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Increasingly, there are two ObamaCares. There’s the one in coastal and northern areas, where the marketplaces include multiple insurers and plans. And there’s the one in southern and rural areas, where there is often little competition, a situation that can lead to higher premiums. (Sullivan, 8/22)

So much for choice. In many parts of the country, Obamacare customers will be down to one insurer when they go to sign up for coverage next year on the public exchanges. A central tenet of the federal health law was to offer a range of affordable health plans through competition among private insurers. But a wave of insurer failures and the recent decision by several of the largest companies, including Aetna, to exit markets are leaving large portions of the country with functional monopolies for next year. According to an analysis done for The Upshot by the McKinsey Center for U.S. Health System Reform, 17 percent of Americans eligible for an Affordable Care Act plan may have only one insurer to choose next year. (Abelson and Sanger-Katz, 8/21)

Pullbacks by national insurers and failed co-op plans are leading to a significant decline in exchange competition for 2017, according to two new analyses of rate filings. Seventeen percent of potential Obamacare customers may have just one insurer selling exchange products in their area, according to the McKinsey Center for U.S. Health System Reforms. That’s up from just 2 percent of customers who had only one coverage option for this year. (Demko, 8/19)

The latest evidence comes in a study from consulting firm Avalere Health, which examined areas, known as rating regions, that insurers use to set premiums and decide where to offer plans to individuals under the Affordable Care Act. According to Avalere, 36 percent of the approximately 500 rating regions in the U.S. may have just one health insurer when the 2017 signup season starts on Nov. 1. Another 19 percent could have just two carriers. There was far more competition this year, with about two-thirds of rating areas having three or more health insurers vying for customers’ business, according to Avalere. (Tracer, 8/19)

It’s an increase over 2016 levels, according to Avalere data, which shows that 4 percent of ratings regions — which are geographic areas used to set insurance premium rates — had just one insurer offering plans on the exchanges in 2016. Pinal County in Arizona is, as of now, the only county in the country expected to have no insurers offer plans next year. (McIntire, 8/19)

With the fourth open-enrollment period set to begin this fall for the marketplaces set up by the Affordable Care Act, it’s becoming clear that the market for health insurance has not evolved as expected, or hoped. The market is smaller than projected. The people who have bought health plans overall are sicker than predicted. And health insurers have incurred larger losses than anticipated. (Boulton, 8/22)

Last week, Minnesota regulators issued a request for proposals from groups that might be willing to step in and sell coverage on the state’s MNsure exchange, particularly in counties outside the Twin Cities metro. It came after Blue Cross and Blue Shield of Minnesota announced in June a pullback that could cut options in 11 rural counties. The request came on the same day that Connecticut-based health insurance giant Aetna announced it would stop selling next year coverage on 11 of 15 state exchanges where it currently competes. (Snowbeck, 8/20)

Blue Cross and Blue Shield of Georgia says it is reassessing the premium increases it has previously proposed for the state health insurance exchange, with an eye to revising them upward. This comes in the wake of Aetna’s pullout from the exchange here. Blue Cross, the state’s largest health insurer, reiterated its stance that it will remain in Georgia’s exchange next year. But it won’t have much time to readjust its rate proposal. (Miller, 8/19)

The Obama administration is moving to end duplicate coverage for tens of thousands of people who are enrolled in Medicaid and simultaneously receiving federal subsidies to help pay for private health insurance under the Affordable Care Act. ... The action ... comes more than nine months after congressional investigators from the Government Accountability Office said they had discovered the potential for duplicate coverage, with double payment. The potential is significant because low-income people can switch back and forth between Medicaid and subsidized private coverage as their circumstances change. (Pear, 8/21)

Some small companies that dropped group health insurance for their employees are reversing course, driven by a tightening labor market and rising costs and fewer choices for individual coverage. Laura Cottrell, owner of a seven-person home-furnishings and home-improvement products business in St. Louis, dropped group coverage in 2014, not only because of the cost but also the complexities of picking the right plan within a short deadline. Instead, she gave her employees a raise that they could use to buy their own health plans, sparing her from choosing for them. (Simon, 8/21)

When Obamacare was developed, one goal was to allow middle-class Americans to use the new marketplaces to buy the same kind of health insurance they had at their jobs. People could retire early, or quit a corporate job and become a freelancer, and still have the great care and financial protection that come with high-end plans. But six years into the health law, the reality is that a typical Obamacare plan looks more like Medicaid, only with a high deductible. (Sanger-Katz, 8/21)

The tanning salon industry is feeling burned by "Obamacare." Business owners around the country say the little-noticed 10 percent tax on tanning in President Barack Obama's health care overhaul has crippled the industry, forcing the closing of nearly 10,000 of the more than 18,000 tanning salons in the U.S. Experts say the industry is overstating the effects of the "tan tax" and that it has been hurt by other factors, too, including public health warnings about the dangers of tanning and the passage of laws in dozens of states restricting the use of tanning salons by minors. (Kennedy, 8/20)

Election Day 2016 will raise the curtain on the final act in the nation's long-running political drama over President Barack Obama's health care overhaul. If Republican Donald Trump wins, the unraveling begins. "We have an obligation to the people who voted for us to proceed with 'repeal and replace,'" said Sen. John Barrasso, a Wyoming Republican. If Democrat Hillary Clinton goes to the White House, it gets very difficult for Republicans to keep a straight face about repealing "Obamacare." (Alonso-Zaldivar, 8/20)

When Bruce Bradford was fired after nearly two decades as a federal police officer, he lost his income, his health insurance and eventually his wife and apartment as his medical problems mounted. He ended up being thrown a lifeline by the very politicians he can't stand. Bradford, a longtime Republican who dislikes big government and what he regards as handouts, obtained insurance and a monthly government subsidy under President Barack Obama's health care overhaul. (Kennedy, 8/20)

With a household income too high for a federal subsidy, Bruce Mainzer and Beth Shadur are bracing for higher health insurance premiums in 2017. As in other states, many insurers in Illinois have requested double-digit rate increases. Americans ineligible for the government subsidies that help cover their premiums will be hit hardest. (Johnson, 8/20)

Health care will be on Rebecca Esparza's mind in the voting booth this fall. The two-time cancer survivor from Corpus Christi, Texas, said repealing the Affordable Care Act, as Republicans have tried to do dozens of times, could make her uninsurable. "I realize this is something that could happen," she said. "It's a terrifying thought for me not to have any insurance at all." (Johnson, 8/20)

It's a popular part of the Affordable Care Act. Soon after the provision went into effect, the number of uninsured Americans ages 19 to 25 dropped by 1.6 million, according a government survey. More young adults received health insurance as the law's other provisions took effect in 2014. By last year, fewer than 5 million were uninsured, about half the number when the law passed in 2010. (Mulvihill, 8/20)

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

The top Senate Republican is urging the Obama administration to use any funding it is planning to use to increase enrollment in the Affordable Care Act exchanges to respond to the Zika virus. Senate Majority Leader Mitch McConnell (R-Ky.) wrote to Health and Human Services Secretary Sylvia Burwell on Friday, seeking details on reports of an advertising campaign for the federal health insurance exchanges created under the Affordable Care Act. Any funding the department has for such a campaign should instead go toward the Zika virus, McConnell said. (McIntire, 8/19)

The continued increase in the number of pregnant women possibly infected with Zika—which reached 529 in the states and the District of Columbia as of Aug. 11, according to the Centers for Disease Control and Prevention—is focusing renewed attention on the controversial issue of late-term abortions. It comes as many state legislatures are tightening restrictions on such procedures. Some of the most active efforts are in the South, one of the regions most vulnerable to the spread of Zika by mosquitoes. (Campo-Flores and Frosch, 8/21)

The threat of a Zika epidemic of the virus in the U.S. is raising the ethical dilemma of presenting abortion as an option to infected mothers who may be likely to give birth to babies with significant developmental disabilities. Some policymakers and anti-abortion activists have already rallied against easing or increasing access to abortion, and experts say the arrival of Zika in the U.S. during an election year makes it nearly impossible to have a conversation about abortion as a medical decision. (Johnson, 8/20)

For years, most Americans have opposed abortions late in pregnancy. Zika could change that, potentially undermining support for a national ban on abortion after 20 weeks of pregnancy. Pregnant women with the Zika virus risk giving birth to babies with devastating brain defects, which can be detected only around 18 to 20 weeks and often much later than that. More than 1,200 pregnant women have been diagnosed with the virus in the U.S., so far, mostly in Puerto Rico. (Haberkorn, 8/19)

Amanda Paradiz is 16 weeks pregnant, and she has a mission: to get through her entire pregnancy without a single mosquito bite. It hasn’t been easy. Ever since health officials in July announced four cases of Zika transmission by local mosquitoes detected in a Miami-area neighborhood, Mrs. Paradiz and her husband, Alex, have largely secluded themselves in their Broward County home. (Rabin, 8/19)

The Zika virus has changed how blood banks collect donations in Florida – and now it’s changing sperm and egg donations as well. An Orlando sperm and egg donation bank will not sell any specimens collected after August 1 because of the Zika virus. Cryos International is a large sperm bank in Europe, and its first U.S. office is located next to the University of Central Florida in Orlando. (Aboraya, 8/22)

Early Friday afternoon, Gov. Rick Scott announced that the area between Eighth Street and 28th Street in Miami Beach is an active zone of Zika transmission, with five non-travel-related case of the virus linked to the city. However daily life continued uninterrupted in Miami Beach – tourists lounged along Ocean Drive, and residents walked their dogs with tank tops and shorts on. (Kranz, 8/21)

Toxicologists say Floridians using mosquito repellent for Zika virus prevention should not overuse it. Mosquitoes in Miami-Dade County are transmitting the illness, which is linked to birth defects. And misusing repellent could cause some health issues, too. Most mosquito repellents contain the chemical DEET, like OFF!, Cutter and Sawyer.  A study done in the late 1990s showed that when pregnant women used products with DEET as directed, they and their babies were just fine. Alfred Aleguas is director of the Florida Poison Information Center in Tampa. He said, though, it is possible to suffer side effects from applying high concentrations of DEET and then not washing it off. (Meszaros, 8/22)

Monday is the first day of school across Miami - where there are growing concerns about the Zika virus. ... The Florida Department of Health handed out free bug repellent at Miami Beach Senior High. Students from here and one other school in the newest Zika zone were encouraged to spray themselves before class. Melanie Fishman, principal at South Pointe Elementary in Miami, said they don’t want students to spray themselves at school because “some kids might have asthma.” (Begnaud, 8/21)

The head of the government's infectious disease center said the states along the Gulf Coast are most at risk for an outbreak of the Zika virus, pointing specifically to Louisiana as it deals with destructive flooding. "I would not be surprised if we see cases in Texas, in Louisiana — particularly now, where you have a situation with flooding in Louisiana," Dr. Anthony Fauci, director of the National Institutes of Health said on ABC's "This Week." (Savransky, 8/21)

A National Institutes of Health official said Sunday that the Zika virus could "hang around" the United States for a year or two. Dr. Anthony Fauci told ABC's "This Week" that other Gulf Coast states, besides Florida, are most vulnerable to the spread of the disease. (8/21)

The droplets would awaken any insects in the area, cause them to take flight and then kill them. The spraying is called adulticide — as opposed to larvicide, or killing insects before they hatch — and it was the first time that such a truck had ever rolled through the neighborhood. (Santora, 8/21)

If you swat it away, the tiger mosquito buzzes right back. Known scientifically as Aedes albopictus, it lives and breeds around people, and it’s what most people complain about to Chatham County Mosquito Control. But this pesky, striped-legged nuisance might be just what protects the Savannah area from the Zika virus. That’s because it has outcompeted another mosquito, Aedes aegypti, that’s the main carrier of the disease. (Landers, 8/20)

As local government and tourism officials emphasized that the safety of residents, workers and guests came first, it was hard to sidestep the obvious: Would tourists stay away from the island’s alluring beaches, hip hotels and just-about-anything-goes clubs? And if they did, what would it mean for the economy of Miami Beach — the superstar of the county’s $36 billion tourism industry? (Alvarez and Madigan, 8/20)

There are five new local cases of Zika in Miami Beach and a new 1.5-square-mile transmission zone from the beach to the Intracoastal Waterway, Florida Gov. Rick Scott confirmed Friday during a Miami visit to talk about the virus. The new cases involve three tourists and two local residents, Scott said during a news conference. The new zone runs from Eighth Street to 28th Street in Miami Beach, he said. The Centers for Disease Control and Prevention, along with Florida health department, quickly issued a travel advisory after the news conference, telling pregnant women to avoid the Miami Beach Zika transmission area. (Chang, 8/19)

Florida Gov. Rick Scott confirmed Friday that the Zika virus is being spread locally by mosquitoes in Miami Beach, a development that marks an expansion of the outbreak in South Florida and immediately prompted a new travel advisory by federal officials. "We believe we have a new area where local transmissions are occurring in Miami Beach,” Scott said at a noon press conference. The suspect zone covers about 1.5 square miles between 8th and 28th streets, and between the beach and the intracoastal waterway -- a stretch that encompasses the city's central tourist area. (Dennis, 8/19)

That decision to issue a warning about the entire city was prompted by the agency's concern that there may be other outbreaks in other parts of Miami-Dade that haven't been identified yet, CDC Director Thomas Frieden told reporters during a briefing. "What we are doing is stepping back and saying, 'There have now been multiple instances of local transmission,'" Frieden said. "We will always err on providing more information to the public." (Stein, 8/19)

The affected area of Miami Beach includes South Beach and stretches from the beach to the Intracoastal Waterway, from 8th Street to 28th Street. The neighborhood is several miles away and on the other side of Biscayne Bay from Wynwood, the first Miami neighborhood to experience a Zika outbreak.People who live in or who have traveled to this part of South Beach since July 14 should be "aware of active Zika virus transmission," the CDC said. (Szabo and Freeman, 8/19)

A spokeswoman for the C.D.C. said that the agency is required to comply with a state’s wishes about how broadly to draw the boundaries of areas it advises people not to travel to. But agency officials clearly want to sound the alarm about possible Zika spread in a much larger area of South Florida. In announcing the new cases on Friday, Governor said the new area in Miami Beach is just under 1.5 square miles and is between Eighth and 28th Streets from the beach to the intracoastal on Miami Beach, an area that includes the heart of the South Beach neighborhood, one of South Florida’s biggest tourist attractions. (Alvarez and Belluck, 8/19)

The new president was facing America's biggest economic crisis since the Great Depression. Key advisers urged him to keep his focus on economic recovery. The opposition party signaled it would wage an all-out fight to block healthcare reform. And his own party was divided on how to proceed. But President Barack Obama charged ahead. “Now is the time to deliver on healthcare,” he told Congress in September 2009. (Meyer, 8/20)

As President Barack Obama heads into the homestretch of his two terms in office, he once again tops Modern Healthcare's ranking of the 100 Most Influential People in Healthcare—the third time he's won the honor. And that's not surprising given his name—courtesy of his most vitriolic opponents—will be forever attached to the most significant expansion of health insurance coverage since the creation of Medicare and Medicaid in 1965. (May, 8/20)

Nonprofit hospitals have extensive business ties that can pose conflicts of interests for their administrators and board members, a Wall Street Journal analysis of newly released Internal Revenue Service data shows. While having relationships with companies doing business with a nonprofit hospital isn’t necessarily improper—as long as the deals are disclosed and at market rate—administrators and board members sometimes may be forced to choose between what’s best for the hospital and what’s best for their private interests. (Fuller and Evans, 8/21)

Freestanding emergency centers have sprouted in recent years across the suburban landscape, taking root in affluent neighborhoods and directly challenging nearby medical clinics and hospitals. ... As these centers offer another choice for people tired of deflating wait times at hospital emergency rooms, their escalating numbers are sending ripples across the health-care field. Critics say they do little to help those in rural America with dire medical needs, siphon away skilled emergency physicians and too often stick patients with overinflated bills. (Warren, 8/21)

Hospitals have traditionally been reticent to disclose to patients or their family members the specifics of how a medical procedure didn’t go as planned for fear of malpractice lawsuits. In recent years, though, many are beginning to consider a change. Instead of the usual “deny-and-defend” approach, they are revamping their policies to be more open. To help them move in this direction, the federal Agency for Healthcare Research and Quality released in May an online toolkit designed to expand the use of the agency’s “Communication and Optimal Resolution” process, which establishes guidelines for adopting more transparency in communicating adverse events. (Tan, 8/22)

As health insurance coverage has expanded under the federal health law, hospitals in Minnesota have seen a significant decline in costs to cover free and discounted care. The 10 largest hospital systems in the state last year spent about $236 million on what the industry calls charity care — a decline of $43 million, or 15 percent, from 2013, according to a Star Tribune analysis. (Snowbeck, 8/21)

A week after UCF officials announced that they were looking for a partner to build a teaching hospital in Lake Nona, they filed documents with the state showing their intent to build a 100-bed hospital, newly posted state documents show. The letter of intent, filed on behalf of UCF Academic Health Center and signed by UCF medical school dean Dr. Deborah German, is the first steps in the state's Certificate of Need process. (Miller, 8/19)

Texas has seen an “unusual,” dramatic increase in the number of women who died from pregnancy-related causes in the past five years, according to a new study. The state’s rate of maternal mortality nearly doubled between 2010 and 2014, according to research published by the medical journal "Obstetrics and Gynecology." Although maternal mortality rates are up nationwide, no other state experienced such a sharp rise, the study’s authors found. (Walters, 8/19)

A federal judge Thursday issued a permanent injunction against a new Florida abortion law that would have led to increased inspections of clinic records and prevented abortion providers from receiving public money for other health services. The ruling made permanent a preliminary injunction that U.S. District Judge Robert Hinkle issued June 30. Planned Parenthood filed the lawsuit after the Republican-controlled Legislature and Gov. Rick Scott approved the controversial law early this year. (8/19)

It's estimated that, in the United States, there are almost one million frozen embryos now in storage, a number that includes embryos reserved for research, as well as those reserved to expand families.In a 2005 study that interviewed 58 couples who conceived through IVF and had at least one frozen embryo in storage, more than 70 percent had not yet decided — even several years after the procedure — how they would dispose of a surplus embryo. (Fraga, 8/20)

The HPV, or Human Papilloma Virus, vaccine has continued to be seen as controversial. Despite years of recommendations and support from leading medical institutions, parents remain wary about requiring children to receive an HPV vaccination for school admissions, according to a new study. While just 21 percent of parents thought laws requiring the vaccine for school were a "good idea," that number rose significantly -- to 57 percent -- if there was an "opt-out" provision offered, according to the study published today in the journal Cancer Epidemiology, Biomarkers and Prevention. (Chevinsky, 8/19)

The U.S. Food and Drug Administration is asking for new scientific research as it reevaluates a controversial policy banning men from donating blood if they admit to having had sex with another man in the past year. Gay rights advocates say the rules are not based in science, but on decades of stigma regarding gay men and AIDS. (Feliciano and Green, 8/20)

Interpreters routinely help people who speak limited English — close to 9 percent of the U.S. population, and growing — understand what’s happening in the hospital. They become even more indispensable during patients’ dying days. But specialists say interpreters need extra training to capture the nuances of language around death.Many doctors and nurses need the assistance of interpreters not only to overcome language barriers but also to navigate cultural differences. Opportunities for miscommunication with patients abound. Words don’t always mean the same thing in every language. (Brown, 8/22)

Laura Katz Olson taught health-care policy for decades at Lehigh University and could rattle off the ins and outs of Medicare and Social Security. But none of that prepared her for caring for her mother, Dorothy Katz, a Senior Olympics medal winner who developed Parkinson's disease. Thrust into a long-distance caregiving role, Olson, 71, began grueling travel between Pennsylvania and Florida. Her mother's health failed with each passing visit. (Arvedlund, 8/21)

Consumer activity trackers like Fitbit are increasing becoming a tool used by researchers in clinical trials like [Joe] Casserly’s, which look at activities that could stop diseases from progressing or recurring. More than 100 studies listed on the federal government’s trial-tracking website feature Fitbits, with smaller numbers relying on the Apple Watch or Jawbone, Garmin, Pebble and other devices. Wearables have made their way into the precision-oriented world of clinical trials in part because patients like them, they’re easy to use and more convenient for participants than coming to a clinic to be monitored. While the devices may lack clinical-grade accuracy, particularly when it comes to heart-rate technology and tracking calorie burning, they are considered far more accurate that self-reported data. (Colliver, 8/21)

If a general manager could decrease his team’s man-games lost to injury by 20 percent, he would sell his owner’s personal jet to make sure such a scenario became reality. Injuries, especially the preventable groin strains, keep GMs up at night as they call up reinforcements, pursue help on the trade market, and perform hourly check-ins with their medical staff. The only barrier between teams and better health is acceptance. Catapult, an Australian company specializing in data to maximize athlete performance, believes it can help teams minimize injuries. Part of Catapult’s injury solution lies within its technology. (Shinzawa, 8/20)

For the past several years, Dr. Lee Daugherty Biddison, a critical care physician at Johns Hopkins, and colleagues have led an unusual public debate around Maryland, from Zion Baptist Church in East Baltimore to a wellness center in wealthy Howard County to a hospital on the rural Eastern Shore. Preparing to make recommendations for state officials that could serve as a national model, the researchers heard hundreds of citizens discuss whether a doctor could remove one patient from lifesaving equipment, like a ventilator, to make way for another who might have a better chance of recovering, or take age into consideration in setting priorities. (Fink, 8/21)

Jennifer Weiss-Burke knew there was a potentially life-saving medication for her 15-year-old son, who became addicted to painkillers and heroin after a sports injury. Yet she had to call dozens of doctors before finding one to prescribe it. ... The medication, buprenorphine, is used to treat addiction to opioids, such as heroin or prescription painkillers. It can suppress withdrawal symptoms, decrease cravings and cut the risk of relapse. (Shedrofsky, 8/22)

Maybe on an average day, when [Huntington, W. Va., with] about 50,000 people sees two or three overdoses, that would have been it. But on this day, the calls kept coming. ... From about 3:30 p.m. to 7 p.m., 26 people overdosed in Huntington, half of them in and around the Marcum Terrace apartment complex. The barrage occupied all the ambulances in the city and more than a shift’s worth of police officers. (Joseph, 8/22)

Over the last 15 years, McCreary County has seen a 75 percent increase in the mortality rate for white women between the ages of 35 and 59, one of the highest increases in the nation, according to a Washington Post analysis of national mortality rates. The analysis also showed that the mortality rate for similarly aged white women nationally increased 23 percent; for white men increased 16 percent; for black women decreased 10 percent; for black men decreased 20 percent; for Hispanic women decreased 11 percent; and for Hispanic men decreased 16 percent. (McCoy, 8/20)

You hear similar stories from others who come to this idyllic mountain community to shake their addiction. Outdoor recreation, a mild climate, scenic vistas and a welcoming attitude toward those in recovery is touted in a promotional video by a group called Drug Rehab Arizona. And with its motto "Welcome to Everybody's Hometown," Prescott has become a hub for the multi-billion-dollar recovery industry. It's even listed by the recovery website TheFix as one of the top 10 destinations in the country to get sober. (Stone, 8/22)

Heroin is entrenched in Denver, Colorado Springs and Pueblo, but it’s now also leaving its mark in rural corners of the state that lack the resources of their big-city counterparts. The Otero County deputies on the recent raid had no drug-sniffing dogs, months of wiretaps or experienced state prosecutors at their immediate disposal. On Tuesday in Denver, federal and state authorities announced a year-long investigation into a heroin organization operating in the metro area that netted more than two dozen indictments and the seizure of over $2 million in drugs. In the Lower Arkansas, there are only a few drug investigators dedicated to covering a vast stretch of towns and highways. (Paul, 8/20)

Pennsylvania this week is at last going to launch what is frequently described as one of the most effective public policy tools to rein in out-of-control opioid overdose rates. Starting Thursday, the statewide prescription database will allow medical providers to check for evidence that their patients may be abusing or selling drugs -- getting the same oxycodone scripts from multiple doctors and filling them at different pharmacies, for example. (Sapatkin, 8/22)

Just like the pills found at Prince’s home, the fentanyl-filled pills that the Drug Enforcement Administration has been finding look just like run-of-the-mill prescription pills. “The counterfeit pills often closely resemble the authentic medications they were designed to mimic, and the presence of fentanyl is only detected upon laboratory analysis,” a DEA report warned last month. (Contrera, 8/22)

Pills marked as hydrocodone that were seized from Paisley Park after Prince’s overdose death actually contained fentanyl, the powerful opioid that killed him, according to a source with knowledge of the investigation. The musician, who weighed only 112 pounds at the time of his death April 21, had so much of the drug in his system, autopsy results later showed, that it would have killed anyone, regardless of size, the source said. (Montemayor, 8/20)

Drugs collected from Prince's Paisley Park estate after his body was discovered April 21 were counterfeit pills that contained fentanyl, the powerful painkiller that an autopsy report said caused his death. Nearly two dozen pills found in one Aleve bottle were falsely labeled "Watson 385," an official told the Associated Press, speaking on condition of anonymity because of the ongoing investigation. (Blas, 8/21)

Starting in 1966, Dr. Henderson, known as D. A., led the World Health Organization’s war on the smallpox virus. He achieved success astonishingly quickly. The last known case was found in a hospital cook in Somalia in 1977. (McNeil Jr., 8/21)

D.A. Henderson picked up right away. What I thought would be a five-minute conversation stretched to an hour and a half. He talked thoughtfully about his view that society should destroy all remaining smallpox samples, given that an effective vaccine exists and that maintaining live samples risks accidental infections or, worse, vials falling into terrorists' hands. He recalled that during his tenure as dean of the Johns Hopkins Bloomberg School of Public Health, it was nearly impossible to keep tabs on all the specimens that all the quirky researchers kept in laboratory deep freezers. The smallpox discovery at NIH was serious, but he understood how something could get overlooked for decades. (Dennis, 8/21)

There are few people in the field of global public health so well-known that you merely need to utter two initials to evoke instant recognition. But to raise in conversation Dr. Donald Ainslee Henderson, the man who led the successful effort to eradicate smallpox, all anyone ever bothered to say was “D.A.”Henderson, a few weeks shy of his 88th birthday, died late Friday of complications that arose after he recently fractured a hip. (Branswell, 8/21)

According to a report by the American Cancer Society’s Action Network, Wyoming could do much more to reduce cancer rates. Each year, the report evaluates ten different policy areas that deal with prevention and quality of treatment in each state. Out of those ten areas, Wyoming only did well in two—oral chemotherapy fairness and funding for the state tobacco prevention program. The biggest thing that would improve Wyoming’s score would be to expand Medicaid. (Mullen, 8/19)

Health officials in metropolitan Phoenix are working to stop a parasite outbreak at several swimming pools in Maricopa County that causes diarrhea. The Maricopa County Department of Public Health (MCDPH) and the Environmental Services Department (MCESD) are responding to growing concerns since the microscopic parasite cryptosporidium was first reported August 4. More than 100 people have been sickened at about 20 public recreational water facilities, officials said. (Ansari, 8/20)

More than 100 people in Maricopa County, Arizona, have been infected with Cryptosporidium, a parasite officials believe was in at least 20 pools in the community.Cryptosporidium, or "Crypto," causes problems ranging from stomach cramps to vomiting and fever. The most common symptom is watery diarrhea, which generally begins a week after infection. Those with healthy immune systems don't need treatment and usually recover after a week or two. (Chuck, 8/20)

Veterans Affairs officials say they’re making progress towards shorter wait times at the VA St. Louis Health Care System, but the numbers show that challenges remain. At a meeting Friday with the leaders of veteran’s service organizations, Keith Repko, interim medical director, cited the latest report: In St. Louis, patients are waiting an average of five days for mental health appointments, 12 days for primary care and about eight days to see a specialist. (Bouscaren, 8/19)

Union officials met Saturday to continue conversations about another possible strike against five Allina Health hospitals, where as many as 4,800 nurses could walk out in a labor dispute over health benefits, workplace safety and staffing. The nurses rejected a proposed Allina contract on Thursday, voting against it with a wide enough margin to authorize a strike. They have to give Allina 10 days’ notice before a strike can occur. (Sawyer, 8/20)

With the November election starting to draw closer, a group backing a proposed constitutional amendment that would broadly legalize medical marijuana raised $34,526 from Aug. 6 to Aug. 12, according to a finance report posted Thursday on the state Division of Elections website. The group, People United for Medical Marijuana, received $20,000 from the Washington, D.C.-based Marijuana Policy Project. Orlando attorney John Morgan has spearheaded the effort to legalize medical marijuana and has contributed heavily to People United for Medical Marijuana, which is also known as United for Care. (8/19)

One in five Americans is estimated to have a mental health condition at any given time. But getting treatment remains difficult — and it’s worse for children, especially those who identify as black or Hispanic.That’s the major finding in research published last week in the International Journal of Health Services. The study examines how often young adults and children were able to get needed mental health services, based on whether they were black, Hispanic or white. (Luthra, 8/22)

More than 100 people rallied outside the Mount Vernon headquarters of Chase Brexton Health Care Friday to protest the recent firings of five employees and draw attention to what they say has been a decline in the quality of care provided. The rally comes after the firings that some employees and others allege are a part of a growing labor dispute between management and workers trying to unionize. The union seeking to represent Chase Brexton employees filed a complaint with the National Labor Relations Board last week claiming that the five employees were fired to intimidate other workers and dissuade them from voting to join the union. (Cohn, 8/19)

The DAWN — Dedicated to Aurora’s Wellness and Needs — Clinic was formed in March 2015 by a group of medical students and community members at the Dayton Street Opportunity Center, which was opened last year by Rep. Rhonda Fields. The clinic at 1445 Dayton St. is owned and operated by the Fields Foundation. (Mitchell, 8/19)

The U-Md. School of Dentistry and the hospital have opened the Monocacy Health Partners Dental Clinic in a unique arrangement that school officials hope will serve as a model for providing dental care to low-income adults, who often still lack coverage even as access to health insurance has been vastly expanded in recent years under the federal Affordable Care Act. Last year, more than 1,200 people seeking toothache relief came to Frederick Memorial. (Cohn, 8/21)

The state Department of Public Health has notified Watertown that West Nile virus has been found in samples of mosquitoes taken in town. The town’s health department issued a statement to residents on Friday noting that it is not unusual for mosquitoes to carry viruses “in this warm, dry weather.” The notice came three days after the state announced that a resident of Middlesex County, a woman in her 70s, is the first person this year to be infected with West Nile. ... A total of 25 cities and towns in Middlesex County, including Cambridge and Newton, have had mosquitoes test positive for West Nile virus, according to data tracked by the state public health department. (Sennott, 8/21)

Phoenix will be the first Arizona city to offer transgender-inclusive health-care benefits to its workforce of municipal employees and their families, Mayor Greg Stanton announced Thursday evening. The city will provide coverage for employees and their dependents who are transgender and seek access to a range of care, such as hormone therapy or surgical procedures, as they transition their bodies to match their gender identity. (Gardiner, 8/20)

Sea Port Products Corp is voluntarily recalling a batch of its scallops after at least 206 people became sick with hepatitis A, prompting an investigation by the US Food and Drug Administration and Centers for Disease control and Prevention. The federal agencies are assisting the Hawaii Department of Health, which reported the cases on August 17. The cases are linked to raw scallops. Of those who contracted hepatitis A, 51 were hospitalized. All the cases involve adults. (Christensen, 8/21)

I am a millennial; half my peers are single and on Tinder, half are getting ready to start families. I’m also a scientist, working toward a master’s degree in bioethics. And I am more and more worried about Zika. This summer, I co-wrote a guide for travelers to Rio de Janeiro about how to stay healthy in a place where Zika infection is common. After the Olympics’ closing ceremony, I worry that Americans will stop paying attention to the virus. They shouldn’t. (Kelly McBride Folkers, 8/20)

Even if military and medical might could eliminate every single trace of Zika, the social, environmental and political conditions that made Brazil, Florida, and Puerto Rico vulnerable to the rapid spread of a new infectious disease remain in place. These conditions include, global warming, movements of populations into overcrowded urban areas, and attitudes and policies that restrict women’s sexual and reproductive rights. (Susan Sered, 8/19)

In June, when I was on the ground in Puerto Rico working with local providers at community health centers to help stop the spread of Zika, a virus that has become a public health emergency, there were 130 cases of Zika-positive pregnancies on the island. Since then, that number has shot up to about 900 and, today, there are probably many more. Unfortunately, I had little to share with her that day other than the typical lines: We don’t know much, she should stay protected if she can with mosquito nets and condoms. During pregnancy, a woman often worries about the food she’s eating, if she’s sleeping in the right position. The threat of Zika doesn’t just alter the equation: It blows it up. (Kristyn Brandi, 8/22)

Pregnant women across the United States are living in fear of Zika every single day. The economic and emotional costs of this virus are astronomical and growing, with new cases in Miami Beach sounding the latest alarm. Yet the American public and some elected officials are downplaying a public health crisis that threatens an entire generation of babies. I am one of those pregnant women, one with a master’s degree in public health. I plan my life around a tiny insect that could cause devastating birth defects to my unborn child. There is no reprieve from the planning. And when all the precautions fail to prevent the dreaded mosquito bite, there is no reprieve from the worry. (Kelsey Mishkin Gardner, 8/21)

Like climate change deniers, the United Nations for years has stood virtually alone against the weight of scientific opinion on its own peacekeepers’ responsibility for the outbreak of cholera six years ago in Haiti, which continues to suffer from the world’s worst epidemic of that deadly disease. (8/21)

As Zika was moving north from Brazil to the United States, a different mosquito-borne disease — yellow fever — was cutting a devastating trail through Angola and the Democratic Republic of Congo, killing more than 400 people and sickening thousands. This epidemic is not yet over, and, like Ebola in West Africa, it has exposed glaring weaknesses in how the world confronts infectious diseases. (8/20)

So it’s worrisome that in recent decades, Lyme cases have surged, nearly quadrupling in Michigan and increasing more than tenfold in Virginia. It’s now the “single greatest vector-borne disease in the United States,” Danielle Buttke, an epidemiologist with the National Park Service in Fort Collins, Colo., told me, and it’s “expanding on a really epic scale.” What’s behind the rise of Lyme? Many wildlife biologists suspect that it is partly driven by an out-of-whack ecosystem. (Moises Velasquez-Manoff, 8/20)

According to an old bit of folk wisdom, if one person says you are drunk, you can wave him off. If two people tell you, go home. When UnitedHealth Group announced a few months back that it was going to stop selling individual health insurance in most Obamacare exchanges, informed observers were not alarmed. They noted that nearly all exchange customers still had at least two, and most had three or more, insurers competing for their business. (Henry J. Aaron, 8/19)

Since I last wrote about it, Aetna’s withdrawal from the Obamacare exchanges has ginned up even more drama. Jeff Young and Jonathan Cohn of the Huffington Post published a letter in which Aetna told the Justice Department that it would reduce its exchange participation unless Justice allowed the merger with Humana to go through. This has naturally triggered a firestorm of accusations about “extortion” and renewed calls for a public option that can protect people against the threat of insurance-less insurance exchanges. (Megan McArdle, 8/19)

This Greg Ip column presents one of the best summaries I have seen of problems with the Affordable Care Act stemming from its major, popular feature: prohibiting insurers from discriminating in enrollment or premiums based on an individual’s pre-existing health conditions. The 2010 health-care law, Mr. Ip writes, is suffering the same slow “unraveling” of the health insurance market it was designed to fix: attracting disproportionate numbers of older, sicker patients, whose health-care costs drive up premiums, which in turn prompts younger, healthier customers to drop the insurance (even with subsidies) or to opt out of enrolling (and choosing to pay a modest “tax” penalty). (Robert Litan, 8/21)

One of the biggest factors fueling the angst over drug prices in the U.S. is that some older medicines that should be sold cheaply as generics are still priced very high, often owing to a dwindling number of generic competitors and the rising cost of producing these drugs. Bernie Sanders and Hillary Clinton like to blame generic-company mergers and greedy drugmakers. But a closer look reveals that a series of regulatory policy blunders is at fault. (Scott Gottlieb, 8/19)

This column is a mea culpa. In this week's issue of Modern Healthcare, we highlight the leaders whom our readers and the editorial staff consider the most influential people in healthcare. We go through a form of crowd-sourcing to determine who gets on the list. It begins by asking readers to nominate candidates. Over 9,000 suggested one or more names this year. (Merrill Goozner, 8/20)

We’ve known for decades, of course, that the retirement of the huge baby-boom generation — coupled with low birthrates — would make the United States an older society. Similarly, we’ve known that this would squeeze the federal budget. Social Security and Medicare spending would grow rapidly, intensifying pressures to cut other programs, raise taxes or accept large budget deficits. All this has come to pass. But the study goes a giant step further, claiming that the very fact that the United States is an aging society weakens economic growth. “The fraction of the United States population age 60 or over will increase by 21 percent between 2010 and 2020,” says the study. This aging shaves 1.2 percentage points off the economy’s present annual growth rate, the study estimates. (Robert J. Samuelson, 8/21)

Oregon and California attracted national notice this year as battlegrounds in the struggle for accessible contraceptive care. New laws in both states allow pharmacists to prescribe hormonal birth control to women directly. Yet the fight for increased access to contraception isn’t being fought on the West Coast alone; it’s also taking place on computer and smartphone screens all over the country. A handful of companies and nonprofits have developed websites and phone apps allowing women in most states to obtain a prescription for oral contraception from a physician without visiting a doctor’s office, either by answering a series of online questions or talking to a clinician via video or online call. (8/21)

McDonald’s plan to get children active by providing them with fitness trackers ended almost as quickly as it started. The fast-food company replaced the toys in its Happy Meals with pedometers, but soon scrapped the devices after “limited” reports surfaced that they could irritate children’s skin. (Steven Overly, 8/20)

For someone who talks big about job creation, Gov. Terry Branstad is doing a stellar job of jeopardizing the solvency of some Iowa employers. Four months after implementation of his plan to privatize Medicaid administration, the carnage is in full swing. Stories of small employers not being paid by managed care companies are being reported across the state. (8/20)

Mercy Medical Center has tentative plans to build an 11-story hospital tower and two parking garages as part of a campus overhaul in Des Moines. With an expected cost of $500 million, it would be one of the most expensive real estate projects in central Iowa, behind data centers for Microsoft and Facebook. (8/21)

I'm willing to bet most people know someone who has been treated for breast cancer and is now cancer free. Most can also probably name someone who died of the disease. That's the way people regard breast cancer: either you're cured or you die. But about 30 percent of breast cancer patients live with a different reality. (Julie Klasky, 8/21)

A federal appeals court gave medical marijuana advocates what seemed like a big win last week with a unanimous ruling that the federal government may not prosecute people who grow and distribute medicinal cannabis if they comply with state laws. The decision affirms a mandate from Congress, which barred the U.S. Department of Justice in 2014 and 2015 from bringing cases against legitimate pot shops in states that have medical marijuana laws. It makes clear that if operators are meticulously following the rules, they shouldn’t have to worry about the feds coming after them. (8/22)

Ms. Fogarty holds dental therapy license No. 2 from the state of Minnesota, which in 2009 became the first state to recognize these midlevel professionals. Dental therapists are not massaging patients’ teeth and gums; they are specialists with years of training. At the University of Minnesota, getting a dual bachelor’s in dental hygiene and master’s in dental therapy requires 32 months of dedicated course work, taking the same classes as dental students who stay for the full program. After passing a state exam, dental therapists are authorized to clean teeth and fill cavities, though they cannot do orthodontic or reconstructive work. (Eric Boehm, 8/19)

After interviewing several residents at Boston teaching hospitals (their names are changed or omitted to protect their privacy) and reviewing the research, I'm starting to understand the scale of mental health disorders in residency and why this problem seems to be growing worse. Residency’s long hours, trauma, sleeplessness and social isolation inevitably erode our healthy coping mechanisms. At the same time, there is a powerful culture of fear, stigma and lack of self-care that prevents residents from seeking help. The resources that are in place in residency programs are simply not adequate. (Elisabeth Poorman, 8/19)

Not long ago, a good friend of mine said something revealing to me: “I don’t think of you as disabled,” she confessed. I knew exactly what she meant; I didn’t think of myself as disabled until a few decades ago, either, even though my two arms have been pretty significantly asymmetrical and different from most everybody else’s my whole life. (Rosemarie Garland-Thomson, 8/19)

Many contemporary feminists consider abortion to be an integral part of women's rights. As such, they are unaware that the same women who fought for the right to vote also fought for the rights of the unborn to be born and for their mothers to be supported. It's important to understand the suffragists' adamant opposition to abortion as we continue the fight for equal rights today. (Marilyn Kopp, 8/21)