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The quest for union support already appears to have had an impact on the candidates’ positions on at least one issue. Clinton, Sanders and O’Malley have all called for repeal of the “Cadillac tax” in the Affordable Care Act, a 40% levy on certain generous employer-sponsored health coverage plans, which is set to take effect in 2018. Getting rid of that tax is a prime issue for the Culinary Union and other labor organizations that have negotiated substantial benefit plans for their members. (Lee, 10/15)

Over the last year, California politicians have been blazing a trail many doubted the rest of the country would follow: offering free healthcare to hundreds of thousands of people in the country illegally. But on Tuesday, presidential front-runner Hillary Rodham Clinton took a stance on the contentious issue during a televised Democratic debate, boosting it onto a prominent national stage. (Karlamangla, 10/14)

The Democratic debate made clear that the two leading candidates for the party’s presidential nomination both would allow illegal immigrants to buy coverage on government websites, but not much more. That’s about the same as the status quo. The 2010 health-care overhaul — supported by all the candidates on the stage Tuesday night — requires people to prove legal residency to shop for coverage on HealthCare.gov or obtain tax credits to help pay premiums. They also can’t enroll in Medicaid, the state-federal program for the poor that also locks out many legal immigrants. The Obama administration extended those rules to children granted immigration enforcement reprieves under a 2012 executive action, and has said it would do the same for adults. (Radnofsky, 10/14)

Let's acknowledge this off the top. A certain set of videos, congressional hearings, efforts to defund a large organization and a big announcement from that same agency that it would change the terms of its fetal tissue program have occupied a lot of time and attention over the last few months. But Tuesday night, it seemed as if the words "abortion" and "Planned Parenthood" almost went missing from the first Democratic debate. (Ross, 10/14)

No news is good news for biotechs. The Nasdaq Biotechnology Index is getting reprieve Wednesday, up 1.9% midday versus the S&P 500’s 0.1% decline, after the recently contentious topic of drug pricing received little attention in Tuesday night’s Democratic presidential candidate debate. ... Despite Mrs. Clinton being vocal about her disdain for drug costs lately, the topic only briefly came up during Tuesday’s debate when candidates were asked which enemy they are most proud of. Mrs. Clinton named drug companies in a list that also included health insurance companies, Iranians, Republicans and the National Rifle Association. (Scholer, 10/14)

Sen. Bernie Sanders touted his record on veterans' issues during Tuesday's debate, citing his position as the former chairman of the Senate Committee on Veterans Affairs when Congress provided billions of extra dollars to boost healthcare for veterans last year. ... Yet some veterans groups and others criticize Sanders for what they call a lack of oversight of the VA, and for at times coming to its defense in the midst of the scandal that rocked the agency in 2014. (Griffin and Devine, 10/14)

Lawmakers must raise the debt limit in the next 30 days, the Congressional Budget Office warned Wednesday. The nonpartisan agency said the Treasury Department will run out of the accounting maneuvers as well as the cash reserve it's used to stave off default "sometime during the first half of November." (Faler, 10/14)

Each one could be called the Ryan Plan, for short, or the Ryan Budget: a single-minded — Democrats would say absurdist — quest by Representative Paul D. Ryan, Republican of Wisconsin, to drastically cut federal spending and taxes, transform Medicare essentially into a voucher program, partly privatize Social Security. ... Those sweeping budget proposals, the product of a young, heavy-metal-loving policy wonk’s obsession with transforming American fiscal policy, catapulted Mr. Ryan to prominence within the Republican Party. ... Republicans, on the other hand, passionately embraced them, and Mr. Ryan came to be seen as one of his party’s most influential thinkers on fiscal issues. His budget proposals showcase the thinking and philosophy of a lawmaker who many Republicans believe is now their best choice for speaker of the House... But Mr. Ryan’s personal dedication to fiscal issues could mean he might prefer to remain in the powerful, more policy-oriented post of chairman of the tax-writing Ways and Means Committee (Herszenhorn, 10/14)

Anti-abortion activists have given Congress lengthy, unedited videos they recorded showing Planned Parenthood officials discussing their retrieval of fetal tissue, a Republican House committee chairman said Wednesday. Democrats complained that the recordings seemed to be copies and not originals. That could mean they wouldn’t help resolve conflicting claims about whether the videos — including shorter versions that abortion foes began posting online this summer — were misleadingly edited. (Fram, 10/14)

Daleiden, 26, is the anti­abortion activist who masterminded the recent undercover campaign aimed at proving that Planned Parenthood illegally sells what he calls aborted “baby body parts.” He captured intimate details of the famously guarded organization, hobnobbing at conferences so secretive that they require background checks and talking his way into a back laboratory at a Colorado clinic where he picked through the remains of aborted fetuses and displayed them luridly for the camera. (Somashekhar, 10/14)

Kentucky sometimes failed to ensure that all consumers who signed up for insurance on the state’s health exchange were eligible for coverage, the latest federal audit found. The audit, released Thursday by the inspector general for the Department of Health and Human Services, found that some of the Kentucky exchange’s controls for confirming consumers’ eligibility weren’t effective. Earlier audits also identified deficiencies in the federal exchange, Healthcare.gov, as well as state-run exchanges in California, Connecticut and New York. (Armour, 10/15)

Covered California has fixed an enrollment gap for middle-income uninsured pregnant women, allowing them to receive affordable benefits through the exchange. (Vesely, 10/14)

Illinois wants insurance companies in the small group market to submit changes to their small business policies as quickly as possible following a bipartisan adjustment to the nation's health care law. President Barack Obama signed legislation last week that gives states flexibility about whether to change the definition of "small business" under the law. (10/14)

More than 565,000 Ohioans -- 68 percent of the state's uninsured residents -- are eligible to receive subsidized insurance or Medicaid coverage but have not signed up, according to a new study. The data from the nonprofit Kaiser Family Foundation revealed that large numbers of eligible citizens are failing to obtain coverage because of a lack of awareness of financial assistance, concerns about affordability, or misperceptions about eligibility rules. (Ross, 10/14)

One day after House Republicans killed a Medicaid expansion plan, state leaders met to discuss an alternative. “It was a good meeting,” said Senate President Wayne Niederhauser, R-District 9. Niederhauser sat down with Gov. Gary Herbert and House Speaker Greg Hughes Wednesday afternoon. The meeting lasted approximately hour, during which the three agreed they would revisit the issue during the 2016 legislative session. (Connolly, 10/14)

Valeant Pharmaceuticals International, which has come under fire for aggressively increasing the prices of its drugs, said late Wednesday that it had received two federal subpoenas related to its pricing, distribution and patient support practices. The subpoenas were issued by the United States attorney’s offices in Manhattan and Massachusetts. (Pollack, 10/14)

Valeant, which received the subpoenas recently, says they mostly requested information about its programs to help patients pay for the company’s drugs. “The company is reviewing the subpoenas and intends to cooperate with the investigations,” Valeant said in a statement. (Rockoff, 10/15)

For the first time, a consortium of top U.S. cancer hospitals will provide patients with guidance about the cost of drugs used in their treatment, helping address a concern for many people undergoing a major medical event - what the financial repercussions of their condition are. The information will supplement summaries that the group, the National Comprehensive Cancer Network (NCCN), has provided for 20 years on the effectiveness, side effects, and evidence backing the therapies. (Cortez, 10/15)

On Theranos Inc.’s website, company founder Elizabeth Holmes holds up a tiny vial to show how the startup’s “breakthrough advancements have made it possible to quickly process the full range of laboratory tests from a few drops of blood.” The company offers more than 240 tests, ranging from cholesterol to cancer. It claims its technology can work with just a finger prick. Investors have poured more than $400 million into Theranos, valuing it at $9 billion and her majority stake at more than half that. ... But Theranos has struggled behind the scenes to turn the excitement over its technology into reality. (Carreyrou, 10/15)

The Food and Drug Administration was “lax” and “permissive” in its review of a blood-thinning drug designed to prevent strokes and clots in patients with a heart condition affecting millions of Americans, a watchdog group said Thursday. (Rein, 10/15)

UnitedHealth Group Inc. said its revenue soared 27% in its third quarter, as the health insurer continues to grow its health-services business and add members in its insurance operations. ... UnitedHealth, which kicks off earnings reports for health insurers, is also being helped by its acquisition of pharmacy-benefit manager Catamaran Corp., which closed in July. UnitedHealth is the largest health insurer by revenue. (Dulaney, 10/15)

UnitedHealth Group’s third-quarter profit slipped, but the nation’s largest health insurer still beat Wall Street expectations due in part to prescription drug management and its other fast-growing businesses. (10/15)

In a report to Congress last year, the American Dental Association found that more than 181 million Americans didn’t visit a dentist and that more than 2 million people showed up in the emergency room with dental pain in 2010, double the rate from 2000. Some people believe a solution to improve access is to create dental therapists, a provider whose responsibilities fall between a dentist and a hygienist. This summer the agency that accredits dental schools said it would create guidelines to train this new mid-level professional. Supporters say this could build momentum for legislation pending in more than ten states that would allow these new workers to drill, fill and extract teeth. (Gorenstein, 10/14)

Paula Bennett pockets about $3,000 a year from her employer mainly for driving around 80 miles roundtrip for a deal on doses of her Crohn's disease treatment Remicade. The extra income comes through SmartShopper, a program offered by some employers to provide cash to workers who choose quality health care options with lower prices. (Murphy, 10/14)

For many workers, leaving full-time employment means leaving employer-provided health insurance behind as well. In 2015, only 23 percent of employers with 200 or more employees offer any form of health insurance for their retirees. No wonder the main reason people give for working well beyond typical retirement age is the need to stay on their employer's health insurance plan. (Martin, 10/!5)

Samantha Cunningham was halfway through a five-hour road trip to a music festival in Bradley, Calif., when she realized she’d left her asthma inhaler back home in Sacramento. ... a friend on the trip suggested she try American Well, a service that allows smartphone or Web device users to have a video consultation with a physician. ... Cunningham, 23, was soon discussing her predicament face to face with Dr. Minoti Parab, a family doctor in Charlotte, N.C., who sees only “telemedicine” patients like Cunningham on her home computer. The app download and visit with Dr. Parab took about 30 minutes and cost $49 — far less than a traditional office visit. When it was over, Cunningham had a prescription for a new inhaler that she filled at a pharmacy in Bradley. ... It’s also a perfect example of how telemedicine — using electronic technology to provide remote patient care and to exchange medical information — is transforming health care delivery. (Pugh, 10/14)

As a child, Bishop Douglas Miles heard the warnings about vans trolling East Baltimore streets, snatching up young African-Americans for medical experiments at nearby Johns Hopkins Hospital. Whether there was any truth behind those stories—Hopkins has always denied them—hardly mattered. The mythology lived on and, combined with the hospital’s very real development decisions, contributed to a persistent view of Hopkins as an imperious, menacing presence amid the largely poor and African-American neighborhoods surrounding it. (Ollove, 10/13)

The University of Central Florida announced a five-year deal with the country’s largest for-profit hospital chain to train doctors after graduation, with the hope that those slots will mean as many as 550 doctors will stick around Florida to practice medicine. Initial residency programs will be in internal medicine, family medicine and OBGYN. Doctors who graduate medical school can’t immediately see patients; rather, they must then do residency and fellowship programs after graduation. (Aboraya, 10/14)

With Florida facing another cut next year in a key hospital-funding program, Senate President Andy Gardiner, R-Orlando, said Wednesday it "remains to be seen" whether lawmakers will use state tax dollars to help deal with the reduction. Gardiner addressed the issue, involving a program known as the Low Income Pool, while speaking to reporters and editors from across the state who gathered at the Capitol for an annual Associated Press event. (10/14)

A Missouri House committee is putting together recommendations that could place further restrictions on abortion providers, namely Planned Parenthood. Several Republican lawmakers began brainstorming various proposals toward the end of a public hearing Wednesday at the State Capitol. They included random inspections of any facility that performs abortions, including hospitals. (Griffin, 10/15)

State attorneys will try to convince a judge on Thursday that Utah's decision to block federal money from going to Planned Parenthood is not unconstitutional and allowed under contracts with the organization. A judge ruled late last month that the money should temporarily keep flowing to Planned Parenthood, but that order expires Thursday and the organization wants to see it extended. (10/15)

State health officials appear to have taken up Republicans’ ongoing fight against Planned Parenthood by adopting guidelines that prohibit abortion-affiliated groups from contracting with Texas to run abstinence education programs. Officials at the Health and Human Services Commission recently added language to the requirements for groups applying for contracts under the state’s Abstinence Education Services program that would prohibit entities even loosely affiliated with abortion providers from receiving any funding. The move comes even though the state's elected lawmakers did not ask for it when they approved the budget earlier this year, and Planned Parenthood doesn't participate in the state's abstinence programs. (Ura, 10/15)

In a packed day of action Tuesday at the state Capitol, GOP lawmakers advanced a bill to ban certain research on tissues derived from aborted fetuses. The bill moved forward on the same day that national Planned Parenthood officials said they would no longer accept any reimbursement for the costs of donating such tissues for research, with the group's officials saying they are doing so to push back against opponents' claims that Planned Parenthood is seeking to profit from tissue transfers. The group has said only a handful of its clinics, and none in Wisconsin, are involved in the donations. (Stein, 10/13)

When Kansas City police pick up people who appear to be suffering mental health problems, they have two choices — take them to an emergency room or jail. Neither option is ideal. And that’s why an agreement creating a mental health assessment and triage center at 12th Street and Prospect Avenue was heralded Wednesday by city, county and state officials. (Stafford, 10/14)

The sale of two Kansas City-area hospitals will generate $20 million in the next decade to help operate a new mental health crisis center on the city’s East Side, Missouri Attorney General Chris Koster said Wednesday. Koster made the announcement while standing outside the state office building at the corner of 12th Street and Prospect Avenue that will house the 16-bed Kansas City Area Adult Behavioral Health Assessment and Triage Center. (Sherry, 10/14)

Virginia’s hard-to-qualify-for Medicaid program is even stingier when it comes to treatment for substance abuse disorders — strictly limiting who can get services and what kinds of services the program covers. The rising problem of prescription, heroin and other opioid overdose deaths in Virginia has state officials looking at how to enhance or expand those services. (Smith, 10/14)

Joy Newcom of Forest City told Gov. [Iowa] Terry Branstad on Wednesday his proposed privatization of Medicaid services was too much, too soon and had too many unanswered questions. Newcom, the mother of a 24-year-old son with mental and physical disabilities, expressed her concerns at a town hall meeting Branstad held in Mason City. About 100 people attended, many of whom had questions about the changes in Medicaid. Under the new program, as of Jan. 1, about 600,000 Medicaid recipients in Iowa will go from a state-run program to one operated by four managed care organizations. (Skipper, 10/14)

Months without financial aid from Harrisburg - and no sign the spigot will flow again soon - is starting to wear on officials and agencies across the region. Through this month, Delaware, Chester, Montgomery, and Bucks Counties have shelled out more than $70 million from reserves to keep critical social service providers afloat. But officials from each aren't sure how long they can last and are watching their coffers week by week. (Nussbaum, 10/14)

Costs of mammograms in the Atlanta area can vary enormously — with some more than 5 times as expensive as others — a differential that’s among the widest in the United States. The prices of mammograms in metro Atlanta range from $89 to $488, according to Castlight Health, a company that helps businesses analyze health care prices. (Miller, 10/14)

While a growing number of states have turned their attention to marijuana legalization, another proposal has been quietly catching fire among some legislators—raising the legal age to buy cigarettes. This summer, Hawaii became the first state to approve increasing the smoking age from 18 to 21 starting Jan 1. A similar measure passed the California Senate, but stalled in the Assembly. And nearly a dozen other states have considered bills this year to boost the legal age for buying tobacco products. (Bergal, 10/14)

[T]he Obama administration, while not granting unlimited flexibility, has been reasonably flexible when Republican governors have come to them asking for waivers [in the Medicaid expansion program]. One of the first to get a Medicaid waiver from the Obama administration was Ohio, led by now presidential candidate Governor John Kasich. I will suggest that the Kasich administration has achieved some pretty remarkable results—and also continued to take a lot of conservative criticism for their Medicaid expansion. (Robert Laszewski, 10/14)

About 32 million people in the U.S. remained uninsured as of early 2015, a Kaiser Family Foundation analysis of federal survey data has found, with about half of them eligible for Medicaid or subsidies under the Affordable Care Act. With the high-profile resistance in some states to Medicaid expansion and the ACA generally, you may think those places are the main obstacle to covering more of the uninsured. But the uninsured remain a problem in both red and blue states. (Drew Altman, 10/14)

Is the Affordable Care Act still widely unpopular? Apparently not. Poll results reported this week by nonpartisan public policy firm PerryUndem Research/Communication show that a majority of likely voters in five key battleground states – Florida, Nevada, Ohio, Virginia and Pennsylvania – believe the Affordable Care Act is here to stay (64%) and want Congress to improve the law, not repeal it (71%). This result is particularly significant for us in Pennsylvania, as the majority of our state’s congressional delegation has staunchly opposed the health care law and continued to push for repeal, despite the gains in coverage, new consumer protections and other benefits that have been brought to their constituents. (Antoinette Kraus, 10/14)

Despite a near-universal assumption that the Supreme Court will take up an abortion case in its new term, the general chatter hasn’t included much detail about the specific issue, the stakes or the prospects. This column is an effort to address those questions. The stakes couldn’t be higher, either for women who live in the growing number of states governed by anti-abortion politicians or for the court itself. During the next few weeks, the justices will decide whether to hear an appeal filed last month by several Texas abortion clinics. The clinics are among those that will be forced to close under a law that the United States Court of Appeals for the Fifth Circuit upheld in a series of decisions culminating in June with Whole Woman’s Health v. Cole. (Linda Greenhouse, 10/15)

D.C. council members members seem to feel there is no limit to the demands they can make on companies that try to do business in the city. Witness the burst of legislation in the past three years requiring employers to pay higher salaries, provide new benefits and face new regulations . Now, with the ink barely dry on those laws, a majority of the council wants to put an additional burden on employers with a tax that would allow workers to take up to 16 weeks of paid family leave annually. No doubt the American workplace needs to become more family-friendly, but this proposal is not grounded in reality and would end up hurting the District and its workers by driving up costs and driving away jobs. (10/14)

The public and private sectors are now engaged in an unprecedented array of virtuous efforts to improve end-of-life care. That these efforts are generally not evidence-based is not the fault of the organizations promoting them. It is the responsibility of investigators and research sponsors to identify, develop, and rigorously test interventions so that they can offer guidance as growing political and cultural tolerance increasingly permits implementation of end-of-life care programs. (Scott D. Halpern, 10/14)

Open enrollment for health insurance starts Thursday. So millions of people 65 and older are getting lots of ads in the mail for insurance that covers what Medicare doesn’t. I got my first taste this year, as I approached 65. I was Medicare to-be. In just a few months, I received 40 mailings from insurers and brokers — plus Medicare’s own 152-page guide to Medicare. (George Judson, 10/15)