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As concerns increase about higher health insurance premiums on the government exchanges, President Obama on Wednesday urged navigators and others helping with the new open enrollment to persevere to get more people signed up for plans. "You are changing people’s lives with your work," Obama said on a conference call with Health and Human Services Secretary Sylvia Mathews Burwell. (O'Donnell and Jackson, 11/4)

But the nonprofits have been caught in a financial squeeze. A federal formula to spread out risk among insurers resulted in many co-ops paying steep fees. At the same time, lawmakers eager to chip away at the Affordable Care Act put restrictions on a federal government program to cover insurance company shortfalls. Of the 23 operating co-ops, 11 have recently folded or said they would close. One other never got off the ground. (Armour, 11/4)

After nearly two years in operation and millions of dollars spent in development, the small business health insurance exchange created by the Affordable Care Act is struggling to catch on. Nationally, about 85,000 people, from 11,000 small businesses, have coverage through the online marketplace known as the Small Business Health Options Program, or SHOP, according to the latest federal data released in May. Those totals do not include employers that began coverage in 2014 and have not yet renewed their coverage through HealthCare.gov for 2015. (Galewitz, 11/5)

Republican Matt Bevin’s victory in the Kentucky governor’s race Tuesday highlighted the enduring power of public sentiment about the federal health law to energize GOP voters as the national parties prepare for the 2016 elections. The Affordable Care Act, also known as Obamacare, played a central role in the contest, which Mr. Bevin won resoundingly, 53% to 44%, against Democrat Jack Conway. The Republican pledged to dismantle the state’s health exchange—which earned praise for its relatively smooth launch—and to roll back or modify the expansion of Medicaid under the law. If he follows through, it would mark the first time a state significantly reversed implementation of the health law. (Campo-Flores and Radnofsky, 11/4)

Republican Matt Bevin’s election Tuesday as governor has placed Kentucky’s widely lauded health insurance expansion under the Affordable Care Act squarely in the crosshairs, with the governor-elect having pledged to eliminate or at least scale back the plan also known as “Obamacare.” More than a half-million Kentuckians now get health coverage through the federal law implemented under executive order of Gov. Steve Beshear. That includes more than 400,000 low-income Kentuckians covered through the Medicaid expansion and another 100,000 who have purchased private plans, many with federal subsidies to offset the costs. (Yetter and Kenning, 11/4)

The election of a conservative outsider as Kentucky governor has given Republicans a laboratory to show the rest of the country how they'd replace President Barack Obama's health care law. Three years into a coverage expansion that has brought the share of uninsured Americans to historically low levels, Matt Bevin's lopsided victory underscores how politically divisive the law remains. But experts say slamming the brakes in a state already deeply entrenched in the Affordable Care Act would cost lots of time and money, testing the new Republican administration's ability to rein in costs. (11/4)

Perhaps the most significant consequence of Republican Matt Bevin's victory in Kentucky's gubernatorial race last night is that it could result in the dismantling of maybe the most extensive (and successful) effort to implement Obamacare in the entire country. (Todd, Murray and Dann, 11/4)

The Republican victories in Kentucky’s gubernatorial race and Virginia’s state legislative elections on Tuesday provided a jarring wakeup call to Democrats that they could be facing a tough slog in the 2016 campaign. ... One important preliminary finding is that the Kentucky and Virginia election results may be a harbinger for Republican efforts to dismantle Obamacare and block a further extension of Medicaid health care benefits to many of the nation’s poorest individuals and families. (Pianin and Matishak, 11/4)

The Democratic Party’s half-century of decline across the South was all but complete Wednesday after Kentucky elected a Republican governor who campaigned against abortion, gay marriage and, for a time, Obamacare. ... He ran television commercials calling Conway, Kentucky’s attorney general, “pro-abortion,” “anti-coal” and a champion of President Obama’s “liberal agenda” — reprising themes that swept many Republicans into office in last year’s midterm elections. ... For Bevin, Obama’s unpopularity in culturally conservative states like Kentucky proved a major asset. His advertising leaned heavily on tying Conway to the president. (Finnegan, 11/4)

The incumbent Democrat, Gov. Steve Beshear, used his executive authority to establish state-based health insurance exchange, Kynect, under the measure, and also expanded Medicaid, which now covers an additional 420,000 more Kentuckians — almost 10 percent of the state’s population. Mr. Bevin, who gave a radio interview but made no public appearances on Wednesday, has pledged to end Kentucky’s state exchange, and vows to stop enrolling new people in Medicaid. (Stolberg, 11/4)

Matt Bevin won the Kentucky governorship on a vow to dismantle Obamacare, but the obstacles he faces rolling back a law that covers nearly one in 10 Kentuckians offers a preview of the struggles that a Republican president would face living up to a “repeal and replace” pledge in 2017. Even before the votes were cast, Bevin had started hedging his repeal bet, saying he would not take coverage away from people who have it. He can give the health law in his state a more conservative veneer. But he can’t scrap it completely. (Pradhan and Demko, 11/4)

For much of this year, Sara Goodrich of Lakeland has gone without health insurance -- despite trying over and over again to complete enrollment on HealthCare.gov. “For the last six months, all of the agents have been telling me something else is the issue. Resubmit here, there's an address error, it's your birthday, for some reason, that would affect my application, and I just said, I am trying to follow the rules here, and you guys aren't helping,’” she said. (Watts, 11/5)

A prominent House Republican on Wednesday accused MNsure executives of misleading him about their budget and asked the federal government to stop giving the controversial health care exchange any more money, provoking a war of words with MNsure leaders. At issue are millions of dollars in federal grants provided to MNsure by the Centers for Medicare and Medicaid Services. MNsure hasn't yet received permission from the federal government to use these grants next year but counts on them in its budget. (Montgomery, 11/4)

MNsure's board of directors Wednesday unanimously accepted Twin Cities business executive Mark Nyquist as the single finalist to become the exchange's next chief executive. (Zdechlik, 11/4)

Minnesota's health exchange named an experienced former insurance executive as the sole finalist Wednesday to take over as the fourth CEO of the embattled, three-year-old organization. MNsure board members publicly identified Mark Nyquist as the lone finalist for the position. Nyquist has previously worked as a vice president at UnitedHealth Group and several private consulting businesses with clients in the health care field. (Potter, 11/4)

A special congressional committee launched an investigation of pharmaceutical pricing Wednesday, focusing on recent medication cost hikes at four companies. Amid cost complaints from patients and the medical community, the Senate Special Committee on Aging sent letters seeking information from Valeant Pharmaceuticals International (VRX), Turing Pharmaceuticals, Retrophin (RTRX) and Rodelis Therapeutics. The companies have been the subject of numerous media reports about drug pricing. (McCoy, 11/4)

Notably, the senators called for a face-to-face meeting with Turing Pharmaceuticals CEO, Martin Shkreli, “as soon as it is practicable.” A former hedge fund manager, Shkreli has become the public face of the pricing controversy, after his company raised the price of the anti-infection drug Daraprim by more than 5,000 percent. The drug, which Turing acquired in August, is the only U.S.-approved treatment for a deadly parasitic infection that can affect pregnant women and patients with HIV.” (Perrone, 11/4)

The senators’ letter to Valeant asks CEO Michael Pearson for more details about the company’s acquisition of the rights to sell Isuprel and Nitropress, drugs used to treat cardiac arrests, and Cuprimine, a drug used to treat Wilson’s Disease. The letter says that the price of Nitropress rose by 625% the day Valeant purchased the rights, while Isuprel’s cost rose by 820% and Cuprimine soared by 2429%. ... In the letter to Retrophin CEO Stephen Aselage, the senators asked for information on the pricing of Thiola, a drug designed to treat kidney disease. The letter says that Retrophin acquired the rights to the drug from Mission Pharmacal Co. and subsequently raised the price to $30 from $1.50 per tablet. (Farrell, 11/4)

Rep. Kevin Brady (R., Texas) will likely become the next chairman of the House Ways and Means Committee after winning an intraparty contest Wednesday. ... Mr. Brady will become one of the party’s leading voices on tax, trade and health policy. He said in a statement that he wanted to implement a “pro-growth agenda” for the country. “This includes taking real steps toward fixing this broken tax code, reforming welfare, saving Social Security and Medicare for the long term and enlarging America’s economic freedom to trade,” he said. (Rubin, 11/4)

Brady’s nomination is also the latest victory for the small group of hard-line conservatives who helped force Boehner’s ouster. The race to replace Ryan as chairman came down to Brady, a southern conservative with a strong background in healthcare policy, and Rep. Pat Tiberi (R-Ohio), a business-friendly Boehner ally with a history of working with Democrats. Ways and Means oversees some of the most important issues on the Republican agenda — including tax policy, trade, Social Security and Medicare — making its chairmanship one of the most coveted positions in Congress. (Snell, 11/4)

The House Republican Conference must ratify the decision, but that is considered a formality. Brady, an 18-year veteran of Congress, is the seventh chairman from the state of Texas. (Sherman, 11/4)

Republicans are openly feuding over whether to seek drastic changes to Medicare, Social Security and other entitlement programs, risking a potentially damaging intraparty battle ahead of the 2016 elections. The rift was exemplified this week by the biggest GOP stars of the moment. Newly installed House Speaker Paul D. Ryan (R-Wis.) said he plans to pursue a “bold alternative agenda” that would include major revisions in entitlements. At the same time, leading GOP presidential candidate Donald Trump railed against proposals to end or significantly change Medicare. (Costa and O'Keefe, 11/4)

The 2015 elections were rougher for Democrats in redder states, as they suffered a surprisingly large defeat in the Kentucky governor’s race, failed to win a majority in the Virginia Senate and saw voters thump an LGBT rights ordinance in Houston. But in blue states and cities, the party held or gained ground. As the parties head into a new presidential year, the country’s partisan divide has deepened. Republicans walked away from Tuesday with the big wins. Democrats walked away with fresh confidence that their map can win a third presidential election in a row. (Weigel, 11/4)

Democratic presidential candidate and Vermont Sen. Bernie Sanders is proposing to end the federal prohibition on marijuana. The Senate bill set to be introduced by Mr. Sanders would remove marijuana from the list of substances controlled under federal law and repeal federal penalties for possessing or consuming it. “The time is long overdue for us to take marijuana off of the federal government’s list of outlawed drugs,” Mr. Sanders said on the Senate floor last week. (Tau, 11/4)

Christie has signed bills improving access to drug prevention and treatment. In 2013, he signed a so-called "Good Samaritan" law that provides immunity from arrest for people who call 911 if they are with someone who overdoses while doing drugs. New Jersey also made Naloxone, a drug that can reverse the effects of opiates, available to friends and family members of known drug users. But he has taken a hard line on marijuana, calling medical marijuana programs a "front for legalization" and vowing to crack down on the drug from the federal level if he is elected president. (Zezima, 11/4)

The Association of American Medical Colleges projects that the nation will face a shortage of 12,000 to 31,000 primary-care physicians by 2025. So it's no wonder you may be finding it harder to find a doctor or to schedule an appointment with the one you have. What's fueling this problem? The baby boom generation pouring into older age, an aging physician workforce preparing to retire and an estimated 30 million Americans joining the ranks of the insured since enactment of the Affordable Care Act in 2010. (Kraft, 11/4)

A possible unintended consequence of one of health reform's biggest goals -- curbing excess health care spending -- could be a surge in malpractice lawsuits, a provocative study published in the British Medical Journal Wednesday suggests. Researchers tracked more than 24,000 Florida physicians over a nine-year period and found that in six specialties, doctors who spent the most health care resources on hospitalized patients had the lowest likelihood of being sued. (Johnson, 11/4)

When an obstetrician makes a substantial mistake, Jack Olender goes after millions. The Washington, D.C., lawyer has, by his own account, brought hundreds of doctors to court — and there are enough malpractice attorneys out there to make this kind of case a multibillion dollar industry. (Boodman, 11/4)

When you're coming down with a cold, there are a few items you typically reach for to start feeling better: cough drops, herbal tea, maybe an over-the-counter medication. For most of us, though, a smartphone wouldn't top that list. But that may change as health care companies increasingly steer customers toward streaming video apps that connect patients with doctors online. (Perrone, 11/4)

The Legislature will reconvene this month for a special session intended to address New Hampshire's substance abuse crisis. The Executive Council voted 4-1 Wednesday in favor of Democratic Gov. Maggie Hassan's call for a special session despite some Republican lawmakers' objections that the state shouldn't rush the legislative process. Among the efforts she has outlined are increasing penalties for dealing the prescription drug fentanyl, requiring state medical boards to revamp their rules for prescribing opioids and strengthening the state's prescription drug monitoring program. (11/4)

New Hampshire’s medical board adopted emergency rules for opioid prescribers Wednesday, but rejected many of the changes sought by Gov. Maggie Hassan. The rules take effect Friday and require doctors and nurses to use an “evidence-based screening tool” to assess patients’ risk of abuse, and to provide information on how to dispose of unused medication. (Wallstin, 11/4)

Testimony like that has motivated law enforcement across the country to start offering Vivitrol in jails and drug courts in recent years. Alkermes, the pharmaceutical company that manufactures Vivitrol, has donated doses of the drug to about 30 programs since the U.S. Food and Drug Administration (FDA) approved Vivitrol to treat alcohol addiction in 2006 (the drug was approved to treat opiate addiction in 2010). Many more programs have found funding elsewhere. Dr. Elina Chernyak helped get some free doses for the Rock Springs area earlier this year — enough to give 25 offenders like Largent a shot on their way out of jail, and a shot a month later. She said medically, Vivitrol is considered a “complete antagonist.” The drug binds with the brain’s opioid receptors and shuts them down, she said, which means that while the Vivitrol is active, opiate drugs and alcohol won’t make the patient feel high. Other opiate addiction medications can actually give addicts a buzz. (Bryan, 11/4)

In a small but growing number of places, people who land in hospitals after being revived by the drug are being guided toward long-term treatment. That's largely because decision makers have heard so many stories about people being brought back from the brink — sometimes repeatedly — and then turned loose to use again. The drug, pronounced nuh-LOX-ohn but often known by the brand name Narcan, is administered via shot or nasal spray and can almost immediately revive a victim of an overdose on heroin and its painkiller relatives, known as opioids. It's widely distributed to anyone likely to encounter an overdose victim, including police, paramedics and users' families. (11/4)

The United States' opiate drug problem isn't limited to illegal narcotics. The sale of dangerously addictive painkillers prescribed by physicians has quadrupled in the past decade, and one company in particular is pushing pain to the legal edge of aggressive medical marketing. (Gusovsky, 11/4)

The price tag for providing health care to hundreds of thousands of low-income New Mexicans is rising, and state lawmakers said Tuesday they are concerned future costs will be unsustainable as they work to balance the budget. New Mexico is one of the states that opted to expand Medicaid under the U.S. Affordable Care Act. Enrollments have surged beyond initial projections, and federal aid will soon be scaled back, putting more pressure on states to come up with the difference. (Bryan, 11/4)

Bills passed by the Legislature over the past two years aimed at lowering the cost of Medicaid expansion may not provide the savings expected, according to a warning issued by the Legislative Fiscal Office, an independent agency created to give lawmakers unbiased information. The warning Tuesday (Nov. 3) came as a surprise to Medicaid expansion advocates, who said the concerns raised by the Fiscal Office were never discussed at the time the legislation was being debated. The bills set up a mechanism that would allow Louisiana hospitals to be assessed a fee that would help offset the federal matching funds required for Medicaid expansion states in 2017. (Litten, 11/4)

Tampa-based WellCare Health Plans, which manages care for about 800,000 people in Florida's Medicaid program, saw an increase in earnings during the third quarter of the year, according to a filing Wednesday with the federal Securities and Exchange Commission. WellCare reported net income from July 1 to Sept. 30 of $36.4 million, or 82 cents per diluted share, up from $19.3 million, or 44 cents per diluted share, during the same period in 2014. (11/4)

State authorities have reported a $54 million settlement with drug companies to close an investigation into Medicaid overcharges. New York Attorney General Eric Schneiderman says Delaware-based AstraZeneca LP will pay 49 states and the federal government $46.5 million and Pennsylvania-based Cephalon Inc. will pay $7.5 million. The settlement resolves allegations the companies underpaid drug rebates to the states by treating certain fees paid to wholesalers as discounts. (11/4)

After years of resistance, Republican legislative leaders are now heading down the path toward legalizing marijuana for medical purposes. (Siegel, 11/5)

An advisory panel cautioned Wednesday against expanding Minnesota's medical marijuana program to include patients suffering chronic pain starting next year. The recommendation from the panel's medical experts to Department of Health Commissioner Ed Ehlinger is not a final say — it's up to Ehlinger to make the decision by Jan. 1. But five of eight panel members voted against the possible expansion, arguing that there's limited evidence of marijuana's efficacy in treating pain and noting physicians' reluctance to using the drug as a treatment. (11/4)

A recent federal court ruling in San Francisco is a blow to Justice Department efforts to limit the sale of medical marijuana in California and 22 other states, according to legal experts and government officials. In a scathing opinion last month, U.S. District Court Judge Charles R. Breyer challenged the Justice Department’s narrow interpretation of part of a law passed by Congress last year that bars the department from spending any money to prevent a state from implementing its medical marijuana laws. (Phelps, 11/4)

Millions of Floridians -- including 175,000 state workers and their families -- are in health plans that place them at risk for whopping surprise bills after hospital treatment. These are plans that have networks of contracted doctors and hospitals but are not HMOs. Most of the plans with this risk are preferred provider organizations, or PPOs. (Gentry, 11/4)

A settlement Nevada negotiated with pharmaceutical companies is bringing nearly $8 million to women's health research in the state, including for studies on premature birth, Alzheimer's and breast cancer. The Nevada Attorney General's Office announced Wednesday that the University of Nevada School of Medicine is getting $3.8 million over 5 years, and Las Vegas' University Medical Center is getting another $3.8 million. (Rindels, 11/4)

Some Democrats frustrated by Republicans’ opposition to Medicaid expansion and gun control argue that Tuesday’s loss leaves McAuliffe free to blast the policies and politics of his conservative foes. Others say he should work with Republicans and use his coming two-year budget to build a legacy on education, workforce development and economic development. (Portnoy and Vozzella, 11/4)

In the zip codes surrounding St. Louis’ nationally-ranked children’s hospitals, a disproportionate number of babies never make it to their first birthday. North of the Delmar Loop, in 63113, the infant mortality rate is 20 deaths per 1,000 live births, according to the most recent five-year averages kept by the state. That’s more than three times the U.S. rate, and on par with countries like Nicaragua and the Marshall Islands. But just a few miles away from 63113’s empty cribs, less than four out of 1,000 babies born in the Clayton's 63105 zip code die in their first year. (Bouscaren, 11/4)

A Houston doctor has been convicted in a scam that falsely billed Medicare and Medicaid for more than $600,000 in fraudulent claims, federal authorities said. Following a six-day trial, jurors found Enyibuaku Rita Uzoaga, 43, guilty on six counts of health care fraud and one count of conspiracy to commit health care fraud. Federal prosecutors told jurors that between 2006 and 2010, Uzoaga, Harris and others falsely billed Medicare and Medicaid for unnecessary vestibular diagnostic tests, authorities said. Those tests are used to diagnose a person for vertigo or dizziness. (Hassan, 11/4)

Rep. Jackie Speier (D-Hillsborough), who once spoke about her own abortion on the House floor, will serve on a newly formed House select committee investigating claims that Planned Parenthood profited from providing fetal tissue to researchers. Minority Leader Nancy Pelosi (D-San Francisco) named Speier and five other Democrats to serve on the panel. Speier told the Los Angeles Times that she asked for the assignment. (Wire, 11/5)

The latest front in the debate over religious freedom is all about an 8 1/2-by-11-inch piece of paper. This particular piece of paper is a notice — one the state of California will soon require to be posted in places known as crisis pregnancy centers. These resource centers, often linked to religious organizations, provide low-cost or free services to pregnant women, while encouraging these women to not have abortions. (McEvers, 11/4)

The clinic's local efforts target an illness that's expanding rapidly among Native Americans, who are twice as likely as non-Hispanic whites to be diagnosed with diabetes, according to the Indian Health Service. Particularly alarming is the impact of the disease on Native American young people ages 10 to 19. Statistics show those children and teens are nine times more likely to be diagnosed with Type 2 diabetes than non-Hispanic white kids (Romero, 11/4)

The island's health care system is sagging, burdened by funding shortages, an inability to borrow money, and an increasing flow of doctors, nurses, and medical technicians to the mainland--where they can make more money and work under better conditions. (Fletcher, 11/5)

Tennessee is the fourth-fattest state in the country. A recent WalletHub study determined the states' rankings, with Mississippi topping the chart as most obese and Hawaii as the least. The data included percentage of adults and children who are overweight, obese, consume drinks with a high sugar content and lead a sedentary lifestyle. (Todd, 11/4)

New Hampshire Public Radio and Reveal found a history of not just mistreatment, but also violence, abuse and sexual assaults at Lakeview based on an extensive review that included six years of 911 call logs, hundreds of pages of reports from states and watchdogs, and interviews with dozens of former staff members, inspectors and families. That review also uncovered Lakeview’s connections to a network of similar facilities across the country – and to owners who have evaded accountability for 40 years. (Rodolico and Starcheski, 11/4)

The Democratic Party has prospered for decades by promising voters entitlements in return for Election Day loyalty. It worked with Social Security and Medicare, and so it was supposed to work for ObamaCare: Pass it and they will come. Instead the Affordable Care Act has become a recurring political catastrophe for Democrats, most recently on Tuesday in Kentucky. (11/4)

Matt Bevin, the newly elected Republican governor of Kentucky, says his state can't afford to keep covering the people who have gained health insurance through Medicaid expansion. If money really is the issue, Bevin may find Kentucky can't afford not to. (11/5)

Thirty states have expanded Medicaid under the Affordable Care Act since the Supreme Court made it a state option in 2012. Ten of them have Republican governors, two of whom are presidential candidates, John Kasich and Chris Christie. If, however, you follow campaign commentary on cable TV you would think expanding Medicaid is a political black mark in the eyes of all Republicans. To be sure, the most activated elements of the GOP base–conservative campaign contributors, super PACs, and conservative legislators–oppose Medicaid expansion, primarily because they see it more as embracing Obamacare than providing federal funding to states to help them expand coverage for low-income residents. But the limited polling the Kaiser Family Foundation has done on the issue has found that most Republicans do not oppose Medicaid expansion. In fact, they favor it. (Drew Altman, 11/4)

Opponents of the Affordable Care Act keep trying to chip away in court and at the state level at pieces of the whole -- Kentucky's governor-elect, Matt Bevin, has pledged to roll back the state's Medicaid expansion. But a slew of recent attacks has taken aim at what one would think is the law's most sacrosanct provision. That's the protection of insurance customers with preexisting medical conditions, otherwise known as "guaranteed issue." (Michael Hiltzik, 11/4)

“Everyday people with good health insurance and ready access to medical care die of preventable diseases,” my friend John, a retired surgeon, wrote me recently. My friend was lamenting a recent article appearing in many Idaho newspapers about the tragic death of a woman with asthma. Her death was blamed on lawmakers who have refused to expand government-run programs like Medicaid to include able-bodied, childless adults. The article is but the first, I’m sure, of many that will claim that someone’s death is connected to the unwillingness of lawmakers to put more people on government assistance. That legislators are to blame for people dying is a lie, but it’s one advocates for Medicaid expansion figure will move lawmakers to act. (Wayne Hoffman, 11/4)

Yet another attack on the ACA is making its way through the courts. Frustrated that dozens of votes to repeal the ACA have gone nowhere, the House of Representatives voted along party lines in 2014 to file a lawsuit challenging the administration's implementation of two provisions of the law. First, the House claimed that the decision of the Obama administration to delay the employer mandate violated the ACA. Second, it claimed that the administration was illegally reimbursing insurers for reducing cost sharing for enrollees under the ACA's cost-sharing reductionprogram, asserting that Congress had not specifically appropriated funds for the program. ... Although the technical legal issue in House v. Burwell is whether funding for the cost-sharing reductions has been properly appropriated, the really significant issue in the case is whether the House can bring the lawsuit at all. (Timothy Stoltzfus Jost, 11/4)

It’s been well over a year since the deception and negligence at the U.S. Department of Veterans Affairs shocked the American people. Even though the headlines have faded, the situation continues to worsen. Whereas 40 veterans died in the wait-list scandal first uncovered at the Phoenix VA, a September VA inspector general’s report found as many as 307,000 veterans nationwide died before their applications were processed. How can veterans trust this failing agency with their health and well-being? A federal agency is only as good as the people working in it, and although the vast majority of VA employees deserve our thanks, it is undeniable that a small minority has contributed to a culture of deception and disregard for veterans’ well-being. (Pete Hegseth, 11/4)

Clinton made her views known in an Oct. 23 interview with MSNBC. She declared that last year’s wait-list scandal in Phoenix was little more than an anomaly: “It’s not been as widespread as it has been made out to be.” She also claimed that “veterans who do get treated are satisfied with their treatment,” while arguing that Republicans manufactured a non-existent crisis to serve their political ends. These are astounding comments from someone who wants to command America’s men and women in uniform. They betray a shocking ignorance of the facts on the ground. Time and again, the VA has let down the veterans who fought and bled for their country. Simply look at the reams of evidence released since the wait-list scandal was first uncovered in Phoenix in April 2014. (Thomas McInerney, 11/5)

George was 18 when he was diagnosed with acute myeloid leukemia, a blood cancer that is fatal but curable with effective therapy. He was treated and went into remission. This was 24 years ago .... Unfortunately, in May 2015, at age 42, his leukemia came back. ... we recommended a clinical trial in our department at MD Anderson in the hope of controlling his leukemia. ... Our expert opinion was that the clinical trial was his best option. It is approved by the Food and Drug Administration .... However, George's insurance company denied coverage for the clinical trial. Unfortunately, this is a common scenario. We routinely encounter situations where insurance companies deny clinical trial coverage for patients with cancer using a variety of excuses. The only motive is to save money. (Nitin Jain and Hagop Kantarjian, 11/4)

Two Princeton economists startled other Americans — and themselves — when they uncovered a trend that had escaped the medical and scientific world: Between 1999 and 2013, white middle-aged men and women in the United States, especially those with only a high school education, began dying at a sharply increased rate, largely a result of problems with legal and illegal drugs, alcohol-related liver disease and suicide. The health and financial implications are disturbing for the country, and for what the two economists called a “lost generation.” (11/5)

That’s the story that Steven Francesco, a longtime pharmaceutical industry executive and consultant, tells in “Overmedicated and Undertreated,” his harrowing memoir of raising Andrew, his son. He makes clear that the larger problem — even from his view as an industry insider — is a sector that sometimes puts profits above public well-being. Here’s the central issue: Children with emotional or mental disorders have become a gold mine for the drug industry. Psychiatric medicines for children account for billions of dollars in sales annually, and the market has boomed. (Nicholas Kristof, 11/5)

The public outcry and political scrutiny over the pricing policies of drug companies Valeant and Turing has amplified the national debate over high specialty drug costs. To address the problem in a way that might actually improve things, it is important to recognize that not all high-priced drugs are created equal. Some are novel agents that enter relatively large markets at high prices, such as the Hepatitis C medication Sovaldi. Their prices are likely to remain high. Others, however, reflect older off-patent medications that were sold for years at low prices and have recently experienced large and sudden price increases, such as Daraprim. Both kinds of drugs cause distress for insurers and consumers, but they have very different implications for overall health care spending, and they require different policy solutions. (Joshua M. Liao and Mark V. Pauly, 11/4)

Ohio voters did the right thing on Tuesday by overwhelmingly rejecting a deeply flawed marijuana legalization ballot initiative. The proposal would have amended the state’s constitution to grant a monopoly on commercial cultivation of cannabis to a small group of investors, which is a terrible idea. By a margin of 64 percent to 36 percent, voters rejected the measure, called Issue 3, which was backed by a group of business interests that spent about $25 million on their campaign. Ohioans narrowly approved another measure that was meant to undo a yes vote on the legalization proposal. (Vikas Bajaj, 11/4)

It's a mistake to make a federal case out of a single outbreak of food poisoning. It's worth pointing out, however, the utter failure of Congress to do more to prevent foodborne illness, which costs Americans some $15 billion in treatment and lost work days every year. (11/4)

Between 2002 and 2014, a total of 16 new allopathic and 15 new osteopathic medical schools opened in the United States and many existing schools increased their class sizes, for an estimated 49% increase in first-year enrollment nationwide. This explosion in the number of medical students after a long period of level numbers of graduates has raised concerns about the adequacy of the U.S. system of graduate medical education (GME) to provide residency positions for all U.S. medical school graduates. ... Traditionally, there have been many more entry-level positions available than there have been U.S. medical graduates (M.D. and D.O.) to fill them. ... The GME system is proving responsive to the increased output of U.S. medical schools. The country would be best served if academic medicine focused its considerable intellect and energies on the task of transforming GME to respond to our rapidly evolving health care system. (Fitzhugh Mullan, Edward Salsberg and Katie Weider, 11/4)

Tattoos are becoming increasingly common worldwide. In the United States, at least 21% of all Americans have 1 or more tattoos. Despite this, tattooing is minimally regulated. In the United States, tattoo inks are considered cosmetic products and are not subject to monitoring by the US Food and Drug Administration. ... Instead, regulation occurs at the state or local level. ... This lack of oversight extends to the provision of aftercare instructions. Aftercare instructions are the guidelines that describe how to care for a new tattoo. ... Providing written and verbal aftercare instructions may minimize rates of postplacement tattoo infections and complications. (Walter Liszewski, Jared Jagdeo and Anne E. Laumann, 11/4)