier and thus gotten enough sleep. But the research also shows that it’s difficult for children, especially teenagers, to fall asleep before 11 p.m. (Dan Walters, 11/3)

If California approves Proposition 64 next week, it is likely to create significant momentum toward legalizing marijuana throughout the U.S. and beyond. The results of the election may signal the birth of a massive new “vice” industry along the lines of the tobacco and alcohol behemoths. (Robert MacCoun, 11/3)

Even if you have enough money for retirement, who will help you manage your finances when you can’t? Who can you count on to be a caregiver? Don’t have an answer to those questions? You are not alone. (MIchelle Singletary, 11/3)

Last week, the UN special rapporteur on torture, Juan E. Méndez, published a report that compared the use of solitary confinement in 26 countries and eight US states. It found that by almost every measure, the United States imposes the most punitive regime of solitary confinement in the world. No one knows for sure how many people are being held in solitary confinement at any one time, but it is estimated to be between 80,000 and 100,000 in the United States. There are no effective limits on how long someone can be locked up like this. (Scott Gilmore, 11/3)