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The public emergence of the bluntly worded letter, from Aetna’s Chief Executive Mark T. Bertolini, has led critics to question the motives behind the insurance company’s recently disclosed pullback from the insurance exchanges. It also has added a layer to a broader debate over the causes and cures for the red ink the exchanges are generating for insurers. (Wilde Mathews and Armour, 8/17)

The big health care news this week came from Aetna, which announced on Monday it was dramatically scaling back participation in the Affordable Care Act ― thereby reducing insurer competition and forcing customers scattered across 11 states to find different sources of coverage next year. ... the move also was directly related to a Department of Justice decision to block the insurer’s potentially lucrative merger with Humana, according to a letter from Aetna’s CEO obtained by The Huffington Post. (Cohn and Young, 8/17)

In the July 5 letter, Aetna Chief Executive Officer Mark Bertolini said it would have to cut back because it would be some time before the company recouped the investment it had made in this market over the past 2-1/2 years. "Our ability to withstand these losses is dependent on our achieving anticipated synergies in the Humana acquisition," Bertolini wrote. (Humer, 8/17)

Rep. Frank Pallone Jr. (N.J.), ranking Democrat on the Energy and Commerce Committee, issued a statement Tuesday saying he was "troubled by reports this announcement could be in retaliation" to the Justice Department's decision. Earlier this month, after Aetna announced in an earnings call this month that it was reevaluating its participation in the exchanges, Sen. Elizabeth Warren (D-Mass.) wrote on Facebook: "The health of the American people should not be used as bargaining chips to force the government to bend to one giant company’s will." (Johnson, 8/17)

The change in tack for Aetna is also noteworthy because Bertolini was talking up the business potential of the exchanges as recently as April, when he said during a call with analysts and investors that the exchanges were "a good investment," despite the losses incurred. At the time, Bertolini said that Aetna was "committed to working constructively with the administration and lawmakers to find solutions that can improve this program, stabilize the risk pool, and expand product flexibility, all with the goal of creating a sustainable program that makes health care more affordable and accessible for all consumers." Now, the company appears to be taking its ball and going home. (Hensley, 8/17)

The trend of health insurers pulling back from public exchanges raises concern for the future of the Affordable Care Act. It is far less of a worry for investors. Aetna announced plans earlier this week to withdraw from 11 of the 15 states in which the insurer currently offers public exchange plans to individuals. ... Regardless of motivation, Aetna has chosen to exit an unprofitable business. The company said it lost $200 million in pretax income from the exchange business in the second quarter and expects to lose more than $300 million this year. (Grant, 8/17)

Barack Obama’s signature health-care law is struggling for one overriding reason: Selling mispriced insurance is a precarious business model. Aetna Inc. dealt the Affordable Care Act a severe setback by announcing Monday it would drastically reduce its participation in its insurance exchanges. Its reason: The company was attracting much sicker patients than expected. Indeed, all five of the largest national insurers say they are losing money on their ACA policies and three, including Aetna, are pulling back from the exchanges as a result. The problem isn’t technical or temporary; it’s intrinsic to how the law was written. (Ip, 8/17)

Facing high-profile withdrawals from online insurance exchanges and surging premiums, the Obama administration is preparing a major push to enroll new participants into public marketplaces under the Affordable Care Act. The administration is eyeing an advertising campaign featuring testimonials from newly insured consumers, as well as direct appeals to young people hit by tax penalties this year for failing to enroll. But as many insurers continue to lose money on the exchanges, they say the administration’s response is too late and too weak. (Pear and Abelson, 8/17)

Aetna's sudden decision to quit most of its Obamacare insurance markets was the latest mess in the health law's rockiest stretch in almost three years. It's Kevin Counihan's job to clean it up. Counihan, CEO of the federal insurance marketplace, told POLITICO's "Pulse Check" podcast that Aetna's flip-flop — the company announced Monday it will exit from 69 percent of counties it now serves through Obamacare, just three months after committing to stay and even expand — doesn't alter the administration's strategy. (Diamond, 8/18)

Recent decisions by giant health insurers to pull back from Obamacare exchanges across the country could make this fall’s enrollment period crucial to the program that has helped millions of people gain health coverage. “We won’t know until the next open enrollment, are we still moving forward or are we stalled or moving backward?” said Gary Claxton, director of the nonprofit research group Health Care Marketplace Project at Kaiser Family Foundation. “If the market grows, then I think many insurers will find a way to be part of it. “The next couple of months are a moment of truth,” he said. (Petersen and Sisson, 8/17)

Aetna said this week it is drastically curtailing its participation on the Affordable Care Act's insurance exchanges. But one of the largest not-for-profit health insurers does not plan on abandoning them anytime soon. Kaiser Permanente, the $61 billion system that includes health plans, hospitals and medical groups, is “absolutely” sticking with the exchanges over the long term, Kaiser CEO Bernard Tyson told Modern Healthcare on Wednesday. (Herman, 8/17)

Some of the Affordable Care Act’s insurance marketplaces are in turmoil as the fourth open enrollment season approaches this fall, but what’s ahead for consumers very much depends on where they live. Competition on these exchanges will be diminished next year when three of the nation’s largest health insurers — Aetna, UnitedHealthcare and Humana — will sell individual plans in many fewer markets. So too will several Blue Cross and Blue Shield plans in various states. That’s on top of the 16 nonprofit co-ops that have closed since January 2015. (Galewitz, 8/17)

Oscar Insurance Corp., the startup backed by Silicon Valley investors, posted losses in New York, Texas and California in the first half of the year, the latest example of insurers both large and small losing money in new markets created by President Barack Obama’s health-care overhaul. In New York, Oscar’s biggest market, the loss widened to $52.2 million from $15.5 million in the first half of 2015. The insurer also lost $12.9 million in California and $17.9 million in Texas, according to state filings, after starting to sell plans in Dallas, San Antonio and the Los Angeles area this year. (Edney and Tracer, 8/17)

Scott & White Health Plan, an insurance program run by the Dallas-based Baylor Scott & White Health system, said Wednesday that in 2017, it will exit the federal health care marketplace established under the Affordable Care Act. The announcement follows Aetna's decision to stop selling plans on the marketplace announced Tuesday.  Scott & White Health  said the decision was made before they became aware of United Health Care and Aetna's decisions. (Rice, 8/17)

Health insurance premiums for Massachusetts’ small businesses and individuals covered by Harvard Pilgrim Health Care will rise by double digits over the next six months, nearly twice the pace of last year. Those are among the higher rate increases announced Wednesday by the Massachusetts Division of Insurance for small businesses and individual customers of the state’s health insurers. On average, small businesses will see their rates rise 8.2 percent for plans that renew Oct. 1. Those plans affect 106,426 people who work for companies with fewer than 50 employees. Roughly half those members are covered by Blue Cross Blue Shield’s HMO Blue plan, where rates will rise 4.6 percent on Oct. 1, compared with 8 percent a year ago. (Healy, 8/17)

Aetna Inc.’s decision to scale back participation in the Affordable Care Act’s exchanges is putting new pressure on Hillary Clinton over health care, a onetime signature issue that has taken a back seat in her presidential campaign. The pressure is coming from the right but also the left. Liberals say the Aetna decision shows the need for a government-run option to compete with the private insurance companies, or even for a single-payer, Medicare-for-all program, as Sen. Bernie Sanders proposed again this week. (Meckler, 8/18)

Sen. Bernie Sanders (I-Vt.) renewed push for a government-run healthcare plan is getting a tepid reception from Democrats, with some saying he is waging a losing battle. Long-time “public option” supporters like Sanders believe Aetna’s decision to flee the ObamaCare marketplaces this week proves what they’ve been saying all along: that the time has come for a new government-run healthcare plan in the United States. (Ferris, 8/18)

Two days in a row, in prepared speeches, Trump asserted that that his rival Clinton lacks “mental and physical stamina” to do the job as president. That’s surely no accident, but a campaign official did not respond to a query about why the GOP presidential nominee was making this claim. We assume Trump’s rhetoric is related to a not-so-quiet campaign among right-leaning news entities to highlight “concerns” about Clinton’s health, often shared on social media with #HillarysHealth. Our colleague David Weigel has already taken a good look at the smorgasbord of junk science being used to promote such claims. (Kessler, 8/18)

Roughly 20 million more Americans have health insurance now than when President Obama’s health care law was passed in 2010. But as Mr. Obama prepares to leave office, there are still about 24 million adults with no coverage, according to a survey by the Commonwealth Fund, a health research group. That translates to an uninsured rate of about 13 percent, down from 20 percent in 2013. Who are the remaining uninsured? (Goodnough, 8/18)

Some of those remaining uninsured are undocumented immigrants who don’t qualify for federally subsidized coverage. Others may be eligible but unaware of their options, and still others said they were worried about costs, according to the survey by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) There is a lingering perception “that it is not affordable for them,” said Bianca DiJulio, an associate director at the foundation. Many of those still without coverage are Latino; one-third of all Latino survey respondents are still uninsured. (Gorman, 8/18)

Nearly three-quarters of Californians who didn’t have health coverage before the Affordable Care Act are now insured, yet many are still concerned about their medical expenses, according to a report released Thursday. A Kaiser Family Foundation survey tracking the state’s uninsured population found that 72% of those without insurance in 2013 had a health plan in 2016. That’s a small increase from the 68% who had coverage last year and 58% the year prior. (Karlamangla, 8/18)

The study, the fourth in a series of surveys of Californians who did not have health insurance in 2013, found that 72 percent have since obtained coverage, either through their employer, the state exchange created by the federal health law or through Medi-Cal, the state’s Medicaid program for the poor. This number is slightly higher than the 68 percent reported last year, a gain that represents hundreds of thousands of newly insured Californians. The state had the largest number of uninsured in the country, with about 6 million residents lacking coverage in 2013. (Colliver, 8/18)

From here on, experts say, any significant enrollment gains are likely to come about as a result of changes to federal or state health care policies, including attempts by California legislators to allow undocumented residents to join Medi-Cal, which is now prohibited. (Seipel, 818)

Patients who gained health coverage through the Affordable Care Act are filling significantly more prescriptions while paying less for their drugs, according to a new study that credits the health law and adds to evidence of its benefits for previously uninsured Americans and those with chronic conditions such as asthma, diabetes and high blood pressure. The innovative study is based on more than 1 billion pharmacy transactions from 2013 and 2014, which allowed researchers to look at how a sample of nearly 7 million patients were paying for drugs before and after the health law’s historic coverage expansion. (Levey, 8/17)

Uninsured Americans went to the doctor and got needed prescriptions once covered under the Affordable Care Act while their out-of-pocket costs fell, according to a new analysis. A new RAND Corporation analysis is the latest evidence of pent up demand for healthcare services for those who didn’t have coverage and may bode well for better health outcomes and potentially lower costs down the road. The study is published in the September issue of the journal Health Affairs. (Japsen, 8/18)

Previously uninsured people who gained coverage under Obamacare in 2014 used a lot more prescription drugs on average than they had before but spent much less out of pocket per prescription, according to a new study in Health Affairs. The newly insured who bought private Affordable Care Act plans filled 28 percent more prescriptions than they had in 2013 but paid 29 percent less for them, according to the findings of RAND Corporation researchers and an HHS analyst. Those who were newly covered by Medicaid filled 79 percent more prescriptions and paid 58 percent less per fill. (Norman, 8/17)

The study found that during the first year of Obamacare’s coverage expansion, the proportion of uninsured prescription drug users decreased by 30 percent. Uninsured people who gained private coverage between 2013 and 2014 also filled 28 percent more prescriptions and paid 29 percent less out-of-pocket per prescription in 2014 compared to the prior year. (Owens, 8/17)

The 2010 health law was meant to expand insurance coverage so that Americans could get medical care they would otherwise go without — and not spend a fortune doing so. Though it’s still early, new evidence suggests this scenario is playing out. Research published online by Health Affairs Wednesday examines what happened when people got insurance through the law — either with a private plan purchased via the online marketplaces or through Medicaid, the state-federal program for low-income people. The study specifically focuses on how many medical prescriptions they filled. (Luthra, 8/17)

Gov. Matt Bevin wants able-bodied adults to volunteer in their communities in exchange for their Medicaid benefits. But an organization representing nearly 600 of the state’s nonprofit groups says its members aren’t ready to welcome an influx of tens of thousands of people who would need training, supervision and — in some instances —criminal-background checks. ... [State officials seeking to revise Kentucky's Medicaid expansion program are preparing a] waiver application that would tighten eligibility standards for the 1.4 million Kentuckians who get health insurance through the program. The waiver application is being revised this month following much public comment, most of it critical. (Cheves, 8/17)

Politicians, clergy and academics who favor Medicaid expansion made their pitch Wednesday on the steps of City Hall, this time with a new report to back them up. Tampa Bay and the rest of Florida, they said, would be in much better health if the Legislature would change course and expand Medicaid to cover more residents. Expansion also could boost the area's fortunes, according to the report, sponsored by Florida CHAIN, a pro-expansion nonprofit. (Suntrup, 8/17)

Consumer advocacy group Florida CHAIN released a new [report] Wednesday that once again calls for the expansion of Medicaid in the state. But Florida House lawmakers have shut down expansion in Florida each year since 2010. Advocates say Medicaid expansion would cover up to 800,000 Floridians without insurance. Mark Pafford, a former Democratic lawmaker who now leads Florida CHAIN, said if the group continues to push for expansion, it'll eventually happen. (Miller, 8/17)

A group of lawmakers and health care officials working on a health care expansion plan gathered in Nashville once again on Wednesday, this time to further delve into the details of a proposal that will need approval from the federal and state government. During a meeting at Vanderbilt University, four lawmakers serving on the 3-Star Healthy Task Force met with TennCare chief Dr. Wendy Long and Melinda Buntin, chair of the Department of Health Policy at Vanderbilt University's School of Medicine. (Ebert, 8/17)

The Obama administration has announced that it will spend $17 million to help law enforcement agencies deal with the increase in heroin and opioid abuse. At the same time, the administration is using the announcement to encourage Congress to meet President Barack Obama's call for $1.1 billion in new funding to help states expand access to treatment. (8/17)

The Obama administration on Wednesday announced it would provide $17 million to a handful of states considered to be high intensity drug trafficking areas to strengthen efforts to disrupt the spread of drugs. The funding will expand the heroin response strategy for high-intensity areas in Atlanta and the Carolinas, Michigan and Ohio. Of that funding, $5.6 million will go toward 13 projects to disrupt the trafficking of prescription opioids, fentanyl and heroin, as well as training providers on safe prescribing practices and on how to distribute naloxone, a drug that can reverse an opioid overdose, the Office of National Drug Control Policy said in a release. (McIntire, 8/17)

Officials in a West Virginia city are warning people about an especially dangerous batch of heroin after authorities responded to 26 overdoses in within a four-hour span. The rash of overdoses came Monday in the city of Huntington, which sits in Cabell County along the Ohio River in the western part of the state. Gordon Merry, the county's EMS director, said at a news conference Tuesday that the heroin the users had taken was laced with a strong substance, but authorities aren't sure what it is. (8/17)

The Charleston Gazette-Mail reports that police in Huntington, W.Va., responded to 26 heroin overdose cases in a span of four hours on Monday evening. To get a sense of the scale of the outbreak, consider this: Huntington is a small city with a population of about 49,000 people, according to the Census Bureau. An overdose outbreak of similar magnitude in New York City (population 8.4 million) would affect more than 4,400 people. The cases overwhelmed first responders in Huntington. (Ingraham, 8/17)

What if you could design a drug that has all the pain-relieving power of morphine but none of its dangerous or addictive side effects? Scientists have spent years trying to do just that, and on Wednesday, they unveiled one of their most promising compounds yet — a chemical concoction they dubbed “PZM21.” When tested in mice that were placed on a hot surface, PZM21 offered nearly as much pain relief as morphine and lasted for up to three hours. That’s “substantially longer” than morphine or other experimental drugs, the scientists wrote in the journal Nature. (Kaplan, 8/17)

Now scientists are trying to create opioid painkillers that give relief from pain without triggering the euphoria, dependence and life-threatening respiratory suppression that causes deadly overdoses. That wasn't thought possible until 2000, when a scientist named Laura Bohn found out something about a protein called beta-arrestin, which sticks to the opioid receptor when something like morphine activates it. When she gave morphine to mice that couldn't make beta-arrestin, they were still numb to pain, but a lot of the negative side effects of the drug were missing. They didn't build tolerance to the drug. (Chen, 8/17)

The main cause of opioid overdose is respiratory suppression, but researchers have identified a compound that mimics commonly used drugs’ painkilling effects and lacks that lethal characteristic. In a collaborative study, scientists at multiple U.S. universities found the drug candidate PZM21, which was tested in mice, resembles morphine and other drugs like it, but may be less addictive. The compound could one day help reduce the nearly 30,000 drug overdose deaths from respiratory suppression that occur annually in the United States, they argued. (Fox News, 8/17)

An online drug-tracking program aimed at curbing abuse of opioids and other prescription drugs is slated to launch Monday, but many health care providers still haven’t registered to use the system, prompting an urgent call to action Wednesday from the statewide physician’s association. The president of the Massachusetts Medical Society said the state’s new prescription monitoring program is critical in helping stem the region’s opioid crisis. It will help prescribers learn whether patients are visiting several offices, known as doctor shopping, to accumulate opioid drugs, he said. (Lazar, 8/17)

Health advocates hope to “turn the tide” on the drug crisis by encouraging candidates and local and state officials to support a new five-point plan, including making Medicaid expansion permanent. New Futures launched the accountability initiative at a news conference Tuesday attended by substance abuse experts, counselors, legislators, recovering addicts and police. The other goals are restoring the state’s alcohol fund, investing in evidence-informed prevention programs, advancing behavioral health workforce development, and removing barriers to insurance coverage. (Tuohy, 8/16)

Advocates, first responders, and local and federal lawmakers say the state has made great strides in combating an opioid crisis, but much more still needs to be done.  At two press conferences in Concord Tuesday, the focus was on efforts at the state and federal levels both past and future. (Sutherland, 8/17)

Health care has become so expensive in the United States that a growing number of Americans (and their employers) are finding it more cost efficient to fly across the globe for certain medical procedures. The savings are so great — and the quality high enough — that a handful of American insurance companies are now encouraging the practice and covering the travel and treatment costs. Medical tourism” was valued at about $439 billion last year in a new report by Visa and Oxford Economics, which projected that it could grow 25 percent a year over the next decade. (Braverman, 8/17)

With scientists still trying to better understand the virus — and without any treatments available — hospitals have been forced to adapt to a changing Zika outbreak, particularly in states such as Florida, Texas, and New York that are at risk for local transmission or have seen large numbers of travel-related cases. Hospitals say they have built up their diagnostic tools, started performing more regular ultrasounds for patients, and are keeping closer-than-usual watch on amniotic fluid levels and fetal heart rates. Social workers and physical, speech, and occupational therapists are preparing to work with babies born with Zika-associated defects, should they require their care. (Joseph, 8/17)

The fight against the Zika virus has a new weapon: the genetically engineered mosquito. It's recently been approved by federal regulators and may soon be available in parts of the U.S. that are confronting the virus, like Puerto Rico and Miami. The Florida Keys do not have a Zika problem at the moment, but on Aug. 5 the Food and Drug Administration approved trial releases of these mosquitoes in the Keys. But because of the vocal opposition of people there, the local mosquito control board hasn't yet approved the trials, instead putting it on the November ballot as a nonbinding referendum. (Allen, 8/17)

Texas state health officials say it’s inevitable that homegrown mosquitoes will start spreading Zika to Texans — and there’s only so much they can do about it. A patchwork of city and county health departments in Texas, some very poor and understaffed, are responsible for tackling public health problems like Zika under Texas law. Most do not have extra money to try to kill the mosquitoes that carry the Zika virus, let alone prepare for it by stocking blood tests that would show pregnant women if they definitively are infected with the virus. (Cook, 8/17)

Iowa has recorded its first West Nile virus infections of the summer, state health experts reported Wednesday. The mosquito-borne virus isn’t snagging as many headlines as its newer cousin, the Zika virus. But West Nile is an annual threat in much of the United States, including Iowa. (Leys, 8/17)

It's increasingly clear that bad experiences during childhood are associated with long-lasting health effects, including higher rates of heart disease, diabetes and depression. And childhood abuse in particular has been associated with psychiatric problems and chronic diseases years down the line. But whether that translates to a higher risk of early death for abuse survivors isn't well studied. According to research published Wednesday, there is an association between reports of childhood abuse and premature death, but only in women. And because of the nature of the study, the link isn't definitive. (Hobson, 8/17)

Five years ago in Germany, a bland vegetable caused one of the more devastating outbreaks of food-born illness in recent years. Fifty three people died and nearly 4,000 were hospitalized due to a particularly gnarly strain of E.coli. ... It took officials weeks to 60 days to officially identify the culprit: German grown bean sprouts sold through grocery stores. Scientists at IBM want to drastically cut down on the time it takes to pinpoint the cause of a food-born illness like E.coli, norovirus and salmonella. Its researchers have developed a way to tap into grocery stores' existing scanner data to quickly identify possible foods using big data and machine learning. (Kelly, 8/17)

The Food and Drug Administration put the experimental drug esketamine (also known as ketamine) on the fast track to official approval for use in treating major depression, Janssen Pharmaceutical announced Tuesday. This designated "breakthrough therapy" would offer psychiatrists a new method for treating patients with suicidal tendencies and would qualify as the first new treatment for major depressive disorder in about half a century. In some quarters, though, this potentially effective medicine can't escape its reputation as "Special K," a street drug known for producing a high similar to an out-of-body experience -- and sometimes used as a date rape drug. (Scutti, 8/17)

An unidentified patient in Florida is being treated after being infected with a brain-eating amoeba last week, according to the Florida Department of Health. It is the fourth known case this year of infection by the parasite Naegleria fowleri. ... The parasite is almost always deadly. According to the Centers for Disease Control and Prevention, between 1962 and 2015 there were 138 known cases of primary amebic meningoencephalitis, the infection caused by the amoeba, and only three of those patients survived. (Goldschmidt, 8/18)

Mindfulness meditation is designed to settle and ground you in the present moment. That's something that Carole Kinder had a difficult time with after her husband was diagnosed with cancer. Then one day, the couple was sitting in the waiting room at Moffitt Cancer Center in Tampa and Kinder saw a flyer about a meditation program for cancer patients and their caregivers. She thought it could be just what she needed after a stress-filled eight months.  (Ochoa, 8/17)

McDonald's is removing Step-It activity trackers from Happy Meals due to concerns over skin irritations, according to a statement sent to CNN on Wednesday. ... The exact number of reports was not specified. Casey Collyar of Arkansas, wrote on Facebook last week that her child was burned by the Happy Meal toy after playing with it for eight minutes. (Chen, 8/17)

Genetic tests for an inherited heart disorder are more likely to have incorrect results in black Americans than in whites, according to a new study that is likely to have implications for other minorities and other diseases, including cancer. Mistakes have been made because earlier research linking genetic traits to illness did not include enough members of minority groups to identify differences between them and the majority white population or to draw conclusions about their risks of disease. (Grady, 8/17)

People in the healthy comparison groups in these studies were white; whereas some people in the studies with HCM apparently had some African ancestry. As a result, some of the gene variants flagged as being linked to the illness simply represented racial differences between the groups and had nothing to do with HCM. That problem would likely have been avoided if the original scientists had added four or five African Americans to the control group, Kohane says. It turns out that two of these variants commonly identified in African Americans actually don't pose a health risk at all. (Harris, 8/17)

For consumers, the idea of getting a genetic test to determine risks for hereditary diseases is becoming an increasingly common proposition, but new research suggests that sometimes the accuracy of those results may depend on what ethnicity you are. Take, for instance, hypertrophic cardiomyopathy, one of the most common hereditary heart diseases. ... African Americans have traditionally been considered at higher risk for the disorder. But a study out Wednesday in the New England Journal of Medicine concluded that common ways to determine that level of risk may be skewed because studies have traditionally had low numbers of black participants. (Tan, 8/17)

Facing increasing criticism from health care providers about recent cuts in Medicaid reimbursement rates, Gov. Sam Brownback said Wednesday that he will attempt to restore the cuts by increasing a tax on hospitals. In a statement issued Wednesday afternoon, Brownback said he was forced in May to order a 4 percent cut in provider reimbursement rates after efforts to negotiate an increase in the surcharge failed. (McLean, 8/17)

The federal government gives Kansas $1.28 for every dollar the state spends on Medicaid, so when Brownback cut provider rates he also triggered a more than $70 million cut to federal aid. Restoring the cut would allow the state to recoup some of that money. (Dunn and Woodall, 8/17)

The waiting list for Medicaid services for Kansans with physical disabilities has dropped by more than 1,700 since last year but hasn’t budged for those with intellectual or developmental disabilities. In July, 3,450 Kansans with intellectual or developmental disabilities were waiting for home and community-based services provided through Medicaid, as were 10 Kansans with physical disabilities. (Hart, 8/17)

Computer giant Hewlett Packard Enterprises has entered into a $215 million contract with the state of Kansas to upgrade a Medicaid computer system that tracks patient claims payments to providers. According to a recent news release from the California-based company, Hewlett Packard Enterprises, or HPE, will work with partners that include Kansas City-based Cerner to overhaul the state’s Medicaid Management Information System (MMIS) to meet new federal standards. (Marso, 8/17)

A ballot measure that would provide universal health care coverage to all Coloradans has split open liberal politics in the state, with typical allies now standing on opposite sides. On Wednesday, the liberal group ProgressNow Colorado held a news conference outside its Uptown Denver offices to announce its opposition to the measure, known as Amendment 69 or ColoradoCare. The organization was joined by the abortion-rights group NARAL ProChoice Colorado and by Crisanta Duran, a Democrat who is the state House majority leader. (Ingold, 8/17)

Banner Health said Wednesday that it has acquired 32 urgent-care centers in Arizona from Urgent Care Extra. Terms were not disclosed. Banner, which operates hospitals in seven Western states, said that the centers provide an important access point for patients outside of hospital emergency departments. The centers will be rebranded as Banner Urgent Care on Oct. 1. (Barkholz, 8/17)

The rate of Texas women dying of pregnancy-related causes nearly doubled from 2010 to 2014, with the state seeing more than 600 such deaths in the four-year span. In a new study, set to be published in the September issue of Obstetrics and Gynecology, researchers found that Texas experienced a dramatic increase in pregnancy-related deaths from 2010 to 2012. While the rest of the country also experienced an increase, no other state saw the rate nearly double like it did in Texas. (Martin, 8/17)

At a time when Houston didn't even have an official ambulance system, the idea of medical helicopters swooping into urban mayhem and whisking away patients fighting for their lives might have seemed impossible. But Army veteran and trauma surgeon Dr. James "Red" Duke knew military helicopters saved lives on the battlefields of Korea and Vietnam, and he wanted to bolster survival rates by getting civilians who had been shot, stabbed or in car accidents to a hospital as quickly as possible. (Schiller, 7/17)

A “surprise medical bill” is any bill where the insurer paid less than the patient expected, according to a 2015 Consumers Union report. To address “surprise” bills, Bonta’s AB72 has set a pay cap on doctors. That will only create more problems. ... AB72 would require insurers to reimburse out-of-network providers at 125 percent of the rate Medicare pays or of the insurer’s average contracted rate, whichever is greater. It does not address that insurers have narrowed their provider networks so significantly over the past five years that it is nearly impossible for patients to find a full complement of providers who work within their discounted network. (Natuzzi, 8/17)

The Florida Supreme Court will hear arguments Nov. 1 in a closely watched case about a 2015 law that would require women to wait 24 hours before having abortions. The court issued an order Tuesday setting the date for arguments. Abortion-rights supporters challenged the law, contending that it violates women's privacy rights. (News Service of Florida, 8/17)

Insurance researchers are recommending a nearly 20 percent hike in workers compensation rates.  The increase comes in the wake of recent court decisions. Employers in Florida—nearly all of them—purchase workers compensation insurance to cover employee injuries.  Those benefits can cover missed wages, medical costs and rehab.  Right now, Florida premiums are near the middle of the pack compared to other states, but it wasn’t always that way. (Evans, 8/17)

In a letter publicized late Tuesday, the Minnesota-run company informed doctors that it is voluntarily updating its instructions for using the minimally invasive EnVeo R delivery system, which doctors use to implant the Evolut R aortic valve in the heart. The device is used to treat a narrowing of the valve called aortic stenosis, which can lead to heart failure, irregular heart beats and fainting. (Carlson, 8/17)

The University of Maryland 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 alone more than 1,200 people seeking relief for a terrible toothache came to Frederick Memorial. (Cohn, 8/17)

A transgender inmate is suing the Florida Department of Corrections. The woman argues she is being denied medically necessary treatment. Reiyn Keohane is a transgender woman currently being held in a male prison. Keohane has identified as female since the age of 12, and began hormone therapy at the age of 19. Since entering the Everglades Correctional Institution she has been denied that therapy. (Payne, 8/17)

With less than a day’s supply of vital type O blood on hand, Bloodworks Northwest has issued an urgent appeal for summer donors. Vacations typically cause blood supplies to dip by 15 percent, but this year, they’re down by as much as 25 percent, according to David Larsen, spokesman for the Seattle-based agency. It takes about 900 donors each day to maintain a sufficient supply of blood for more than 90 hospitals served by Bloodworks in Washington, Oregon and Alaska. (Aleccia, 8/17)

The University of Arizona's top administrator overseeing medical schools in Phoenix and Tucson on Wednesday defended his agency's accomplishments and said he was "deeply troubled" by recent questions about his agency's spending of public funds and the accuracy of its public documents. Dr. Joe G.N. "Skip" Garcia, UA's senior vice president for health sciences, said in a statement that he was not aware of the "specifics of the allegations" that Arizona Board of Regents President Eileen Klein publicly aired during a meeting last Friday. (Alltucker, 8/17)

Fairview Health Services has settled a lawsuit brought by a transgender woman who was denied onsite treatment for chemical dependency. After moving from Colorado to attend Carleton College in Northfield, Minn., Nova Bradford developed a serious drug abuse problem and became homeless in 2014, according to a complaint filed last year in U.S. District Court in Minneapolis (Verges, 8/17)

Aetna’s announcement this week that it was pulling out of most of the states where it was serving the Obamacare individual exchanges was a head-scratcher; after all, just three months earlier, Chief Executive Mark Bertolini was calling its participation in the market “a good investment,” despite near-term losses. Bertolini also had tried to tamp down speculation that its withdrawal was anything like a payback for the government’s move to block its $37-billion merger with Humana. That was “a separate conversation” from its evaluation of the exchange business, he said during an Aug. 2 conference call with Wall Street analysts. (Michael Hiltzik, 8/17)

The news that Aetna will stop selling health insurance on the public exchanges in 11 states may not be catastrophic for the Affordable Care Act. The company covers only 8 percent of Obamacare enrollees, after all, and Aetna’s job-based health insurance business was perhaps never well-suited to building low-cost networks for individual customers. Nevertheless, after earlier defections by UnitedHealth and Humana, Aetna’s move suggests deterioration in the market for health-care coverage on state exchanges. (8/17)

Democrats claimed for years that ObamaCare is working splendidly, though anybody acquainted with reality could see the entitlement is dysfunctional. Now as the law breaks down in an election year, they’ve decided to blame private insurers for their own failures. Their target this week is Aetna, which has announced it is withdrawing two-thirds of its ObamaCare coverage, pulling out of 536 of 778 counties where it does business. The third-largest U.S. insurer has lost about $430 million on the exchanges since 2014, and this carnage is typical. More than 40 other companies are also fleeing ObamaCare. (8/17)

Giant insurer Aetna announced this week that it was withdrawing from the Obamacare exchanges in 11 of the 15 states it had been doing business, becoming the third major insurance company to scale back its offerings dramatically in the face of heavy losses. The news led to a chorus of “I told you so’s” from critics of the 2010 healthcare law, who have long predicted that it would collapse under its own weight. But they are confusing the growing pains of a new market with the death rattle of a failing one. (8/17)

On Monday evening, one of the nation’s largest insurers released a statement announcing its intention to stop offering individual coverage in most Obamacare markets. Aetna’s announcement, just six paragraphs long, explained that it had lost more than $430 million on the public exchanges since 2014, thanks largely to too many high-cost (read: sick) enrollees. ... But earlier this year, Bertolini let slip another figure that didn’t make it into Monday’s six paragraphs: Aetna enjoyed a record $6.5 billion in government program premiums in the first quarter. In other words, doing business with the government isn’t so bad after all. (8/17)

Could the last one out please shut off Obamacare? The fatally flawed health care program is slowly, and inevitably, succumbing to its wounds, but not before inflicting millions of Americans with mediocre, overpriced health insurance. The latest setback for the comically named Affordable Care Act was Aetna’s decision to withdraw from Obamacare exchanges in 11 of the 15 states it currently serves. (8/17)

Accountable care organizations (ACOs) have emerged as a prominent alternative to traditional fee-for-service payment. What was initially conceptualized as a pilot program for physicians to take responsibility for improving quality and slowing spending has become a national movement now covering more than 28 million Americans, 60% of whom are under commercial ACO contracts. Limited evidence on the effectiveness of the ACO model to date, however, has led some to question the merits of this approach to delivery system reform. However, it would be a mistake to reverse course so early in the life of this promising payment and delivery model. (Zirui Song and Elliott S. Fisher, 8/16)

Accountable care organizations (ACOs) were the cornerstone of the novel payment strategies for Medicare reform under the Affordable Care Act (ACA). In an effort to move from fee-for-service medicine, the Centers for Medicare & Medicaid Services (CMS) aimed to encourage hospitals and physicians to collaborate by offering a bonus if they improved the quality and efficiency of care. The ACO concept appeared in 2 different initiatives under the ACA—the Pioneer ACO program and the ACO program under the Centers for Medicare & Medicaid Innovation (CMMI)—and was intended as an experiment in health policy. (Kevin A. Schulman and Barak D. Richman, 8/16)

Proponents of market-driven reform of U.S. health care agree that the worst solution to the problem of rapidly rising medical expenditures is government-imposed cost controls. They question the capacity of the federal government to manage something as complex as resource allocation in health care without unintended negative consequences. They propose instead to bring greater discipline to the health sector through market-based reforms and through innovation and cost-cutting driven by the private sector. (James C. Capretta, 8/17)

Here is something I bet you don't know. On March 23, 2010, President Barack Obama signed into law a bill that wiped out more than $50 trillion in Medicare's unfunded liability. That's not a misprint. That's trillion with a T. The savings are almost three times the size of our entire economy. Furthermore, in doing this he also solved the long-term budgetary problem of Medicare. Unless some future Congress and some future president change the law, Medicare's growth will stay in line with the growth of our economy, ensuring that the program will remain affordable  indefinitely. (John C. Goodman, 8/17)

Nonprofits are worried about the governor’s proposal to promote “community engagement” by requiring able-bodied, working-age adults to work or volunteer in exchange for Medicaid coverage. The requirement would be 20 hours a week of work or volunteering after a year on Medicaid and would be phased in slowly .... While volunteers are prized by many nonprofits, they must be trained and managed. Organizations employ volunteers a couple of hours a week, seldom more than 10 hours a week. Some organizations require and pay for background checks and medical and drug tests for volunteers. There’s no provision for reimbursing charities for any of these new costs under Bevin’s plan. (8/17)

With a proven record of cutting waste and reducing spending, I am a fiscally conservative Republican, as well as a health care professional. But the Georgia GOP legislative leadership and I have reached very different conclusions about Medicaid expansion and the Affordable Care Act (ACA). (Jack Bernard, 8/17)

While Congress remains on recess, the Zika virus is now spreading on U.S. soil, right where every day Americans live and enjoy their own vacations. Yet Congress continues to play politics with this public health crisis. Emergency spending is for emergencies, and stopping the spread of Zika is a genuine emergency. Zika infection during pregnancy causes microcephaly and other significant disabilities. (Peter Berns, 8/17)

During the Olympic Games, the world gazes admiringly upon athletes with preternatural musculature and athletic ability — and then laments every tainted urine test, every revelation of doping. In the mind of the public, this is the problem with anabolic steroids: They undermine fairness in competition between elite athletes. Damaging the spirit of sport, however, is a minor concern compared with how anabolic steroids impair the health of those who use them — not only Olympians and professional athletes, but also high school football players and rank-and-file weightlifters. (Ruth Wood, 8/17)

You can’t legally buy a drug in the United States that hasn’t undergone rigorous testing, mandated by Congress, to prove that it’s safe and effective. By contrast, that lipstick, shampoo, or deodorant you use every day may have undergone no such testing. And there’s cause to wonder if those products are safe. More than 21,000 complaints of itching, rashes and hair loss, for instance, have been sent to the manufacturer and distributor of Wen Hair Care products. And hair-straightening products that contain formaldehyde, a known carcinogen, have caused allergic reactions, hair loss, rashes, blisters and other problems in salon workers and their customers. (8/17)

In her hometown of Rio de Janeiro, Olympian Rafaela Silva, 26, was Brazil’s first gold medal this year. The winner in women’s judo, Silva was raised in poverty in one of the city’s infamous favelas. Olympian Mavis Chirandu, now 21, was years ago abandoned by the side of the road as an infant and grew up in an SOS Children's Village. She is today representing the nation of Zimbabwe as a member of the women’s soccer team at the 2016 Olympics. (Jessica Sager, 8/17)

It has been 30 years since the first findings that heart attacks are most common in the early morning. Since then, research has revealed that those first three hours after waking are also when a cardiac event is most damaging. In fact, the whole cardiovascular system is controlled by circadian rhythms that influence the likelihood of stroke, kidney failure, and heart attacks. (Jessa Gamble, 8/17)