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Morning Briefing

Summaries of health policy coverage from major news organizations

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Monday, Nov 14 2016

麻豆女优 Health News Original Stories 4

  • Abortion By Mail Delivers Promise For Better Access But Political Questions Remain
  • Community Paramedics Work To Link Patients With Mental Health Care
  • Study: Many Caregivers Spend $7K Annually Out Of Pocket
  • Republicans Likely To 'Give Themselves Time' To Set Health Law Replacement

Health Law 3

  • Trump Open To Preserving Most Popular Parts Of Health Law
  • The GOP Infighting Begins As Dream Of 'Repeal And Replace' Comes Closer To Reality
  • California Keeping Health Law Anyway 'Probably Out Of The Realm Of Possibility'

Women鈥檚 Health 1

  • Trump Stands Firm On Goal Of Overturning Roe V. Wade

Administration News 2

  • 2016 Version Of Washington's Quadrennial Guessing Game: Who Will Run HHS?
  • 'Every Day Was An Ethical Challenge': How Guantanamo's Psychiatrists Cared For The Enemy

Marketplace 1

  • Watchdog Group Asks Judge To Halt Anthem's Attempt To Switch Consumers' Health Plans

Public Health 4

  • Stress From Election Results Taking Physiological Toll On Americans
  • Prisons Experiment With Pricey Shot That May Help Addicted Inmates Stay Off Opioids After Release
  • Study Clears Lingering Shadow Over Common Pain Reliever
  • Roundup: 'Minibrains' May Help Zika, Alzheimer's Research; Many Parents Pick Pediatricians Who Insist On Vaccinations

State Watch 1

  • State Highlights: Legal Challenges Ahead For Expansion At Boston Children's; Virginia Gets Mediocre Grade On Dental Health

Editorials And Opinions 2

  • Public Health Perspectives: Animals In Medical Research; Using Data To Fight Childhood Trauma
  • Viewpoints: How Much Of Obamacare Will Remain In Trumpcare?

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

Abortion By Mail Delivers Promise For Better Access But Political Questions Remain

The experiment 鈥 involving 50 women in Hawaii, Oregon, New York and Washington 鈥 breaks ground by letting women get an abortion without visiting a clinic. ( Phil Galewitz , 11/14 )

Community Paramedics Work To Link Patients With Mental Health Care

Training these first responders to identify people who are suffering from mental illness and connect them with treatment other than the emergency room could be part of the solution to gaps in the nation鈥檚 mental health system. ( Shefali Luthra , 11/14 )

Study: Many Caregivers Spend $7K Annually Out Of Pocket

Caregivers often pay some housing, medical, transportation and other living expenses for those they help, an AARP survey finds. ( Rachel Bluth , 11/14 )

Republicans Likely To 'Give Themselves Time' To Set Health Law Replacement

KHN's Julie Rovner joins a panel on 'NewsHour' to talk about how the new Trump administration and congressional Republicans might seek to repeal and replace the federal health law. ( 11/11 )

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Summaries Of The News:

Health Law

Trump Open To Preserving Most Popular Parts Of Health Law

Donald Trump says the ban on insurers denying coverage to people who are sick and the provision allowing young adults to stay on their parents coverage are "the strongest assets" of the Affordable Care Act.

President-elect Donald Trump said he would consider leaving in place certain parts of the Affordable Care Act, an indication of possible compromise after a campaign in which he pledged repeatedly to repeal the 2010 health-care law. In his first interview since his election earlier this week, Mr. Trump said one priority was moving 鈥渜uickly鈥 on President Barack Obama鈥檚 signature health initiative, which Mr. Trump said has become so unworkable and expensive that 鈥測ou can鈥檛 use it.鈥 Yet, Mr. Trump also showed a willingness to preserve at least two provisions of the law after Mr. Obama asked him to reconsider repealing it during their meeting at the White House on Thursday. (Langley and Baker, 11/11)

Just days after a national campaign in which he vowed repeatedly to repeal President Obama鈥檚 signature health care law, Donald J. Trump is sending signals that his approach to health care is a work in progress. Mr. Trump even indicated that he would like to keep two of the most popular benefits of the Affordable Care Act, one that forces insurers to cover people with pre-existing health conditions and another that allows parents to cover children under their plan into their mid-20s. (Abelson, 11/11)

The ban on insurers denying coverage to individuals who are sick "happens to be one of the strongest assets," of the Affordable Care Act, Trump said. He acknowledged that keeping the provision allowing children to stay on their parents鈥 plans for a period of time "adds cost, but it鈥檚 very much something we鈥檙e going to try and keep." (Tracer, 11/11)

The shift brings Trump in line with past Republican attempts at repealing and replacing the law, which focused on rolling back large elements like the individual mandate while holding onto several of its most popular provisions. However many policy experts have warned that requiring plans to cover sick people without a mandate or other way of bringing healthy people into the insurance pool will send premiums sky-high. (Cancryn, 11/11)

Trump seemed more set on repealing and replacing the law in an interview with CBS' "60 Minutes" set to air in full Sunday, and he said there wouldn't be a lull period between the two. "We're going to do it simultaneously. It'll be just fine. That's what I do. I do a good job. You know, I mean, I know how to do this stuff," he said. "We're going to repeal it and replace it. And we're not going to have, like, a two-day period and we're not going to have a two-year period where there's nothing. It will be repealed and replaced. I mean, you'll know. And it'll be great health care for much less money." (Ferris, 11/11)

President-elect Donald Trump has said he may keep some parts of his predecessor's signature health care overhaul. No final decisions have been made. Based on interviews with congressional Republicans, here's a general idea of what goes, what may stay, and what's in doubt. (11/12)

The fight over Obamacare became so inflammatory that not a single Republican in the House or Senate voted for it on final passage, fearing to invoke the wrath of the Tea Party. So it鈥檚 not surprising that in the wake of Republican billionaire Donald Trump鈥檚 聽historic victory over Democrat Hillary Clinton for president last week, Trump and Republican leaders who have long called for the repeal and replacement of Obamacare are now struggling to concoct a workable alternative that won鈥檛 abruptly strip millions of low and middle-income people of their health care insurance and trigger a revolt. (Pianin, 11/12)

The GOP Infighting Begins As Dream Of 'Repeal And Replace' Comes Closer To Reality

Some Republicans want to dismantle the health law the minute Donald Trump is sworn into office, while others say it would be unwise to uproot the legislation that quickly.

For some Republicans, obliteration of Obamacare can鈥檛 come soon enough. Others want a gradual phaseout, fearing both the political and practical consequences of throwing 20 million Americans off their health plans virtually overnight. And President-elect Donald Trump, who vowed to repeal and replace 鈥渢he disastrous鈥 Obamacare, sent mixed signals Friday about how he will proceed. (Haberkorn, 11/11)

Congressional Republicans face internal divisions over how far to go in repealing and replacing ObamaCare, one of their top political priorities of the past six years, without disrupting the lives of millions of Americans.聽Conservatives like Texas Sen. Ted Cruz (R) and Utah Sen. Mike Lee (R) are pushing for the law to be ripped out 鈥渞oot and branch,鈥 something Senate Majority Leader Mitch McConnell (R-Ky.) has promised to do. 聽One Senate Republican aide said the far-reaching repeal measure passed by the Senate in 2015 should be the 鈥渂aseline鈥 for unwinding the law. 聽鈥淚 wouldn鈥檛 expect anything less than that, and of course people will be pushing for more,鈥 the aide said. (Bolton, 11/13)

Congressional Republicans are looking for the quickest ways to tear down Obamacare following Donald Trump's election as U.S. president, including rapidly confirming a new health secretary who could recast regulations while waiting for lawmakers to pass sweeping repeal legislation. Trump's victory on Tuesday means Republicans will control the White House, Senate and House of Representatives. But congressional Democrats are expected to put up a huge fight against Republican efforts to repeal the 2010 law considered President Barack Obama's signature domestic policy achievement. (Cornwell, 11/12)

President-elect Donald Trump and congressional Republican leaders are promising to make repeal and replacement of the Affordable Care Act one of their highest priorities in the first 100 days after they take full control of the federal government in January.But both Republican and Democratic health policy experts say the road will be rocky and that it may take a lot longer and involve a lot more compromises than they think. They predict Republicans may seek Democratic support in crafting a replacement to avoid full responsibility for any problems that follow.Some predict bipartisan support is highly unlikely if Republicans pursue their goal of completely wiping out the ACA framework rather than making more modest fixes. (Meyer, 11/12)

John Davidson looked eagerly to January, when the health-insurance plan he bought on the federal marketplace would go into effect. The plan, made available through the 2010 health-care law known as Obamacare, cost less than the policy the Ohioan received through a small company where he is vice president of operations. The new plan included vision and dental coverage, something his family of six had gone without before. But with President-elect Donald Trump and congressional Republicans vowing to repeal the 2010 law they love to hate, Davidson, 43, of Canton, said he's in limbo. (Holbrook, 11/14)

The Affordable Care Act in its existing form has been a dead man walking since Donald Trump won the presidency last week, following months of campaigning to "repeal and replace" the insurance overhaul that always lacked Republican support. But聽health care experts say an immediate聽decapitation of the聽health care law,聽also known as Obamacare, is unlikely and impractical聽as tens of thousands of Michiganders (and many more聽nationwide)聽have聽already begun聽shopping on the聽Healthcare.gov聽marketplace for聽2017 individual market聽coverage 聽that will聽kick聽in Jan. 1 鈥斅爐hree weeks before the聽Trump inauguration. (Reindl, 11/12)

Julie Rovner, of Kaiser Health News, joined NPR鈥檚 Scott Horsley and USA Today鈥檚 Alan Gomez on PBS NewsHour on Thursday to discuss the Trump administration鈥檚 priorities in the first 100 days, including dismantling the Affordable Care Act. (11/11)

After surviving two challenges that reached the U.S. Supreme Court and more than six years of unrelenting controversy, the Affordable Care Act in its current form聽is doomed. Now the questions are how the Trump administration and Republican-controlled Congress will go about dismantling the law, how soon that may happen,聽and what would replace it. That鈥檚 where all this could get messy. (Boulton, 11/13)

President-elect Donald Trump could not completely dismantle ObamaCare on his first day in office. But there is plenty he could do.聽Without any action by Congress, Trump on his first day in the Oval Office could immediately cancel 鈥渃ost-sharing reductions,鈥 the payments that help low-income ObamaCare enrollees afford their deductibles.聽House Republicans have sued the Obama administration over these payments, arguing they are being made unconstitutionally because Congress has not provided an appropriation for them. (Sullivan, 11/11)

The steepest challenges聽facing health care are not the reforms of the Affordable Care Act, but persistent demographic trends that have long unsettled the industry, said experts聽who worry the real problems will be overlooked in the clamor for a repeal-and-replace policy in the next federal administration. The U.S. is mired in health care challenges. It鈥檚 battling a rapidly aging population and rampant chronic disease amid a physician shortage and an expensive shift in technology. (Fletcher, 11/12)

Meanwhile, Congress has returned, but its lame duck session could look a lot different than predicted聽鈥

Congress returns this week with diminished expectations for action on major health care legislation following the GOP's electoral sweep. Political jockeying over Obamacare repeal could dominate the lawmakers' health care agenda during the lame-duck session, overshadowing efforts to overhaul the FDA drug approval process, reform the mental health care system and provide funding to battle the nation's opioid epidemic. (Cancryn, 11/13)

California Keeping Health Law Anyway 'Probably Out Of The Realm Of Possibility'

If the federal health law is repealed or dismantled, the $20 billion California receives in assistance would dry up, making it nearly impossible for the state to keep its version of the exchanges.

Millions of Californians have gained health insurance under the Affordable Care Act. Now the future of that federal聽law 鈥 and medical coverage for those people 聽-- is in doubt. President-elect Donald Trump said repeatedly during his campaign that one of his first acts would be to 鈥渞epeal and replace鈥 the law known as Obamacare. The Times spoke to experts about whether it would be possible for the state to keep operating its Obamacare exchange called Covered California, where consumers shop for subsidized health insurance, if the law was repealed. (Petersen, 11/11)

California led the way with Obamacare, signing up more people for health insurance聽than any other state.聽Now with a possibility that President-elect Donald Trump will repeal the law, as he has promised, the stakes are higher here than anywhere else.聽鈥淲e鈥檝e basically cut the number of uninsured in a little bit more than half, which is enormous progress,鈥 said Dr. Gerald Kominski, head of the UCLA Center for Health Policy Research. But California鈥檚 huge gains also mean that if the Affordable Care Act is undone, 鈥渨e have the most to lose.鈥 (Karlamangla, 11/13)

California went all in on Obamacare and now faces the prospect of President-elect Donald Trump and Congress dismantling key parts of that historic expansion in coverage. Under the Affordable Care Act, the state鈥檚 insurance exchange has enrolled more than 1.4 million people and California鈥檚 Medi-Cal program added about 3.5 million lower-income residents to the rolls. (11/14)

Women鈥檚 Health

Trump Stands Firm On Goal Of Overturning Roe V. Wade

Although Donald Trump walked back other campaign promises in an interview Sunday, he reiterated that abortion rights decision should be left to the states. When asked what that would mean for women in states that make abortion illegal, he said, "鈥淲ell, they鈥檒l perhaps have to go 鈥 they鈥檒l have to go to another state.鈥 Meanwhile, language allowing health care workers to be exempt from performing services that violate their beliefs crops up on Trump's transition website.

President-elect Donald J. Trump appeared to soften some of his hardest-line campaign positions on immigration on Sunday, but he also restated his pledge to roll back abortion rights and used Twitter to lash out at his critics, leaving open the possibility that he would continue using social media in the Oval Office and radically change the way presidents speak to Americans. (Davis, 11/13)

On the transition website, the first two lines in a set of bullet points say that the Trump administration will protect health-care workers from being required to perform services that violate their religious or moral beliefs and that it will 鈥減rotect innocent human life from conception to natural death.鈥 Neither had figured among the campaign鈥檚 health-care positions. (Goldstein, 11/11)

It is unclear what will happen to the Affordable Care Act, and in particular, what affect policy changes might have on women's health聽post-election.聽Right now, women have access to low-cost birth control and other preventative care, but that may change. Additionally, Trump has said he would cut federal funding for Planned Parenthood, despite the fact it provides services for millions of women. (O'Leary and Hershman, 11/11)

In other news, Trump's聽win prompts聽a surge of both donations to Planned Parenthood and women seeking long-lasting contraception聽鈥

Planned Parenthood is reporting a spike in donations and demand for long-acting contraceptives since Donald Trump's election as U.S. president while abortion foes hope to gain momentum in their quest to cut public funding to the women's health organization. Officials with Planned Parenthood said its patrons are worried about the impact of a Trump presidency on access to abortions and birth control in the United States. (Mincer and Ingram, 11/12)

Administration News

2016 Version Of Washington's Quadrennial Guessing Game: Who Will Run HHS?

Stat takes a look at some of the people whose names are being mentioned for secretary of the Department of Health and Human Services and Modern Healthcare reports on the transition team.

There are so many unknowns about how President-elect Donald Trump will change health policy. But one early tell will be who he taps to lead the Department of Health and Human Services. A lot of names are floating around right now, and initial聽speculation聽can seem ill-conceived聽in hindsight;聽we never had HHS Secretary Tom Daschle under President Obama, after all. Nevertheless, here are possible contenders for the most powerful position in health policy, according to early and often anonymously sourced reports. (Scott, 11/14)

Sources say President-elect Donald Trump's transition team for HHS will be led by Andrew Bremberg, who worked at the agency under President George W. Bush and was an adviser to Senate Majority Leader Mitch McConnell and during Wisconsin Gov. Scott Walker's presidential bid. Bremberg was on Walker's team when the candidate unveiled a healthcare proposal that included repealing the Affordable Care Act and splitting Medicaid into smaller programs with separate funding. Trump has also reportedly selected Paula Stannard to reportedly concentrate on healthcare reform measures. Stannard is a former deputy general counsel and acting general counsel of the HHS to advise more broadly on health reform initiatives. (Dickson, 11/11)

'Every Day Was An Ethical Challenge': How Guantanamo's Psychiatrists Cared For The Enemy

The New York Times offers a look at the mental health teams that worked at Guantanamo Bay.

Every day when Lt. Cmdr. Shay Rosecrans crossed into the military detention center at Guant谩namo Bay, Cuba, she tucked her medical school class ring into her bra, covered the name on her uniform with tape and hid her necklace under her T-shirt, especially if she was wearing a cross. She tried to block out thoughts of her 4-year-old daughter. Dr. Rosecrans, a Navy psychiatrist, had been warned not to speak about her family or display anything personal, clues that might allow a terrorism suspect to identify her. (Fink, 11/12)

Ramzi bin al-Shibh, an admitted and unapologetic co-conspirator in the Sept. 11, 2001, attacks, was captured in Pakistan in 2002. For years, the C.I.A. shuttled him through its network of prisons, interrogating him with some of its most brutal methods. The full list of techniques used against him remains classified, but a Senate Intelligence Committee report and former government officials have said that he was chained naked to the ceiling, deprived of sleep for more than 72 hours at a time, and subjected to long stretches of darkness, cold temperatures and persistent loud music. (Apuzzo and Fink, 11/12)

Marketplace

Watchdog Group Asks Judge To Halt Anthem's Attempt To Switch Consumers' Health Plans

Anthem is moving to shift 500,000 Californians to plans that offer no coverage for out-of-network care.

A consumer group has asked a judge to immediately stop Anthem Blue Cross from switching 500,000 Californians to health plans offering no coverage for out-of-network care. The dispute is over a change Anthem made to its 2017 plans known as preferred provider organizations, or PPOs, throughout much of the state. (Petersen, 11/11)

In other news on insurers聽鈥

Long-term care insurance helps pay for nonmedical care when you can鈥檛 live independently because of a disability or condition such as Alzheimer鈥檚 disease. The rate hikes have caught many policyholders by surprise. ... But understanding the reasons for rate hikes and your choices can help you move forward. (Marquand, 11/14)

The health assessments, often run through an insurance company, are a window into the overall health of a group of people. Assessments give a broad picture to employers about whether they should consider healthier vending machines or stress management information. The health of employees is emerging as a priority for business leaders trying to manage rising health care costs, particularly soaring pharmaceutical costs.聽The average total health benefits cost per employee was $11,920 per employee in 2016, according to Mercer. (Fletcher, 11/11)

For decades, insurance brokers relied on commissions paid by health insurance companies. But for individual health plans, that practice has changed recently: Carriers have either reduced commissions or eliminated them entirely. So, for the first time in their careers, some area health insurance brokers are asking customers to pay fees. ... Brokers are no longer receiving commissions from Cigna, the only carrier on HealthCare.gov that offers in-network access to BJC HealthCare doctors and facilities. And Anthem Blue Cross Blue Shield, the other carrier on HealthCare.gov in the St. Louis area, has cut its commissions to a flat dollar amount for each application, instead of per person, drastically reducing the commission for larger families. (Liss, 11/11)

Public Health

Stress From Election Results Taking Physiological Toll On Americans

Doctors have seen an increase in stress-related symptoms at higher levels than even after the 9/11 attacks.

Experts often describe stress as a "fight or flight" response, explaining that your body is reacting as it would if you were being chased by a lion: heightened heart rate, hormones, brain chemicals. Well, if you're a Hillary Clinton supporter who has been stressing out for the last few weeks about the tight presidential race, it's kind of like the lion just got you. And if you're a Donald Trump supporter, you may be gratified by his victory, but still deeply distressed by the division among your countrypeople and your loved ones. So how聽do you cope 鈥 at the level of personal health, rather than politics? (Goldberg, 11/11)

Teachers in schools across the nation have had an unexpected new task this week, assuaging the fear of students from immigrant and minority families who believe they will be deported or bullied because Donald Trump was elected president of the United States. They also have had to quash an uptick in racist sentiment from students emboldened by the election. (Lambert, 11/11)

Prisons Experiment With Pricey Shot That May Help Addicted Inmates Stay Off Opioids After Release

In other news on the nation's drug epidemic, the Philadelphia Inquirer reports on a network that flies Puerto Ricans who are addicted to heroin to Philadelphia and other cities to so-called recovery houses. But some say the system is a form of human trafficking. And the Drug Enforcement Administration puts a synthetic opioid, called U-47700, on the list of most restricted controlled substances.

U.S. prisons are experimenting with a high-priced monthly injection that could help addicted inmates stay off opioids after they are released, but skeptics question its effectiveness and say the manufacturer has aggressively marketed an unproven drug to corrections officials. A single shot of Vivitrol, given in the buttocks, lasts for four weeks and eliminates the need for the daily doses common with alternatives such as methadone. But each shot costs as much as $1,000, and because the drug has a limited track record, experts do not agree on how well it works. (Johnson, 11/14)

The Drug Enforcement Administration placed a synthetic opioid called U-47700 on the most restrictive list of controlled substances, calling the drug a threat to public health and blaming it in part for scores of deaths around the U.S. The ban, which is scheduled to take effect聽Monday, is the latest action by the DEA to try to crack down on the growing peril of synthetic narcotics. (Campo-Flores, 11/11)

Since the late 1990s, pastors, police, and mayors in Puerto Rico have been sending hundreds of heroin addicts, many of them HIV-positive, to Philadelphia, New York, Chicago, and other cities. The officials work with mainland ministers, some of whom travel from Philadelphia to the island to recruit addicts, offering drug treatment based on abstinence and prayer....Once in Philadelphia, the drug users, who are overwhelmingly young men, are funneled into so-called recovery houses where they complain that pastors belittle them in rants imbued with religious overtones. (Lubrano, 11/13)

Study Clears Lingering Shadow Over Common Pain Reliever

Doctors have been concerned about Celebrex for years because it is similar to another pain reliever that was pulled from the market after being linked to heart attacks and strokes. The new study, however, showed it's safe. In other heart health news, the U.S. task force has new recommendations out concerning statin drugs, an analysis finds that a healthy lifestyle can outweigh genetics when it comes to heart risks and a new tracking app aims to cut back on readmissions for heart failure patients.

The drugs seemed miraculous when they were introduced in 1999, and they soon became blockbusters, with billion-dollar sales. Vioxx, made by Merck, and Celebrex, made by Pfizer, could quell pain and inflammation just as well as drugs like ibuprofen and naproxen, but they did not cause ulcers and gastrointestinal bleeding. But then, the shocker. A Merck clinical trial asking if Vioxx could also prevent colon cancer revealed that the drug increased the risk of heart attacks, and the company pulled it off the market in 2004. (Kolata, 11/13)

In 2004, when drugmaker Merck voluntarily pulled the pain-reliever Vioxx off the market amid evidence that it increased the risk of heart attacks, concern naturally turned to its nearly identical rival, Celebrex. The medication works the same way, by inhibiting production of an enzyme that causes pain and inflammation 鈥 as do naproxen, ibuprofen and others in the class of widely used analgesics known as non-steroidal anti-inflammatory drugs (NSAIDS). Now the first large-scale study of the three drugs finds that Celebrex poses no greater risk of heart attack, stroke, other cardiovascular problems or death than naproxen or ibuprofen. (Bernstein, 11/13)

Nissen and other heart specialists cautioned that Celebrex can increase the chance of cardiovascular complications. But it doesn't appear to boost those odds nearly as much as Vioxx, or even as much as other painkillers thought to be safer. Both Vioxx and Celebrex are so-called Cox-2 inhibitors, which act by blocking an enzyme involved in inflammation. (Stein, 11/13)

The U.S. Preventive Services Task Force on Sunday issued new guidance聽for the use of cholesterol-busting statin drugs. The report greatly expands the universe of people who should be screened to see if they need the medication to everyone over age 40 regardless of聽whether they have a history of cardiovascular disease. (Cha, 11/13)

Is genetics destiny when it comes to heart disease? A new analysis of data from more than 55,000 people provides an answer. It finds that by living right 鈥 by not smoking, by exercising moderately and by eating a healthy diet heavy in fruits, vegetables and grains 鈥 people can tamp down even the worst genetic risk. (Kolata, 11/13)

You can't choose your parents, so you can't help it if you're born with genes that increase your risk of heart disease. But a study finds that you can reduce that risk greatly with a healthful lifestyle. Scientists have been wondering whether that's the case. To find out, one international consortium looked at data from four large studies that had isolated genetic risk factors for heart disease. (Harris, 11/13)

Cardiology nurse Lois Freeman calls the heart failure patients who are regulars at the Baltimore VA Medical Center "frequent fliers." They cycle in and out of the hospital because they can't or won't follow the strict diet and exercise regime required to keep their medical conditions in check. Intent on breaking this cycle of repeat readmissions, Freeman came up with the concept of a smartphone app to track the diet, weight and exercise of cardiology patients. Her idea recently received development funding estimated at $1 million from the Department of Veterans Affairs. (Prudente, 11/11)

Roundup: 'Minibrains' May Help Zika, Alzheimer's Research; Many Parents Pick Pediatricians Who Insist On Vaccinations

In other public health news, the trauma of the Dallas police shootings still reverberates and two new studies quantify the need for a community-based health approach. News outlets also report on "elder orphans," the social stigma of diabetes and work wellness programs.

Some tiny clusters of brain cells grown in a lab dish are making big news at this week's Society for Neuroscience meeting in San Diego. Known as "minibrains," these rudimentary networks of cells are small enough to fit on the head of a pin, but already are providing researchers with insights into everything from early brain development to Down syndrome, Alzheimer's and Zika. (Hamilton, 11/13)

Pediatricians around the country, faced with persistent opposition to childhood vaccinations, are increasingly grappling with the difficult decision of whether to dismiss those families from their practices to protect their other patients. Doctors say they are more willing to take this last-resort step because the anti-vaccine movement in recent years has contributed to a resurgence of preventable childhood diseases such as measles, mumps and whooping cough. Their practices also have been emboldened by families who say they will only choose physicians who require other families to vaccinate. (Sun, 11/12)

The psychological impact of gun violence and mass shootings was discussed by world experts at a conference of the International Society for Traumatic Stress Studies in Dallas this week. Military members, veterans and people of color are at highest risk of developing PTSD, they said.聽In the days and weeks after a mass shooting, people exposed to the attack can suffer poor sleep, irritability, depression and anxiety. Physical symptoms include chest pain, headaches, stomach aches and nausea.聽Those feelings are normal and should fade within a month, experts said. But if symptoms persist for longer than a few weeks, you might have post-traumatic stress disorder. One in five people who survives a tragedy develops PTSD, said Dr. John Burruss, CEO of Metrocare, the largest provider of mental health care in Dallas County. (Yasmin, 11/12)

National health expenditures are expected to hit $3.35鈥塼rillion this year, most of it spent on care for one person at a time: doctors鈥 visits, hospital stays, prescription drugs. But to really improve the health of Americans, two new studies suggest, we also need to aim for a culture of health in communities as a whole. (Scudellari, 11/14)

Nearly a quarter of Americans older than 65 are 鈥 or are at risk of becoming 鈥 what some experts call 鈥渆lder orphans.鈥 They are people who are getting older without a spouse, partner or adult children 鈥 or at least any who live nearby. With an aging baby boomer population and a third of Americans ages 45 to 60 either choosing to be or finding themselves single, the number of seniors living alone will only grow, experts say. (Pyle, 11/13)

After 58 years of living with type 1 diabetes, Marilyn Krupnick thought she'd heard it all. Children who warned others to stay away from the "dirty diabetic" or they'd "catch it, too." Well-meaning friends and relatives with misguided advice the Abington resident and former schoolteacher long ago learned to quietly ignore...Her experience illustrates a serious problem for people with diabetes: Not only must they cope with the physical effects of a chronic disease, they also must contend with the stigma of having a condition even many doctors don't really understand. A 2014 poll for the diaTribe Foundation, a nonprofit diabetes organization, suggested that most people with diabetes feel stigmatized by the condition, regardless of its origins. (Rush, 11/13)

Companies say they offer them to make work more fun, improve workers' health, boost employee productivity or save money on health insurance costs. Some employees and advocacy groups, however, worry that fitness trackers might invade an employee's privacy and that some wellness programs may not be truly optional. It also remains unclear whether workplace trackers consistently improve employee health or save employers money on health care costs. This year, 31 percent of 540 companies with 1,000 or more employees surveyed by brokerage and consultancy Willis Towers Watson offered wearable activity trackers to workers. Another 23 percent said they were considering doing so in the next two years. (Schencker, 11/11)

State Watch

State Highlights: Legal Challenges Ahead For Expansion At Boston Children's; Virginia Gets Mediocre Grade On Dental Health

Outlets report on health news from Massachusetts, Virginia, Florida, Pennsylvania, Wisconsin, California, Ohio, Minnesota, Washington, Maryland and Texas.

Opponents of a controversial expansion plan by Boston Children鈥檚 Hospital notified the state they will appeal its decision to allow the project. The group, which objects because the project would build over Prouty Garden, a serene green space on the hospital鈥檚 Longwood Medical Area campus, is claiming that state public health officials who approved the $1 billion expansion in October 鈥渃onducted a flawed and legally insufficient review.鈥 (Dayal McCluskey, 11/11)

A new report suggests that when it comes to oral health, Virginia has room for improvement. The state earned a C+ on a new report card released by the Virginia Oral Health Coalition, which was compiled by examining data on residents鈥 oral health. (Demeria, 11/11)

Massachusetts鈥 court system ranks among the worst in the country at providing specialized services for people with mental illness and keeping them out of prison or jail, where they often suffer emotionally and get subpar treatment. Court personnel are, in the main, poorly equipped to deal with those with mental illness. (Cramer, Russell, Rezendes, Helman and Wallack, 11/12)

State health officials said聽Thursday聽that five more locally transmitted cases of the Zika virus have been found in Miami-Dade County, which has been hit hard by the mosquito-borne illness. One of the new cases was linked to an area of Miami Beach where health officials have worked to prevent the spread of the virus. The other four involved Miami-Dade residents, and the state Department of Health said it is investigating to determine where they were infected. (11/14)

On Wednesday, international experts on a devastating lung disease will gather in Philadelphia to discuss the latest research on prevention and treatment. Chronic obstructive pulmonary disease, better known as COPD, is the third leading cause of death in the United States, according to the American Lung Association. Gerard Criner has just led Temple's contribution to a study that questioned the value of oxygen therapy for some COPD patients. The meeting is part of a global initiative to raise awareness about COPD, heighten prevention efforts, promote better treatments, and improve outcomes for those who have it. (Bauers, 11/12)

In more than a century, medical literature has recorded fewer than 200 cases in which the fetal trachea fails to form. Babies born with this anomaly, called tracheal agenesis, die silently, having never drawn a breath. Only five, and only due to extraordinary surgical intervention, have survived. None in the United States. None, until Thomas David Richards, born this spring at Ministry St. Joseph鈥檚 Children鈥檚 Hospital in Marshfield. (Stephenson, 11/13)

While some parts of the country have reported shortages of body donors, the UC body donation program has seen 鈥渕odest but consistent鈥 increases statewide, roughly 3 percent a year in the last decade, said Brandi Schmitt, executive director of the University of California鈥檚 Anatomical Donation Program, which covers five medical school campuses in Irvine, Los Angeles, Sacramento, San Diego and San Francisco. (Buck, 11/12)

Step by Step Academy, a long-time provider of therapy and educational services for central Ohio children with autism, has been struggling financially and is turning over operations to a larger nonprofit agency. Franklin County Residential Services has signed a 120-day management contract with Step by Step, which likely will lead to a merger, JoAnn Reilly, a spokeswoman for Franklin County Residential Services, said on Friday. (Pyle, 11/11)

Minnesotans looking to buy new Medica individual insurance policies, but have not already made the purchase for 2017, are out of luck. The state Commerce Department announced early Friday that Medica of Wisconsin and Medica Insurance Co. reached a cap on the number of new policies they are willing to sell. That means that for much the state, Medica stopped selling policies to people who are not already customers.聽People who already have Medica policies are not affected. Also unaffected are the majority of Minnesotans who get insurance through their employers or government programs. Five percent of Minnesotans purchase insurance in the individual market. (Davis, 11/11)

Eight Washington children have been hospitalized with confirmed AFM since September, according to the Centers for Disease Control and Prevention (CDC). The disorder has been ruled out in a ninth child, Daniel Ramirez, 6, of Bellingham, who died Oct. 31. The cause of his death remains under investigation. (Aleccia, 11/12)

Conducted once a week, these taste tests are part of what makes the Oakland Unified School District a national model for farm-fresh school food. Up to 80 percent of the produce it serves comes from nearby farms, and some of its pasta and meat brands are commonly seen on Whole Foods shelves. (Duggan, 11/13)

Just 1 percent of the 16,000 doctors who treat patients in Maryland have signed up for the state's medical marijuana program, and two of the largest hospital systems in the state have banned their physicians from participating. The lack of enthusiasm threatens to undermine the fledgling program by limiting access to the drug that has shown promise in easing pain and other severe conditions...Only 172 doctors have registered to be able to recommend patients for medical marijuana, according to information obtained by The Baltimore Sun from the Maryland Medical Cannabis Commission through a public records request. 聽(Cohn and McDaniels, 11/12)

The Lone Star debate will likely coalesce around medical marijuana, according to both proponents and critics of more permissive weed laws. The most high-profile advocates say they will try to expand a law passed last year that allows doctors to prescribe low-THC cannabis oil to children with epilepsy. (Toohey, 11/13)

Earlier this year, Carr heard about something new, Epidiolex, an experimental drug using cannabinoid ingredients 鈥 essentially a form of medical marijuana. A new law made medical marijuana legal in Ohio on Sept. 8. But being legal and being available are different things. (Johnson, 11/14)

Editorials And Opinions

Public Health Perspectives: Animals In Medical Research; Using Data To Fight Childhood Trauma

Editorial and opinion writers offer thoughts on an array of health issues.

Some people with spinal cord injuries may one day be able to walk again because of scientific research that depends on monkeys. Again, the ethical question arises: Does medical progress trump animal rights? Our short answer: Yes. Sometimes. (11/13)

Kansas City鈥檚 Resilient KC initiative, a partnership of Healthy KC and Trauma Matters KC, supports the emerging 鈥渦pstreamist鈥 movement in health care. The concept is to address health problems before they emerge as individual or community-centered health issues. Resilient KC targets community-based trauma. (Tom Bell and Herb B. Kuhn, 11/13)

With the presidential election behind us, and fresh from marking Veterans Day, Congress will have a chance to make a major reform to the Veterans Administration. A bill passed with a veto-proof bipartisan majority in the House will be ready for the Senate. And a sponsor of the companion bill in the Senate is Miami鈥檚 own Sen. Marco Rubio. (11/13)

Today I got another letter from AARP. The letters have been coming pretty much every week for 25 years. But in the past two months they鈥檝e changed. AARP used to ask me to join. Now the letters from the lobbying group for older Americans say that I have joined but I haven鈥檛 paid my bill. (Stephen Miller, 11/11)

According to a recent study by the Department of Veterans Affairs, since 2001, the age-adjusted rate of suicide among male veterans has increased 30.5 percent. In comparison, the age-adjusted rate of suicide among female veterans has increased 85.2 percent. And among veteran women ages 18 to 29, the risk of suicide is 12 times the rate of nonveteran women. It is clear that gender-specific interventions are needed to support our female veterans. (Elisa Borah, 11/12)

The Association of American Medical Colleges projects that the shortage could range from 46,000 to 90,000 physicians in just 10 years.聽This is particularly worrisome for Arizona, as our state is ranked 34th in total active physicians per 100,000 residents. Locally, Maricopa Integrated Health System, Dignity Health St. Joseph鈥檚 Hospital and Medical Center and District Medical Group, Inc.聽are partnering with Creighton University School of Medicine to meet this demand by increasing the number of doctors and other health professionals in Arizona. (Steve Purves, Patty White, Kote Chundu and Daniel Hendrickson, 11/13)

Viewpoints: How Much Of Obamacare Will Remain In Trumpcare?

A selection of opinions and editorials from around the country.

After reiterating his promise to repeal and replace the Affordable Care Act, President-elect Donald Trump has indicated聽that he may聽keep two of the law鈥檚 most popular provisions. One is straightforward enough 鈥 children up to age 26 being allowed to stay on their parents鈥 plan. The other 鈥 preventing insurance companies from denying coverage because of preexisting conditions 鈥 offers a perfect illustration of why Trump and most of the other Republicans critics of Obamacare don鈥檛 understand the health insurance market. (Steven Pearlstein, 11/12)

When it comes to healthcare, President-elect Donald Trump made it clear Friday that he鈥檚 all in favor of dessert but doesn鈥檛 want any Brussels sprouts. He said in an interview with the Wall Street Journal that he鈥檚 not against all aspects of Obamacare. He鈥檚 in favor of the ban on insurers denying coverage to people with preexisting conditions, and he supports keeping kids on family policies until they turn 26. (David Lazarus, 11/11)

Liberal tongues were wagging all over the internet on Friday, because Donald Trump promised to repeal Obamacare, while guaranteeing health insurance coverage to those with pre-existing conditions. They claim Trump鈥檚 goal is impossible. But the joke鈥檚 on them, because in this case, Donald Trump is right. (Avik Roy, 11/2)

Obamacare repeal ... might not seem like a retirement issue at first glance. But if Trump and Republican lawmakers make good on their promises to repeal the Affordable Care Act, millions of older Americans who fall short of Medicare鈥檚 eligibility age (65) likely will lose their health insurance. Hate Obamacare if you like, but it has hugely benefited millions of older low- and middle-income households. The Commonwealth Fund estimates that the percentage of uninsured Americans aged 50-64 fell to 9.1 percent this year, compared with 14 percent in 2013. That translates to 3.1 million previously uninsured people who now have health insurance. (Mark Miller, 11/11)

When the new Congress and President-elect Trump take office in January, Republicans will have a real chance to repeal President Obama鈥檚 Affordable Care Act. If they succeed, it will be the result of their carefully executed strategy to repeal the law and repeated congressional votes to do so. This approach was the subject of much derision from Democrats, but sticking to it has now put the Republicans in a position where they can reach their goal. (Tevi Troy and Lanhee J. Chen, 11/13)

Mr. Trump won over the white working-class individuals in small rural areas. Sluggish economic recovery in these areas played a significant role in his unanticipated victory. It is these disenchanted individuals watching the American Dream slip through their fingers who voted for Mr. Trump. Those same people want the freedom to buy the insurance they need, and not what the bloated government shoves down their throats. 25% of the population lives in rural areas yet only 10% of the physicians practice in there. Physicians are leaving the system in droves, closing their patient panels, and not keeping up with demand, thereby threatening patient access in these isolated locales. (Niran Al-Agba, 11/12)

Hours after Tuesday鈥檚 election results were final, tweets, Facebook messages and articles began bouncing around the internet urging women to go seek birth control right away. 鈥淕et an IUD Before It鈥檚 Too Late,鈥 advised a Daily Beast headline. 鈥淗ere鈥檚 Why Everyone Is Saying to Get an IUD Today,鈥 explained a popular New York Magazine piece.聽"My phone was ringing off the hook,鈥 said Andrea Miller, the president of the National Institute for Reproductive Health, who said her organization heard from some anxious women, concerned that their birth control options might become quickly and severely limited. (Margot Sanger-Katz, 11/11)

On a normal day, Planned Parenthood of Mid and South Michigan fields nine calls from women interested in long-acting birth control like the intrauterine device. Wednesday 鈥 the day after the presidential election 鈥 Planned Parenthood's call center booked 37 appointments for women seeking IUDs. By noon on Friday, Planned Parenthood centers across the state had booked 134 appointments for long-acting contraceptives, along with appointments for screenings, checkups and other routine care, about a hundred additional calls each day, in total. (Nancy Kaffer, 11/12)

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