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More than a million people have signed up for 2017 health insurance coverage on HealthCare.gov, and more than 300,000 of them selected plans in the three days after Donald J. Trump won the presidential election, the Obama administration said on Wednesday. About one-fourth of those using the online exchange to sign up — 246,400 people — were new to the federal marketplace, and the other 761,800 were renewing coverage they had this year. (Pear, 11/16)

A little more than 1 million people renewed health coverage or signed up for the first time through HealthCare.gov around the start of open enrollment, which coincided with a GOP election sweep likely to scramble President Barack Obama's signature law. The figures released Wednesday by the Obama administration represent steady sign-ups but no enrollment surge so far. (Alonso-Zaldivar, 11/16)

The government says that more than a million people selected plans on the federal exchange during the first two weeks of open enrollment under the Affordable Care Act, indicating sign-ups so far haven’t been hurt by President-elect Donald Trump’s plan to repeal or amend the health law. (Armour, 11/16)

Despite a surge in enrollment in HealthCare.gov coverage the day after the presidential election, plan selections for the first two weeks of open enrollment are just slightly ahead of last year's. More than 1 million people have selected a plan through the HealthCare.gov marketplace in the first two weeks of open enrollment, the CMS said Wednesday. About a fourth of those plan selections were made by new marketplace customers, while the rest were made by shoppers returning to the exchange to renew their health coverage for 2017. Enrollment is moving at a slightly quicker pace than last year. Shoppers have made 53,000 more plan selections during the first 12 days of open enrollment this year than last year, the CMS said Wednesday. (Livingston, 11/16)

More than 1 million people have registered for ObamaCare coverage for 2017 since the sign-up period began Nov. 1, the Obama administration announced Wednesday. The registrations include about 250,000 new consumers and 750,000 returning. The Obama administration used the numbers to argue that people still want ObamaCare coverage, despite the cloud of uncertainty hanging over the law due to GOP efforts to repeal it. (Sullivan, 11/16)

More than 1 million people selected insurance plans through the Affordable Care Act in the first two weeks of sign-ups, outpacing last year, the U.S. Centers for Medicare and Medicaid Services said in a report Wednesday. From Nov. 1, when the sign-up markets opened, to Nov. 12, about 246,433 new consumers chose an Obamacare plan for next year, and 761,785 renewed their existing coverage. That amounts to about 53,000 more plans than were selected during the first 12 days of open enrollment last, year, the government said. (Doherty, 11/16)

There were 53,000 more signups during the first 12 days of open enrollment this year than last, according to the health agency. The outpouring over the first two weeks of the enrollment period comes amid rising uncertainty about the fate of the insurance system set up by the 2010 health law. (Levey, 11/16)

Steven Lopez has gone without health insurance for 15 years, and the Affordable Care Act hasn’t changed his mind. Once again this year he will forgo coverage, he said, even though it means another tax penalty. Last tax season, the 51-year-old information technology professional and his family paid a mandatory penalty of nearly $1,000, he said. That’s because they found it preferable to the $400 to $500 monthly cost of an Obamacare health plan. (Ibarra, 11/17)

Covered California, the state’s health insurance exchange, is at a crossroads brought about by President-elect Donald Trump’s vow to repeal at least parts of the Affordable Care Act. Obamacare pays income-based subsidies to 87% of the 1.3 million Californians currently covered by plans sold through the exchange. Elimination of those payments could very well lead to mass cancellations by people no longer able to afford their insurance policies. (Sisson, 11/16)

Fallout from this month’s election may be driving some Minnesotans to refrain from buying health insurance, MNsure leaders said Wednesday. President-elect Donald Trump and the Republican majorities in Congress have promised major changes to the country’s health care law, though exactly what will be kept from the Affordable Care Act passed under President Barack Obama remains uncertain. Meanwhile Republicans who have called to eliminate MNsure, Minnesota’s state-run health insurance exchange, have majorities in both chambers of the state Legislature. (Montgomery, 11/16)

Republicans on Capitol Hill are growing confident that they can begin to repeal Obamacare once President-elect Donald Trump is sworn in, along with a pledge to replace it later. “We have an Obamacare emergency right now,” said Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate HELP Committee. “I think we could move forward in January on some aspects of repeal but we need to make sure that we are helping people and that we do no harm.” (Haberkorn, 11/16)

A Republican plan to quickly repeal most of ObamaCare but delay the effects for up to two years is gaining steam on Capitol Hill.  The plan would allow Republicans to deliver on promises to repeal the law in the next Congress while buying them time to come up with a replacement. But there’s a problem: If insurers know the law is going away, they might drop out immediately, causing chaos for enrollees before any replacement plan has time to take shape. (Sullivan, 11/17)

Despite President-elect Donald Trump's campaign vow to get rid of Obamacare, Central Floridians who are signing up apparently will get to keep their coverage through 2017. "We have people asking us right now, 'What is this going to mean? Are we going to have coverage throughout the year?'" said Anne Packham, lead marketplace navigator in Central Florida. (Miller, 11/17)

A top Obama administration official overseeing ObamaCare said Wednesday that the President-elect Donald Trump's transition team had not yet reached out ahead of taking over the White House. “We are committed to having a great transition, and when they contact us we will have a great transition,” said Andy Slavitt, head of the Centers for Medicare and Medicaid Services, which oversees ObamaCare. “They have not been in touch with us yet.” A delay in signing a transition memorandum of understanding, which was finally finished on Tuesday, has contributed to a lack of communication between many agencies and the transition team that will be taking over. (Sullivan, 11/16)

Insurers are still committed to Affordable Care Act marketplaces, a top Obama administration health official said Wednesday, despite speculation over changes a Trump administration might make to the health care law. Andy Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services, said Wednesday that insurers are keeping their focus on 2018 coverage in the federal and state marketplaces. He and other CMS officials have had conversations with many health plans in the past week, he said. (McIntire, 11/16)

Perhaps no presidential son-in-law has ever been more in the spotlight than Jared Kushner. He was President-elect Donald Trump’s “de facto campaign manager” and helps run the executive committee of Trump’s tumultuous transition team. And rumors are swirling that Trump’s team is trying to get him top-secret security clearance so he can attend the official presidential daily briefings. But here’s something you might not know: Jared Kushner’s younger brother, Joshua Kushner, is the co-founder of a startup created to capitalize on the promise of the Affordable Care Act — which Trump has vowed to move quickly to dismantle. (Robbins, 11/17)

President-elect Donald Trump's promise to repeal the Affordable Care Act while preserving some key elements has triggered rampant speculation about the future of American health care — and plunged millions of patients who benefit from the law into deep uncertainty about the future of their coverage. Little is known about the replacement plan that will ultimately emerge. But one voice angling to shape future policy is the leader of the Mayo Clinic, neurologist John Noseworthy. The issue he thinks has been strangely missing from the years-long debate over malfunctioning websites, politics and soaring premiums is this: the patient's health. (Johnson, 11/16)

Most of the six remaining Obamacare co-ops continue to lose money, but at a slower rate than in prior years, according to new quarterly financial filings. The five startup insurers for which reports were available lost roughly $55 million combined through the first nine months of this year. That was roughly half the level of red ink for the five nonprofits at this point in 2015. (Demko, 11/16)

A new legislative subcommittee will monitor health care policy changes that President-Elect Donald Trump proposes in order to help Virginia lawmakers prepare for either the repeal or repair of the Affordable Care Act, as well as other potential shifts in federal health care laws under the new administration. (Martz, 11/16)

The federal government likely will have some changes to the state's small-scale Medicaid expansion plan, which currently is awaiting approval. And that means the state will not be able to begin enrolling individuals by Jan. 1, the originally projected start date, said Nate Checketts, the Utah Department of Health's deputy director. The plan, projected to cover 9,000 to 11,000 people, targets childless adults who are chronically homeless, involved in the justice system or in need of mental-health or substance-abuse treatment. (Stuckey, 11/16)

Adult enrollment in ObamaCare’s Medicaid expansion has more than doubled expectations in states across the country -- pointing to ballooning costs that threaten budget dollars for priorities like education and infrastructure, according to a report released Wednesday by The Foundation for Government Accountability. Newly obtained data from 24 of the 29 states with Medicaid expansions show at least 11.5 million able-bodied adults have enrolled. The FGA says adult enrollment for all these states exceeds projections, by an average of 110 percent. Some states have signed up more than four times as many adults as they expected would enroll. (Singman, 11/16)

The U.S. Surgeon General issued a call to action on Thursday to end what he said was a public health crisis of drug and alcohol addiction that is both underappreciated and undertreated. Dr. Vivek Murthy issued the first-ever Surgeon General's report on substance abuse and said he hopes it will galvanize work on the issue the way a similar report 50 years ago sparked decades of effort to combat smoking. (Clarke, 11/16)

“The reason I’m issuing this report is I want to call our country to action around what has become a pressing public health issue,” Murthy said in an interview. “I want our country to understand the magnitude of this crisis. I’m not sure everyone does.” The report, “Facing Addiction,” pulls together the latest information on the health impacts of drug and alcohol misuse, as well as on the issues surrounding treatment and prevention. It offers reasons for optimism despite a still-increasing overdose epidemic that has killed more than 500,000 Americans since 2000, and it presents evidence that addiction is a treatable brain disease, with new therapies under development. (Bernstein, 11/16)

The report itself has three basic themes. Addiction is a chronic neurological disease, not a moral failing or lack of will power. That means it’s time to stop the “shame and misunderstanding,” the report says. Prevention is key. Keeping teens in particular from trying drugs and alcohol vastly lowers the likelihood of addiction later on. And treatment works. Not perfectly, but it works. (Kenen, 11/17)

Though little in the report is new, it puts impressive numbers to the problem, and some surprising context: More people use prescription opioids than use tobacco. There are more people with substance abuse disorders than people with cancer. One in five Americans binge drinks. And substance abuse disorders cost the U.S. more than $420 billion a year. (11/17)

Overwhelmed by the opioid crisis, public health agencies across the US and Canada are increasingly training the public to use the overdose antidote drug naloxone. Now, with more potent narcotics hitting the streets, a debate is springing up over whether that’s enough — or whether the public should also be trained to use CPR techniques such as chest compressions or rescue breathing. There’s general consensus that such tactics, done right, could save some overdose victims at a time of sharply rising death tolls. But many public health teams fear that adding another step makes it tougher to train the public and could discourage people from stepping in to help, especially since many are reluctant to perform rescue breathing on an unconscious stranger. (Bigham, 11/16)

The Teamsters union called Tuesday for health-care giant McKesson to take back millions of dollars in incentive pay from chief executive John H. Hammergren, citing damage to the company's reputation caused by its role in the opioid crisis. In a letter, Ken Hall, general secretary and treasurer of the International Brotherhood of Teamsters, urged the company's board of directors to use its “executive clawback policy to recover all or a significant portion of CEO Hammergren's incentive pay” over the past year and suspend future payouts until it restructures its compensation system. (Bernstein and Higham, 11/15)

LLR Partners, Philadelphia, is leading a $34 million investment in Sun Behavioral Health, a Red Bank (Monmouth County), N.J.-based company that is building a national chain of "freestanding psychiatric hospitals" that treat addictions, LLR said in a statement.  Previous investors NewSpring Capital (of Radnor) and HealthInvest, Petra Capital Partners and SV Life Sciences joined LLR in backing Sun. Sun opened a 148-bed facility in Houston in January, and plans additional hospitals in Georgetown, Del.; Columbus, Ohio; and Cincinnati's Kentucky suburbs.  Sun sees behavioral health and addictions as a "signficant and growing unmet need," CEO Steve Page said in a statement.  "Recent legislation" and has helped make Sun "well-positioned," said LLR vice president Elizabeth Campbell in a statement. (DiStefano, 11/16)

A trip to the emergency room can be traumatic enough, but researchers warn that many insured patients may be in for another shock when the medical bills arrive. Even if patients go to a hospital included in their health insurance network, the emergency room physicians might not be. That could mean an unexpected expense. (Murphy, 11/16)

Patients who get emergency care at a hospital in their insurance network have nearly a 1 in 4 chance of being treated by an out-of-network ER physician who may send a “surprise” bill, according to an analysis in the New England Journal of Medicine. The study, by two Yale University economists, is one of the first to quantify the surprise-bill issue that has caused patient uproar and stoked friction between ER doctors and insurers. (Beck, 11/16)

The stories can be dramatic, like the case of a New York man hit by an unexpected $117,000 bill from an assistant surgeon who didn’t take his health insurance. That and stories like it, told by The New York Times, drew attention to the phenomenon of “surprise billing.” It occurs when a patient gets care from a facility within his insurance network but unknowingly receives treatment from a doctor who doesn’t accept his insurance, and ends up with a bill for out-of-network care. (Levin Becker, 11/16)

After working at Theranos Inc. for eight months, Tyler Shultz decided he had seen enough. On April 11, 2014, he emailed company founder Elizabeth Holmes to complain that Theranos had doctored research and ignored failed quality-control checks. The reply was withering. Ms. Holmes forwarded the email to Theranos President Sunny Balwani, who belittled Mr. Shultz’s grasp of basic mathematics and his knowledge of laboratory science, and then took a swipe at his relationship with George Shultz, the former secretary of state and a Theranos director. (Carreyrou, 11/16)

Despite major coverage expansions under the Affordable Care Act, Americans are sicker and have more trouble affording care than 10 other high-income countries, a new survey shows. Moreover, almost half of the poorest U.S. adults can't get the care they need, and many resort to the emergency room for treatment, according to the Commonwealth Fund study.  The non-partisan group surveyed almost 27,000 adults across 11 high-income countries about their health and experience with their country's healthcare system. The nations surveyed included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. (Livingston, 11/16)

Amid anxiety and uncertainty about what President Donald Trump will mean for medical science, researchers are looking to one man for hope: Newt Gingrich.Trump himself has said precious little about medical research. He has flirted with anti-vaccination rhetoric, and he has stated that what he hears about the National Institutes of Health is “terrible.” But Gingrich, the former House speaker and Trump confidant, is a longtime booster of medical research. (Scott, 11/17)

What could the world of medical research look like under a Trump administration? It's hardly an idle question. The federal government spends more than $30 billion a year to fund the National Institutes of Health. That's the single largest chunk of federal research funding spent outside the Pentagon's sphere of influence. (Harris, 11/15)

There have been a lot of big, somewhat dubious assumptions behind the rise in stocks since the election. Drug stocks offer a prime example. Biotechnology emerged as a major winner. The Nasdaq Biotechnology Index has risen 17% since Nov. 8. Yet the NYSE Arca Pharmaceutical Index with biotech’s bigger brothers in it is up less than 5% over the same period. (Grant, 11/16)

The teen birth rate in America’s small towns is 63% higher than in its biggest cities, a new government report reveals. In 2015, there were 18.9 births for every 1,000 women between the ages of 15 and 19 living in counties with large urban areas, according to a report published Wednesday by the Centers for Disease Control and Prevention. That compares with 30.9 births per 1,000 women in the same age group who lived in rural counties, the report said. (Kaplan, 11/16)

Flu season is upon us, which means it's time for the wave of advertisements promoting $8 juices or even more expensive supplements to "boost your immunity" or "support immune function." But those are marketing terms, not scientific ones. And there's no proof that those products are going to keep you from getting sick. (Hobson, 11/16)

Popular category of heartburn medications — including Nexium, Prevacid, Prilosec and Protonix — may increase your risk of stroke, a new study suggests. Known as proton pump inhibitors (PPIs), these drugs increased people's overall stroke risk by 21 percent, said study lead author Dr. Thomas Sehested. (Thompson, 11/16)

As Republican lawmakers plot a full repeal of President Barack Obama’s signature health law, benefits for mental health care and substance abuse treatment for a little more than 2.6 million Texans enrolled in small or individual health plans may be among the casualties. The 2010 federal health law classified mental health and addiction services among the essential health benefits that must be covered by small and individual plans, without annual or lifetime caps on benefits. (Evans, 11/17)

The heads of Kansas’ 26 community mental health centers are preparing to push an ambitious set of proposals to address what they say are growing gaps in the state’s behavioral health system. In addition to restoring funding cuts made prior to the Great Recession, the center directors want Republican Gov. Sam Brownback and lawmakers to expand a network of regional crisis intervention centers. Currently, the Rainbow Services Inc., or RSI, center in Kansas City and one operated by Comcare in Wichita appear to be relieving pressure on the mental health system by stabilizing people in crisis who otherwise might end up in state hospitals, local emergency rooms or county jails. (McLean, 11/16)

When it comes to the outcome of the presidential election, kids are experiencing the same feelings and emotions as adults: everything from fear, anxiety and dejection to excitement, hope and vindication. The biggest difference, though, is that children often don't have the language or life experience to understand or express those feelings. We visited one Boston public school, Phineas Bates Elementary in Roslindale, where students, teachers and parents are navigating the tough terrain of teaching empathy and respect after the election. (Mosley, 11/17)

A Department of Veterans Affairs employee who told Congress the agency was using unauthorized wait lists for mental health care in Colorado has resigned, saying he was subjected to retaliation for speaking out. Brian Smothers told The Associated Press Wednesday the VA had opened two separate inquiries into his actions and tried to get him to sign a statement saying he had broken VA rules. He said he refused. (11/17)

For 22 years, Nick Fugate washed dishes at a local hotel near his home in Olathe, Kan. "There was nothing easy," he says, and chuckles. "I just constantly had to scrape the dishes off to get them clean." ... But things got tough last year when Nick lost his job and his health insurance. For the first time, he enrolled in Medicaid. He got his basic medical care covered right away, but in Kansas, there's now a long waitlist — a 7-year wait — for people with intellectual disabilities to get the services they need. Decades ago, Fugate might have been institutionalized, but Medicaid now provides services to help people remain independent — including job coaching, help buying groceries, food preparation and transportation. These are the services Nick is eligible for but must wait to receive through Medicaid. (Smith, 11/16)

Florida wants to pilot a program that would reimburse managed-care plans for residential placement and other services for Medicaid enrollees with severe mental illness or substance use disorders. If approved by the CMS, Medicaid beneficiaries in Florida would be eligible to receive services such as help searching and applying for a rental home and assistance finding ways to subsidize rent. (Dickson, 11/16)

A divorced man and woman must mutually consent to using embryos that were frozen and stored while married, a Missouri appellate court has ruled in declaring the embryos marital property, not humans with constitutional rights. The Missouri Court of Appeals’ 2-1 ruling Tuesday upheld a St. Louis County judge’s 2015 finding that Jalesia “Jasha” McQueen and Justin Gadberry maintain joint custody of the embryos, which have been frozen since 2007. The couple separated in 2010 and divorced last year; dissolution proceedings were drawn out by their dispute over the embryos. (Suhr, 11/16)

The Chicago City Council unanimously approved an ordinance Wednesday, over industry objections, requiring pharmaceutical sales representatives to carry a special license. Mayor Rahm Emanuel has said the ordinance is aimed at curbing opioid abuse by preventing "aggressive and deceptive marketing" by pharmaceutical representatives. But a coalition of pharmaceutical companies and other groups have said the ordinance will be an unnecessary burden on an important part of Chicago's economy. (Schencker, 11/16)

The infant mortality rate in Ohio increased in 2015, despite millions of dollars of state, federal and philanthropic funding being poured into programs to address the problem. The state's 2015 infant mortality rate, calculated as the number of deaths of a live-born baby before age one per 1,000 live births, is 7.2. That's about 21 percent higher than the most recently reported national rate and up from 6.8 the year before. (Zeltner, 11/16)

Another measurement of child well-being in North Carolina slipped in 2015. The rate of child deaths, encompassing mortality for all children from birth to age 17, ticked upwards to 58.3 per 100,000 children, up from an all-time low in 2013. Several of the negative trends pushing up North Carolina’s child death rate are the state’s stubbornly high infant mortality rate, which has ticked up in the past few years, and the rates of homicide and suicide among teenaged boys...Suicides and homicides of children have hovered between 1.5 to 2 children per 100,000 for the past decade. But the big driver of child death in North Carolina is infant mortality. Two-thirds of the child deaths in 2015 were in children under the age of one, said Michelle Hughes who heads the advocacy group NC Child. (Hoban, 11/16)

Hospital systems Advocate Health Care and NorthShore University HealthSystem will continue fighting for their merger, they said Wednesday, despite a recent federal appeals court decision against them. A three-judge panel of the 7th U.S. Circuit Court of Appeals sided late last month with the Federal Trade Commission and the state of Illinois, which are seeking a preliminary injunction to temporarily stop a merger between the two systems. The FTC has argued that a union between the two systems would harm competition, leading to higher prices. (Schencker, 11/16)

Thornton planners are working on a large-scale development project that will convert a concentration of crowded medical practices in the city’s oldest region into a revitalized health care district that they say will be a massive economic player. For the last three years, Thornton has worked closely with officials at the North Suburban Medical Center at 9191 Grant St. to identify the best ways to craft the 88-acre area directly east of Interstate 25 and Thornton Parkway into a health care district that combines new development and the expansion and renovation of older medical spaces. (Mitchell, 11/16)

Chicago-based health information provider ContextMedia announced Wednesday it was buying AccentHealth, which has dual headquarters in Tampa and New York.Terms of the all-cash deal were not disclosed. (Harrington, 11/17)

A northern Minnesota mother says she wants the federal courts to restore her parental rights so she can help her son, who is undergoing a sex-change procedure. “Not only was I robbed of the opportunity to help my son make good decisions, but I also feel he was robbed of a key advocate in his life, his mother,” a teary-eyed Anmarie Calgaro told reporters Wednesday in announcing she is suing St. Louis County, two health-care providers and the St. Louis County School District....The suit claims Minnesota law violates the U.S. Constitution by denying parental rights. Calgaro, of Iron Junction, said that Park Nicollet Health Services, Fairview Health Services and the St. Louis County School District will not let her see her son’s records. She said that state Medical Assistance funds are helping him live in his own apartment and paying for medicine, including hormone drugs to help him with the sex change and powerful narcotics. (Davis, 11/16)

More areas of Georgia are reporting increases in respiratory illnesses as the smoke from wildfires spreads over a wide swath of the state. State health officials reported Wednesday that the areas of Rome and LaGrange had joined metro Atlanta, Dalton, Gainesville and Jasper as seeing a rise in hospital emergency room visits for asthma. (Miller, 11/16)

For close to nine years, four families who bought government subsidized homes in Tampa endured a financial disaster, their dream homes blighted by Chinese drywall...Hillsborough County commissioners on Wednesday unanimously approved a joint plan with the city of Tampa and the Tampa Housing Authority to rehabilitate four homes in Belmont Heights. (O'Donnell, 11/16)

State officials acknowledged during a legislative hearing Wednesday at the Statehouse that the organizations overseeing and placing children in foster homes may have financial conflicts of interest. Kasey Rogg, deputy general counsel for the Kansas Department for Children and Families, told a legislative committee that the current system of bundled payments encourages the state’s private contractors to spend less on services for children in foster care. Placement agencies also have incentives to put foster children in homes that might not be appropriate, he said. ... Kansas privatized its foster care and adoption systems in 1997 after a class-action lawsuit alleged that DCF’s predecessor, the Kansas Department for Social and Rehabilitation Services, failed to adequately care for children in its custody. Some legislators have questioned the decision in the past year after several high-profile child deaths in foster care. (Wingerter, 11/16)

Bays is one of about four dozen women who are moving from a local hotel into the building this week after a renovation that began in June 2015.The women's residency program is host to women with mental illnesses who have suffered from chronic homelessness, and often addiction. The number of women affected by homelessness and mental illness is growing, and so, too, has the residency program; expanding to accommodate 91 women, instead of the 60 it housed before the renovation. (King, 11/16)

California’s decision to legalize marijuana was touted as a victory for those who had argued that the state needed a system to decriminalize, regulate and tax it. But the new law, approved by voters on Nov. 8, also could be a boon to the tobacco industry at a time when cigarette smoking is down and cigarette companies are looking for ways to expand their market, according to researchers in Los Angeles County and around the state. (Gorman, 11/17)

Real estate speculators stake out territories for what’s to come, infrastructure builders and lawyers queue up for business, investors jostle to get in on the ground floor, and tech startups seek ways to make a new industry run more efficiently. This could be any nascent industry, but in this case it’s marijuana. (Dahlberg, 11/17)

[Today] the Office of the Surgeon General released Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. This is the first surgeon general’s report to focus on substance misuse, substance use disorders, and related harms, and it places substance abuse disorders in a public health framework rather than in a criminal justice framework. The report is a response to one of the most pressing public health issues in the United States. (Surgeon General Vivek H. Murthy, 11/17)

During his presidential campaign, Donald Trump was largely silent on Medicare, though he often suggested he’d leave the program untouched. Not any more. It now looks as if Trump may push for major changes in the principal health care program for older adults and some younger people with disabilities. But what will he do? He has not said, but House Speaker Paul Ryan (R-WI) has been explicit about what he has in mind. And since the election Trump seems to have adopted much of Ryan’s language, suggesting he may also embrace his policy proposals. Those include redesigning the basic financial structure of the program and making Medicare Advantage managed care plans more attractive. (Howard Gleckman, 11/16)

Doctors’ offices are overwhelmed, and we are paid less and less per visit even as we are compelled to document more and more on our computers. We must see more patients to make ends meet, yet we are afraid to argue against excessive patient demands for fear that a poor outcome, no matter how remote the risk of that outcome occurring, will lead directly to a complaint or a malpractice claim. ... wouldn’t it be cheaper with less pressure on the overburdened doctor’s office for more services to be paid for out of pocket, with tax deductions attached? And if a doctor wasn’t worried about being sued, wouldn’t he or she be far less likely to order extensive tests and treatments? Surely catastrophic insurance is needed to cover hospitalization and severe illness just as it was essential in the 1930s, but beyond this, patients would ultimately be more frugal and cost conscious if they had some skin in the game and their doctors had less. (Marc Siegel, 11/16)

Donald Trump says that he’s inclined to keep the provision of Obamacare that requires insurance companies to cover people with pre-existing conditions. If so, he’s headed down a blind alley. And Obamacare won’t truly be repealed and replaced. If the United States isn’t to slide into treating health care entirely as a public good provided by government, as is the case in other industrialized democracies, then there has to be a robust individual health insurance market. (Robert Robb, 11/16)

A repeal of the Affordable Care Act, which the Republicans have been threatening for years, would obviously be unpopular with the 20 million people who have received coverage under the A.C.A. But Republican leaders don’t seem too concerned with those people. Instead, they are trying to convince people who don’t rely on the A.C.A. that repeal of the law would leave them better off. (Teresa Tritch, 11/16)

Americans placed the future of their health insurance in the hands of a Republican-controlled Congress that has voted dozens of times to repeal or dismantle the law. ... The "shake up" that Trump supporters were seeking may soon be realized, and it may get personal. Their candidate won the election, but it's not clear what the country won when it comes to health care. The GOP has no answers either. It has not arrived at anything resembling a consensus for an alternative that would guarantee insurance to all Americans. Only days after the election, Trump was already pointing out provisions in the law he wanted to retain. It also must be dawning on Republicans that stripping health insurance from millions of Americans will have political consequences. (11/16)

President Obama will be leaving office with the Affordable Care Act (ACA), his signature policy initiative, in deep peril. An incoming Republican president and Congress, concerned with the cost of ACA exchange plans jumping by an average 25 percent next year and employee health care costs rising, have pledged to repeal the law. For his part, the President sought to shift the blame for rising out-of-pocket cost from the ACA’s flaws to employers and insurers. (Tevi Troy and Mark Wilson, 11/16)

Donald Trump will be coming into office waving the banner of deregulation. While most of the speculation about his plans has focused on the financial industry and the possibility of eviscerating Dodd-Frank reforms, keep your eyes on the Food and Drug Administration. In a Trump administration the agency, figuratively speaking, will have a big bull’s-eye on its back. (Michael Hiltzik, 11/16)

As a new administration dawns, anyone with a beloved policy project starts to dream. Maybe this time the power brokers — now, president-elect Donald Trump and his appointees — will see the wisdom of our proposals. For my part, I am optimistic that my goal — easing the nation’s organ shortage — might just gain traction. This is because my preferred solution — rewarding kidney donors – will yield a fiscal windfall for the federal government. (Sally Satel, 11/15)

After a difficult and divisive campaign, the election of Donald Trump and Michael Pence has stunned many in the fields of medicine and public health who had hoped for a different outcome. Eight years ago, I was part of the transition after the election of President Barack Obama. Our excitement about what was now possible for the country was tempered with a recognition that others saw matters quite differently. This experience informs several thoughts about the current transition. (Joshua M. Sharfstein, 11/16)

Cardiovascular disease is the leading cause of death and disability in the United States, accounting for 1 in 4 deaths and more than $200 billion in direct and indirect costs annually. In July 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a new episode-based payment model for myocardial infarction. This model aims to improve the quality and efficiency of cardiac care and helps move the United States toward CMS’s goal of having 50% of traditional Medicare payments in value-based models by 2018. (Zirui Song and Daniel M. Blumenthal, 11/15)

Americans pay far more for branded prescription drugs than people in any other developed nation, exactly the kind of bad deal that President-elect Donald Trump decried repeatedly in his campaign. The U.S. was reminded of this outrage in September when it learned that drugmaker Mylan NV has been charging Americans more than $600 for its EpiPen two-pack while selling it for only $69 in the U.K. Why does this kind of inequality persist? The main reason is that, by law, Medicare and Medicaid cannot use their volume purchasing power to negotiate lower prices, as do health agencies in virtually all other developed nations. (Red Jahncke, 11/16)

Doug Moore was out of town at a Florida conference on information technology in October 2015 when he was struck with terrible abdominal pain. He tried to go to an urgent care center and called several local doctors. No one could see him. So he headed to the nearest emergency room. On the way, he called his insurance company to make sure the visit would be covered. Once he got to the Palms of Pasadena Hospital emergency room, a doctor gave him some medication and tests, and let him go. A month later, feeling better and back at home in Baton Rouge, La., Mr. Moore, 34, received an out-of-network bill from the doctor who treated him — for $1,620. (Margot Sanger-Katz and Reed Abelson, 11/16)

Extortion increasingly is the motive behind cyberattacks of healthcare companies, a panel of experts told a luncheon audience of the Nashville Health Care Council. The evolution from worms and viruses to large-scale breaches aimed at exposing clients and extracting ransoms should put every employee of a healthcare organization on high alert, said Paul Connelly, vice president and chief information security officer at hospital giant HCA Holdings and a former chief information security officer at the White House. Having a chief information officer isn't enough, he said. (Dave Barkholz, 11/16)

If the Affordable Care Act is repealed by the Trump administration and the U.S. Congress, people suffering from mental illnesses will be among the first victims of those cuts. Whenever there’s a mass murder or sensational violent crime and the person suspected of the offense has a history of mental illness, the public immediately wants to know if that person has received proper treatment and, if not, why not. Of course, the vast majority of people suffering from mental illnesses commit no crimes. ... Yet, we know that about one-third of the people in Cook County Jail have been diagnosed with a mental ailment and Cook County Sheriff Tom Dart has said the jail has become the largest mental health care institution in Illinois. (Phil Kadner, 11/16)

For many wistful Americans, the image of the community physician making routine house calls is a lost icon, a symbol of nostalgia. In a simpler time, in a much more rural United States, often the local doctors knew all their patents well and may even have been paid in produce or poultry instead of money. Those days are long gone, and house calls are a rarity in the medical profession, not the norm. ... But it is a time for reflecting about how we deliver our services and what the future of health care will look like. (John Marrero, 11/16)

Here in Hamilton County, more than half of the babies who died in our community in the past year died because they were born before the end of the second trimester. Building on recent success in reducing our local preterm birth rate belongs at the top of our community’s agenda. This month, Cradle Cincinnati and the March of Dimes came together to jointly issue a report on extreme preterm birth in Cincinnati. Thursday, as we mark World Prematurity Day, we are calling on new partners to get involved in the fight for our babies. (Ryan Adcock, 11/16)

For millions of women with Lena's experience or worse — sexual molestation or rape — Donald Trump’s election stirs up painful feelings or actual traumatic memories. What does it mean for them when a man on record describing women using words like "bimbo" or "dog" or "slob" and boasting about grabbing women's genitals is rewarded with the highest office in the land? (Alie Zoldbrod, 11/16)