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Deep into the final year of his presidency, Barack Obama is working behind the scenes to secure Obamacare’s legacy, struggling to bolster a program whose ultimate success or failure will likely be determined by his successor. With no lifeline coming from the divided Congress, Obama and his administration are redoubling their pleas for insurers to shore up the federal health care law and pushing uninsured Americans — especially younger ones — to sign up for coverage. The administration is nervously preparing for its final Obamacare open-enrollment season just a week before Election Day, amid a cascade of headlines about rising premiums, fleeing insurers and narrowing insurance options. (Demko, 9/16)

President Barack Obama told insurers this week his health care overhaul has had some growing pains. But with premiums rising and marquee insurers bailing, could the real diagnosis be "failure to thrive?" The medical term refers to when patients, often youngsters but also adults, fail to achieve or maintain proper weight. This is the fourth election cycle in which the Affordable Care Act has been in play, struggling for political traction and a healthy level of acceptance from a divided public. (Alonso-Zaldivar, 9/15)

Included among the many uplifting economic numbers released by the Census Bureau on Tuesday was a remarkable one about health insurance in the United States: Only 9.1 percent of Americans do not have coverage, the lowest level ever recorded by the agency. ... So does that mean the Affordable Care Act is solving the puzzle of getting people covered, a major goal of the law? It certainly looks that way. About 18 million more people have coverage now than did in 2013. But the new numbers also highlight where the law is not working well — and how difficult it will be to drop the uninsured rate much lower. (Abelson and Sanger-Katz, 9/15)

Obamacare is a mess, crammed down the throats of Americans by Democrats in Congress. Premiums are soaring and insurers are backing out, cutting consumer choice. The next Congress must repeal and replace it. These were the primary messages in a U.S. Senate committee hearing today that was scheduled by, and dominated by, Republicans. ... A partisan imbalance in a congressional hearing doesn't mean the critics are wrong or right about the Affordable Care Act, also known as Obamacare. But the hearing offered a preview of what's to come in 2017 – both for insurance and for politics, depending on which political party controls the White House and Congress. (Koff, 9/15)

Senate Democrats and liberal groups are unveiling a new push to add a public option on ObamaCare on Thursday. The effort is led by senators including Chuck Schumer (D-N.Y.), on track to be the next Democratic leader, and Bernie Sanders (I-Vt.), who galvanized liberals in his presidential campaign with a push to go even further and set up a “Medicare for all” system. Sen. Jeff Merkley (D-Ore.) is spearheading the effort. (Sullivan, 9/15)

Former Kansas Insurance Commissioner Sandy Praeger says members of Congress should set aside partisan differences and fix problems with the Affordable Care Act. Failing to do so, she warned, could hasten consideration of a single-payer system. Praeger, a Republican who crossed party lines while in office to support the ACA, says the problems that are causing some insurance companies to pull out of the online health insurance marketplace are fixable. (McLean, 9/15)

Missouri-based Centene Corp. is seeking regulatory approval to sell ACA marketplace health insurance in Maricopa and Pima counties next year. Cigna would join the effort as a medical provider for Centene's insurance plans in Maricopa County, but Cigna now says that it doesn't expect to offer its own marketplace insurance in Maricopa County. (Alltucker, 9/15)

Oregon settled with a California software giant in a lawsuit that accused Oracle America Inc. of collecting tens of millions of dollars to create a state health care exchange website that didn't work. The state initially asked for more than $6 billion in punitive damages when it filed the lawsuit in 2014 against the Redwood Shores, California company, but Oregon ultimately accepted a package that included $35 million in cash payments and software licensing agreements and technical support with an estimated upfront worth of $60 million. (Flaccus, 9/15)

Under the guidelines of 2010's Affordable Care Act, employers must provide employees who need to express breast milk a "reasonable" amount of time and a private space that is not a bathroom. As [Ruth] Rodriguez's case shows, the mere existence of a law doesn't mean conditions change immediately, but it does give workers the option to contact the Department of Labor for help. The ACA guidelines, however, largely exclude salaried employees and management. So Philadelphia lawmakers in 2014 passed similar guidelines to cover all people working in the city. (Pompilio, 9/15)

According to the 2015 Investing in the Health and Well-Being of Young Adults report, only 55 percent of Americans ages 18 to 25 visited a doctor's office in 2009 and only 34 percent visited a dentist. There are lots of reasons: feeling invincible, difficulty navigating the health care system, concerns about costs and co-pays, and the inconvenience of making an appointment and seeing a doctor or dentist. Under the [health law], everyone who can afford it is legally obligated to get health insurance or pay a penalty. One of the main reasons some major insurers have cited for leaving the exchanges is the lack of young, healthy people signing up, leaving the exchanges full of older and less healthy people who cost more to cover. (Akman, 9/16)

Turns out Zika is as much a political quagmire as it is a health crisis. Finger-pointing and partisan backbiting abound on Capitol Hill, despite pleas from both sides of the aisle to take the politics out of efforts to combat the disease that has infected 805 Floridians and tarnished the state’s reputation as a tourist mecca. (King, 9/15)

A long impasse that has delayed money to combat Zika for months neared an end Thursday as congressional aides said Republicans would relent and let Planned Parenthood affiliated clinics share in new funding to fight the virus. The potential deal would ease the way for Congress to quit work until after the Nov. 8 election. (Taylor, 9/15)

Scientists have produced the strongest evidence yet that Zika virus infection in pregnant women causes microcephaly in their babies. In a report released Thursday, researchers from Brazil and Britain studied babies born this year in the heart of the epidemic in northeastern Brazil. They compared 32 babies born with microcephaly to 62 babies born around the same time in the same hospitals who did not have the severe birth defect. (Sun, 9/15)

Babies exposed to the Zika virus as fetuses are more than 50 times more likely to be born with abnormally small heads and underdeveloped brains — a condition called microcephaly — as other babies, according to a new study. The authors of the study, published Thursday in Lancet Infectious Diseases, cautioned that the finding was an interim result and research is still going on, “so the magnitude needs to be treated with some caution.” But outside researchers said this type of research, known as a case-control study, is more likely to avoid the biases that can affect other types of studies. This was the first case-control study looking at the association between microcephaly and Zika. (Joseph, 9/15)

A first-of-its-kind study is strengthening the case that Zika is the culprit behind Brazil’s mysterious surge in babies born with microcephaly. Preliminary results from a study commissioned by the Brazilian Ministry of Health found that 13 out of 32 newborns with microcephaly tested positive for the Zika virus. Meanwhile, none of the 62 newborns in a comparison group who had normal-sized heads showed any sign of infection. (Kaplan, 9/15)

The crowd was in the throes of an anti-Naled frenzy, incensed at the aerial spraying over Miami Beach meant to kill off Zika-carrying mosquitoes. No amount of talk about a public health emergency would pacify the Beach’s rowdiest commission meeting in memory. Wednesday’s gathering gave us the startling scenario of public health specialists being jeered like a pack of lying dogs with their talk of microcephaly and other terrible birth defects caused by the Zika virus. (Grimm, 9/15)

It would be four days before Gov. Rick Scott would announce the case to the public, but Health Department epidemiologists in Pinellas and Hillsborough were already on full alert to try to limit the spread of the virus. And it was in Tampa, not Pinellas, where most containment efforts took place, according to Health Department emails obtained by the Tampa Bay Times. Crucial to devising a containment plan were extensive interviews conducted over at least two days with the Tampa Fire Rescue firefighter, now classified by epidemiologists as a Person Under Investigation. (O'Donnell, 9/16)

House Energy and Commerce Committee Chairman Fred Upton is pushing to get his signature healthcare bill moving again. The Michigan Republican is working on a new version of his 21st Century Cures Act. The revamp could be introduced as soon as next week, though lobbyists and aides say that there is still much work to be done, and it would be tough for the legislation to move before the November elections. (Sullivan, 9/15)

In response to the intensifying outrage over the cost of medicines, a bipartisan group of lawmakers Thursday introduced a bill that would require drug makers to justify their pricing and provide a breakdown of their costs before raising prices on certain products by more than 10 percent. Under the Fair Drug Pricing Act, which is cosponsored by Senator John McCain (R-Ariz.) and US Representative Jan Schakowsky (D-Ill.), drug makers would be required to notify the US Department of Health and Human Services and submit a justification report 30 days before they increase the price of certain drugs by more than 10 percent. (Silverman, 9/15)

To get more doctors to embrace value-based payments, the CMS wants to team up with states to launch multi-payer efforts that could qualify as alternative payment models under the Medicare Access and CHIP Reauthorization Act (MACRA). But some state officials may see the initiative as too closely linked to the Affordable Care Act. Last week, the CMS issued a request for information (PDF) from states on what they would need to implement APMs. Responses to the document are due Oct. 28. (Dickson, 9/15)

The Senate on Thursday approved legislation to spend $270 million to aid the residents of Flint, Mich., and other poor communities that have suffered from lead-contaminated water, attaching the funds to a broader bill authorizing $9 billion to repair ports, dams, levees and other water infrastructure in 17 states. (Davenport, 9/15)

The U.S. Senate passed a bill today that authorizes $10.5 billion for water projects, including millions for cities suffering from water issues, like Flint, Michigan. The funding includes $100 million in loans and grants for replacing lead-contaminated pipes, $50 million for lead testing in schools’ water systems and $70 million for infrastructure loans. The bill will also pay for watershed restoration and repairs for waterways and flood-control systems in other parts of the country. For Flint, the money is sorely needed. (Tam, 9/15)

Republican presidential nominee Donald Trump said that as president he would use Medicaid to cover poor people who can’t afford private health insurance, and make birth control available without a prescription. The comments appeared to differ both with what some Republicans have proposed in the past, and -- in the case of Medicaid -- aspects of Trump’s own policy proposals on his website. Republicans generally opposed the expansion of Medicaid to higher income levels under Obamacare, for example. (Cortez and Tracer, 9/15)

Donald Trump says he believes women should be able to obtain birth control without a prescription. Speaking on an episode of "The Dr. Oz Show" airing Thursday, the Republican nominee suggested that, for many women, obtaining a prescription can be challenging. "I would say it should not be prescription," he told the audience, adding that many women "just aren't in a position to go get a prescription." (Colvin and Sharp, 9/15)

The head of a major anti-abortion rights group is coming on board as chairwoman of Donald Trump’s pro-life coalition. Marjorie Dannenfelser, the president of the Susan B. Anthony List, is assuming that position on Trump’s behalf, her organization plans to announce Friday. Co-chairs are slated to be rolled out later this month. (Glueck, 9/16)

On Friday Trump reinforced his commitment to three anti-abortion platforms and announced he would also back making the Hyde Amendment permanent law... The Hyde Amendment withholds certain federal funds from being used for abortion. There are exceptions to protect the life of the woman or if the pregnancy is the result of rape or incest. (Collins, 9/16)

Hillary Clinton returned to campaigning without offering apologies for keeping her pneumonia a secret, focusing on criticizing opponent Donald Trump instead of how she handled her health problem and the three-day rest ordered by her doctor. (Pace and Lerer, 9/16)

In this year’s presidential campaign, health care has taken a back seat. But one issue appears to be breaking through: the rising cost of prescription drugs.The blockbuster drugs to treat hepatitis C as well as dramatic price increases on older drugs, most recently the EpiPen allergy treatment, have combined to put the issue back on the front burner. ... Here are five reasons why this issue is back — and why it is so difficult to solve. (Rovner, 9/16)

Donald Trump released a letter from his personal doctor on Thursday that summarizes his latest physical exam, saying he takes a cholesterol-lowering drug and is overweight but overall is in “excellent physical health.” Trump discussed the results of the exam on "The Dr. Oz Show" on Thursday afternoon, saying that presidential candidates have an "obligation" to voters to be healthy and that he feels like he is still in his 30s. (Costa and Johnson, 9/15)

Donald Trump released a one-page doctor’s letter Thursday saying he is “in excellent physical health” while pressing his case that he has more strength and stamina than Hillary Clinton. The letter from Harold N. Bornstein, a Manhattan doctor who has treated Trump since 1980, said the Republican presidential nominee takes low-dose aspirin and a statin drug to lower his cholesterol. (Finnegan, 9/15)

Until now, [Donald] Trump had released far less health information than Democratic rival Hillary Clinton, and Thursday's TV show and letter were an attempt to address that disparity. Clinton has faced her own increased scrutiny this week after a bout of pneumonia. On Wednesday, she released updated details from her doctor declaring her fit to serve as president. Trump's latest letter was more detailed than a four-paragraph summary that his physician, Dr. Harold Bornstein, had issued last December. Still, it doesn't offer a complete picture of the candidate's health. (Neergaard, 9/15)

Against a growing outcry over the surging price of EpiPens, a chorus of prominent voices has emerged with a smart-sounding solution: Add the EpiPen, the lifesaving allergy treatment, to a federal list of preventive medical services, a move that would eliminate the out-of-pocket costs of the product for millions of families — and mute the protests. ... A point not mentioned by these advocates is that a big potential beneficiary of the campaign is Mylan, the pharmaceutical giant behind EpiPens. The company would be able to continue charging high prices for the product without patients complaining about the cost. (Lipton and Abrams, 9/16)

Mylan, the maker of EpiPens, an injection device for severe allergy attacks, is trying to persuade the United States Preventive Services Task Force to add the product to the group’s list of preventive medical services. That could make EpiPens available to patients with no insurance co-pay. It could also benefit the company by allowing it to raise prices on the product while limiting complaints from the public. The higher prices would be pushed to the government, insurers or employers. (Abrams, 9/16)

Dr. Jason Hochfelder, an orthopedic surgeon affiliated with Phelps Memorial Hospital Center in Sleepy Hollow, performed the Lower Hudson Valley’s first robotic-assisted total knee replacement operation at Phelps early this year. And in 2015, an advanced Navio-robotic-assisted partial knee replacement surgery was performed for the first time in New York state at Northern Westchester Hospital in Mount Kisco, according to Dr. Victor Khabie, chief of the department of surgical services and co-director of the Orthopedic and Spine Institute at the hospital. (Sowder, 9/15)

Commercially, sweat holds enormous promise for some biotech startups that see in sweat glands the same kind of foundational technology that could spark new health-monitoring applications, much as silicon chips helped pioneer a profusion of electronic gadgetry. The possibilities of sweat are clear: Strap a sophisticated sweat-detector patch on your arm and watch detailed data on your biochemistry gush forth on a tablet or smartphone, alerting you to a medical peril before illness or injury strike. Dehydration, stress, muscle cramping, and depression, for example, are just four of numerous maladies that reveal their presence with chemical markers in blood—and sweat. (Bachman, 9/16)

Mammograms have been responsible for alerting thousands of women of the presence of breast cancer, but a new test is even more effective for women with dense breasts. The process, called molecular breast imaging, is performed in conjunction with a traditional mammogram and helps identify cancer that test may have missed. It is estimated that half of all women have dense breasts, and in their mammograms tissue shows up white, the same color as a tumor. (Welsh, 9/15)

Novavax Inc. shares fell 84% in after-hours trading Thursday after the vaccine company reported unfavorable results from two clinical trials. A drug candidate known as the RSV F Vaccine didn’t meet its efficacy goals, including the primary objective related to prevention of respiratory tract disease. (Beckerman, 9/15)

Peloton Therapeutics, Inc. has raised $52.4 million in venture capital, which it plans to use to support clinical trials on a novel kidney cancer treatment it has developed. The Dallas-based biotechnology company completed a Series D financing round, and added new investor Foresite Capital Management, a private equity and venture capital firm from San Francisco that focus on emerging healthcare drug and device opportunities. (Rice, 9/15)

In Alaska, an investigation by Reveal from The Center for Investigative Reporting found it took a hard-won system with identical goals that was working better and made it worse. Far worse. Under the Choice program, seeing private medical providers through the VA got a lot more complicated in Alaska. The VA’s own nationwide analysis says the program is costing taxpayers more money. And the volume of care in Alaska declined – the opposite of what Congress intended. (Romney, 9/15)

Ms. Stoga’s “classes” typically produce six dogs that are ready to be service animals. She refers to them as “geniuses,” and she should know—she owns two that failed the program. Ones that don’t make the grade are held for further training or released for adoption. Successful graduates learn over 90 commands and acquire astonishing skills, from pulling off their owner’s socks and placing them in a laundry basket to waking them from post-traumatic-stress-related nightmares by turning on a closet light or pulling the sheets off their bed. (Gardner Jr., 9/15)

It's official: Brain cancer has replaced leukemia as the leading cause of cancer deaths among children and adolescents. In 1999, almost a third of cancer deaths among patients aged 1 to 19 were attributable to leukemia while about a quarter were caused by brain cancer. By 2014, those percentages were reversed, according to a report published Friday by the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention. (McGinley, 9/16)

A small government office that monitors misconduct in biomedical research is in turmoil, jeopardizing oversight of billions of dollars in grants to universities and other institutions around the country. Six of the eight investigators in the federal Office of Research Integrity have signed a letter hinting that they may leave, a move that could hobble federal efforts to detect data ma­nipu­la­tion and other misconduct by laboratory researchers. The office’s new head has filed personnel actions against the two division directors she inherited and installed a new deputy to supervise the entire staff. (Bernstein, 9/15)

A month after assuming regulatory oversight over e-cigarettes, the U.S. Food and Drug Administration has cracked down on online sales by the industry, issuing 24 letters to websites for illegal sales to minors. The letters, which the FDA released Thursday, are the first sent since the FDA banned e-cigarette sales to anyone under 18 years old on Aug. 8. The agency also issued warning letters to 28 retailers of cigars and e-cigs and three letters to websites selling cigars. (Mickle, 9/15)

Early this year, a railroad worker who had just been briefed on his duties for the day was discovered in a restroom, dead from an overdose of illegal prescription drugs. In the months that followed, tests conducted after three railroad accidents resulted in six employees testing positive for drugs. Testing in 2016 has shown that nearly 8 percent of workers involved in rail accidents were positive for drug use, including marijuana, cocaine, ecstasy, benzodiazepine, OxyContin and morphine, according to internal federal documents obtained by The Washington Post. (Halsey, 9/15)

Nurse practitioners would be allowed to certify patients for medical marijuana and dispensaries would be allowed to post product prices on their websites, under new regulations proposed by the Department of Public Health. The changes, according to state health officials, build off of lessons learned during the first three years of experience with medical marijuana in Massachusetts. (Lannan, 9/15)

Saying they did not follow their own rules, an administrative law judge scalded state health officials for the method used to grant highly coveted medical-marijuana licenses to nurseries last fall. Administrative Law Judge John Van Laningham also made clear that he intends to recommend that the Department of Health issue another "dispensing organization" license because Alpha Foliage --- already distributing medical marijuana --- did not meet the legal criteria for the license it received in November. (Kam, 9/15)

Marijuana legalization proponents in Massachusetts can count Jonathan Bush, the CEO of Watertown-based health care company Athenahealth and a cousin of former President George W. Bush, in their corner. According to state political finance records, Bush donated $10,000 to the Yes on 4 campaign, which seeks to legalize the use and sale of recreational marijuana in the state through a ballot initiative this November. (Vaccaro, 9/15)

Researchers analyzed federal crash data in 18 states over the period from 1999 to 2013. States that passed a medical marijuana law during this period saw a reduction in opioid involvement in fatal car accidents, relative to states without such a law. The reduction was greatest among drivers aged 21 to 40, the age group most likely to use medical marijuana where it's available. (Ingraham, 9/15)

In street marijuana, the THC-to-CBD ratio now tends to be 10 to 1, and it is increasing, a trend occurring even at some marijuana clinics, Dr. Winstanley said. And few people know what effect that has on their brains. A new study by Dr. Winstanley’s group in the Journal of Psychiatry and Neuroscience examines how these two chemicals shape our willingness to face a challenge. Does marijuana make us lazy? (Pinker, 9/15)

The Drug Enforcement Administration has received a torrent of backlash from patients with chronic pain and former opiate users after announcing plans to ban kratom, a plant gaining popularity across the United States for its opiate-like effects. Kratom, which originates in Southeast Asia, has become more widespread in the United States in the past decade, fueled by online testimonials from users and a lack of federal regulation. Advocates say the plant — typically crushed and mixed or brewed with water — poses few health risks while helping users relieve severe pain and overcome addictions to powerful prescription painkillers. (Ingraham, 9/15)

As treatments get less invasive and recovery times shrink, a new kind of hospital is cropping up — the “bedless hospital." They have all the capabilities of traditional hospitals: operating rooms, infusion suites, and even emergency rooms and helipads. What they don’t have is overnight space. ... The growth in outpatient healthcare is a fundamental shift in US medicine. MetroHealth, which gets part of its funding from taxpayers and serves a large Medicaid population, has expanded outpatient visits from 850,000 to 1.2 million in the last four years, a 40 percent increase. (Ross, 9/16)

Hospitals in Florida and most other states have made progress in reducing preventable “readmissions,” the unplanned return of patients within a month of discharge, federal officials say. A report estimates that 100,000 Medicare beneficiaries – including more than 3,000 in Florida -- were spared a quick return to the hospital last year because of changes the industry has made since 2010. (Gentry, 9/16)

Former New York City Mayor Michael Bloomberg is giving $300 million to Johns Hopkins University to deal with public health challenges. The university announced the gift Thursday. Officials say the money will create the Bloomberg American Health Initiative. The initiative will study ways to fight air pollution, gun violence and obesity. (Jones, 9/15)

The Henry Ford Health System says it will save more than  $125 million after undertaking  a massive debt refinancing this week that could be the biggest of its kind in Michigan history. The Detroit-based health system announced that it sold about $1 billion in bonds on Tuesday in order to buy back older bonds that had higher interest rates. (Reindl, 9/15)

Highland Hospital, with a $6 million grant from the Kaiser Permanente Community Fund, is buying magnetic resonance imaging equipment that will double the number of patients who can be tested for cancer, disease and health problems. Early detection is key to keeping them healthy and alive. Highland Hospital in East Oakland is the flagship for Alameda Health System, a public health consortium that runs several hospitals and clinics. (Hedin, 9/15)

Ascension's operating surplus exceeded three-quarters of a billion dollars last year, as the hospital system bought new facilities and recorded more outpatient activity. The system's $753 million operating surplus came from $21.9 billion of revenue in its most recent fiscal year, which ended June 30, resulting in a 3.4% operating margin, according to Ascension's financial documents (PDF) filed with bondholders this week. The operating margin was almost identical to what Ascension recorded in fiscal 2015. Revenue was 6.6% higher. (Herman, 9/15)

Medical Center of Trinity, a 288-bed hospital at 9330 State Road 54, is the first hospital in the Tampa Bay area and the third in the state to use this technology as a way to enhance bonding, said Mary Sommise, director of marketing. Jackson Memorial Hospital in Miami and Memorial Hospital West in Pembroke Pines are also using NicView, Sommise said, adding that the $40,000 financial investment at Trinity came from leftover construction funds from the $7 million Level II neonatal intensive care unit that opened this year. (Miller, 9/15)

Minnesota Attorney General Lori Swanson has been asked to intervene in a dispute involving Allina Health and an elected north suburban hospital board after the board voted Wednesday night to dissolve and stop collecting taxes to support Unity Hospital in Fridley. The North Suburban Hospital District was formed in the 1960s to build and support Unity as a general hospital for the surrounding communities, but board members say the organization’s purpose is dwindling in an era of hospital consolidations and mergers. (Olson, 9/15)

Stormont Vail Health of Topeka is closing two regional clinics because of financial pressures created by recent cuts in Medicaid reimbursements and the decision by state leaders not to expand the health care program. Stormont will close Cotton O’Neil clinics in Lyndon and Alma, according to a news release issued Thursday. The Lyndon clinic will close Dec. 31. The clinic in Alma will close Jan. 31, 2017. (McLean, 9/15)

After some administrative mistakes by Virginia’s Department of Health, the State Board of Health postponed an expected vote on proposed amendments to regulations for the licensure of abortion facilities. The vote originally was slated for Thursday, but the board decided instead to hold a specially scheduled meeting before Dec. 1 to vote on the regulations. (Demeria, 9/15)

An initiative on California's November ballot aimed at reining in prescription drug prices is favored by 66 percent of state voters, according to a new poll released on Thursday. The California Drug Price Relief Act, also known as Proposition 61, seeks to restrict state-run health programs from paying more for medications than prices paid by the U.S. Department of Veterans Affairs, which is billed about 25 percent less for drugs than other government agencies. (Beasley, 9/15)

The unexpected charges come when patients are treated by an out-of-network provider at an in-network facility. After several failed attempts in recent years, the California legislature passed AB-72, which aims to protect patients’ pocketbooks when they’re hit by these surprise bills. Gov. Jerry Brown has until the end of September to sign or veto the legislation. He is expected to sign it into law. (O'Neill, 9/16)

Can states save money on increasingly expensive prescriptions for Medicaid patients by setting prices based not on drugmakers’ wishes, but on how well the medicines control, contain or cure disease? The notion of tying drug payments to results, called “pay-for-performance pricing” or “value-based pricing,” already is being tested by some health insurance companies, some pharmaceutical companies and Medicare. And just last week, the Oregon Health & Science University announced it will undertake a large-scale research project to examine how states could apply the concept to Medicaid. (Ollove, 9/16)

After a series of hits to their budgets, community mental health centers in Kansas are adjusting through cutbacks, changes in services or a combination of the two. In Topeka, Valeo Behavioral Health Care plans to limit sessions for uninsured patients. Valeo provided about $2 million in charitable care last year but can’t offer that much this year because of cuts to Medicaid and other revenue streams, CEO Bill Persinger said. The center won’t turn anyone away, but patients who don’t have a form of insurance covering mental health care may receive fewer therapy sessions than in the past, he said. (Hart, 9/15)

Young Erika is one of almost 138,000 undocumented children in California who have gained Medi-Cal coverage under the so-called “Health for All Kids” law, which provides health care for all California children regardless of their immigration status. Dental coverage under the state’s Denti-Cal program is included in the expanded benefits, and there is widespread hope that it will improve pediatric oral care in California. But delivering on that promise could be a stiff challenge for a program in which more than half of children who were covered before the law took effect had not seen a dentist in the previous year. (Ibarra, 9/15)

Orange County will refrain from aerial spraying of the insecticide naled to fight Zika, even if there is local transmission.Miami residents have protested the use of naled because of health and environmental concerns. The insecticide has been used for decades in the U.S., but was banned in the European Union in 2012. The chemical made headlines when millions of bees died in South Carolina when the chemical was sprayed during the day because of Zika fears. (Aboraya, 9/15)

Public school students traumatized by civil unrest in their communities can get professional help under new federal grants announced Thursday. The U.S. Education Department’s Promoting Student Resilience program provided $1.4 million in funding to St. Louis schools, $2.4 million to Baltimore schools and $1.3 million to schools in Chicago. The funding is for the establishment of school-based mental-health, counseling and behavioral programs. (Hobbs, 9/15)

The Baltimore City Health Department has received a $5 million federal grant to help families in West Baltimore deal with the traumatic affects of living in violent communities. The five-year grant will be used to set up programs in Sandtown-Winchester, Penn North and Upton/Druid Heights that will include mentoring, yoga and other mindfulness activities, youth development and healing circles. The activities will center around trauma-informed care, which takes into accounts the way people's life experiences impact behavior and health. (McDaniels, 9/15)

About one-fifth of the 2.5 million people living in Dallas County were uninsured in 2015, according to new estimates from the U.S. Census Bureau. That’s an improvement from 2012, when nearly a third of the county was uninsured.The census provides statistics on changes in the rate and distribution of health insurance coverage as part of its annual American Community Survey. The changes can reflect evolving economic and demographic trends as well as the impact of policy changes on access to care. (Rice, 9/15)

With this stroke of the pen, the liberal-controlled court made Wisconsin the first state to utilize a ridiculous “risk contribution” theory to target businesses that hadn’t done anything wrong. It maintained that even if a plaintiff couldn't identify which lead-based product made him or her sick, they could still sue paint manufacturers for their contribution to a "general risk." Former Wisconsin Supreme Court Justice Diane Sykes would call the standard " a form of collective tort liability untethered to any actual responsibility for the specific harm asserted." (Schneider, 9/15)

Wills Eye Hospital and Medicare are in a heated licensing dispute centered on the ratio of inpatient to outpatient services a facility must provide to qualify as a hospital. Both sides say the outcome could have "cataclysmic" consequences. Three years ago, Wills finished a $6.5 million renovation of its building at Eighth and Walnut Streets in  Center City, including the addition of four inpatient beds in what had been licensed as an ambulatory surgery center. (Brubaker, 9/15)

Minnesota health officials have confirmed nine cases of Legionnaires' disease in Hopkins — up from five late last week — in the state's largest outbreak of the disease since the mid-1990s. Investigators with the Minnesota Department of Health (MDH) are homing in on the source of the bacteria, which has infected only people who live and work in Hopkins. Health investigators from Hennepin County and the state are looking at several Hopkins-based businesses, including a Supervalu warehouse, a plastics facility called Thermotech and an outdoor Cargill fountain, among other sources, said Health Department spokesman Doug Schultz. (Sawyer, 9/15)

Florida State University officials say more than a dozen cases of hand, foot and mouth disease have been reported on campus, prompting the cancellation of several on-campus events. According to officials, the disease is a common viral illness that typically affects children under 5 years old and includes symptoms such as fever, sore throat, mouth sores and skin rash. (9/15)

The two nominees to fill open seats on the Board of Health have a tall order facing them – helping to decide how to search for a new health commissioner. Mayor John Cranley has selected Dr. Christopher Lewis, a UC Health primary care physician, and insurance consultant Ronald Robinson to join the nine-member Board of Health. City Council is expected to vote on the nominations Wednesday.If the men are approved, they will attend their first regular monthly Board of Health meeting Sept. 27. (Saker, 9/15)

In any one of the 60 minutes of a regulation hockey game, a variety of bad things can happen on the ice. So, as the NHL season approaches, Blue Jackets players aren’t the only ones in Columbus training. On Monday, the team’s medical and athletic-training staff joined more than 30 Columbus Division of Fire paramedics and six emergency physicians from OhioHealth on the rink at Nationwide Arena to prepare for the worst. (Mogan Edwards, 9/16)

The public health success of diabetic retinopathy (DR) screening programs depends on patients’ adherence to the timetable of follow-up eye care recommended by the screening program. African Americans are among those at highest risk for DR and have one of the lowest rates of eye care use. ... After a DR screening program in a public clinic largely serving an African American population, only one-third of participants adhered to interval recommendations for follow-up eye appointments, even though cost and accessibility were minimized as barriers to care. Our findings suggest that DR screening programs are not likely to meet their public health goals without incorporation of eye health education initiatives successfully promoting adherence to recommended comprehensive eye care for preventing vision loss. (Keenum et al., 9/15)

Patient cost sharing for contraceptive prescriptions was eliminated for certain insurance plans as part of the Affordable Care Act. ... we examined the contraceptive choices made by women in employer groups whose coverage complied with the mandate, compared to the choices of women in groups whose coverage did not comply. We found that the reduction in cost sharing was associated with a 2.3-percentage-point increase in the choice of any prescription contraceptive, relative to the 30 percent rate of choosing prescription contraceptives before the change in cost sharing. A disproportionate share of this increase came from increased selection of long-term contraception methods. Thus, the removal of cost as a barrier seems to be an important factor in contraceptive choice. (Carlin, Fertig and Dowd, 9/7)

We analyzed insurance claims for 635,075 women with employer-sponsored insurance who were initiating use of the pill, to examine rates of discontinuation and nonadherence, their relationship with cost sharing, and trends before and during the first year after implementation of the ACA mandate. We found that cost sharing for oral contraceptives decreased markedly following implementation, more significantly for generic than for brand-name versions. Higher copays were associated with greater discontinuation of and nonadherence to generic pills than was the case with zero copayments. Discontinuation of the use of generic or brand-name pills decreased slightly but significantly following ACA implementation, as did nonadherence to brand-name pills. Our findings suggest a modest early impact of the ACA on improving consistent use of oral contraceptives among women initiating their use. (Pace, Dusetzina and Keating, 9/7)

Block grants and per capita caps have been proposed as mechanisms for controlling Medicaid expenditures. Block grants would allocate money to states based on current overall spending levels in each state, and per capita caps would allocate funds based on current spending per enrollee. In this brief we show that federal spending (adjusted for the size of each state’s low income population) varies across states by more than 5 to 1 and spending per enrollee varies on the order of 2 to 1. In general, high income states will get larger block grants and higher spending per enrollee caps because they spend more today. These disparities would be locked in under these kinds of proposals. (Holahan and Buettgens, 9/8)

Data from the 2012 School Health Policies and Practices Study indicated that 79.9% of school districts required schools to have a comprehensive plan that includes provisions for students and staff members with special needs, whereas 67.8% to 69.3% of districts required plans that addressed family reunification procedures, procedures for responding to pandemic influenza or other infectious disease outbreaks, and provision of mental health services for students, faculty, and staff members, after a crisis. (Silverman et al., 9/16)

The number of physician practices owned by hospitals and health systems jumped 86% from 2012 to 2015, according to a survey conducted by Avalere Health for the Physicians Advocacy Institute (PAI). The number of physicians employed by hospitals increased by nearly 50% during the same period, from 95,000 doctors in 2012 to more than 140,000 physicians in 2015, the survey shows. (Terry, 9/14)

Exposing physicians to a tool to identify high variability in costs and outcomes on a patient encounter level reduced costs and improved quality within three key areas in a large healthcare system, according to a new study published in the September issue of JAMA. The gains were found in total hip and knee joint replacements, hospitalists' use of laboratory services, and management of sepsis. (Frellick, 9/14)

In the United States, 25 states have legalized medical marijuana, including 19 that let patients with a prescription buy pot from dispensaries. Proponents argue that expanding the availability of medical marijuana reduces opioid abuse and overdose deaths because it gives people an alternative for pain relief. About 3 out of 5 opioid overdoses occur in people with legitimate prescriptions for pain pills. These are the people who might opt for medical marijuana instead. Three recent studies support that claim. (Begley, 9/14)

The more that vaping takes hold in England, the better the odds that smokers there will succeed in their attempts to stop using regular cigarettes. These parallel trends, reported Wednesday in the BMJ medical journal, don’t prove that electronic cigarettes help smokers kick the habit. But that possibility is looking more and more likely, experts said. (Kaplan, 9/13)

Drug companies are fond of saying that they have no choice but to charge high prices for their products, because the “cost of innovation” is so high. Today, Arizona Sen. John McCain (R.) announced a bipartisan bill, the Fair Drug Pricing Act, that attempts to hold them to their word. ... The ten-page Fair Drug Pricing Act is a fairly modest piece of legislation, one that doesn’t really get at the underlying drivers of high drug costs: overly burdensome FDA regulation, and the lack of a consumer driven health care system. .... But, despite those deficiencies, the bill would bring some accountability to a system that is driven as much by crony capitalism as by market forces. (Avik Roy, 9/15)

A veteran is choosing death every 72 minutes, and the VA could be doing more to keep that person alive. When veterans manage to ask for help, too many of their calls are not getting through to VA's suicide hotline (800-273-8255). The agency isn't offering enough veterans the kind of cutting-edge treatment therapies that researchers are finally uncovering. (9/15)

Among veterans and the American public at large, suicide is a public health crisis. Losing even one veteran to suicide is unacceptable, which is why suicide prevention is a top priority at VA. We know that we save lives when we get veterans into treatment. This past year, VA has expanded our suicide prevention efforts providing greater access to our services, and we are continuing to ensure same-day access for urgent mental health needs at every medical center. (David J. Shulkin, 9/15)

It's hard to imagine someone like Melissa Crews of Bedford, New Hampshire, voting for Donald Trump in the presidential election. But the former Democratic voter says that's what she intends to do. I first met Crews during the primary campaign, in February, when New Hampshire was at the center of candidates' attention. The state's heroin epidemic was a big campaign issue, candidates were doing their best to show interest, and Crews was a co-founder and the board chairman of HOPE for New Hampshire, a nonprofit then beginning to build a local network of recovery centers. ... To her surprise, she found that she liked the Republican candidates better. They were more willing to talk about their own experiences with friends' and family members' addiction, and more sympathetic to her approach: using recovering addicts to help others lead sober lives. (Leonid Bershidsky, 9/15)

As Democratic presidential nominee Hillary Clinton demonstrated when she nearly collapsed from the effects of walking pneumonia early this week, the benefits of running for elected office may include many things, but sick days are not among them. This is perhaps unavoidable in light of the fact that the job of actually being an elected official doesn’t allow for much rest and recuperation, either. ... Going to work sick is not just a function of political work, however, or even of merely being human — it is a profoundly American behavior. (Emily L. Hauser, 9/15)

If the political furor over Clinton’s pneumonia lingers longer than the illness — which should clear up in a few weeks — that would be a sharp break with history. Voters pay little attention to their own health, and up to now, they haven’t paid much more to the health of the people who want to be president. (Arthur L. Caplan, 9/15)

Ever since antibiotics were first developed and heralded as a miracle of modern medicine more than half a century ago, experts have warned of the dangers of their misuse. By exposing bugs to just enough medicine to encourage resistance, the fear was that we would end up encouraging germs to evade the very drugs that were designed to counter their impact. ... Without immediate action, previously treatable infections and minor surgical procedures will once again become potentially fatal, killing an estimated 10 million people a year by 2050, according to the Review on Antimicrobial Resistance. (Seth Berkley and Jeremy Farrar, 9/15)

Researchers recently revealed in a Nature Genetics paper that they had identified a new gene linked to ALS, a neurodegenerative condition also known as Lou Gehrig’s disease. The July announcement was a milestone in the fight against ALS, which affects about 30,000 Americans, and a historic moment in financing disease research. That’s because the discovery was made possible by donations from people who completed the ALS Ice Bucket Challenge, a viral fundraising effort that called for donors to dump ice water over their heads. Now is the time to build off this success and accelerate research to eradicate cancer. (Jon M. Huntsman Sr., 9/15)

While the national maternal mortality rate has gone up 27 percent, the Texas rate has doubled since 2011, according to research published in the August issue of the medical journal “Obstetrics and Gynecology.” The study reported that 537 Texas women died in pregnancy or within 42 days of delivery from 2011 to 2015 compared to 296 between 2007 and 2010. The numbers reflect poorly on state leaders who have taken a staunch position against expanding Medicaid as part of the Affordable Care Act and have taken drastic swipes at women’s access to health services by slashing funding for Planned Parenthood. (9/15)

On Monday, Attorney General Mike DeWine's office filed a notice of intent to appeal a unanimous three-judge Ohio appellate court ruling from July that found that both state health regulations and an underlying law restricting abortion-clinic operations in Ohio -- the immediate impact of which would have been to force a Toledo clinic to close -- were unconstitutional and not motivated by health considerations. ... Is DeWine overstepping on his abortion appeals in a way detrimental to Ohio taxpayers? Or is he just doing his duty in defending Ohio laws? Our editorial board roundtable takes a look. (9/16)

The federal Centers for Medicare and Medicaid Services said no to Healthy Ohio last week. The state program with that name would have required Medicaid recipients to make monthly contributions to a form of health savings account; the state would have contributed a baseline $1,000 a year, plus incentive payments to reward healthy behavior. The end of this proposal should not be the end of the goal of giving Medicaid beneficiaries a bigger stake in controlling costs and improving their own health. (9/15)

The 2010 passage of the Affordable Care Act (ACA) raised numerous opportunities for disease prevention. Of the 10 legislative titles comprising the ACA legal framework, Title 4 (“Prevention of Chronic Disease and Improving Public Health”) initially held the most promise for delivering new financial resources as well as effective policy for prevention. Six years later, Title 4 outcomes show mixed results. In the meantime, however, other ACA innovations are redesigning health systems by incorporating prevention into a range of new care models. Doing so connects the clinic and the community in ways not necessarily envisioned in the statute, thereby broadening possibilities for the future of population health. (Howard K. Koh, Rahul Rajkumar, John E. McDonough, 9./13)

The transition of health care from volume to value is no longer theoretical, or wishful thinking. .... Health care is finally entering an era of significant change, and the model for health care delivery is being redesigned from the ground up. Redesign is being accelerated by a long-needed transition in the payment system away from fee-for-service to value-based payments. The Centers for Medicare & Medicaid Services have committed that 90% of Medicare payments will reward value by 2018, and commercial payers are starting to do the same. (Michael E. Porter and Thomas H. Lee, MD, 9/13)

What does Noah’s Ark have to do with childhood cancer? A life-size replica of the biblical boat was recently finished and opened to the public in Kentucky. The cost of this construction exceeded a staggering $100 million. Money was raised through private sources as well as local bonds and a Kentucky sales tax incentive, the subject of a court battle, which infused $18 million into the project. I make no commentary upon the propriety of building a life-sized Noah’s Ark, or the religious debate overall. My point is that as a nation, there is often a prioritization of investment into projects like Noah’s Ark over funding things like medical research. The ark, which received funding from private and public sources, represents more than half of what is spent on childhood cancer specific research by the NCI. (Jonathan Agin, 9/15)

Workplace safety is a critical issue in health care. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed towards persons at work or on duty.” This Viewpoint discusses the scope and characteristics of workplace violence in health care settings, relevant government regulations, the responsibility of health care leaders in addressing workplace violence, a model program for violence prevention in health care settings, and a comprehensive environmental risk analysis. (Ron Wyatt, Kim Anderson-Drevs and Lynn M. Van Male, 9/13)

This short film, narrated by Jay Z (Shawn Carter) and featuring the artwork of Molly Crabapple, is part history lesson about the war on drugs and part vision statement. As Ms. Crabapple’s haunting images flash by, the film takes us from the Nixon administration and the Rockefeller drug laws — the draconian 1973 statutes enacted in New York that exploded the state’s prison population and ushered in a period of similar sentencing schemes for other states — through the extraordinary growth in our nation’s prison population to the emerging aboveground marijuana market of today. We learn how African-Americans can make up around 13 percent of the United States population — yet 31 percent of those arrested for drug law violations, even though they use and sell drugs at the same rate as whites. (Asha Bandele, 9/15)

"Cam" my mother said, "the G6 flower is still our top seller, but the brownies and cookies are going like crazy!" Two years ago, hearing my mom talk about different kinds of marijuana would have been empirically weird, but today it is completely common. In November 2015, she, two business partners and I opened Harbory — a medical cannabis dispensary in Marion, Ill., two hours from my hometown of St. Louis. (Cameron Lehman, 9/15)