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Federal health officials Friday proposed changes to the rules for health coverage sold through insurance exchanges, including a possible floor for how many doctors and other providers each plan must include. The rules are intended to make it easier for consumers to compare their options in the marketplaces created under the Affordable Care Act. They would define standard deductibles and co-payments, and allow insurers to sell plans with that specific benefit design. (Goldstein, 11/20)

The CMS has proposed mandating minimum network standards for health plans sold on the federal insurance marketplace in 2017 as part of an effort to handle the broad shift toward narrow provider networks. The Affordable Care Act requires that all medical policies on the exchanges have enough in-network hospitals and doctors for members so that “all services will be accessible without unreasonable delay.” In addition, ACA-compliant plan networks must update their provider directories monthly and include at least 30% of essential providers. (Herman and Dickson, 11/20)

The next sign-up season for 2017 health coverage under the Affordable Care Act will begin just as the 2016 election campaigns draw to a close, under draft rules released by the Obama administration on Friday afternoon. The open enrollment period for people buying insurance on their own for 2017 will start Nov. 1, 2016, and end Jan. 31, 2017, federal officials outlined in the draft rules. In earlier iterations of regulations, they had suggested starting as early as Oct. 1, before appearing to settle on the same dates they are using for this year’s open enrollment period, which is now three weeks under way. (Radnofsky and Wilde Mathews, 11/20)

Federal regulators on Friday proposed potential solutions to some of the Obamacare problems that led UnitedHealth Group to warn it may exit the health exchanges in 2017, but the government also may make it tougher for insurers to limit the number of doctors and hospitals in their plan networks. The proposed rule from the Centers for Medicare and Medicaid Services would reduce insurers' administrative costs, maintain fee levels and improve the accuracy of a payment formula designed to minimize insurers' risks when taking on new customers. (O'Donnell, 11/21)

The Obama administration on Friday proposed a new type of partnership between state and federal health marketplaces in an attempt to address the mounting financial pressures on state-run exchanges. Under the new model, states would be allowed to use federal resources like call centers or website platforms while maintaining their own decision-making power. (Ferris, 11/20)

Health insurers Aetna Inc. and Anthem Inc. on Friday said their individual commercial businesses have performed within expectations lately, a day after UnitedHealth Group Inc. said it was considering exiting the Affordable Care Act’s exchanges. The statements could be a sign that big problems with business on government exchanges aren’t widespread across insurers. (Becker, 11/20)

Health insurers rallied Friday to ease investor and customer concerns about the Affordable Care Act's public insurance exchanges a day after the nation's biggest insurer questioned its future in that still-developing market. Blue Cross-Blue Shield insurer Anthem and Medicaid coverage provider Molina Healthcare both said they are making money off their exchange business, and Anthem joined Aetna, the nation's third-largest health insurer, in reaffirming its 2015 earnings forecast. (Murphy, 11/20)

U.S. health insurers Aetna Inc and Anthem Inc on Friday sought to reassure investors that their Obamacare businesses had not worsened after UnitedHealth Group Inc warned of mounting losses in that sector. Aetna and Anthem said their individual insurance businesses, which include the plans created by President Barack Obama's national healthcare reform law, had performed in line with projections through October. Both backed their earnings forecasts for 2015. (Humer, 11/20)

Health insurance giants Anthem and Aetna are standing behind their ObamaCare plans one day after a top competitor warned it might pull out of the exchanges. In a statement on Friday, both companies backed their 2015 forecasts and said they remained committed to the exchanges. (Ferris, 11/20)

Thursday's news that the No. 1 U.S. health insurer, UnitedHealth Group, might withdraw from the health insurance exchanges mandated by so-called Obamacare legislation divided experts into two camps. (White, 11/21)

UnitedHealth may quit the nation’s insurance exchanges, but Aetna and Anthem say they are staying and will work on problems with the marketplaces. The largest U.S. insurer by market value, UnitedHealth said this week it expects to lose as much as $500 million selling coverage under the Affordable Care Act next year. (Radelat, 11/20)

The possible departure of insurance leader UnitedHealth Group Inc. from the Affordable Care Act signals worsening prospects for hospitals already facing a slowdown in gains from the program. ... Hospitals, including for-profit chains HCA Holdings and Tenet Healthcare, have already agreed to cuts in Medicare reimbursements, expecting they'd see fewer uninsured patients, said Sheryl Skolnick, an analyst with Mizuho Securities USA Inc. in New York. The administration has predicted slow growth in sign-ups under the ACA, and UnitedHealth's announcement suggests insurers are less willing to participate. (Lauerman, 11/20)

UnitedHealth Group's announcement this week that it may pull out of Affordable Care Act exchanges is not expected to have much of an impact on Covered California, experts said, but the move could have serious repercussions in other exchanges. (Lauer, 11/20)

Consumer advocates and antitrust experts are urging state regulators to closely examine the proposed mergers of major health insurance companies, saying they threaten to leave consumers with fewer choices and higher prices. On Friday, David A. Balto, an antitrust lawyer and former federal regulator, asked the National Association of Insurance Commissioners, composed of state officials, to create a working group to help regulators conduct their reviews. (Abelson, 11/20)

Although young people have been slow to sign up on their own [for insurance following the health law's passage], insurance plans have to cover dependent children through age 26, resulting in increased coverage— and a lot more young people who don't necessarily have to work in order to have access to health care. New research suggests that some of those young people are taking advantage of the newfound freedom, and are feeling pretty good about it. (DePillis, 11/21)

Persuading someone that age and with that income to buy health insurance is a major challenge facing the Affordable Care Act as its third enrollment period is underway. The law sets out to convince people who are young, healthy and on tight budgets that health insurance — even if the plan covers primarily large medical expenses — is no longer an optional purchase. (Boulton, 11/23)

Troubling signs about the Affordable Care Act and the state of health care in the U.S. have bubbled up in the last few weeks. The administration’s Obamacare enrollment projections for the coming year are down, the projected cost of premiums and out of pocket costs are up, nearly half of the insurance co-ops associated with the program are going out of business, and UnitedHealth Group, the nation’s largest health insurer, said it may withdraw from the government marketplaces in 2017. Now comes a new survey by Gallup showing growing discontent with Obamacare and the U.S. health-care industry more generally after years of relative satisfaction with the quality and cost of the health-care system. (Pianin, 11/22)

A new plan for government-run health care that covers everyone is coming from a surprising corner: Colorado, a politically moderate swing state where Republicans and Democrats often share control of state government. Universal coverage proposals — known as "single-payer" — have failed time and again in the United States. Left-leaning Vermont recently pursued such a system, only to abandon it as too expensive. President Obama's health care law doesn't cover everyone and has sparked enormous political backlash. (Wyatt, 11/22)

The Cios family of Bucks County could be a living advertisement for the wonders of modern medicine: dad's double knee replacement, mom's successful treatment for thyroid cancer, their two teenage daughters' repairs of assorted sports injuries. Along with the benefits, however, comes a flip side: a never-ending array of billing and insurance complications that are growing increasingly familiar to Americans wrestling with the health care system. (Sapatkin, 11/22)

EPOs are a relatively new type of plan that limits coverage to in-network providers — except for medical emergencies. They are often considered hybrid insurance policies. "Some may say an EPO is just a more flexible HMO plan," says Michael Lujan, president of the California Assn. of Health Underwriters. Unlike an HMO, "you typically do not need a referral to see a specialist in an EPO plan." But the specialist has to be in your network. EPOs typically pay nothing if you see an out-of-network doctor. (Zamosky, 11/20)

Hillary Rodham Clinton on Friday proposed a tax credit for families and individuals who face excessive and unexpected health care costs, the first part of multipronged approach to giving middle-class Americans tax relief that she will unveil in the coming days, according to her campaign. The proposal, which would provide a tax credit on health costs of up to $2,500 for an individual and $5,000 for a family, comes as Mrs. Clinton has sought to use the issue of taxes on the middle-class to draw a distinction between her proposals and those of her main rival for the Democratic presidential nomination, Senator Bernie Sanders of Vermont. (Chozick, 11/20)

[Hillary] Clinton, who was in the midst of a campaign swing through the South, has tried to create a wedge on taxes with her main rival for the nomination, Vermont Sen. Bernie Sanders. In Memphis, she touted a tax refundable tax credit of up to $5,000 for families and $2,500 for individuals she proposed earlier this year. Americans with out-of-pocket health care expenses exceeding 5 percent of their income would be eligible for the refund. Her campaign says the tax cut will be funded through tax increases on wealthy families and by "demanding" rebates from drug manufactures. (Sainz and Lerer, 11/20)

All week, Clinton’s and San­ders’s camps traded barbs over middle-class taxes, an issue that Clinton’s campaign believes is a proxy for broader differences between the two candidates. Clinton’s stance highlights her focus on preserving President Obama’s health-care legacy, while Sanders has offered a proposal that seeks to make good on his promise of bringing a “political revolution.” ... in campaign stops in Tennessee and South Carolina, she focused on health care and a plan to give middle-class families as much as $5,000 in tax credits for unexpected out-of-pocket health-care costs. (Phillip and Wagner, 11/21)

If you’re caring for an aging parent, deciding whether to invest in rural America or struggling to pay medical bills, Hillary Clinton has a tax credit for you. As the Democratic presidential front-runner rolls out her policy agenda, she has repeatedly turned to the tax code as one of her favorite policy tools. It offers a way to reward behavior she wants to see more of, punish actions that she sees as harmful and directly aid families with particular challenges. ... The Clinton campaign pitched its latest idea on Sunday, a tax credit worth up to $1,200 for people caring for aging parents and grandparents. The credit would be available to those whose out-of-pocket expenses reach $6,000, with the value of the credit phasing out for upper-income families. (Rubin and Meckler, 11/23)

[Hillary Clinton] is seeking a tax credit to offset up to $6,000 in caregiving expenses for elderly family members. In her proposal, Clinton states that the number of Americans needing long-term care and support is expected to grow from about 12 million today to 27 million by 2050. She says that family members often have to take time away from work, using vacation time or personal time to provide care. (Lucey, 11/22)

A senior aide to Sen. Bernie Sanders on Sunday characterized Hillary Clinton’s latest tax plans as “tentative half-steps that sound Republican-lite,” escalating the sparring between the Democratic presidential campaigns over their respective commitments to helping the middle class. ... The statement came in response to a pair of initiatives put forward by Clinton on Sunday that would benefit people who care for an elderly parent or other family member. (Wagner, 11/22)

Sanders has said repeatedly that he wants to build on the health-care system created under the Affordable Care Act and to expand it to provide health insurance regardless of income or age. It’s clear that the provisions in his bill to “repeal” ACA state exchanges was not just for the sake of repealing the law, in the way critics who oppose passage of ACA use the term “repeal.” But the language of his legislation — all three times he introduced it — clearly stated that existing federal programs would be replaced with a new program that he sought to create. It wouldn’t simply increase current levels of coverage but would create a whole new health insurance system with new quality-control methods, a new standards board, and more. (Lee, 11/23)

As a surgeon, [Ben Carson] was praised for his dedication, unassuming demeanor and attention to detail. As a candidate, he has sometimes seemed imprecise or ill-informed, as when he said China had intervened in Syria, and prone to odd assertions like his belief that Joseph built the pyramids to store grain. Some articles have questioned the accuracy of parts of “Gifted Hands.” His comments doubting evolution and the medically recommended schedule of vaccines have baffled people in science and medicine. (Belluck and Eder, 11/22)

Pfizer has clinched a blockbuster merger with a fellow drug maker, one worth more than $150 billion, that can best be described in superlatives. When it is announced — most likely on Monday, people briefed on the matter said — the deal to buy Allergan, the maker of Botox, would be one of the biggest ever takeovers in the health care industry. And it would be the largest acquisition yet in a banner year for mergers. (de la Merced, 11/22)

Pfizer Inc. and Allergan PLC agreed on a historic merger deal worth more than $150 billion that would create the world’s biggest drug maker and move one of the top names in corporate America to a foreign country. The boards of each company ratified the deal Sunday and it could be announced Monday, according to people familiar with the matter. The final terms include 11.3 Pfizer shares for every Allergan share and the deal also contains a small cash component, they said. (Rockoff and Mattioli, 11/22)

Pharmaceutical giants Pfizer and Allergan are set to announce a $150 billion merger on Monday that would create the world’s largest drug company.The deal, which combines the makers of Viagra and Botox, may spark a political uproar because the transaction is designed to lower corporate tax bills. And it may also reignite concern about the extent to which drug discovery will remain an important part of the pharmaceutical playbook. (Silverman, 11/23)

Turing Pharmaceuticals AG, the small drug maker that gained notoriety for raising the price of an anti-parasite tablet more than 50-fold, is drawing up plans to discount the drug as much as 50% to hospitals, according to a person familiar with the matter. Even with the discounts, the drug—Daraprim—would still cost hospitals far more than it did before Turing bought the U.S. rights in August and raised the price to $750 a tablet, from $13.50. The amount of the discount will depend on how much of the drug hospitals use, the person said. (Rockoff, 11/20)

As questions mount about the viability of Valeant Pharmaceuticals International Inc.’s business model, concerns are also spreading to other drug makers seen as following a similar playbook. Shares of Horizon Pharma PLC and Mallinckrodt PLC, two of the largest companies most often compared with Valeant, have fallen roughly 25% in the past three months. ... Like Valeant, the firms are part of a new breed of pharmaceutical company that has limited costly investment in research and development and instead sought sales growth through debt-fueled acquisitions. (Walker, 11/22)

With most products, you'd expect a flood of new supply to quickly drive back down a price spike caused by a temporary shortage. Not so in the topsy-turvy world of hospital pharmaceuticals. Just look at prices for glycopyrrolate, an everyday drug used to dry up secretions prior to surgery. After one of only two makers of the drug temporarily closed its factory in 2012 to fix quality control problems, Hikma Pharmaceuticals raised prices on its injectable version more than 800 percent over the next year. Both manufacturers are now making the drug again, yet Hikma's prices have only fallen slightly and remain more than eight times higher than they were in early 2013. (Koons and Langreth, 11/21)

The Obama administration began building a political case Friday for government actions to protect people against high pharmaceutical costs, saying millions of Americans were unable to afford lifesaving prescription drugs. "As costs go up, so does everyone’s anxiety about their continued access to their prescription medicine,” said Andrew M. Slavitt, the acting administrator of the federal Centers for Medicare and Medicaid Services. He spoke at a daylong forum the administration held to solicit ideas from consumer advocates, doctors, drugmakers, insurers and employers. (Pear, 11/20)

The Obama administration set the stage Friday for a national debate on the rising cost of prescription drugs, a pressing issue for voters but one that's unlikely to see quick solutions under a lame-duck president facing an opposition Congress. Saying that too many people are struggling to pay for their medications, Health and Human Services Secretary Sylvia Burwell opened a daylong forum that presented a range of perspectives, from the pharmaceutical industry to a cancer patient with $270,000 in bills for just one drug. (Alonso-Zaldivar, 11/20)

The Obama administration’s top health officials said Friday that the nation needs greater clarity about the cost and effectiveness of prescription drugs as part of a strategy to make medicines more affordable without stunting the emergence of new pharmaceuticals. The current scattered system, in which drugs are priced differently depending on who is paying for them, "end[s] up obscuring" their true cost and, in turn, the impact on which patients have access to them, said Andy Slavitt, who oversees Medicare, Medicaid and insurance exchanges in the Health and Human Services department. (Goldstein, 11/20)

Dr. Michael Reilly's lawyer gave his client strong advice after reviewing a lucrative employment contract that the North Broward Hospital District offered him 15 years ago. “I should throw this in the trash,” Reilly, a now-retired orthopedic surgeon, recalls the attorney telling him. The contract, the lawyer said, had major problems, including that it violated the federal Stark law, which bars physicians from referring Medicare patients to hospitals, labs and other doctors that the physicians have financial relationships with unless they fall under certain circumstances. (Schencker, 11/21)

The U.S. Justice Department is investigating the medical necessity of angiograms performed at a DaVita HealthCare Partners subsidiary, the company disclosed Wednesday in a filing with the Securities and Exchange Commission. The False Claims Act investigation centers on the medical necessity of the procedures performed at two Florida centers that are part of RMS Lifeline, a DaVita subsidiary that provides vascular access management services for dialysis patients, according to the filing. The Justice Department has asked for medical records for 10 patients, among other documents, from January of 2008 through the present. (Schencker and Rice, 11/20)

Soon, it might become the norm to verify your identity at the hospital or clinic by scanning your fingerprint. One California clinic, the Kern County Medical Center in Bakersfield, recently started experimenting with a biometric fingerprint reader, called SafeChx, to avoid mixing up patients with similar names, and potentially even crack down on fraud. It’s the first hospital in California to use the SafeChx system. (Farr, 11/23)

United States military operations in Afghanistan, now in their 15th year, are routinely described as America’s longest war. For overseas combat, that is true. But nothing tops the domestic “war on drugs” that an American president declared more than four decades ago. The casualty rate has been exceedingly high. Nearly 44,000 Americans a year — 120 a day — now die of drug overdoses. Neither traffic accidents nor gun violence, each claiming 30,000-plus lives a year, causes so much ruination. The annual drug toll is six times the total of American deaths in all wars since Vietnam. (Haberman, 11/22)

As the opioid epidemic has exploded in small towns and suburbs in recent years, officials have scrambled to put naloxone in the hands of drug users’ families and friends, and to make it more widely available by equipping police officers with the drug. At the same time, thousands of lives are being saved by giving the antidote to drug users. More than 80 percent of overdose victims revived by “laypeople” were rescued by other users, most of them in the past few years, according to one national survey published in June. (Bernstein, 11/22)

Thirty-five states saw youth drug overdose deaths increase dramatically in the past decade, according to a new report. And in five states – Kansas, Montana, Ohio, Wisconsin and Wyoming – the overdose death rates more than quadrupled. Drug overdoses were the leading cause of injury death in 2013, exceeding that of motor vehicle crashes, says the report released Thursday from Trust for America's Health, a national non-profit group that watchdogs public health issues. (Thadani, 11/20)

Several scientists are concerned about racial bias in federal funding of medical research. Using National Institutes of Health data obtained through the Freedom of Information Act, researchers find persistently lower approval levels for grants filed by minority researchers, as compared to white applicants. The issue has major implications for America’s health and how its tax money is spent. (Garrison, 11/20)

What kind of care do you want at the end of your life? Stanford University researchers put that question to members of three major ethnic groups in the San Francisco Bay area and found little variation in their responses. “There is a common humanity – people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center. (Feder Ostrov, 11/23)

On Tuesday, and again in January, a Food and Drug Administration advisory committee will consider whether to recommend approval of two drugs to slow the muscle deterioration at the root of Duchenne [muscular dystrophy]. If approved, the medications would become the first treatments for a condition that affects an estimated 1 in 3,500 boys. “It’s really a momentous time,” said Louis Kunkel, a Harvard geneticist, credited with discovering the gene behind Duchenne, who has long helped search for treatments. “For years, we’ve been able to do nothing for these families and their children. . . . I thought we would have cracked this nut a long time ago.” (Dennis, 11/21)

A panel of health experts is calling for sweeping changes to the way infectious disease threats are managed, saying a bungled response by the World Health Organization and others to the West African Ebola epidemic exposed dangerous vulnerabilities. In a frankly worded report published online Sunday in the scientific journal The Lancet, the panel proposed 10 changes, from expanding oversight of epidemic response beyond the WHO to creating economic incentives that would prod countries to report, rather than try to hide, disease outbreaks. (McKay, 11/22)

Danielle Montgomery woke up in a panic, peering around her darkened bedroom. To the teenager's relief, she was still alive. Not like in the nightmare where her lifeless body lay under a black tarp as her family huddled around crying. The dream interrupted her sleep again and again after the 15-year-old saw a dead body for the first time last year. While headed to the bus stop one morning on her way to school, she stumbled upon a crime scene. What she saw came to haunt her: Police milling around in a yard, a black tarp on the ground, and, underneath, a dead body. (McDaniels, 11/22)

It's a 2:54 on a sunny Thursday afternoon in the gang-ridden Tenderloin district of San Francisco, and community volunteers wearing lime-green and orange vests are patrolling an 11-block stretch. Their mission is to keep area schoolchildren safe from drug dealers, gangbangers and other threats as the kids walk to their afterschool activities. Called the “corner captains,” they are the mothers of the students as well as other volunteers participating in the Safe Passage initiative. Cool and collected, they keep watch for an hour each weekday. Earlier this year, an intersection in this area, Turk and Leavenworth, was the site of a double shooting on an early Monday afternoon. (Kutscher, 11/21)

Most Western countries require a doctor’s prescription for hormonal contraceptives like pills, patches and rings, but starting sometime in the next few months, women in California and Oregon will be able to obtain these types of birth control by getting a prescription directly from the pharmacist who dispenses them, a more convenient and potentially less expensive option than going to the doctor. Pharmacists will be authorized to prescribe contraceptives after a quick screening process in which women fill out a questionnaire about their health and medical histories. The contraceptives will be covered by insurance, as they are now. (Belluck and Tavernise, 11/22)

Federal officials say their final analysis of a Montana community wracked by a deadly asbestos contamination shows a costly and much-criticized cleanup is working, even though some 700 properties have yet to be investigated and concerns linger over asbestos left behind. The U.S. Environmental Protection Agency has spent more than $540 million removing asbestos in and around the town of Libby in northwest Montana. The material came from a W.R. Grace and Co. vermiculite mine that is now closed. Health workers have estimated that as many as 400 people have died and almost 3,000 have been sickened from exposure. Yet after a lengthy review of the health risks, the EPA said in a report issued Friday that people could continue to live in Libby and neighboring Troy without excessive exposure. (Brown, 11/21)

Alicia Mitchell was 15 years old when her father sued Motorola Inc., alleging the company’s cellphones caused his brain tumor. She’ll turn 30 in February and the lawsuit is still winding its way through court. ... So far, the cases have mostly been a battle over legal procedure, not science. Ms. Mitchell’s father’s lawsuit, Murray v. Motorola, faces another test Tuesday when the sides argue over what legal standard should be applied when evaluating evidence brought by scientists. (Knutson, 11/22)

A labor union representing Illinois home health care workers has filed legal action to force government payment of health insurance costs. SEIU Healthcare Illinois filed in St. Clair County Friday seeking a temporary restraining order against Gov. Bruce Rauner and Comptroller Leslie Munger. (11/21)

Rush University Medical Center said it plans to build a $500 million outpatient facility as part of a significant reconfiguration of its Near West Side campus. The academic medical center said it is in the early stages of developing a master plan, which also calls for demolishing student housing to the east of its butterfly-shaped hospital along the Eisenhower Expressway and redeveloping land the organization is buying from Malcolm X College on the north side of the highway. (Sachdev, 11/20)

The only suicide prevention outreach program on a South Dakota Indian reservation where at least 20 people have killed themselves this year will end in December due to lack of funding, tribal officials said Friday. The move comes after a federal agency denied the Oglala Sioux Tribe's application for a grant that would have paid for the program on the Pine Ridge reservation for five more years. A copy of the application obtained by The Associated Press shows the tribe was seeking more than $3.6 million for a revamped program. However, federal officials rated the application poorly. (Garcia Cano, 11/20)

For a few transgender Americans, this has been a year of glamour and fame. For many others, 2015 has been fraught with danger, violence and mourning. While Caitlyn Jenner made the cover of Vanity Fair and Laverne Cox prospered as a popular actress, other transgender women have become homicide victims at an alarming rate. By the count of the National Coalition of Anti-Violence Programs, there have been 22 killings so far this year of transgender or gender-nonconforming people — including 19 black or Latina transgender women. (Crary, 11/21)

There are currently four medical marijuana dispensaries open in Massachusetts — in Salem, Brockton, Northampton and Ayer. But patients aren’t able to buy the full 10 ounces every 60 days that is allowed by state law because most of the marijuana grown by these facilities is not passing state testing standards, which dispensaries say are too strict and not realistic. Now the state is proposing a fix. (Bebinger, 11/20)

Three rural health care providers in Michigan will receive federal grants for equipment and technology to reach people without easy access to doctors or hospitals. The U.S. Department of Agriculture is providing the funding through its Distance Learning and Telemedicine Grant program, which helps doctors have video consultations with patients in different locations. (11/21)

Blue Cross and Blue Shield of Georgia will again have a dominant share of members and dependents in Georgia’s state employee and teacher health plan in 2016. The state’s largest health insurer will serve more than 75 percent of State Health Benefit Plan members next year with its various health plans. (Miller, 11/20)

Confusion, frustration, anger. Some Wayne County retirees injured on the job say they are grappling with all three as they prepare for life without county-provided health care coverage, a reality forced by the county’s efforts to cut costs in the face of its financial emergency. But these retirees also say they feel betrayed, because some will be getting the county’s lowest stipend — $100 per month before taxes — to defray the cost of health insurance, which could cost them hundreds of dollars per month. The county says 4,000 retirees qualify for the Retiree Stipend Program, which was crafted based on a legal settlement. (Lawrence, 11/22)

Elizabeth Brooks delivered her first baby in a hospital. But for the second, due in January, she and her husband, Erik, wanted a more homelike setting, with a nurse midwife attending the birth. They’ve signed up to use Charlotte’s first non-hospital-based birth center, which opens this weekend on Providence Road, about a block from Novant Health Presbyterian Medical Center. (Garloch, 11/21)

An outbreak of E. coli linked to Chipotle that originated in the Pacific Northwest has spread south and east and has now infected people in six states. New cases have been reported in California, New York and Ohio, the Centers for Disease Control and Prevention said Friday. The first cases were discovered late last month in Oregon and Washington, and more recently in Minnesota. (11/22)

The movement to make 21 the legal age for purchasing tobacco products throughout the Kansas City metropolitan area netted two of the region’s largest municipalities Thursday. In a move designed to make a big splash, elected officials in Kansas City, Mo., and the Unified Government (UG) of Wyandotte County and Kansas City, Kan., voted within hours of each other to increase the legal age from 18. (Sherry, 11/21)

Health insurance stocks took a nasty tumble last week, and maybe the markets are realizing that ObamaCare isn’t performing as well as the political class pretends. Sooner or later, reality tends to assert itself—for President Obama’s domestic legacy no less than his foreign policy. The immediate cause of the selloff was UnitedHealth Group’s shock $425 million downgrade to its earnings forecast for 2015, almost entirely driven by losses on the Affordable Care Act exchanges. UnitedHealth is the largest U.S. insurer by enrollment, and the company is warning it may withdraw from ObamaCare in 2017. The insurer has already suspended advertising for its ObamaCare coverage and stopped paying commissions to insurance brokers for signing people up. (11/22)

There's turmoil in the individual markets for health insurance. ... Blue Cross lost about $280 million in its exchange-based business in 2014. The consulting giant McKinsey & Co. estimated that the insurance industry lost $2.5 billion on Obamacare policies in 2014. About two of every three health care payers lost money; many of the rest eked out small profits. ... Thursday brought another thunderbolt: UnitedHealth Group, the nation's largest health insurer, warned it may bail on Obamacare in 2017 if it can't find a way to make money. ... Obamacare has a fever coming on. The Obama administration has been loath to reopen the law with Congress, given that many Republicans vow to repeal it. But the White House has to acknowledge that changes are needed now. (11/21)

Yes, Obamacare has hit a few rough patches lately. But they’re much less significant than a lot of the reporting, let alone the right-wing reaction, would have you believe. Health reform is still a huge success story. (Paul Krugman, 11/23)

United is the nation's biggest health insurer. But that's misleading: in the individual market served by the Obamacare exchanges, it's small beer. UnitedHealth's core business is selling employer-sponsored health plans, and it hasn't been known for its familiarity with or success in the individual market, which is dominated nationwide by Blue Cross and Blue Shield plans, especially those owned by Anthem Inc. (Pre-ACA, Blues were the biggest individual insurers in 34 states.) After enactment of Obamacare, United moved only gingerly into the exchange market, participating in only five states in 2014 and 15 this year. (Michael Hiltzik, 11/19)

One of the most consequential provisions of the Affordable Care Act (ACA) is also one of its most obscure. The “productivity adjustment factor,” inserted by the ACA into the Medicare program, is a massive spending cut, one of the largest in the program’s history. It was included to make room in the federal budget for the ACA’s expensive new health insurance subsidies. If Congress follows past practice, the ACA’s higher spending will be with us long after savings from the productivity adjustment factor have been reduced or eliminated altogether. (James C. Capretta & Joseph Antos, 11/23)

For the first three years of the program, the federal government had promised to fully fund Medicaid expansion, but that was a clock that started ticking two years ago. Even if Alabama expanded Medicaid next year, it probably wouldn't be soon enough to capture the last year of that funding. About $3 billion, which could have been spent in Alabama, which could have closed that health care gap, has gone elsewhere. We might as well have put that money in a pile and set it on fire. (Kyle Whitmire, 11/20)

It is one of the central political puzzles of our time: Parts of the country that depend on the safety-net programs supported by Democrats are increasingly voting for Republicans who favor shredding that net. ... Last year, Paul R. LePage, the fiercely anti-welfare Republican governor of Maine, was re-elected despite a highly erratic first term — with strong support in struggling towns where many rely on public assistance. And earlier this month, Kentucky elected as governor a conservative Republican who had vowed to largely undo the Medicaid expansion that had given the state the country’s largest decrease in the uninsured under Obamacare, with roughly one in 10 residents gaining coverage. (Alec MacGillis, 11/20)

To win state regulators' approval for its purchase of a rival health insurer, Blue Shield of California promised (among other things) to contribute $14 million annually for 10 years to healthcare-related charities to improve access to care. Not long after the state issued a news release trumpeting that pledge, however, Blue Shield made it clear that it was not going to contribute $14 million more per year. In fact, executives said the nonprofit already had been contributing a considerably larger amount, on average, than $14 million. The new commitment, they said, simply set a floor for future donations. Bait and switch? Not at all, the company insists. But the public could be forgiven for thinking that it's getting less than the state promised. (11/22)

The Centers for Disease Control and Prevention reported this month that the adult smoking rate in the United States has fallen to a new low, a testament to the decades of education about the dangers of tobacco and measures to discourage its use. Now Republicans in the House are seeking to slash the very government programs that have helped to achieve such remarkable success. ... progress might well be slowed or reversed if Congress approves two riders attached to an appropriations bill for the 2016 fiscal year by a Republican-dominated House committee. (11/21)

We — both physicians and patients — usually think more treatment means better treatment. We often forget that every test and treatment can go wrong, produce side effects or lead to additional interventions that themselves can go wrong. We have learned this lesson with treatments like antibiotics for simple medical problems from sore throats to ear infections. Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. (Ezekiel J. Emanuel, 11/21)

When Hillary Clinton was pregnant, the country didn’t even guarantee employees the ability to take unpaid time off when a new baby arrived, which meant new moms risked their jobs just to recover from birth. The Family and Medical Leave Act didn’t become law until 1993. Today, the way we see the right to time off to bond with and adjust to a new child has changed. There is perhaps no better proof than the 2016 presidential contest. For probably the first time ever, all of the current Democratic candidates openly support a national paid leave program. (Bryce Covert, 11/23)

With hardly a ripple of dissent, Medicare authorized payment for end-of-life discussions. Now health care professionals can punch in a code to bill Medicare for sitting down with patients to discuss end-of-life decisions. ... this modest move by Medicare could make a substantial difference. Far more important than the money — physicians aren’t going to boost their income enormously by billing $86 for a half-hour — is the message. (Paula Span, 11/20)

Hillary Clinton has plenty of allies as she demonizes drug-company profits and pushes for federal control over how drugs are priced. There’s a drug-pricing task force led by the White House and a similar Democrat-led effort in Congress. Many of the pharma industry’s proponents in Washington and on Wall Street dismiss this as political noise, arguing that new restrictions impeding investment and innovation are unlikely to get through a Republican Congress. But the Affordable Care Act reordered the legal framework to let a president impose price restrictions unilaterally through the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation. These executive-branch bodies were crafted to control what procedures doctors perform, but there is reason to believe they can also control drug prices. (Scott Gottlieb, 11/22)

You wouldn't think TV commercials for prescription drugs would boost sales. Sure, the ads draw you in with claims of curing all maladies, even ones you didn't know existed. But then — warning! — they scare you silly with an endless list of potential side effects. Car insurance ads, we understand those: Fifteen minutes will save me money. But what use is a miracle cure that will cause severe itching? And we don't want to think about certain conditions lasting four or more hours. ... The AMA is wrong to push for a ban on prescription drug ads. Consumers get the benefit of learning about potential treatments. Then, as the ads say, they can discuss the options with their doctors. That's when issues such as cost and alternate treatments can be considered. (11/20)

The debate over doctor-assisted suicide is often framed as an issue of personal autonomy and privacy. Proponents argue that assisted suicide should be legalized because it affects only those individuals who — assuming they are of sound mind — are making a rational and deliberate choice to end their lives. But presenting the issue in this way ignores the wider social consequences. What if it turns out that the individuals who make this choice in fact are influencing the actions of those who follow? (Aaron Kheriaty, 11/20)

A group of doctors in the field of infectious diseases has begun to rally around a mantra of "bare below the elbows," suggesting that health professionals avoid wearing white coats altogether, as is the custom in the U.K. ... The debate over white coats has forced me to consider my own practice. In the end, I think the issue is as much about generational change as it is about infection control. I'd give up my white coat instantly if I knew it was spreading harmful bacteria. But colonization with bacteria is different from transmitting them to another person. Bacteria live on all of us, so are white coats necessarily worse than our other garments or even our own skin? (John Henning Schumann, 11/21)

Until my older children tired of the ritual, I would take them to the Silver Diner in Rockville, Maryland, every Saturday morning. A few years ago, we noticed a drastic change in the menu, with more emphasis on healthy food. A new analysis of that change published in Health Affairs backs up our family's experience and suggests that it had substantial effects on the food children ordered. ... No magic silver bullet exists to reduce childhood obesity. Instead, progress will have to come from the accumulation of many small changes, like the Silver Diner’s new menu. (Peter R. Orszag, 11/20)