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With an atypical burst of bipartisanship, the Senate shipped legislation to President Barack Obama on Wednesday lowering hurdles for government drug approvals as the 114th Congress bumped toward the end of a two-year run highlighted by upheaval and stalemate. A week after the House easily approved the biomedical bill, senators passed it by a similarly overwhelming 94-5 margin. (Fram and Taylor, 12/7)

In many ways the bill, known as the 21st Century Cures Act, is a return to a more classic approach to legislation, with policy victories and some disappointments for both parties, and potential benefits for nearly every American whose life has been touched by illness, drug addiction and mental health issues. Years in the making, the measure passed 94 to 5 after being overwhelmingly approved by the House last week. (Steinhauer and Pear, 12/7)

The bill provides for $4.8 billion in new funding for the National Institutes of Health; of that, $1.8 billion is reserved for the “cancer moonshot” launched by Vice President Biden to accelerate research in that field. Another $1.6 billion is earmarked for brain diseases including Alzheimer’s. Also included are $500 million in new funding for the Food and Drug Administration and $1 billion in grants to help states deal with opioid abuse. (DeBonis, 12/7)

Sen. Lamar Alexander, R-Tenn., who leads the committee involved in writing the bill, on Wednesday said it would “help us take advantage of the breathtaking advances in biomedical research and bring those innovations to doctors’ offices and patients’ medicine cabinets around the country.” (Siddons, 12/7)

The new legislation places a strong emphasis on science, pushing federal agencies to fund only programs that are backed by solid research and to collect data on whether patients are actually helped. The bill strengthens laws mandating parity for mental and physical health care and includes grants to increase the number of psychologists and psychiatrists, who are in short supply across the country. (Szabo, 12/7)

But the Cures Act, nearly 1,000 pages long, does not lay out many deadlines. “The dirty secret is it’s going to take many years to implement these things,” said Bethany J. Hills, who runs the FDA practice at Mintz Levin Cohn Ferris Glovsky and Popeo. “There are many provisions requiring guidances, and whenever Congress has mandated that FDA provide guidance on something, FDA historically is perpetually late.”(Kaplan, 12/7)

But the wins come at the expense of funding for public health prevention programs. The bill cuts $3.5 billion over 10 years from President Barack Obama's Prevention and Public Health Fund, which was established under the Affordable Care Act and sets aside money for prevention programs that help battle Alzheimer's disease, smoking, lead poisoning, heart disease, diabetes, stroke and falls among elderly adults. (Johnson, 12/7)

A sprawling health bill that passed the Senate Wednesday and is expected to become law before the end of the year is a grab bag for industries that spent plenty of money lobbying to make sure it happened that way. Here are some of the winners and losers in the 21st Century Cures Act. (Lupkin and Findlay, 12/7)

Republicans have been pushing for the changes for the past few years, arguing that the FDA takes too long to study scientific evidence and sometimes wrongly insists on large, multiyear clinical studies that delay important treatments to patients. The bill’s mechanisms allow the FDA to use shorter and simpler studies more widely. Under the measure, certain new antibiotics could see shorter trials, and a fairly wide range of drugs could get additional approvals for new uses based on relatively low amounts of evidence, such as data summaries and data from company registries. (Burton, 12/7)

The bill had a long and difficult path to final passage, with input from every corner of the healthcare sector. A total of 1,455 lobbyists representing 400 companies, universities and other groups gave input on the bill, according to the Center for Responsive Politics. (Ferris, 12/7)

The legislation has generated concerns among many consumer advocates, who have warned that provisions that would speed federal regulatory review of new drugs and medical devices could expose patients to new risks. “The bill has been sold erroneously as a common sense, bipartisan compromise that enables scientific innovation and medical breakthroughs for America,” said Dr. Michael Carome, director of Public Citizen’s Health Research Group. “But in reality, the legislation includes a grab bag of goodies for Big Pharma and medical device companies that would undermine requirements for ensuring safe and effective drugs and medical devices.” (Levey, 12/7)

President Barack Obama is expected to quickly sign the legislation — one of the final bills of his administration, cementing a health care legacy that extends beyond the Affordable Care Act. (Norman, 12/7)

“We are now one step closer to ending cancer as we know it, unlocking cures for diseases like Alzheimer’s, and helping people seeking treatment for opioid addiction finally get the help they need,” said President Obama, who is expected to soon sign the bill into law. (Radelat, 12/7)

Two months after the Obama administration promised a “moonshot” to accelerate the fight against cancer, Vice President Joe Biden summoned top health care lawmakers to a meeting in the Old Executive Office building. Biden, whose son, Beau, died from brain cancer less than a year earlier, saw a path to fund the initiative in Energy and Commerce Chairman Fred Upton’s 21st Century Cures bill — a measure designed to boost funding for research on cancer and other diseases while making sweeping regulatory changes at the FDA that easily passed the House but was struggling to gain momentum in the upper chamber. (Karlin-Smith, Norman and Haberkorn, 12/7)

Democratic leaders on Wednesday vowed to fight “tooth and nail” against any Republican push to change Medicare so that it relies more on private insurers. “I say to my Republican colleagues: Turn back because we will fight you on this tooth and nail. We will win. You will lose,” Sen. Charles Schumer (N.Y.), the incoming Democratic leader said at a press conference. He was joined by Sen. Bernie Sanders (I-Vt.), House Democratic Leader Nancy Pelosi (Calif.), as well as liberal groups that were delivering to Republican leaders a petition against Medicare cuts with over 1 million signatures. (Sullivan, 12/7)

Senate Democrats have staked out one of the policy arenas in which they will challenge the Trump administration: changes to the health care entitlement programs Medicare and Medicaid. Trump pledged repeatedly during the campaign that he would not touch entitlement programs if he were elected. However, his appointment of Rep. Tom Price of Georgia to run the Department of Health and Human Services, as well as comments from House Speaker Paul Ryan about Republican priorities in the coming Congress, have left Democrats concerned that the popular but expensive programs will suffer under a Trump administration. (Garver, 12/7)

Incoming Senate Minority Leader Chuck Schumer is still hammering Republicans on Medicare, promising a tough confirmation process for Rep. Tom Price, President-elect Donald Trump’s pick to lead the Department of Health and Human Services. “He’s going to get some heck of a hearing when he comes before us in the Senate,” Schumer said at a press conference Wednesday at which Democrats pledged to fight and win any Republican efforts to reform Medicare. He called the Georgia Republican “one of the most avowed enemies of Medicare in the country.” (McIntire, 12/7)

Sen. Charles E. Schumer, the New Yorker who will lead the chamber's Democrats in the next Congress, promised a major fight over President-elect Donald Trump’s pick for secretary of Health and Human Services. Schumer is using Georgia Rep. Tom Price’s Medicare proposals to depict Republicans as leading what Democrats call a “war on seniors.” Schumer on Wednesday told reporters that Trump’s choice of Price is his “biggest statement” on the giant federal health program despite the president-elect's past claims that he wouldn’t cut Medicare. (Young, 12/7)

Millions of Americans, including many struggling with opioid addiction, risk losing access to mental health treatment if Republicans make good on their promise to do away with Obamacare. Full repeal of the health law would gut major benefits and protections for what HHS estimates is 60 million people with mental illness and substance abuse disorders — creating barriers to treatment at a time when opioid abuse is epidemic, suicide rates are at a record high and there's a severe shortage of psychiatric beds. (Ehley, 12/7)

Liberal groups plan to mount a campaign to save Obamacare, sharing the personal stories of thousands of Americans who would lose health insurance in a last-ditch effort to block Republicans’ agenda to gut the law early next year. The goal of the campaign is to take back the narrative from Republican critics who depict the law as a government boondoggle by spotlighting how it has helped millions of Americans who wouldn’t otherwise have health insurance. (Pradhan, 12/7)

Acting CMS Administrator Andy Slavitt on Wednesday urged all lawmakers to improve on the progress made by the Affordable Care Act, rather than plunge the healthcare industry into chaos if the ACA is repealed and inadequately replaced, or isn't replaced at all. “There should be no pride of authorship,” Slavitt said.  “If we can improve upon the things that were started in the ACA, we should do it. It doesn't matter if that comes from a Democrat. It doesn't matter if it comes from a Republican. I would encourage people on both sides of the aisle to say, 'Let's take a step forward, let's focus on the things that haven't been working.'” (Livingsont, 12/7)

The American Academy of Actuaries on Wednesday joined a chorus of experts and interest groups warning House leaders of the potential harm in repealing President Barack Obama's signature health care law without a clear replacement lined up. Repealing major provisions of the law would raise immediate concerns that individual market enrollment would decline, leading to a higher percentage of sick people remaining in the market and causing premiums to become less affordable, the group wrote in a letter to House Speaker Paul D. Ryan of Wisconsin and Minority Leader Nancy Pelosi of California. (Williams, 12/7)

Why worry about buying health insurance when President-elect Donald Trump plans to dump the requirement that most Americans get coverage? For the same reason you should always worry about health insurance: Little health problems can easily turn into big bills without it. (Murphy, 12/7)

Joann Anderson, CEO of Southeastern Health in Lumberton, served as a national voice for rural health care Tuesday as two U.S. hospital associations made a case against the proposed repeal without prompt replacement of the federal Affordable Care Act. ... Anderson heads the 325-bed Southeastern Regional Medical Center in Lumberton, county seat of Robeson, where the ACA has had a significant impact. She said repeal of the act would be catastrophic for health care in Robeson County, recently hit hard by Hurricane Matthew, as well as in other rural areas across the country. (Goldsmith, 12/7)

The federal government says more than 10,000 Granite Staters signed up for insurance on Healthcare.gov in the first four weeks of open enrollment. A total of 10,554 New Hampshire residents signed up for health insurance during open enrollment between November 1 and November 26, according to the Centers for Medicare and Medicaid Services. Over that same period, more than 2.1 million across 39 states have bought coverage on the federal website. (Rodolico, 12/7)

Among Republican ideas to transform the health care system is a proposal to allow health insurers to sell their policies across state lines. President-elect Donald Trump and Tom Price, the Georgia congressman picked by Trump to lead the Department of Health and Human Services, have backed the proposal. They and other advocates see it as a way to boost competition. The interstate sales idea is part of a general GOP blueprint to replace the 2010 Affordable Care Act, often called Obamacare. (Miller, 12/7)

President-elect Donald Trump is weighing naming as Food and Drug Administration commissioner a staunch libertarian who has called for eliminating the agency’s mandate to determine whether new medicines are effective before approving them for sale. “Let people start using them, at their own risk,” the candidate, Jim O’Neill, said in a 2014 speech to a biotech group. O’Neill, has also called for paying organ donors and setting up libertarian societies at sea — and has said he was surprised to discover that FDA regulators actually enjoy science and like working to fight disease. (Kaplan, 12/7)

President-elect Donald Trump’s transition team is considering a Silicon Valley investor close to billionaire Peter Thiel to head the Food and Drug Administration, according to people familiar with the matter. Jim O’Neill, the Thiel associate, hasn’t been officially selected, according to the people, who asked to remain anonymous because the decision process is private, and the Trump team could still go in another direction. (Armstrong, Jacobs and Langreth, 12/7)

A yearlong BuzzFeed News investigation — based on interviews with 175 current and former UHS staff, including 18 executives who ran UHS hospitals; more than 120 additional interviews with patients, government investigators, and other experts; and a cache of internal documents — raises grave questions about the extent to which those profits were achieved at the expense of patients. Current and former employees from at least 10 UHS hospitals in nine states said they were under pressure to fill beds by almost any method — which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal — and to hold them until their insurance payments ran out. (Adams, 12/7)

Abbott Laboratories filed suit to terminate its $5.8 billion purchase of Alere Inc., citing setbacks since the deal was signed in January that it says have significantly eroded the value of the medical-test maker. The news sent Alere shares falling as much as 11 percent on Wednesday, and they were down 7.7 percent to $36.79 at 1:26 p.m. in New York. Alere called the lawsuit “entirely without merit,” and said in a statement that it has complied with all of the terms under the merger. Shares of Abbott Park, Illinois-based Abbott fell less than 1 percent to $38.20. (Cortez, Feeley, 12/7)

Abbott Laboratories on Wednesday filed suit to terminate its acquisition of medical-test maker Alere Inc., adding a new chapter to what has become one of the year's ugliest merger spats. Alere said the suit is without merit and will "take all actions necessary" to force Abbott to see the deal through. The moves come just weeks after the companies looked to be making progress toward a rapprochement of sorts over their $8.4 billion deal (including debt), with Alere agreeing to turn over information related to bribery probes and U.S. billing issues that arose following the announcement of the deal in February. Alere, however, appears to have interpreted that settlement as more of a guideline. The company hasn't yet provided the documents Abbott is seeking, said spokesman Scott Stoffel. (Sutherland, 12/7)

Health care giant Abbott Laboratories said Wednesday that it has filed a lawsuit in an effort to terminate its $5.8 billion agreement to buy Waltham-based Alere Inc., saying the medical test developer has lost significant value since the deal was made public in February. In a statement, Abbott said Alere has “suffered a series of damaging business developments” that caused it to sour on the acquisition, including Medicare’s elimination of billing privileges for a major Alere division, Arriva Medical. (Weisman, 12/7)

Measures similar to Ohio's "heartbeat bill," tacked on to unrelated legislation and hurried through both houses of the legislature Tuesday, were struck down by federal judges in other states as problematic and antithetical to well-established legal precedent pertaining to abortion. The judges who ruled against Arkansas and North Dakota's laws were all appointed by Republicans, and the conservative-leaning U.S. Supreme Court also decided to leave the lower court's rulings in place and reinforce existing precedent. (Heisig, 12/7)

A bill that would require the federal government to conduct more research into health risks faced by women who use medications while breast-feeding is headed to President Barack Obama for his signature. The Senate passed the bill on Wednesday, marking a win for its chief author, Washington state Republican Rep. Jaime Herrera Beutler. The House passed the bill last week. The bill, called the Safe Medications for Moms and Babies Act, would create a new task force of federal and medical experts to study the issue and report to Congress. It’s co-sponsored by Democratic Rep. Kathy Castor of Florida. (Hotakainen, 12/7)

Newly released health-care rankings confirm that the Department of Veterans Affairs hospital in Phoenix remains among the worst in the nation nearly three years after it became the epicenter of a national VA crisis. Internal VA documents leaked to USA Today, and later supplemented with officially approved data, show the Carl T. Hayden VA Medical Center has a one-star score in a rating system where five stars is the top result. In a series published in October on VA reform efforts, The Arizona Republic divulged Phoenix VA Health Care System's bottom ranking, but did not show scores for the system's nearly 150 other hospitals. (Wagner, 12/7)

Active military members, veterans and those around them have mental health care and substance abuse treatment options around the state. There are more than 500,000 veterans living across Tennessee, and an estimated 20 percent of them have a mental health disorder diagnosis, said Marie Williams, commissioner of the Tennessee Department of Mental Health & Substance Abuse Services. The size of Tennessee's veteran population ranked 14th in the country in 2015, according to federal data. Treatment of mental health disorders, such as post-traumatic stress disorder and depression, are increasingly important to the Veterans Health Administration. But VA hospitals in Nashville and Murfreesboro scored poorly in an internal performance evaluation for mental health care. (Fletcher, 12/7)

Soaring use of e-cigarettes among young people “is now a major public health concern,” according to a report being published Thursday from the United States Surgeon General. It is the first comprehensive look on the subject from the nation’s highest public-health authority, and it finds that e-cigarettes are now the most commonly used tobacco product among youths, surpassing tobacco cigarettes. (Richtel, 12/8)

“We know enough right now to say that youth and young adults should not be using e-cigarettes or any other tobacco product, for that matter,” Surgeon General Vivek H. Murthy said in an interview. “The key bottom line here is that the science tells us the use of nicotine-containing products by youth, including e-cigarettes, is unsafe.” (Dennis, 12/8)

The report joins a public debate about the potential benefits and risks of e-cigarettes, which are battery-powered devices that heat nicotine-laced liquid into a vapor. Some groups, including industry advocates and the Royal College of Physicians in the U.K., have argued that e-cigarettes should be promoted as a means to help adults quit smoking conventional cigarettes. (Maloney, 12/8)

E-cigarettes have become the most commonly used tobacco products among teens and young adults in the US, the US surgeon general said Thursday, as he called for prevention efforts to “protect our nation’s young people from being harmed by these products.” The safety of e-cigarettes, which contain nicotine and may contain other chemicals, has been a topic of heated debate, with manufacturers insisting they’re safe and public health groups insisting they are dangerous and are often a gateway to tobacco use by youth. (Thielking, 12/8)

The Surgeon General is calling electronic cigarette use among youth and young adults a “major public health concern” in a new report to be released Thursday. In what will be the first comprehensive report on how electronic cigarettes are impacting the nation’s youth, the surgeon general found that marketing has played a key role in the skyrocketing rates of middle and high school students choosing to vape. (Wheeler, 12/8)

For the first time in more than two decades, life expectancy for Americans declined last year — a troubling development linked to a panoply of worsening health problems in the United States. Rising fatalities from heart disease and stroke, diabetes, drug overdoses, accidents and other conditions caused the lower life expectancy revealed in a report released Thursday by the National Center for Health Statistics. In all, death rates rose for eight of the top 10 leading causes of death. (Bernstein, 12/8)

Americans are dying from heart disease at a faster rate, stalling four decades of gains against the nation’s leading killer and driving up the U.S. mortality rate overall. The death rate from heart disease rose 0.9% last year, according to U.S. mortality data released Thursday by the Centers for Disease Control and Prevention. The death rate also rose 3% for stroke, the fifth-leading cause of death in the U.S. Both changes, which researchers tie in large part to the rise in obesity and diabetes, helped push life expectancy down by one-tenth of a percentage point, to 78.8 years, according to the CDC. (McKay and Winslow, 12/8)

The main reason for this decline is that eight of the nation’s 10 leading causes of death were deadlier in 2015 than in years past, according to a new report from the Centers for Disease Control and Prevention. Heart disease, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer’s disease, diabetes, kidney disease and suicide all claimed more lives last year. (Kaplan, 12/8)

Now, there's a chance that the latest data, from 2015, could be just a one-time blip. In fact, a preliminary analysis from the first two quarters of 2016 suggests that may be the case, says Robert Anderson, chief of the mortality statistics branch at the National Center for Health Statistics, which released the new report. Anderson says government analysts are awaiting more data before reaching any definitive conclusions. (Stein, 12/8)

For the first time in decades, nationwide life expectancy in the US fell in 2015, according to new data from the Centers for Disease Control and Prevention. Infants born in 2015 are expected to live on average to age 78.8 — a decline of 0.1 year from 2014. A decline in nationwide life expectancy at birth hasn’t happened in the US since 1993. Earlier this year, the CDC reported that life expectancy among white Americans fell from 2013 to 2014, but at that time the average across all races was still on the rise. (Samuel, 12/8)

The remarkable recovery of a woman with advanced colon cancer, after treatment with cells from her own immune system, may lead to new options for thousands of other patients with colon or pancreatic cancer, researchers are reporting. Her treatment was the first to successfully target a common cancer mutation that scientists have tried to attack for decades. Until now, that mutation has been bulletproof, so resistant to every attempt at treatment that scientists have described it as “undruggable.” (Grady, 12/7)

Researchers in Spain have taken a key step in unraveling one of nature’s most malignant mysteries: How do cancerous tumor cells that establish a beachhead in one organ strike out in search of new territory to colonize? And more important, how might they be stopped? (Healy, 12/7)

New research demonstrates that, in mice whose brains are under attack by Alzheimer’s dementia, exposure to lights that flicker at a precise frequency can right the brain’s faulty signaling and energize its immune cells to fight off the disease. Light therapy for Alzheimer’s is miles from being ready to treat patients — even those with the earliest signs of the disease. But the new research has already prompted creation of a start-up company — Cognito Therapeutics Inc. — to approach the Food and Drug Administration about clinical trials, and to explore ways to deliver precisely calibrated flickers of light to human research subjects. (Healy, 12/7)

Older women who look on the bright side of life were less likely to die in the next several years than their peers who weren't as positive about the future. The research, published Wednesday in the American Journal of Epidemiology, is the latest to find an association between a positive sense of well-being and better health, though it's not yet clear whether one causes the other. (Hobson, 12/7)

It’s about to get a lot easier to get hearing aids. The Food and Drug Administration launched an effort Wednesday to make the devices available over the counter, a move that could eventually save thousands of dollars for hearing-impaired Americans. The agency said it will immediately stop enforcing a requirement that patients get a medical evaluation before obtaining  hearing aids and consider creating a new category of over-the-counter products, which will encourage new manufacturers to step into the market. (Ross, 12/7)

The court on Monday granted Roof’s request in a 19-page opinion, pointing to an apparent lack of understanding between Roof and his defense team about his decision to go “pro per.” Because many of the case’s records – including those pertaining to Roof’s mental health and competency – are sealed or redacted, it’s impossible to fully understand the thinking behind firing one’s counsel then hiring them back a week later. By choosing to represent himself in the latter phase, where evidence of past trauma and mental health issues could be put forth, Roof may be attempting to dodge scrutiny about his psychological state. (Duncan, 12/7)

[Michael] Cheatham's parent organization, Orlando Health, and several area agencies are in the early stages of putting together plans to train the public on basic bleeding control techniques. (Miller, 12/7)

Governor Jeb Bush signed the first Stand Your Ground measure into law in 2005, ushering in a new era of self-defense. The law follows the "shoot first" philosophy, letting citizens use deadly force if they feel threatened, instead of retreating. Since lawmakers approved Stand Your Ground, gun homicides have jumped 31 percent, and homicides are up 24 percent. David Humphreys at the University of Oxford co-authored the paper. (Payne, 12/7)

More transgender people have been killed in 2016 than any other year. So far this year, at least 22 transgender people have been killed across the U.S., according to the latest estimates from the National Coalition of Anti-Violence Programs, a group that tracks violence affecting the LGBTQ community. Eighteen of the victims were African American. (Martinez, 12/7)

Drug overdose deaths spiked almost 22 percent in New Jersey last year, the state Medical Examiner’s Office reported Wednesday, largely due to opioids including heroin and fentanyl. The finding is almost identical to the 23 percent increase in deaths in Pennsylvania that the local division of the U.S. Drug Enforcement Administration reported several months ago. In some ways, however, the latest data are even more disturbing: While Pennsylvania overdoses have been rising annually for more than a decade, and now far exceed the national average, in New Jersey they had held steady for a couple of years and even seemed to be declining slightly. National data are not available yet, but a number of other states had also experienced plateaus in drug deaths that turned out to be temporary. (Sapatkin, 12/7)

Six months ago, though, Hunter, a mother of three, hit a turning point. She was ready to make a change. That’s when she entered the Newark Addiction Recovery Initiative program. The program, announced in June by Police Chief Barry Connell, was based on the Angel Program started by the Gloucester, Massachusetts, Police Department last year. (Smola, 12/7)

President-elect Donald Trump will soon announce the selection of retired Marine Gen. John F. Kelly to lead the Department of Homeland Security, The Washington Post has confirmed. Kelly served as the head of the U.S. Southern Command, a posting that gave him oversight of U.S. security operations for Central America, the Caribbean and the entirety of South America. Trump settled on Kelly in part for his Southwest border expertise, according to people familiar with the deliberations. In that role, Kelly grappled with issues relating to the international illicit drug trade and the flow of narcotics, including heroin and cocaine, from countries in the Southern Hemisphere to markets in the United States. (Ingraham, 12/7)

Texas could be the epicenter for the nation's next major fight over stricter requirements for immunizations as rates of schoolchildren who refuse shots for non-medical reasons climb in America's second-largest state. The number of Texas kindergarten through 12th grade students who reported filing conscientious exemptions for at least one immunization last school year increased 19-fold since 2003 — though that is still less than 1 percent of enrolled students, according to the Immunization Partnership, a pro-vaccination Texas nonprofit. (12/7)

Coloradans with terminal illness soon can begin making written requests for life-ending prescriptions under the state’s new aid-in-dying law, and authors of the law say multiple people already have inquired. “I fully expect people to begin requesting prescriptions on the first day that the law is effective,” said Kat West, national director of policy and programs for Compassion & Choices, which ran the end-of-life options campaign in Colorado. The law, approved by about two-thirds of voters Nov. 8, goes into effect as soon as Gov. John Hickenlooper certifies the election results, expected between now and the end of December. (Brown, 12/7)

A new pilot program led by Gov. Greg Abbott’s office aims to provide specialized care and services for 500 of the most emotionally traumatized foster children in Texas. The governor’s criminal justice division and the state’s Department of Family and Protective Services announced Wednesday they are planning to spend $8 million on a program for foster kids who are considered the most difficult to find permanent homes for. The two offices are focused on children who are victims of crime, admitted to inpatient psychiatric medical hospitals, and who have been admitted to at least two residential treatment centers in the past year. (Evans, 12/7)

The Camden Coalition of Healthcare Providers, led by MacArthur Fellow and primary-care physician Jeffrey Brenner, has won renown for its efforts to address the complex needs of Camden's sickest residents. Now, on the heels of establishing the National Center for Complex Health & Social Needs this year, the Camden Coalition has won a grant of up to $1.65 million over three years from Aetna Foundation to develop a curriculum that will help other cities adopt the data-driven approach Brenner has used in Camden. The grant is scheduled to be announced Thursday at the first conference of the National Center, which is happening Thursday and Friday at the Sheraton Society Hill in Philadelphia. (Brubaker, 12/7)

Two former employees of an Iowa dental-office chain told authorities the company was billing Medicaid for procedures that were unnecessary or weren’t being performed – leading to a $300,000 settlement of fraud allegations. Lifepoint Dental Partners, which has five clinics, agreed to pay the money to settle a whistleblower lawsuit filed in April by the former employees and federal prosecutors, according to court records released Wednesday. The lawsuit’s allegations were raised by the company’s former chief financial officer, Todd Willson, and a former financial coordinator, Peggy Lemley. They are to receive $45,000 of the settlement. The federal and state governments, which finance Medicaid, will get the rest. (Leys, 12/7)

Texas Gov. Greg Abbott is giving the Department of Family and Protective Services an $8 million grant to improve emergency and long-term placements for up to 1,000 of the state’s neediest foster children. The money — which comes from the federal Victims of Crime Act — will fund a pilot program intended to help bring stability to foster children by attempting to keep them out of psychiatric hospitals and residential treatment centers. The pilot sites have not yet been selected but will likely be located in urban areas. (Ball, 12/7)

Preparing for what likely will be a difficult debate during the 2017 legislative session, the Senate Banking and Insurance Committee next week will start delving into workers' compensation insurance issues. The committee is scheduled Dec. 13 to receive a presentation on workers' compensation issues, after state regulators in October approved a 14.5 percent rate increase for businesses. That increase, which is currently tangled in a legal battle, stemmed heavily from a Florida Supreme Court decision that found unconstitutional strict limits on attorneys' fees in workers' compensation cases. (12/7)

And with the recent presidential election, many people wonder if the Affordable Care Act, known as "Obamacare," will continue. No matter what changes may occur, they won't take effect until 2018, according to David Wiley, an insurance agent with HealthMarkets in Atlanta. Here's what else he said you need to know if you're self-employed and are looking for health insurance. (Caldwell, 12/7)

Minnesota’s leaders continue to negotiate over a possible special legislative session, as their latest self-imposed deadline came and went with no agreement. DFL Gov. Mark Dayton and legislative leaders of each party want to bring the Legislature back this month to pass infrastructure funding that didn’t get done this spring and a tax cut package that Dayton vetoed. They also want to pass temporary relief for Minnesotans facing rising health insurance premiums on the state’s individual market. Even though there’s bipartisan agreement that all three of these things should be done, Democrats and Republicans have not yet agreed on the specifics — and haven’t been able to in on-again, off-again negotiations since May. (Montgomery, 12/7)

The saying “dogs are a man’s best friend” is just a phrase, but to those living on the streets and battling housing insecurity, it can be the honest truth. For people who are contending with homelessness, their companion animals are the world to them. They are their family, their children and their sense of security. But getting proper medical care for their animals can often be even harder than getting it for themselves. (Hosea-Small, 12/7)

Free after eight years of federal imprisonment, one of the nation’s most celebrated cannabis convicts came home to California on Wednesday, walking off a United Airlines flight into the warm embrace of supporters — and a profoundly changed world. Charles “Eddy” Lepp, a defiant 64-year-old Vietnam vet and ordained Rastafarian minister, was convicted on federal felony charges in 2007 for doing something that California now considers legal because of last month’s passage of Proposition 64: growing marijuana. (Krieger, 12/7)

Republican leaders are considering a legislative effort to roll back major provisions of the health law, but the plan they’re considering would keep the current system in place for at least two and possibly three more years. The nickname for the plan is repeal and delay, and the assumption underlying it is that the current system will be sustainable for as long as it takes Congress to pass and the White House to install a new health plan. The plan might be better described as “zombification.” It is not at all clear that Republicans can easily time the expiration date of the Obamacare markets. Insurance experts say the resulting zombie market — not dead, but not alive either — would suffer from many of the maladies of the existing system, and quite a few more. (Margot Sanger-Katz, 12/7)

The Urban Institute released a new analysis yesterday of the impact of a bill that Congress passed last year to repeal large parts of the Affordable Care Act (ACA). Urban’s analysis is based on many uncertain assumptions, including the implausible one that the incoming Trump administration and Congress, despite numerous campaign promises, will not provide any flexibility for people to purchase non-ACA-compliant products after repeal. Urban’s projections should be treated with significant skepticism because of the large uncertainty about its assumptions as well as substantial mistakes Urban has made in the past about the impact of the ACA. (Brian Blase, 12/7)

Republicans who think their “repeal and delay” strategy for Obamacare won’t cause serious and immediate insurance disruptions should read a new report that came out early Wednesday morning. The report, from the nonpartisan Urban Institute, predicts that state insurance markets will start to unravel almost immediately and that, as early as next year, the ranks of the uninsured will begin swelling. And if Republicans can’t come up with a replacement, the report says, the number of people without insurance could eventually rise by 20 million to 30 million people. (Jonathan Cohn, 12/7)

If there weren’t so much at stake, one would be amused at the spectacle of Republican politicians writhing as they try to make good on their ideological promise to “repeal and replace” Obamacare without ruining the lives of millions of their own constituents. ... Not only are they conceding that conjuring up a replacement for the ACA will take much longer than they promised—years, even—but they’re also talking about reinstating provisions of the law that they undermined during their six-year campaign to hobble it. They’re forced to acknowledge that America’s pre-ACA system of health insurance for individuals was so awful that they can’t justify returning to it. (Michael Hiltzik, 12/7)

The belief among Democrats that a Republican could never win another presidential election was apparently so firm that they’re still in a state of shock. They’re even more stunned that Donald Trump has dared to name an ObamaCare critic as his health-care point man—which makes for an instructive moment. ... Now Democrats are assailing Mr. Price for proposing alternatives to the mess they created. The Republican, who took over the House Budget Committee from Paul Ryan, is a thoughtful and well-informed problem solver. Unlike many of his colleagues, Mr. Price hasn’t dodged details and specifics. He proposed an alternative to ObamaCare during the 2009-10 debate and in the years since he’s put flesh on the bones, including with legislative language. (12/7)

It is also clear that certain parts of the ACA have not worked as well as intended, particularly for individuals who buy health insurance on their own. As the new administration and lawmakers develop specific proposals to repeal and transition, it is imperative that they understand: Changes can either begin a stable transition to a better approach, or they can bring about even more uncertainty and instability. ...The best approach to keep insurance affordable and markets stable would be to fund temporary, transitional programs. These would include maintaining subsidies for low- and moderate-income individuals to purchase insurance and financial help for plans that enroll high-cost individuals, through at least Jan. 1, 2019. (Marilyn Tavenner, 12/7)

Congress should pass a repeal bill that goes into effect in three years. But if they fail to come up with a replacement measure in that time, Obamacare would remain in effect. A further three-year extension could be written into the bill that would give legislators another bite at the apple. But if they fail again, Obamacare would stay the law of the land. (Michael Cohen, 12/7)

Much of the repeal-and-replace rhetoric of ACA critics depicts the pre-Obamacare health insurance landscape as a sort of nirvana in which consumers had almost unlimited options to fashion the coverage they wanted, without government interference. So it’s proper to recall what that marketplace was like. A useful reminder comes from Georgetown University’s Center on Health Insurance Reforms, which compiled a list of the conditions that insurance buyers in Illinois had to report when applying for coverage. The list included serious conditions such as heart attacks, emphysema and cirrhosis, but also common maladies such as hay fever, hives, sinusitis and acne. Any of these gave insurers an incentive to deny coverage to applicants or offer it at inflated prices or with exclusions. (Michael Hiltzik, 12/7)

It is important to recognize that for more than 30 years Americans have expressed dissatisfaction with the nation’s health care system. And yet at no time during that period have they ended up supporting a major health care reform bill once it was actually presented. Americans may be unified in their dissatisfaction, but their differing political values and preferences lead them to oppose specific remedies to the problems they cite. (Robert J. Blendon, 12/7)

The emerging GOP plan to repeal Obamacare on a delayed schedule — and then maybe kinda sorta replace it later — has raised a big question: Will Democrats help Republicans pass a replacement that is far less generous and comprehensive than the health law is, allowing Republicans an escape from the political fallout from repeal? In an interview with me, Senate minority leader Chuck Schumer answered this question with a resounding No. Under no circumstances, he vowed, would Democrats throw Republicans such a political lifeline. (Greg Sargent, 12/7)

America pays higher prices for drugs because the government doesn’t negotiate with insurers. The government doesn’t negotiate with insurers in part because we have a powerful pharmaceutical industry that lobbies the government not to, but also in part because we’re not willing to have the government say, “Nope, we’ve decided you can’t sell your expensive treatment here,” which is a major way that other governments get their bargaining power. Telling Americans they can’t have stuff is really politically unpopular, so we mostly don’t do that. Instead, we pay some of the highest prices in the world for prescription drugs. That sounds terrible! But it also has a benefit: Those profits give drug companies the necessary incentive for innovation. (Megan McArdle, 12/7)

Congress has voted to change the way new prescription drugs are approved, in a way that could endanger patients. ... The bill in question would direct the Food and Drug Administration to consider “real-world evidence” in deciding whether a new drug is safe and effective -- that is, evidence (such as observational studies or patient registries) not derived from randomized clinical trials, the gold standard for evaluation. It would also compel the FDA to take into account individual patients’ subjective experiences. And it could open the door to allowing outside experts, rather than just FDA staff, get more involved in reviewing new drugs or devices. Proponents say these changes are needed to speed the review process and bring new drugs to market. But that is a solution in search of a problem. (12/7)

Last week, Jennifer Jacobs of Bloomberg reported that Pete Hegseth, the founder of Concerned Veterans for America, was being considered by President-Elect Donald Trump for the cabinet position of Secretary of Veterans Affairs. While Trump’s cabinet picks have routinely exceeded expectations, picking Hegseth would achieve something rarer: the nomination of the single best qualified person to lead the VA. (Avik Roy, 12/8)

Kratom, an herbal supplement that was once a quiet member among the legion of botanical products sold in the United States, exploded onto the national scene in August 2016 when the Drug Enforcement Administration announced plans to classify it as a Schedule 1 controlled substance. As such, it would join heroin, LSD, ecstasy, marijuana, and other so-called recreational drugs as a substance with “a high potential for abuse and the potential to create severe psychological and/or physical dependence.” The DEA withdrew its call to ban kratom, and instead asked for public comments on the product. The comment period closed Dec. 1. We believe that a move to make kratom a Schedule 1 controlled substance is premature and shortsighted, from both the scientific and clinical perspective. It would make it nearly impossible for researchers to fully examine its safety and clinical uses. (Walter C. Prozialeck and Anita Gupta, 12/7)

Taking care of older patients can be a challenge. Some have multiple health conditions, and many are homebound, making a trip to see their primary care doctor almost impossible. House calls will almost certainly become a way to improve the care of our geriatric patients and will become an essential piece of the provision of care in the future. In fact, legislation being discussed in Congress would help make home-based medical care a financial reality. Making house calls sounds simple. But we worry that physicians-in-training aren’t learning the skills they need to care for their patients at home. (Katherine T. O’Brien and June M. McKoy, 12/7)

Concerns about the mental health of future physicians have existed for decades. For example, in 1936, Strecker et al described 4 levels of impairment of psychologic functioning of medical students. In this issue of JAMA, 80 years later, the studies by Rotenstein and colleagues and by Wasson and colleagues shed new light on the issue of poor mental health of medical students by examining 2 different aspects of the problem. (Stuart J. Slavin, 12/6)

Changes in personnel on the inpatient service, including residents and attending physicians, create uncertainty. Residents who are leaving the service rotation and handing off the patients to the next resident team generally prefer the service to be neat and tidy, to involve little for the next team to have to do immediately, and, perhaps most importantly, to be small. Accordingly, some teams will work especially hard to discharge patients before service change, even though certain patients cannot and should not be discharged because they are too sick, or have social or financial issues preventing safe discharge. Thus, patients remaining after a service change may differ in important ways from those who are able to be discharged. (Vineet M. Arora and Jeanne M. Farnan, 12/6)

Outcomes measures have replaced process measures as the new currency of quality. For example, the quality of care for patients with diabetes is now measured by results of hemoglobin A1C tests, not just the percentage of patients who received the test. The same shift has occurred in graduate medical education (GME). Competency-based education serves to hold residency programs accountable for the outcomes of its graduates. (Lia S. Logio, 12/6)