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U.S. health insurer Anthem Inc on Wednesday raised the prospect of smaller participation in the individual Obamacare exchanges in 2018, saying it would have a market-by-market strategy that hinges on 2017 profitability. The company said that losses due to sicker-than-expected customers in its individual Obamacare plans were a bit less than foreseen in the third quarter and that it was planning for a slight profit in that business next year. (11/2)

The insurer said that 2017 is a critical year as it evaluates its plans for the business. If there aren’t improvements next year, including regulatory changes to the health-law exchanges, “we will likely modify our strategy in 2018,” said Chief Executive Joseph R. Swedish in a conference call with analysts. He said the insurer will look closely at, and reconsider its offerings in, the regions in which it offers health-law plans. Anthem said its ACA exchange plans will show a mid-single-digit loss for 2016, but said it is aiming for a slim profit next year. (Wilde Mathews and Hufford, 11/2)

Insurance company Anthem on Wednesday said it could pull back on its participation in ObamaCare in 2018 if changes are not made to make the market more sustainable. Other large insurers, such as Aetna, UnitedHealthcare and Humana, have already pulled back, citing financial losses on the ObamaCare marketplaces from a smaller and sicker group of enrollees than expected. In 2018, Anthem says it could join its rivals. Like the others, Anthem could drop off in some areas while staying in others. (Sullivan, 11/2)

Health insurer Anthem Inc., which has so far stuck with the Obamacare markets as rivals pulled back, said it may retreat in 2018 if its financial results under the program don’t improve next year. Anthem’s comments up the stakes for the Obama administration as the enrollment season for 2017 Affordable Care Act plans begins, with consumers already facing fewer choices and higher premiums in many markets. “If we do not see clear evidence of an improving environment and a path towards sustainability in the marketplace, we will likely modify our strategy in 2018,” Anthem Chief Executive Officer Joseph Swedish said on a call Wednesday discussing third-quarter results. “Clearly, 2017 is a critical year as we continue to assess the long-term viability of our exchange footprint.” (Tracer, 11/2)

The health insurer Anthem warned Wednesday that it could retreat from the Affordable Care Act marketplace in 2018. The company would consider withdrawing from the marketplace if its financial results from marketplace plans don’t improve next year, CEO Joseph Swedish said on a call Wednesday detailing the insurer’s third-quarter earnings. Swedish said 2017 will be a “critical year” in determining the insurer’s plans for the exchanges going forward. (McIntire, 11/2)

Anthem on Wednesday said its profit for the third quarter of 2016 fell nearly 6% as higher medical claims and expenses related to its pending tie-up with Cigna squeezed earnings.Anthem CEO Joseph Swedish also said results in the insurer's individual ACA business “were disappointing” due to low membership growth and higher than expected medical costs from members with chronic diseases. If the marketplace does not soon show progress toward sustainability, Anthem will likely re-evaluate its 2018 participation, he said. (Livingston, 11/2)

Anthem’s third-quarter earnings slid nearly 6 percent and missed Wall Street expectations, as rising medical costs countered revenue growth and some cost cutting for the nation’s second-largest health insurer. The Blue Cross-Blue Shield insurer also updated on Wednesday a 2016 forecast that falls short of analyst forecasts. (Murphy, 11/2)

President Barack Obama's legacy health care law has reduced the number of Americans going without health insurance to historically low levels, but continued progress threatens to stall this year, according to a new government report. The study released Thursday by the Centers for Disease Control and Prevention suggests the law may be reaching a limit to its effectiveness in a nation politically divided over the government's role in guaranteeing coverage. (Alonso-Zaldivar, 11/3)

The small Boston insurer Minuteman Health is suing the federal government for the second time over the rollout of certain provisions of President Obama’s health care law. Minuteman, launched in 2013, blames those provisions for making it difficult for the company to operate and grow. In the latest suit, Minuteman says it is owed $5.5 million under the Affordable Care Act’s “risk corridor” program, which was designed to help stabilize health insurance markets. (Dayal McCluskey, 11/2)

On the second day of open enrollment, the MNsure Contact Center had received 4,100 calls by late afternoon. For people who got through to a representative, the average wait time was 6 minutes. MNsure officials said the call volume was similar to past experience. In contrast, officials were sent scrambling Tuesday as more than 80,000 call attempts bombarded the MNsure helpline. Officials say they continue to investigate the source of the calls. (Benson, 11/2)

Republicans who support abortion rights are already an endangered species. But they’re likely to become nearly extinct next year in a political winnowing that is knocking off moderates on both sides — and turning the politics of abortion even more rancorous. Five Republicans in Congress regularly buck their party by supporting abortion rights. But one of those, Rep. Richard Hanna of New York, is retiring and two more — Rep. Bob Dold and Sen. Mark Kirk, both of Illinois — face uphill races. And the same narrowing is happening on the other side: No more than seven Democrats in Congress regularly vote against abortion rights. (Haberkorn, 11/3)

Speaker Paul Ryan (R-Wis.) on Wednesday embraced Donald Trump’s call for a special session of Congress to repeal ObamaCare. Ryan, who has at times had a tense relationship with Trump, the Republican presidential nominee, also said repeal of ObamaCare is a reason why Trump should be president. ... Ryan said Republicans would use a process called reconciliation, which would allow a repeal measure to get through the Senate with just a simple majority, rather than the usual 60. (Sullivan, 11/2)

An analysis released Wednesday by Avalere Health, a nonpartisan consulting firm, shows 1.2 million people could gain access to Medicaid if the winners of gubernatorial races in Missouri, North Carolina, and Utah opted to expand it. While governors’ races are happening in 12 states this year, those three states have not expanded the program. (McIntire, 11/2)

For many Missouri health advocates, an increase in the state’s tobacco tax is long overdue. But onlookers might be surprised to hear that tobacco companies are spending a fortune this election year to get one or another increase in that tax passed, while health groups are urging a no vote. What’s going on? The tax increases that the companies want are so low that tobacco researchers say they would have no effect on smokers buying their products — or quitting a dangerous habit. (Smith, 11/3)

Consumers may drive across town to save a few bucks on a gallon of gas or $1 on a gallon of milk, but when it comes to health care, those same buyers aren’t as price-conscious. That is a problem for companies as health costs continue to rise, and it’s increasingly a problem for workers, too, as high-deductible health plans force employees to spend more out of pocket. (Silverman, 11/1)

November is typically open enrollment time for millions who get health insurance, disability insurance and other benefits from an employer. If you’re one of them, among your important choices is whether you want a flexible spending account and how much money to deposit. FSAs are available through some employers as a part of benefits packages. You can spend FSA money only on “qualified medical expenses,” which are determined by the IRS. (Glover, 11/2)

When death approaches, most people would rather spend their days at home. But in Massachusetts, a remarkable number of dying patients often end up in hospital beds instead, and enter hospice for only a few days, a new analysis has found. Massachusetts, especially the eastern part of the state, ranks among the lowest in the nation for the number of days residents spend at home during their final six months. Nearly one-fourth die in hospitals — a sign of the reluctance in the medical establishment to use hospice or palliative care. (Freyer, 11/2)

Death and dying can be costly, but they are rarely considered a business by consumers. Many would rather not ponder critical decisions about feeding tubes, funeral homes and other end-of-life issues until the need is thrust upon them. But as our population ages and the industry gets more attention, new firms — many of them technology companies — are setting out to compete on price and convenience. (Zimmerman, 11/2)

Lots of people think this is how science works: A genius sits in a lab working late into the night and, finally — "Eureka!" After that come big prizes, and maybe even lucrative patents, right? Discoveries are rarely so straightforward. A recent biotech advance that goes by the long, awkward acronym of CRISPR-Cas9 is a perfect case. (Bichell, 11/2)

We hear a lot about the wonders of genetic testing, how it can revolutionize medicine and find cures for fatal diseases. A new study from the University of Michigan also shows how it can waste a half a billion dollars a year. Researchers at the university examined testing for inherited thrombophilia, a genetic quirk that can indicate a patient’s likelihood of developing dangerous blood clots. It sounds like a useful test to have. But, according to the researchers, knowing that you have the trait will not change your treatment. (Ross, 11/2)

As the heroin epidemic rages on with other deadly opioids sneaking into the supply, Kentucky wants to link more people to the medication that can reverse an overdose. The state launched the website KyStopOverdoses.ky.gov on Wednesday, which allows people to search for pharmacies that carry naloxone by city, county, or ZIP code. Soon, the state will add health departments that offer the antidote to the searchable database and map. The drug naloxone, also known by its brand name Narcan, blocks the effects of heroin and opioids in the brain. (DeMio, 11/2)

New York Attorney General Eric Schneiderman says a drug maker has agreed to extend a price cut for a heroin overdose antidote bought by hundreds of government agencies around the state. California-based Amphastar Pharmaceuticals will continue to offer a $6-per-dose rebate through January 2018 for naloxone, which can quickly reverse an opioid overdose. (11/3)

A Vermont woman who worked as a registered nurse at a New Hampshire hospital pleaded guilty Wednesday to using morphine intended for patients at the facility. Attorney General Joseph Foster announced Wednesday that Jennifer Oakley of East Corinth, Vt., pleaded guilty to a felony charge of possession of a controlled drug. Prosecutors said on Jan. 17, 2016, Oakley was working as a nurse at Cottage Hospital in Woodsville and caring for a patient. According to court paperwork, Oakley documented giving the patient 5 mg of morphine at 1:49 p.m., and logging the patient’s “pain is decreased” as of 2:20 p.m. that day. Oakley’s coworkers then reported seeing syringes in her jacket pocket, and urine samples were collected from both the patient and Oakley and tested for narcotics. (11/2)

A bomb goes off. It's noisy. It's smoky. Lights are flashing, people are shouting. The wounded are bloody and dying. But this isn't a real war zone. It's a training class inside a simulator in San Antonio that recreates the real-life chaos and pressure of combat. (Rigby, 11/2)

Since the all-volunteer program started eight years ago, Rector estimates that a couple thousand veterans have learned how to scuba dive, sail, fish and rock climb. Roughly 400 to 600 veterans annually work with 30 trained volunteers to go on excursions across South Florida. As of now, the organization is funded completely by private donations and a grant from the Department of Veterans Affairs. Veterans do not pay for their dives. (Cochrane, 11/3)

Derek Auguste, a former Army sergeant, is used to following instructions. So by the time yoga instructor Molly Birkholm finished her relaxation session, he was at ease. Auguste was one of 40 or so military veterans and community members practicing yoga and relaxation techniques at “Warrior Wednesday,” a monthly forum hosted by United Way of Miami-Dade as part of its Mission United veterans support group. (Hsieh, 11/2)

Community Health Systems is now working on seven transactions to sell 17 hospitals, its home-care business and other real estate, CEO Wayne Smith said during a third-quarter earnings call with analysts Wednesday. The developing divestitures have combined revenue of about $2 billion and should yield net proceeds of about $1.2 billion, Smith said. Some of the deals could be announced this quarter with others revealed by the second half of next year, he said. CHS has been divesting assets to reduce a crushing debt of $15 billion, among the highest for investor-owned hospital companies nationally. (Barkholz, 11/2)

Prince George's [Maryland] Hospital Center said Wednesday it is temporarily closing its neonatal intensive care unit and transferring five babies to other hospitals because of a bacterial outbreak. The decision was made after two babies tested positive for the bacterium Pseudomonas. The bacterium is found widely in soil, water and other parts of the environment. While it doesn't harm most healthy people it can lead to illness in small babies with health challenges. (McDaniels, 11/2)

Edward Hospital in Naperville has lost its "A" ranking for patient health and safety, according to a national nonprofit that reviews medical facilities for "hospital transparency" and overall health care quality. The Leapfrog Group this week awarded a "safety grade" of "B" to the hospital for the second time since 2014. Previously, Edward had received an "A" grade for every period since 2013 with the exception of the "B" it was given in fall 2014, according to data provided by the group. (Bird, 11/2)

The California Department of Public Health rolled out a hefty HIV plan Wednesday with the aim of stopping new cases of the chronic illness statewide. The plan is a collaboration between the department and local health jurisdictions, including the Sacramento County Department of Public Health. “Getting to zero,” according to the plan, means reaching zero new HIV infections and AIDS-related deaths along with no stigma and discrimination against people living with HIV. About 5,000 new HIV diagnoses are made in the state each year. By 2021, the department hopes to reduce the number of new cases to fewer than 2,500 a year. (Caiola, 11/2)

Walker Methodist Health Center’s dental clinic received a national award this week for its innovative way of providing dental care for seniors. The Minneapolis clinic is staffed by University of Minnesota dental students, a model recognized with an innovation award from LeadingEdge, a national association of senior housing and health care organizations. Dental care for the elderly is a growing need, said Stephen Shuman, associate professor and director of the geriatrics program at the university’s School of Dentistry. The clinic provides hygiene and dentistry students with geriatric experience, treating about 1,500 active patients. the elderly come with unique problems: Many seniors are no longer able to floss or brush properly and their care is often complicated by illness, such as diabetes and dementia, said Shuman. (Beckstrom, 11/2)

A fall 2017 trial date is set for a South Florida businessman accused of orchestrating a $1 billion Medicare and Medicaid fraud scheme. Court records show a Miami federal judge on Wednesday scheduled 48-year-old Philip Esformes’ trial for Sept. 18. Esformes, who has pleaded not guilty, faces a potential life prison sentence if convicted of multiple fraud, conspiracy and other charges. (11/3)

One out of five California adults with children living in their homes were beaten, kicked or physically abused when they were children, and one in ten were sexually abused, according to data released recently by a children’s health foundation. Experts believe that’s an undercount. (Wiener, 11/3)

Genesis Healthcare Inc., a Kennett Square company that is the nation's largest operator of nursing homes, said Wednesday it expects to save $10.5 million, or 5 percent, on its annual rent under two deals by its largest landlord to sell 92 of the more than 500 nursing homes Genesis operates for $1.7 billion. Welltower Inc., based in Toledo, Ohio, will continue to be Genesis's largest landlord, with 114 nursing facilities. A previous owner of Genesis sold its real estate as way to generate stronger returns for investors, but Genesis has struggled under heavy rent payments and has been buying back some of the properties. (Brubaker, 11/2)

The mentally ill man who was fatally shot by Boston police officers Sunday had threatened two emergency medical technicians with a steak knife while ranting nonsensically before officers opened fire, according to the head of Boston’s emergency medical services. The account, which he provided to the Globe on Wednesday, bolsters the police department’s assertions that the technicians and officers who had come to the South End apartment in response to a 911 call feared for their lives. (Ransom, 11/2)

A University of Kansas scientist has been named one of the first recipients of an $825,000 fellowship for her work in developing a protein designed to thwart antibiotic resistance. Joanna Slusky, 37, who heads the Slusky Lab at KU and specializes in outer membrane proteins, is one of five inventors nationwide recognized by the Gordon and Betty Moore Foundation in Palo Alto, California. The foundation, established by the co-founder of Intel Corp. and his wife, anticipates awarding a total of $33.75 million to support 50 promising inventors over the next 10 years, according to its website. Slusky is part of the first cohort announced Wednesday. (Margolies, 11/2)

The recently announced 25 percent rise in Obamacare health insurance premiums has brought renewed attention to health policy. As this is my last column before Election Day, it is time to review how the presidential candidates would address the continuing challenge of skyrocketing health costs. (John Graham, 11/2)

Donald Trump and running mate Mike Pence talked about their plans for the U.S. healthcare system again this week, beginning where Republicans usually begin: by calling for the complete repeal of the 2010 Patient Protection and Affordable Care Act, better known as Obamacare. But to get where they say they want to go — providing more affordable health coverage for more Americans — they would be better off skipping that step and moving on to other elements of their plan. That’s because their overall plan isn't fundamentally sound, but several of its planks could help shore up weaknesses in Obamacare. (Jon Healey, 11/3)

Medical students are more at risk of committing suicide than their same-aged peers given that they are 15 percent to 30 percent more likely to meet the diagnostic criteria for depression. (Lisa M. Meeks, 11/2)

In the final debate, Hillary Clinton said she would secure Social Security and Medicare by raising taxes on high-income earners, including herself and her opponent, Donald J. Trump, “assuming he can’t figure out how to get out of it.” As we’ve learned in the past few weeks, Mr. Trump has used all kinds of extravagant maneuvers to get out of paying taxes. Without Mr. Trump’s returns, we can’t know for certain whether he figured out a way to get out of paying into Medicare and Social Security. But we have some clues. (Fred T. Goldberg and Michael J. Graetz, 11/2)

When I was in the first grade, an astute teacher noticed that I had trouble seeing the blackboard. This finding was quickly confirmed by a vision test. Formal evaluation by an ophthalmologist revealed that I had a rare degenerative retinal disease. Worse than that diagnosis was the ophthalmologist’s devastating prognosis for my life: attending college would be very challenging, sports and certain activities would be difficult or impossible, and it was unlikely that I would ever have a professional career. (Kurt R. Herzer, 11/1)

On July 27, 2016, the Centers for Medicare & Medicaid Services (CMS) released the controversial Overall Hospital Quality Star Ratings, despite concerns raised by hospitals and Congress that CMS had not provided enough details regarding the methodology, shared the underlying data, or responded adequately to comments from various stakeholders. Federal legislation has now been introduced to have CMS take down the Star Ratings. ... It is especially important that CMS’ rating system demonstrate merit, given its potential influence. However, the CMS Star Ratings have several shortcomings, with the potential risk of doing more harm than good unless careful revision is undertaken. (Karl Y. Bilimoria and Cynthia Barnard, 11/1)

As in policing, African-American health has historically been at the mercy of white power and privilege. Perhaps the most infamous abuse remains the 40-year-long Tuskegee “study,” during which the United States Public Health Service dishonestly withheld medical treatment from black sharecroppers ravaged by syphilis, simply to observe how the disease progressed. When the truth was finally revealed in the 1970s and the program ended, the deception of researchers only confirmed the suspicion many blacks held toward medical institutions. (Sushrut Jangi, 11/2)

Thomas Sinsky, MD, a primary care internist in Iowa, was burning out. The complexity and intensity of work required for each patient seemed to grow exponentially over the years. The demands of managing prevention, acute and chronic illnesses, phone calls, emails, faxes, prescriptions, forms, and quality measures left him exhausted and unsatisfied. Fortunately, working along with his wife, a fellow internist, and their nurses, they were able to transform their practice into a team-based care model. (Diana Mason, 11/1)

With political candidates sparring about the 25 percent increased premiums for Affordable Care Act (ACA) insurance plans, the questions of why has this occurred and how we can ameliorate it are bouncing around the media. As a primary care doctor, the answers to these questions reveal themselves every day in my office. While it is convenient to demonize the ACA, insurance companies, and even Big Pharma, the actual cause is related to flawed assumptions and rules within our health care delivery system. One just has to see where insurance pays its money to understand how to fix the problem. (Andy Lazris, 11/2)

Now, because of the rising 2017 rates, most of [insurance broker David] Taxer's clients who have incomes too high to qualify for ACA premium tax credits are buying cheaper, short-term health plans that do not comply with ACA rules. In the Portland area, rates for these plans, which can run for up to 364 days, are $500 to $600 a month, about half the price of ACA-compliant plans, whose premiums are up 10% to 30% for 2017. These short-term plans often have broader provider networks. But insurers can turn down applicants with pre-existing health conditions, and the benefits can be much more limited than in ACA-compliant plans. Consumer advocates warn that such products offer tenuous financial protection. (Harris Meyer, 11/2)

With the current nationwide epidemic of opioid abuse, dependence, and fatalities, clinicians are being asked by federal agencies and professional societies to control their prescribing of narcotic medications for pain. Federal guidelines emphasize tapering, discontinuing, and limiting initiation of these drugs except in provision of end-of-life care. Reducing reliance on opioids, however, is a massive task. According to one estimate, more than 650 000 opioid prescriptions are dispensed each day in the United States. Unless the nation develops an increased tolerance to chronic pain, reduction in opioid prescribing leaves a vacuum that will be filled with other therapies. (Esther K. Choo, Sarah W. Feldstein Ewing and Travis I. Lovejoy, 11/1)

Unfortunately, there is a considerable amount of inaccurate information being circulated about Amendment 3, the initiative petition to increase investments in early childhood health and education through a 60-cent-per-pack increase on cigarettes. ... The primary opposition to Amendment 3 is being driven by the cheap cigarette industry and for good reason. They have a lot to lose. They are being subsidized by Missouri’s taxpayers to the tune of $80 million every year. (Melissa Randol, 11/3)