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The Obama administration proposed a rule Thursday that would forbid most health insurers and medical providers to discriminate against transgender patients, including by prohibiting insurers from categorically denying coverage of care related to gender transition. The proposal clarifies a civil rights provision of the Affordable Care Act that bans “any health program or activity” that receives federal funds from discriminating based on race, national origin, sex, age or disability. The proposed regulation expands on that broad language, specifying that the administration considers discrimination on the basis of gender identity a form of sex discrimination. (Goodnough and Sanger-Katz, 9/4)

The ACA already bars discrimination based on sex and other factors, but the long-delayed proposed regulation issued Thursday explains how the protections will be applied to insurers and health-care providers, such as hospitals and doctors who receive Medicare and Medicaid payments, and it clarifies the standards federal officials would use in implementing the law. The proposed regulation comes as social attitudes about sexuality and gender are undergoing major shifts. (Sun and Bernstein, 9/3)

Federal officials have been wrestling for years about how to handle the Affordable Care Act’s provision that requires health insurers and providers to ensure they treat patients equally, including on the basis of their sex and race. The requirement has been in effect since 2010, the year the law was passed, but the administration is still fleshing out its details. The thorniest issue has been whether federal officials also can use the provision to bar bias based on sexual orientation. (Radnofsky, 9/3)

Doctors and hospitals that treat Medicaid patients and insurance companies participating in health law marketplaces would be banned from discriminating against transgender people under rules proposed Thursday by the Health and Human Services Department. Health plans would be prohibited from issuing a blanket denial of services to help a person transition to another gender, although the insurers still could refuse to cover surgery or other care on a case-by-case basis if the decisions are based on a legitimate rationale. (Attias, 9/3)

The Obama administration on Thursday issued a long-awaited proposed rule explaining how it will enforce a wide-ranging ban on health care discrimination. With that release, HHS is seeking to cement one of Obamacare’s key promises — equal access to health care regardless of a person’s race, color, nationality or disability. The rule would also ban health care discrimination on the basis of sex for the first time. (Millman, 9/3)

The Obama administration issued a sweeping proposal Thursday to bolster civil rights protections in health care, barring medical providers and insurers from discriminating based on gender, whether in treatments or access to facilities or services. The long-awaited rules from the Office of Civil Rights in the Department of Health and Human Services further define protections included in the Affordable Care Act, particularly broadening those for transgender Americans. The proposal also includes provisions requiring medical providers to bolster their communication efforts for people with disabilities or limited English proficiency. (Appleby, 9/3)

Transgender individuals would gain new health-care protections in rules proposed today by U.S. regulators. Under the rules, discrimination against transgender people would be a form of sex discrimination. That would block insurers from categorically denying coverage for treatments that help people transition to another gender, according to a fact sheet released today by the Department of Health and Human Services. Some exclusions for transition treatments will be evaluated case-by-case, the agency said. (Tracer, 9/3)

Mirroring a shift in society, the Obama administration proposed Thursday to ban discrimination against transgender people throughout the health care system. Once the proposed regulations are final, they should expand insurance coverage for gender transition and prohibit health care facilities from denying transgender people access to restrooms that match their individual gender identity. (Alonso-Zaldivar, 9/3)

The Affordable Care Act, also known as Obamacare, was passed in 2010 and included anti-discrimination provisions to prevent insurers from charging customers more or denying coverage based on age or sex. That law left some areas open to interpretation and thousands of consumers complain each year about being discriminated against, the U.S. Department of Health and Human Services said on Thursday. (9/3)

The Obama administration is making a major push for transgender rights by prohibiting health insurance companies and medical providers from discriminating against patients because of their gender identities. Under a proposed regulation issued by the Department of Health and Human Services Thursday, transgender people would be entitled to equal treatment in health care and would gain the legal right to make civil rights claims against insurers, doctors, hospitals and others who deny them coverage or necessary care because they are transgender. That includes forbidding health insurers from categorically excluding treatments related to gender transitions. (Young, 9/3)

The Obama administration proposed a new rule Thursday that would ban discrimination against transgender people in the health care system, saying stereotypes about sexual identity have no place in provision of health insurance or medical care. (Fox, 9/3)

Highmark Health said it would reduce its range of offerings on the Affordable Care Act marketplaces, becoming the latest insurer to retrench amid steep financial losses. The big Pittsburgh-based nonprofit company said it would continue to sell plans related to the federal health overhaul in all of the areas it currently serves, which span Pennsylvania, Delaware and West Virginia. But “we will have less products in the market overall,” said David L. Holmberg, the company’s chief executive, who said Highmark had lost $318 million on its individual health-law plans in the first six months of 2015, after rolling out a very broad array of options that had attracted many consumers with chronic conditions who required costly care. (Wilde Mathews, 9/3)

California’s largest health plan group this week declared its opposition to both of the healthcare special session bills that would impose new taxes on managed-care organizations, the latest sign that a replacement for a soon-to-expire health plan tax is unlikely to emerge before lawmakers adjourn next week. (Miller, 9/3)

It's an unusual move, to lock out the people running a local health plan serving about 204,000 people, and to assume state stewardship of that plan. But that's what the California Department of Managed Health Care and its director Shelley Rouillard did, just over one year ago in Alameda County in the East Bay. (Gorn, 9/3)

As the open enrollment season for employer-sponsored health insurance gets underway this fall, experts say there’s one group that should definitely consider changing plans: people who have coverage through their former employer under the federal law known as COBRA. ... Before the health law passed, people who lost their jobs may not have had other options. Plans on the individual market could turn people down because of their health, and the coverage was often skimpy and expensive in any case. Times have changed. (Andrews, 9/4)

A group of 14 health care, social service and legal aid organizations has received more than $2.6 million in federal funding to help North Carolina residents sign up for health insurance through the Affordable Care Act. Officials with the Centers for Medicare and Medicaid Services said Wednesday that the N.C. Navigator Consortium will receive the grant to help consumers sign up during the open enrollment period for 2015-2016. (9/3)

Abortion providers in Texas asked the Supreme Court on Wednesday to reverse an appeals court ruling that would leave the state with 10 abortion clinics, down from more than 40. Should the court agree to hear the case, as appears likely, it could issue its first major abortion ruling since 2007 before its next term ends in June. (Liptak, 9/3)

Texas abortion providers say they expect the U.S. Supreme Court to take up their appeal asking the court to review a 2013 law that would force half of the state’s remaining abortion clinics to close if it is allowed to go into effect in full. The Supreme Court signaled in June that it would probably take up the case when justices voted 5-4 to put a lower appeals court decision to uphold the law on hold. If the case moves forward, it will be the most significant challenge to abortion law in over 20 years. (Martin, 9/3)

Calling it a pivotal moment for abortion rights in the United States, women’s health care providers on Thursday asked the Supreme Court to hear a challenge to Texas’ controversial anti-abortion law. The providers want the justices to strike down two Republican-backed provisions from Texas’ 2013 law that they say would reduce by 75 percent the number of abortion clinics in the nation’s second largest state, to as few as 10 — a tiny number compared to the 500 clinics in California and 250 in New York. (Ruger, 9/3)

Abortion care providers filed a petition this week to the U.S. Supreme Court asking the court to review their case against Texas’ far-reaching restrictions that have already shuttered more than two dozen clinics. The Supreme Court suspended the enforcement of strict standards on abortion clinics in Texas in late June following a lower court ruling that upheld most of the 2013 abortion law, known as House Bill 2. (McSwayne, 9/3)

Texas abortion providers asked the U.S. Supreme Court on Thursday to hear their challenge to the state's Republican-backed restrictions on abortions that they contend are aimed more at shutting clinics than protecting women's health. If the Supreme Court hears the appeal, it would be one of the most anticipated cases of the court's next term, which starts in October. The nine justices are likely to decide by the end of the year whether to hear the case, meaning oral arguments could come in early 2016 with a ruling by the end of June. (Garza, 9/3)

At Thursday’s news conference, U.S. Reps. Carolyn Maloney and Jerrold Nadler, both New York City Democrats, and Peter King, a Long Island Republican, called on their colleagues to make the Zadroga Act permanent. The legislation, signed into law in 2011 after extensive lobbying by survivors, provides for the monitoring and treatment of people suffering from illness and injuries caused by the terrorist attacks. Many 9/11 first responders developed ailments including asthma, lung disease and cancer. (MacMillan, 9/3)

With a shortage of other viable legislative vehicles, Senate Finance Chairman Orrin G. Hatch has his eye on using a potential reconciliation bill later this year or early in 2016 to repeal parts of the health care overhaul, including the 2.3 percent excise tax on medical devices. The top tax writer has been hunting for a home for a device tax repeal (S 149) he authored that has 39 co-sponsors. The House passed a similar plan (HR 160), 280-140, in June. The Utah Republican also is weighing other health-related add-ons for reconciliation, including incentives for manufacturing so-called orphan drugs that combat rare diseases. (Ota, 9/3)

Two high-ranking House Democrats are calling on their Republican counterparts to end their congressional investigations of Planned Parenthood -- or at least expand them to encompass alleged misdeed by antiabortion activists who put the group's fetal tissue practices in the spotlight. Rep. John Conyers (Mich.), top Democrat on the House Judiciary Committee, and Rep. Elijah Cummings (Md.), top Democrat on the House Oversight and Government Reform Committee, said in a letter to the Republican chairmen of those committees that the undercover videos that sparked the investigations are unreliable and may have been obtained by illegal means, calling on them to "halt these one-sided investigations immediately." (DeBonis, 9/3)

Sen. Dianne Feinstein said Thursday she would introduce legislation to move veterans from the county’s alleyways and sidewalk shantytowns onto the U.S. Department of Veterans Affairs' long-contested West Los Angeles campus. (Holland, 9/3)

Congress’ 2007 decision to lift a ban on the District of Columbia’s ability to tap local funds for needle exchange programs averted an estimated 120 cases of HIV over two years and saved almost $45 million, according to a study released Thursday that could expand support for other policy changes. The findings by researchers at the George Washington University’s Milken Institute School of Public Health comes as Congress has shown more openness to providing states with leeway to use federal funds to support needle exchanges in some circumstances, by modifying the ban implemented annually through the appropriations process. (Attias, 9/3)

The first in a long-awaited category of drugs that have been projected to save tens of billions of dollars over the next decade became available today. But its price tag highlights a question economists and industry watchers have been wrestling with for the past few months: how much will these new drugs actually bring down prices? The new drug, Zarxio, is the first American "biosimilar" -- a copycat version of a complex biologic drug. (Johnson, 9/3)

Novartis kicked off a new era in U.S. medicine on Thursday with the launch of the first "biosimilar" copy of a biotechnology drug approved in the United States, at a discount of 15 percent to the original. The Swiss drugmaker's generics unit Sandoz said Zarxio, its form of Amgen's white blood cell-boosting product Neupogen, would increase access to an important treatment by offering a "high-quality, more affordable version". (Hirschler and Shields, 9/3)

The initial stakes are low for the imminent launch of the first U.S. biosimilar drug. Pharmaceutical companies that develop branded drugs shouldn’t expect them to stay that way. ... Beyond Zarxio’s launch, the stakes will get higher as discounts get larger. Likewise, competition will intensify. In aggregate, drugs with biosimilar competition on the way—such as AbbVie’s Humira or Johnson & Johnson’s Remicade—totaled more than $25 billion in U.S. sales in 2014. (Grant, 9/3)

Milly Scott first fell into the Medicare Part D coverage gap a year ago. A seven-year beneficiary of the government prescription coverage program for seniors, Mrs. Scott saw her co-payment for the anti-depressant Pristiq hold steady the last two years at $285 for a 90-day supply. But, between that and her other medications, she fell the program’s “donut hole” of reduced coverage for the first time in October. This year, she landed in the gap even earlier — in July. ... While the federal Affordable Care Act will eventually eliminate the gap, rising drug costs until then are sending more seniors into the hole. (Twedt, 9/4)

Hedge-fund manager Kyle Bass says he’ll persist in his campaign to invalidate what he calls weak pharmaceutical patents, despite being handed two early setbacks in recent weeks. ... On Wednesday, a panel of judges employed by the U.S. Patent and Trademark Office declined to review Mr. Bass’s challenge to Biogen Inc.’s multiple sclerosis pill Tecfidera patent. The ruling, which came ahead of schedule, followed a denial in August of Mr. Bass’s challenges to Acorda Therapeutics Inc.’s drug Ampyra. (Walker, 9/3)

In the ever-changing world of health care, at least this remains constant: Hospitals want to get bigger. The ongoing merger talks between Beth Israel Deaconess Medical Center of Boston and Lahey Health of Burlington are just the latest example of the bigger-is-better strategy health care executives are pursuing. ... The backdrop for these merger discussions is health care costs that are accelerating, according to data released by state agencies over the past week. ... These trends are contributing to the motivation to merge as federal and state laws pressure health care providers to bring costs under control, and new payment systems reward providers for sticking to budgets while improving care. These developments have only added to hospitals’ urgency to find efficiencies through mergers, analysts said. (Dayal McCluskey, 9/3)

The Detroit Three automakers are showing increased interest in the United Auto Workers union's proposal that they pool their healthcare systems, a sign that contract talks between the union and manufacturers are down to the big money issues. The UAW and bargainers for General Motors Co, Ford Motor Co and Fiat Chrysler Automobiles face a Sept. 14 deadline to negotiate new labor agreements for 142,000 U.S. workers. Rising healthcare costs have emerged as a stumbling block in the way of raises for blue collar workers. (Woodall, 9/3)

A chain of hospices in four states has agreed to settle a whistleblower lawsuit concerning overbilling for $5.9 million. The settlement between the federal government and the St. Joseph Hospice chain, based in Baton Rouge, Louisiana, was announced Thursday in Jackson. Federal prosecutors alleged that St. Joseph was driving up Medicare payments by billing for continuous care to patients who weren't eligible under federal rules. (Amy, 9/4)

Health insurance hasn’t attracted much money from Silicon Valley investors. The industry is highly regulated and fiercely competitive, and turning a profit depends on signing up healthy customers and getting favorable prices from hospitals and doctors. Still, investors, including some Facebook backers, put hundreds of millions of dollars into health insurance startup Oscar. “Insurance is a confusing system, confusing as hell,” says Mario Schlosser, a computer scientist and former McKinsey consultant, who is Oscar’s chief executive officer. He co-founded the company two years ago with fellow business school alums Joshua Kushner of venture capital firm Thrive Capital, and Kevin Nazemi, a veteran of Microsoft’s health-care division. They hope to capitalize on the young, tech-savvy customers buying health insurance through the new markets created by the Affordable Care Act. Oscar operates in New York and New Jersey and will start selling coverage in California and Texas in November. (Racer and Satariano, 9/3)

Insurer Molina Healthcare will spend about $200 million to expand the behavioral and mental health services it provides with its coverage. The Long Beach-based insurer said Thursday it will buy two subsidiaries of the Providence Service Corp. They are Providence Human Services and Providence Community Services. Molina said the subsidiaries will complement its health plans. (9/3)

Medtronic Plc, the world's largest standalone medical device maker, reported a 70 percent rise in quarterly revenue, helped by higher sales across its business lines, in part due to the acquisition of surgical products provider Covidien Plc. Medtronic said it is well positioned to benefit from the Medicare bundle payment program, which aims to link payments for multiple services during an episode of care rather than pay providers separately for each service. (Grover, 9/3)

[Marco] Rubio is coming Friday for a fundraiser in San Juan and a rally in Santurce. [Hillary] Clinton plans an event the same day in San Juan about reversing what her campaign calls the U.S. territory’s economic decline and its health care crisis. ... The parade of presidential hopefuls to the territory speaks to the growing power of Puerto Rican voters on the mainland, especially in Florida, the top destination for those fleeing the island’s 12 percent unemployment rate and nine-year economic slump. (Bustos, 9/4)

Hillary Clinton plans to launch a new initiative this weekend as she seeks to weave women’s issues into every facet of her campaign instead of using them in a separate silo as she did in her unsuccessful 2008 presidential bid. ... Unlike previous presidential campaigns, officials say, Clinton will take women’s issues out of their own silo. For instance, Clinton will make expanding paid leave for new mothers part of her economic platform by emphasizing its cost to families. (Przybyla, 9/4)

Donald Trump isn't the only political outsider who's been having a good summer. Retired neurosurgeon Ben Carson is gaining in several polls — especially in the first-in-the-nation caucus state of Iowa, where evangelical voters play a big role. ... On the stump, Carson often talks about his belief in God and his opposition to abortion. He has compared it to slavery and accused Planned Parenthood of targeting African-Americans. (McCammon, 9/3)

Vice President Joe Biden said Thursday that the biggest factor in his decision on whether to run for president is whether he and his family “have the emotional energy to run.” “The honest-to-God answer is, I just don’t know,” he said. That deeply conflicted response was the first public articulation of a thought process he’s discussed until now only privately with top Democrats and close advisers. He gave no timetable for a decision. (Korte, 94/)

All sorts of theories have been proposed to explain the alarming rise -- 6.4 million in 2011, a 42 percent jump from 2004 -- in schoolchildren being diagnosed with Attention-Deficit/Hyperactivity Disorder, or ADHD, requiring therapy, medicine or both to make it through their day. ... Now a new report from the Centers for Disease Control and Prevention brings up another possibility: improper diagnosis. (Cha, 9/3)

The Maryland Department of the Environment says it’s sending out 87,000 letters to landlords who haven’t registered their rental units under a law meant to reduce childhood lead poisoning. (9/4)

People who grow up on farms -- especially dairy farms -- have way fewer allergy and asthma problems than the rest of us. Now one research team thinks they've brought science closer to understanding why. In a study published Thursday in Science, researchers report that they were able to pinpoint one possible mechanism for the allergy protection in mice they studied. Surprisingly, the protein that they fingered as the likely allergy-preventer doesn't actually affect the immune system -- it affects the structural cells that make up the lining of the lung. (Feltman, 9/3)

Truvada (emtricitabine and tenofovir) was originally developed as an antiviral drug for managing HIV, but in 2012 the U.S. Food and Drug Administration (FDA) approved it as a daily prophylactic pill for patient populations at highest risk for HIV, such as gay men with multiple sexual partners. But many have questioned whether the drug was effective enough and also whether the prophylactic treatment might encourage risky behavior and a rise in other sexually transmitted—and highly treatable—infections. ... This week, the private insurance company Kaiser Permanente released the largest population study to date that shows the drug is highly effective for preventing HIV transmission. (Firger, 9/3)

When a new pill to prevent HIV hit the US market in 2012, it sharply divided the health community. Some experts hailed it as a major breakthrough in the fight against AIDS. Others worried it would turn back years of advocacy around condom use and encourage risky sex. ... But some public health researchers and AIDS activists had concerns about how this drug might be used in the real world. They feared that people might take Truvada (the brand name for PrEP) and then abandon condoms altogether — leading to a rise in other types of sexually transmitted infections. Others worried about what might happen if people didn't take the pill every day, as directed. Would it still work? (Belluz, 9/3)

Medicare fraud in all its forms is rampant. Though exact numbers aren't known, the government estimates that $60 billion to $90 billion is lost each year to Medicare fraud and abuse. In California, as many as 20% of fraud allegations investigated each year by the Senior Medicare Patrol involve durable medical equipment. Experts offer these tips to avoid becoming a victim of Medicare fraud. (Zamosky, 9/4)

Half of all retirees leave the workforce earlier than planned due to a health problem or job loss. The index does not measure the risk of early retirement due to job loss or other factors, such as the need to care for a family member. Instead, it looks at cognitive, psychomotor, physical and sensory abilities required to do various jobs. The key finding: highly educated professionals can be as susceptible to early retirement risk as a steelworker or truck driver. (Miller, 9/3)

Floridians depend on cars to get just about anywhere. And getting to the doctor without one can be tough. Orlando resident David Williams knows this reality well, especially since the brand new Orlando VA Medical Center moved from the downtown core to the suburbs. (Aboraya, 9/3)

More than 300,000 American military veterans likely died while waiting for health care -- and nearly twice as many are still waiting -- according to a new Department of Veterans Affairs inspector general report. The IG report says “serious” problems with enrollment data are making it impossible to determine exactly how many veterans are actively seeking health care from the VA, and how many were. For example, “data limitations” prevent investigators from determining how many now-deceased veterans applied for health care benefits or when. (9/3)

The number of confirmed cases of Legionnaires' disease at California's San Quentin prison is holding steady at six, one of three outbreaks of Legionnaires' around the country that have sickened dozens and killed 20. Another 95 San Quentin inmates are under observation because of respiratory illness, state officials said, but they have not been diagnosed with Legionnaires' disease. The inmates are being treated at San Quentin's medical unit. ... In New York City, health officials announced Wednesday that they had detected Legionnaires' bacteria in the water in one building in the Melroses Houses complex in the South Bronx, where four people have fallen ill. Other buildings there are being tested. ... And in Quincy, Ill., the death toll from a Legionnaires' outbreak has risen to eight, health state officials reported Wednesday. (Aliferis, 9/3)

Hundreds of inmates at a state prison in northern Arizona have gotten ill in the past 48 hours, and the state Department of Corrections says it’s working with health officials to identify the cause. The department says lab samples are being sent out to determine why 220 inmates in the Winslow prison complex’s Kaibab and Coronado units have had gastrointestinal illness. (9/3)

Three jail deputies were arrested Thursday on suspicion of murder in the beating death of a mentally ill inmate in Santa Clara County — an act that Sheriff Laurie Smith described as “heinous and cowardly.” ... While in sheriff’s custody, Tyree was waiting for a bed to open at Momentum Crisis Residential, a 24-hour adult residential treatment program. (Rocha, 9/3)

State officials last week started to collect the so-called "clawback" money from pharmacies -- money the state wants to recoup from payments made during the time a 10% rate reduction was held up in court. (Gorn, 9/3)

For years, Massachusetts has been out in front of other states, trying ideas to change the health system. It passed a state law extending health insurance coverage to almost all citizens four years ahead of the federal health law, and then the commonwealth tried to tackle rising health costs. But the latest numbers are disappointing: Massachusetts spent $632 million more on health care last year than it aimed to, according to a report from the state’s Center for Health Information and Analysis. (Bebinger, 9/4)

Six years ago, Children's Hospital outside Denver and dozens of clinics around the state began focusing on long-acting forms of contraception, such as IUDs and hormonal implants. Research shows they're much more reliable at preventing pregnancy than the pill or condoms. Liz Romer, who runs the clinic at Children's, where teenagers and young women can get free and confidential birth control, said that's in part because they're less subject to human error. (Horsley, 9/3)

In a medical-malpractice lawsuit stemming from the death of a woman who hanged herself, the Florida Supreme Court on Wednesday weighed whether her doctor could be found negligent in the suicide. The case, brought by the husband of Sarasota County woman Jacqueline Granicz after her 2008 death, raises issues about physician Joseph Chirillo's "duty" of care. The 2nd District Court of Appeal ruled last year that the lawsuit against Chirillo could move forward, overturning a circuit judge's ruling in the doctor's favor. (Saunders, 9/3)

Attorney General Pam Bondi's office argued this week that a potential challenge at the U.S. Supreme Court should not prevent the state from carrying out a law aimed at restricting doctors from asking questions about patients' gun ownership. A three-judge panel of the 11th U.S. Circuit Court of Appeals in July upheld the controversial law --- dubbed the "docs vs. glocks" law. Opponents last month asked the full appeals court to hear the case. If that request is rejected, the opponents indicated they will take the issue to the U.S. Supreme Court. (9/3)

West Nile virus hit California harder than ever last year, with a record 561 cases of neuroinvasive disease–the most serious types of the illness–reported from the mosquito-borne virus, according to federal health data released Thursday. The number of these serious California cases was 83 percent higher than the previous record number reported in the state in 2005, according to the U.S. Centers for Disease Control and Prevention. (Feder Ostrov, 9/4)

Members of the four American Indian tribes with northeast Kansas reservations recently gathered to talk about health. They discussed continuing the fight against diseases, such as diabetes, that have plagued Indians for generations. But the talk didn’t stop there. “Native Americans are the most at risk for having diabetes. It’s just predispositioned that way. And so, because of that, I knew that that was going to be one of the most important things,” said Tiffany Buffalo, who heads the diabetes program for the Sac and Fox Tribe. (Thompson, 9/3)

In July 2015, emergency responders in Manatee County handled more than 200 heroin overdose calls. And the repeat overdose calls alone are nearly three times what the overall total was for July 2014. Chief Stephen Krivjanik with Manatee County Public Safety Department’s EMS Division called July 2015’s numbers “overwhelming.” (Watts, 9/3)

In fact, the woman from Beavercreek in suburban Dayton not only testified twice publicly for Senate Bill 43 — a law allowing judges to order out-patient treatment for the mentally ill — but also attended a bill-signing ceremony in Gov. John Kasich’s office on June 17, 2014. A photo shows Kasich with his left arm around Baker’s shoulder in the center of a group of lawmakers and advocates. How did things go so wrong? (Johnson, 9/4)

Erica Anderson, a health promotion specialist for the Lawrence-Douglas County Health Department, likes to tell a story about a woman who came to one of her workshops eager to talk about electronic cigarettes. The woman, who was pregnant, said she was in a restaurant when a man at the table next to her started puffing on an e-cigarette, which delivers nicotine to users in a vapor. As the white cloud of vapor wafted over to her, she got up and asked the restaurant owner to tell the man to stop. (Marso, 9/3)

For years, Crystal Davis battled an insurance company for workers' compensation benefits after her husband, Wayne, was killed on the job in 2012. As a result of her struggles, the Texas Department of Insurance has slapped that insurer with what is believed to be the highest fine ever issued for workers' compensation violations in the state — $250,000. None of the money goes to Davis — a stay-at-home mom from Tyler with two children — but the state is requiring that a large chunk of it be used to help children of injured or killed workers. (Satija, 9/3)

A doctor who has an office at New York’s Kennedy Airport is accused of selling oxycodone prescriptions to his patients, prosecutors said Thursday in announcing his arrest. (Balsamo, 9/3)

The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS). ... Approximately 271 000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms. (Marmar et al., Sept., 2015)

[Researchers sought to] describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex .... The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence .... Antipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms. (Olfson, King and Schoenbaum, 9/3)

More than three-quarters of a million (772,000) older Californians are among the “hidden poor” – older adults with incomes above the federal poverty line (FPL) but below a minimally decent standard of living as determined by the Elder Economic Security Standard Index (Elder Index) in 2011. ... This study finds that the FPL significantly underestimates the number of economically insecure older adults who are unable to make ends meet. Yet, because many public assistance programs are aligned with the FPL, potentially hundreds of thousands of economically insecure older Californians are denied aid. The highest rates of the hidden poor among older adults are found among renters, Latinos, women, those who are raising grandchildren, and people in the oldest age groups. (Padilla-Frausto and Wallace, 8/31)

The effects of the Medicaid expansion on state budgets and economies have been key issues for policy makers. This brief ... is designed to provide some insight into the underlying economic and fiscal conditions in [Medicaid] expansion and non-expansion states leading up to 2014. ... Key findings include: The typical expansion state was in a better position across the factors analyzed leading up to the ACA Medicaid expansion in 2014. Median poverty and uninsured rates were higher in non-expansion states. ... Median tax collections per capita have historically been higher in expansion states. ... The typical expansion state spent more per capita on Medicaid and K-12 education prior to the major ACA coverage expansions. (Synder et al., 9/1)

[R]esearchers analyzed the National Study of Drug Use and Health to examine utilization of behavioral health care among current or former wives of service members and veterans who are covered by either TRICARE or CHAMP-VA. Three findings of interest emerged .... First, relative to the comparison group, military wives were more likely to receive behavioral health services, but this pattern was exclusively due to use of prescription psychiatric medications. No difference was found for specialty behavioral health treatment. Second, residing in rural areas was negatively associated with behavioral health care service use for both groups. Third, contrary to expectations, military wives who live more than 30 minutes from a military treatment facility were more likely than military wives who lived closer to receive prescription psychiatric medications but not other types of behavioral health services. (Breslau and Brown, 8/24)

[T]he Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. (Ryan et al., 9/3)

The Department of Health and Human Services (HHS) is the largest grantmaking agency in the Federal Government. In fiscal year 2014, HHS awarded nearly $402 billion in grants. ... Awarding agencies' grant officials use various sources of information and communication to mitigate grantee risks; however, grant officials noted limitations in some instances. For example, information available in databases assists staff from awarding agencies in managing grantee risks, but lack of integration poses challenges. NEARC memorandums contain important information about grantee risks, but not all awarding agencies receive them. Awarding agencies lack a systematic method of sharing information about grantee risks, and sharing occurs infrequently. (Murrin, 9/2)

In less than 20 percent of family meetings in the intensive care unit do doctors and other health care providers discuss religion or spirituality a new study finds. For many patients and families, religion and spirituality are important near the end of life, and understanding these beliefs may be “important to delivering care that is respectful of the patient as an individual,” said senior author Dr. Douglas B. White of the University of Pittsburgh School of Medicine, in email to Reuters Health. (Doyle, 8/31)

Low-income patients with HIV who received care at a facility funded by the Ryan White HIV/AIDS Program (RWHAP) were more likely to achieve viral suppression than those at non-RWHAP-funded facilities, according to a new study. RWHAP-funded facilities were also more likely than others to provide services such as case management and mental health and addiction services. John Weiser, MD, MPH, from the Division of HIV/AIDS Prevention of the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues report their findings online August 31 in JAMA Internal Medicine. (Frellick, 9/2)

A racial gap in kidney transplants appears to have closed, a 13-year study found. Rates of such transplants among white patients used to far surpass those in blacks, but U.S. data on nearly 200,000 end-stage kidney disease patients shows that disparity had disappeared by 2010. Rates remained stable in 2011 and that trend likely has continued, said Dr. Jesse Sammon, the senior author and a urologist-researcher at the Henry Ford Health System in Detroit. (Tanner, 8/31)

Living kidney donors and their recipients would like to share more health information before the transplant surgery, a new survey indicates. Currently, patients must be informed if they’re at risk for acquiring hepatitis or HIV from a donor organ, researchers write in the Clinical Journal of the American Society of Nephrology. Beyond that, transplant professionals cannot share information without the permission of both parties, senior author Dr. Lainie Friedman Ross of the MacLean Center for Clinical Medical Ethics at the University of Chicago told Reuters Health by email. (Doyle, 9/2)

Omega-3 fatty acids and antioxidants are often marketed to promote brain health. But one study to test these supplements has found no evidence that the pills stave off cognitive decline in older people. (Rabin, 8/31)

Mental health has a long-standing public perception problem, but the stigma appears to be shifting, at least in the United States, a new survey reveals. Results from a national online survey on mental health, anxiety and suicide indicate that 90% of Americans value mental and physical health equally. (Ansari, 9/1)

Wrist-worn activity trackers, increasingly popular among consumers and in healthcare research, can vary considerably in their accuracy, a study from Iowa State University suggests. Researchers pitted consumer devices against a gold-standard metabolic monitor and found the wristbands are more accurate for calories burned while resting or jogging, but have higher error rates for activities like weight lifting and crunches. (Kennedy, 9/1)

With rates of binge drinking increasing, the American Academy of Pediatrics recommends that physicians screen children as young as 9 years of age for alcohol abuse, according to the most recent clinical report on the subject. Lorena Siqueira, MD, of the AAP Committee on Substance Abuse, and colleagues cited survey results that indicate children start to think positively about alcohol between ages 9 and 13. They also found that almost 15% of children 14 to 20 years old, including almost 5% (4.5%) of 14- and 15-year-olds reported binge drinking (defined as ≥3 to ≥5 drinks on one occasion, depending on age and sex). (Walker, 9/1)

The American Society of Clinical Oncology (ASCO) has issued guidelines on how cancer doctors should approach the use of new genetic tests that screen for multiple cancer genes at the same time, including counseling patients about genes whose contribution to cancer is still poorly understood. The guidelines aim to educate doctors about the risks and benefits of new genetic tests, argue for regulation to assure quality and call for more equitable reimbursement of the cost of the tests from private and public insurers. (Steenhuysen, 8/31)

If you’ve heard anything about the upcoming budget battle, it’s probably that Republicans want to dramatically slash spending. Yay, fiscal conservatism! What you may not know is that many of their desired funding cuts would increase deficits in the long run. Here’s why. You know how you’re supposed to go to the doctor for preventive care so you don’t get really sick later on? Some government spending programs serve a similar purpose. (Catherine Rampell, 9/3)

A week earlier, my pregnant wife, Jennifer, had undergone a routine prenatal ultrasound that revealed “soft markers” suggestive of genetic abnormalities. Now we were in the consultation room awaiting the results of the amniocentesis, which would conclusively determine whether our daughter would be born with Down syndrome. ... Hammering home the momentous difficulties that would await us as parents was clearly a tactical move by the doctor to push us toward an abortion. That abortion is not the exception, but rather the expectation in cases of Down syndrome, is not limited to medical professionals. Though precise numbers are unavailable, at least two-thirds and as many as 90 percent of fetuses found to have Down syndrome in utero are aborted. (Mark Lawrence Schrad, 9/4)

Americans eat more than 50 pounds of beef per person each year. That’s a lot of beef. It’s also a lot of risk, because about half — or more than two billion pounds — is ground beef, which can too easily harbor dangerous bacteria. ... But as a new report points out, there is more the Department of Agriculture and the Food and Drug Administration can do to keep Americans safe and some simple things consumers could do themselves. (9/4)

A bill that would more than triple the California cigarette tax was gaining little traction in the Legislature until it received a push forward from Gov. Jerry Brown's special legislative session on funding healthcare for the poor. The additional $2-per-pack tax imposed by the bill would initially raise $1.5 billion a year. A well-crafted cigarette tax is a thing of beauty. Not only does it raise revenue, but it helps reduce smoking rates and deters teenagers from developing a cigarette habit, preventing many premature deaths. California, whose cigarette taxes are in the bottom third nationwide, is overdue for an increase. But more than six months after the bill's earliest hearings, the "well-crafted" part is still missing. (9/3)

On April 16, 2015 President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) which, among other things, finally repeals the Sustainable Growth Rate (SGR) mechanism of updating fees to the Physician Fee Schedule (PFS). The SGR had been blamed for causing instability and uncertainty among physicians for over a decade and led to 17 overrides of scheduled fee cuts, at a cost well in excess of $150 billion. The passage of MACRA, however, raises new questions about where the U.S. health care system is headed in the post-SGR world of payment and delivery reform. (John O'Shea, 9/3)

One Monday morning, rounding on a patient who needed relatively urgent coronary-artery bypass surgery, a newly appointed cardiologist in New York asked the team to call a surgical consult .... “We can't call today,” the cardiology fellow explained patiently. “Dr. X. is taking consults. He wouldn't touch our patient with a 10-foot pole.” The fellow scrutinized the call schedule. “The only surgeon who might take him isn't on until Wednesday.” In New York, one of a handful of states where outcomes of cardiac surgery and percutaneous coronary intervention (PCI) have been publicly reported for some years, such situations are not uncommon. Although the aim of report cards was to motivate proceduralists to improve quality, they seem instead to have motivated avoidance of the sickest patients. (Lisa Rosenbaum, 9/2)