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A day after their fiercest debate-stage confrontation to date, Joseph R. Biden Jr. escalated his criticism of his most formidable rival for the Democratic presidential nomination, Senator Elizabeth Warren of Massachusetts, suggesting that she was not being forthright about the costs of her far-reaching policy proposals and questioning her “credibility.” Mr. Biden zeroed in on Ms. Warren’s refusal to say if she would raise taxes on middle-class Americans to pay for “Medicare for all,” a single-payer health care system that would all but eliminate private health insurance. (Glueck, 10/16)

Warren (Mass.) is entering a crucial phase of her campaign, taking attacks from all sides for the first time since she ascended in popularity, and attempting to demonstrate she can withstand the kind of scrutiny that previously fell mostly on Biden, who until recently held an unchallenged lead in the polls. Yet as she attempts to coalesce support on the party’s left flank, Warren faces a renewed challenge from liberal Sen. Bernie Sanders (I-Vt.), whose debate appearance helped alleviate questions about his health and whose new endorsements and deep bank account have made clear he has no intention of leaving the race. (Viser, 10/16)

Sen. Elizabeth Warren’s (D-Mass.) main health care proposal is losing support in the polls, posing a challenge to the emerging front-runner as “Medicare for All” comes under fresh attacks from fellow presidential candidates, hospitals, doctors and insurers. Opposition to Medicare for All was on full display at Tuesday night’s Democratic primary debate, where moderate candidates called the plan a “pipe dream” and an “obliteration” of the private health insurance system. (Hellmann, 10/17)

Elizabeth Warren took a lot of flak at this week’s Democratic presidential debate for being evasive about the taxes needed to pay for the $30 trillion Medicare for All plan she champions. There’s a reason for being vague: Her team hasn’t yet figured out how to pay for it. “Her taxes as they currently exist are not enough yet to cover fully replacing health insurance,” University of California, Berkeley economics professor Emmanuel Saez, who advised the Warren campaign when developing the wealth tax, told Bloomberg News on Wednesday. (Davison and Egkolfopoulou, 10/17)

Pete Buttigieg has spent recent Democratic presidential debates sparring with Medicare for All proponents, but the South Bend, Ind., mayor backed the concept in a 2018 tweet that resurfaced Wednesday. The February 18, 2018 message came as part of an exchange with other Twitter users pushing Democratic politicians to support the sweeping health care plan. (Strauss, 10/16)

"I, Pete Buttigieg, politician, do henceforth and forthwith declare, most affirmatively and indubitably, unto the ages, that I do favor Medicare for All, as I do favor any measure that would help get all Americans covered," Buttigieg wrote in the 2018 tweet, which came in response to a question doubting whether he really supported the proposal for single-payer health insurance. (Sullivan, 10/16)

Kaiser Health News/Politifact: Refereeing Pete Buttigieg, Elizabeth Warren On Public Support For ‘Medicare For All’
Mayor Pete Buttigieg of South Bend, Ind., sparred with Sen. Elizabeth Warren (D-Mass.) at the most recent Democratic presidential primary debate over how to expand health insurance coverage for all Americans. Buttigieg said he favors allowing Americans younger than 65 to enroll in Medicare if they wish. Warren, by contrast, prefers to transition all Americans from their current insurance plan to government coverage. (Jacobson, 10/16)

As the presidential candidates spar over health reform proposals, a new analysis of eight different Democratic reform models found they would cover from 11 million to 35 million more Americans while costing the federal government from $590 billion to $34 trillion over 10 years. Urban Institute researchers examined models ranging from a modest enhancement of Affordable Care Act coverage to a government single-payer system covering all U.S. residents, including additional benefits such as dental and long-term care and requiring no patient cost-sharing. (Meyer, 10/16)

Experts offer widely different estimates for the cost of Medicare for All. So for our analysis, we used a range of tax rates — 11.5%, 15% and 18% — to calculate what health care might cost our four Massachusetts individuals and families if the Unites States transitions to a single-payer system. (Bebinger, 10/17)

And in other news on election politics —

President Trump and his allies sought to turn the Democratic debate on Tuesday night into a referendum on the congressional impeachment inquiry, accusing the party’s presidential candidates and its leaders in Washington of pursuing a vendetta against Mr. Trump while ignoring more pressing pocketbook issues. But Republicans also saw an opportunity to seize on debate moments over middle-class tax increases, health care reform and economic inequality to portray the Democrats as tax-and-spend liberals — in hopes of redirecting the national conversation at a time when public opinion is moving against the president. (Peters, 10/16)

The impeachment inquiry that has imperiled President Trump and captured the attention of a divided nation is now threatening to overshadow House Democrats’ attempts to show that they can govern, posing a political dilemma that deepens as the investigation marches on. Democrats returned to Washington this week determined to spotlight the popular domestic initiatives, like lowering the cost of prescription drugs and education, that helped to sweep them into the majority last year. (Stolberg, 10/16)

Senate Democrats plan to force vulnerable Republicans to vote on legislation that would overturn a controversial Trump administration directive on ObamaCare. The strategy shows Democrats will continue playing offense on ObamaCare, which for years was a political liability for the party. The 2010 law was by and large unpopular until the GOP nearly eradicated it during the last Congress. (Bolton, 10/16)

Maryland Rep. Elijah E. Cummings died early Thursday at Johns Hopkins Hospital due to complications from longstanding health challenges, his congressional office said. He was 68. A sharecropper’s son, Cummings became the powerful chairman of a U.S. House committee that investigated President Donald Trump, and was a formidable orator who passionately advocated for the poor in his district that encompassed a large portion of Baltimore. ... Throughout his career, Cummings used his fiery voice to highlight the struggles and needs of inner-city residents. He was a firm believer in some much-debated approaches to help the poor and addicted, such as needle exchange programs as a way to reduce the spread of AIDS. (Witte, 10/17)

Cummings, who had been absent from Capitol Hill in recent weeks while under medical attention, had health issues in recent years. In 2017, he underwent an aortic valve replacement. The procedure, which aides described as minimally invasive in Cummings’ case, is used to correct narrowing of the aortic valve in the heart. The surgery led to an infection that kept him in the hospital longer than expected. He was later hospitalized for a knee infection, but he said this summer that his health was fine. Cummings had not participated in a roll call vote since Sept. 11. His office said recently that he had undergone a medical procedure but the seriousness of his condition had not been known. (Barker, 10/17)

House Democratic leaders are adjusting their signature bill to lower drug prices in an effort to address progressive concerns that a previous version of it was not strong enough. The underlying bill will allow the Secretary of Health and Human Services to negotiate lower prices for up to 250 drugs per year, and the savings will apply to people in private insurance plans as well as Medicare. (Sullivan, 10/16)

The panel also plans to add a new section to the legislation, H.R. 3 (116), aimed at restraining pharmaceutical companies’ ability to launch new drugs at astronomical prices. Under the proposed language, any medicines that come to market at list prices higher than the U.S. median household income and don't have competition could be evaluated for direct government negotiation as soon as the following year. These drugs would not count toward the annual minimum that must be negotiated. (Cancryn and Karlin-Smith, 10/16)

An amended version of H.R. 3 (116) released this morning contained new exceptions that could significantly reduce how many drugs will be subject to new rebates in Medicare Part D when their prices rise faster than the rate of inflation. Drugs would be exempted from the penalties if the HHS secretary determines their availability is "essential to the health of beneficiaries" or that "extenuating circumstances" caused the price increase. (Karlin-Smith, 10/16)

House leaders are seeking to solidify support from progressives for the bill, which represents one of the party's top domestic priorities and a major campaign issue. “I want to stress that this is a floor,” Pallone said Wednesday of the minimum number of drugs required to be negotiated by the bill. “The secretary can do a lot more and hopefully will.” (Clason, 10/16)

In other news from Capitol Hill —

The top Republican on the House Ways and Means Committee on Wednesday rejected a proposal from the Democratic chairman of the panel to protect patients from surprise medical bills, saying a different approach is needed to solve the problem. “I think we ought to go back to the drawing board rather than pursue that,” Rep. Kevin Brady (R-Texas) told reporters when asked about the proposal from Chairman Richard Neal (D-Mass.). (Sullivan, 10/16)

Some public-health experts urged lawmakers Wednesday to pass legislation aimed at curtailing the use of e-cigarettes, particularly in teenagers and young adults, while others cautioned that such steps could backfire. A House bill would ban flavors in all tobacco products and prohibit advertising e-cigarette use to youths, among other steps. It comes amid a wave of about 1,300 recent U.S. respiratory illnesses linked to vaping and after the Trump administration said it intends to ban flavored e-cigarettes. (Burton, 10/16)

House appropriators pressed a top CDC official in a hearing this morning about what policies and funding the public health agency needs to get more answers on marijuana and THC vapes. Some lawmakers at the House Appropriations health subcommittee asked whether it would help to reschedule marijuana and make it easier to conduct research. (Owermohle, 10/16)

An increasing number of injuries and deaths tied to vaping is prompting Congress to debate legislation to restrict sales of nicotine e-cigarettes — but lawmakers are less clear on what to do about marijuana, even though most people who fell ill said they vaped THC. Lawmakers have surer footing on nicotine e-cigarettes, given their well-documented problems with use by young people. Shifting societal views on marijuana could complicate how to handle the drug’s role in the national outbreak. (Siddons, 10/16)

Health officials say a teenager in Montana has died of a lung disease associated with a national outbreak of vaping-related illnesses. The Montana Department of Public Health and Human Services said Tuesday it was the state's first recorded death connected to e-cigarette use. (10/16)

Two more Minnesotans have died from vaping-related lung illnesses, raising the state’s toll to three and prompting health officials to issue new warnings about vaping illegal cannabis substances. The state’s first death was reported last month by the Minnesota Department of Health. So far, the state has seen 73 confirmed or probable cases of severe lung injury associated with vaping, with an additional 32 cases under review. (Howatt, 10/16)

A new study suggests that vaping e-liquids, specifically propylene glycol and glycerin, may lead to some inflammation in the lungs -- but more research is needed to determine just how much inflammation may occur over a prolonged period of time. The study, published in the journal Cancer Prevention Research on Wednesday, found that in people who had never smoked, after using e-cigarettes just twice daily for a month, levels of propylene glycol in their system was linked with changes in inflammatory cell counts in their lungs, although the magnitude of changes was small. (Howard, 10/16)

Calling vaping-related illnesses among Missouri’s youth an epidemic, Missouri Gov. Mike Parson on Tuesday signed an executive order mandating education to discourage usage. Thousands have been sickened across the country due to vaping-related illnesses. In Missouri, there have been 22 reported illnesses and one death as of Oct. 4. The majority of those cases involve people between the ages of 15 and 24. (Driscoll, 10/16)

It’s now a misdemeanor in Ohio to sell or provide tobacco or vaping products to people under 21. Ohio’s health director says the change is meant to prevent people from starting the habits, to protect young brains from the possible negative effects of nicotine and to create a bigger age gap between minors and the people who might buy cigarettes or vapes for them. Ohio’s statewide Tobacco 21 law goes into effect Thursday, making it a misdemeanor to sell or provide cigarettes and other tobacco products, vaping devices and vape liquid to anyone younger than 21. (Viviano, 10/16)

One of California's largest hospital systems has reached an agreement to settle a massive class-action lawsuit over allegations that it abused its market power and has been overcharging patients for medical bills. Wednesday's announcement of an agreement offered no details but came just in time to avoid a trial, with attorneys preparing to give opening statements Thursday. (Gecker, 10/16)

The details of the settlement are confidential. Court hearings for preliminary approval of the agreement will likely take place in February or March, said San Francisco Superior Judge Anne-Christine Massullo, who is overseeing the case. (Ho, 10/16)

There were audible cheers from the jury following the announcement that the trial, which was expected to last three months, would not continue. Officials with the attorney general’s office and Sutter Health declined requests for comment. (Gold, 10/16)

Sutter had long been viewed as a classic example of a hospital system that grew too big, leading to higher prices in the region. While hospital care for a heart attack costs around $25,000 in San Francisco, for example, the price is closer to $15,000 in parts of Los Angeles. Sutter denied that it engaged in any activities that harmed competition in the region. (Abelson, 10/16)

The settlement would resolve a lawsuit filed in 2014 by a trust that pays health care costs on behalf of the United Food and Commercial Workers union and self-funded employers, as well as a separate suit filed in 2018 by Attorney General Xavier Becerra. The case became a symbol of concern over big hospital chains that require insurers to access their networks on an all-or-nothing basis and make it harder for plans to steer patients to lower-cost competitors. (Colliver, 10/16)

Jonathan Grossman, an antitrust attorney with Cozen O'Conner who isn't involved in the lawsuit, said he expects the settlement in this case will likely include a relatively small amount in damages in exchange for Sutter's commitment to end the practices that were the subject of the litigation. The downside of a settlement is that it does not offer a legal precedent on hospital or insurer practices like a trial would, Grossman said. (Bannow, 10/16)

Consumer advocate Anthony Wright, leader of Health Access California, welcomed the news that remedies or relief might be coming soon for consumers in the north state. “This is a lawsuit that has been watched by hospital chains nationally, and I think it will make health care providers think twice about some of these anti-competitive practices,” Wright said. “Obviously, a lot depends on the details of the settlement, which we won’t know for many months, I believe, but even just the fact that the lawsuit was brought by Attorney General Becerra, by the union and business plaintiffs, that sends a really important signal not just to Sutter but nationwide to the health care industry.” (Anderson, 10/16)

Kaiser Permanente and a union representing 57,000 of its employees ratified a new contract that will create a $130 million workforce development program and boost pay, the union announced Wednesday. The Oakland, Calif.-based integrated health system and the SEIU-United Healthcare Workers West union reached a four-year agreement to recruit, train and place thousands of individuals in licensed healthcare positions; establish 3% annual raises; promote cooperation between frontline workers and managers; ban subcontracting and limit outsourcing of current positions; and form a committee overseeing technology implementation and staffing. (Kacik, 10/16)

“Our new contract recognizes the skill and dedication we bring to our work, and the guaranteed raises and protected benefits give us the peace of mind to focus on caring for our patients,” said Jessica Rodriguez, an emergency department technician at Kaiser Permanente in Oakland. “We are also proud to have negotiated an agreement that is focused on the future and making sure patients have access to highly skilled and trained caregivers in the years to come.” Rodriguez is a member of Service Employees International Union-United Healthcare Workers West. SEIU and two other international labor groups — the Office and Professional Employees International Union and the International Federation of Professional and Technical Engineers — have 83,000 members in the Coalition of Kaiser Permanente Unions.(Anderson, 10/16)

General Motors and the UAW reached a proposed tentative agreement on a new contract Wednesday, the 31st day of a nationwide strike. The proposal does not end the strike. Workers were told to remain on the picket line at least until the union's National GM Council reviews the proposal Thursday and decides whether to submit it to members for ratification. (LaReau, 10/16)

Families of law enforcement officers killed in the line of duty will continue to receive health benefits under a new law Gov. Tony Evers signed Wednesday. The legislation requires Wisconsin municipalities to continue to pay the health insurance premiums they had paid for the public workers instead of forcing families to apply for more costly COBRA health insurance, which is a federal program. (Beck, 10/16)

UnitedHealth Group Inc. will lose two large customers in its retiree health-care business next year, a setback for the insurer in an increasingly competitive marketplace for senior medical benefits. Verizon Communications Inc. will no longer offer UnitedHealth plans to retired workers in its western region starting in 2020, according to people familiar with the matter. A state-sponsored plan for some retired Alabama public employees also will drop the insurer’s coverage, according to information posted on an Alabama government website. (Tozzi and Moritz, 10/16)

A leading medical-device industry lobbying group has launched a new advocacy center focused on digital health. The Advanced Medical Technology Association's new Center for Digital Health will convene a group of companies from its membership to develop and advocate policy positions on issues affecting digital medical technology, such as data privacy, cybersecurity and artificial intelligence, the trade group said earlier this week. (Cohen, 10/16)

The Health Information Technology Advisory Committee may sharpen its focus on price transparency next year, members discussed Wednesday during the group's monthly meeting. Price transparency has proved a complicated topic. But it has come up several times this year, according to Carolyn Petersen, co-chair of HITAC and senior editor for Mayo Clinic's health information website. (Cohen, 10/16)

Eager for changes at the Department of Veterans Affairs, President Donald Trump toyed early on with issuing an executive order to close parts of the VA health system without consulting Congress, according to an upcoming book by his former VA secretary. In the book, obtained by The Associated Press, David Shulkin describes a March 6, 2017, conversation in the Oval Office where Trump explored ways his administration could act quickly to shutter government-run VA medical centers that he viewed as poorly performing. (Yen, 10/16)

In other news from the administration —

Nearly a million children could lose their automatic eligibility for free school lunches under a Trump administration proposal that would reduce the number of people who get food stamps. The U.S. Department of Agriculture has released an analysis that says as many as 982,000 children could be affected by the change. About half would have to pay a reduced price of 40 cents for school lunch and 30 cents for breakfast. Around 40,000 would need to pay the full price, which varies depending on the district. (Choi, 10/16)

The nation’s three largest drug distributors and two manufacturers have agreed with multiple states on a framework to resolve thousands of opioid cases with a settlement worth nearly $50 billion in cash and addiction treatments, according to three people familiar with the negotiations. The agreement would release AmerisourceBergen, Cardinal Health and McKesson Corporation, which together distribute about 90 percent of the country’s medicines, along with Johnson & Johnson and Teva, the Israel-based manufacturer of generic drugs, from a rapidly growing list of more than 2,300 lawsuits that they face in federal and state courts. (Hoffman, 10/16)

The distributors, accused of failing to halt and report suspicious drug orders, are pushing for a settlement to be agreed to before the trial begins Monday, one source said. The second source added that a sticking point was compensation for lawyers who typically are paid a percentage of settlements and represent many of the state and local plaintiffs. (10/16)

News of the discussions comes as jury selection was set to get underway Wednesday in Cleveland, before opening arguments in the federal trial Oct. 21. Some state attorneys general asked the judge in the case to delay the trial as they work on a settlement, but their request was denied, according to The Washington Post. Some of the defendants also filed a motion Wednesday to postpone the trial “due to eve-of-trial prejudicial publicity,” according to the case docket. The motion, though, is sealed. (Tirrell, 10/16)

The CEOs of McKesson Corp., Cardinal Health Inc. and two other companies seeking to settle legal claims over their handling of opioid painkillers were summoned to meet with a judge in hopes of hammering out a final deal, according to two people familiar with the matter. U.S. District Judge Dan Polster in Cleveland, who is overseeing the first federal trial over the U.S. opioid epidemic, demanded that the chief executive officers appear in his court on Friday to discuss their settlement proposals, according to the people, who asked not to be identified because the negotiations are confidential. (Feeley and Griffin, 10/17)

In other news on the opioid crisis —

Use of opioid-alternative pain medications is surging as the U.S. tries to wean off the addictive painkillers, giving physicians concern that the opioid crisis will be substituted by a new prescription drug epidemic, according to a new report. Nearly two-thirds of primary-care physicians shared that sentiment while nearly three-quarters worry that chronic pain patients will turn to illicit drugs if they do not have access to prescription opioids, according to a new report from Quest Diagnostics, which polled 500 primary-care doctors and analyzed 4.4 million lab test results. (Kacik, 10/16)

Despite guidance from the federal government, most state Medicaid programs continue to deny hepatitis C treatments to beneficiaries, although more states are gradually easing restrictions, according to a new analysis. Between November 2018 and July 2019, six states have either removed or eliminated restrictions based on a patient’s stage of liver disease, one state loosened rules that required patients to demonstrate they have not abused drugs or alcohol for a period of time before starting treatment, and six states scaled back prescribing restrictions for health care providers. (Silverman, 10/16)

Gina Diaz-Nino considers herself an extrovert. But since her mouth began deteriorating after years of methamphetamine use and two fights, she receded into the shadows. Her teeth are yellow, crooked and browning around the corners. Most of her top teeth are either chipped, missing or decaying. When they fell out, they crumbled like chalk. “I’ll open my mouth and oh — drug addict,” Diaz-Nino said. “It’s there. It’s like a past that you’re trying to erase and you can’t because you dug yourself that deep and you can’t get yourself out by yourself.” (Tobias, 10/16)

Dozens of people spoke against the proposed $7.85 billion Medicaid block grant amendment Tuesday, Oct. 15, during a hastily-scheduled public hearing at the University of Memphis. And nearly a hundred others clapped and cheered at their outrage and frustration. “This is clear, people will die if this proposal goes into effect, and they will be our poorest, oldest, most vulnerable neighbors,” said Rachel Ledbetter, a third-year law student in Memphis who spoke candidly that the state should be expanding Medicaid plans just as 36 other states have done instead of looking for ways to save money. (Roberts, 10/16)

The Michigan Department of Health and Human Services plans to host a series of public forums this month and in November to help people understand the new Medicaid work requirements that take effect Jan. 1.  Starting in 2020, low-income Michiganders ages 19-61 who receive Medicaid benefits under the Healthy Michigan Plan must prove that they are working at least 80 hours each month or that they are trying to find a job, are undergoing job or vocational training, are working in an internship, enrolled in school, undergoing substance abuse treatment, community service or are otherwise exempt. (Shamus, 10/16)

Americans are already spending millions on CBD gummies and CBD lotions — but that’s chump change, at least if you ask the pharmaceutical companies betting that a CBD-based prescription medicine will ultimately be far more lucrative. A number of pharmaceutical companies are shepherding their CBD-based products through the lengthy and expensive FDA approval process on exactly that bet — and some are further along than others. (Florko, 10/17)

When it comes to hemp and cannabis, there is much confusion among the public about labels, because of how science and the law define these substances. For the average person, it’s almost like having too many cousins with the same first name. Another source of confusion is that recreational use and medical use of marijuana — though they are different things — are both gaining legal and social acceptance in the United States. (Kanne, 10/16)

Suicide death rates among teenagers and young adults have increased at an alarming pace in the past decade, according to a new government report. While suicide has steadily become more common across the population, the increase among youths has outpaced all other age groups. For many years, suicide among youths was relatively rare and its frequency relatively stable. But from 2007 to 2017, the number of suicides among people ages 10 to 24 suddenly increased 56 percent — from 6.8 deaths per 100,000 people to 10.6, the new report shows. (Wan, 10/17)

Violent death, including homicide and suicide, is a major cause of premature death for the age group. Around 2010, the death rate of suicides among adolescents and young adults surpassed the rate of homicide deaths, according to the report. “The chances of a person in this age range dying by suicide is greater than homicide, when it used to be the reverse,” said Sally Curtin, a statistician at the CDC and an author of the report. “When a leading cause of death among our youth is increasing, it behooves all of us to pay attention and figure out what’s going on.” (Abbott, 10/17)

While the overall proportion of teens reporting suicidal thoughts or plans declined for all racial and ethnic groups during the study period, the proportion of black teens attempting suicide surged by 73%. “Whatever is happening to result in a downward trend among teens in the general population is missing black teens,” said Michael Lindsey, lead author of the study and executive director of the McSilver Institute for Poverty Policy and Research at New York University. (Rapaport, 10/16)

In other mental health news on suicides —

The death by suicide suffered on Tuesday by the New York Police Department was the second in the U.S. within 24 hours, continuing a worrying trend among law enforcement. It was the NYPD's 10th so far this year, and it came on the heels of an officer in Montgomery County, Maryland, originally presumed murdered, dying by suicide less than a day earlier. (Barr, 10/16)

The forecast looms like a portent of doom. From 5.8 million people today, the number of Americans with Alzheimer’s disease is projected to reach 13.8 million by 2050, overwhelming caregivers and the health care system — a prospect that has produced alarm bordering on panic about an unstoppable Alzheimer’s tsunami. Reality, however, is far more nuanced: Medical breakthroughs and other factors could dramatically reduce that number — though, paradoxically, such advances could also increase the prevalence of this most common form of dementia. (Begley, 10/17)

Doctors are urging Americans to get their flu shots right away after a bad flu season in Australia has raised concerns about the coming season in the U.S. Public health experts often look to the Southern Hemisphere’s influenza patterns for clues of what’s to come. This year Australia saw an earlier-than-usual peak of flu cases and had a tough season overall. The predominant flu strain in Australia, as in recent years in the U.S., was the H3N2 virus, which generally causes more severe illness, particularly among the elderly, and more hospitalizations and deaths. (Reddy, 10/16)

Public health experts trying to predict the severity of the upcoming flu season in the U.S. often look to the Southern Hemisphere for clues. Here’s the word from Down Under, where winter recently ended:Brace yourself, America. (Oliviero, 10/16)

Carl and Kerri Schwartz say they have good medical reason for not vaccinating their disabled 11-year-old son, Thorn, and until recently his local public school went along with their family doctor's advice. That changed, the Schwartzes said, when New York state did away with religious exemptions for vaccines in the middle of a measles outbreak, and then clamped down on medical exemptions like theirs. Thorn is now barred from his school in Fairport while his parents challenge the district's rejection of his exemption. (10/16)

Educators refer to teens like Alex as "twice exceptional." "I have a large degree of skill in almost every subject of learning," says Alex, who is 16. "But I also have autistic spectrum disorder." For Alex, this dual identity has meant both opportunity and frustration. He has skipped two grades so far, and began taking college math courses last year, when he was still 15. But when he was younger, Alex's underdeveloped social skills caused him a lot of grief. (Hamilton, 10/16)

When it comes to concussions in high school sports, there is good news and bad news, a new study suggests. The rates of football practice concussions and recurrent concussions across all sports have gone down in recent years, according to the study, published in the journal Pediatrics on Tuesday. The bad news: Concussion rates increased in football games. (Howard, 10/15)

More than 200 volunteers recently gave up their Saturday to labor in a Southwest Baltimore schoolyard constructing a modern playground they hope will promote play — and level the playing field. Those behind the effort believe schools with many low-income black students, such as North Bend Elementary/Middle School, have been shortchanged for years when it comes to monkey bars, climbing walls and swings, and the known health benefits of playgrounds. They are making a concerted effort to correct that. (Cohn, 10/16)

Kaiser Health News: ‘Fear Of Falling’: How Hospitals Do Even More Harm By Keeping Patients In Bed
Dorothy Twigg was living on her own, cooking and walking without help until a dizzy spell landed her in the emergency room. She spent three days confined to a hospital bed, allowed to get up only to use a bedside commode. Twigg, who was in her 80s, was livid about being stuck in a bed with side rails and a motion sensor alarm, according to her cousin and caretaker, Melissa Rowley. “They’re not letting me get up out of bed,” Twigg protested in phone calls, Rowley recalled. (Bailey, 10/17)

Toxic heavy metals damaging to your baby's brain development are likely in the baby food you are feeding your infant, according to a new investigation published Thursday. Tests of 168 baby foods from major manufacturers found 95% contained lead, 73% contained arsenic, 75% contained cadmium and 32% contained mercury. One fourth of the foods contained all four heavy metals. (LaMotte, 10/17)

When scientist Giulia Poerio was a little girl, she says she would experience this very peculiar — and distinct — feeling: "a warm, tingling sensation that starts at the crown of the head, almost like bubbles on the scalp. "Even more peculiar? It was triggered by specific sounds or gentle movements, "like watching my mom brush her hair or put makeup on," she recalls, or having her feet measured for school shoes or a teacher explain something to her very carefully. (Kowng, 10/17)

More than 30 million Americans have osteoarthritis, a chronic condition of the joints that affects mainly older people. Many patients seek relief from the pain it causes by getting injections of steroids into their hips and knees. (Goldberg, 10/17)

Florida's mental health system is underfunded and needs to be overhauled, with better coordination between providers, law enforcement and educators, the commission investigating last year's high school massacre recommended to the legislature Wednesday. The Marjory Stoneman Douglas High School Public Safety Commission, meeting in Orlando, found that the state's mental health system is too often a revolving door. (10/16)

New state policies born out of the Parkland school shooting have drawn the scrutiny of two national nonprofit research organizations, which have argued in recent reports that the strategies could lead to violence or discrimination against students. The Aspen Institute, a nonpartisan think tank based in Washington, D.C., and the Southern Poverty Law Center released reports this month criticizing Florida’s response to the Feb. 14, 2018, shooting at Marjory Stoneman Douglas High School. (Bakeman, 10/16)

In 2017, Robert Wayne Johnson had hit a rough patch. The married father of five had lost his job and was living on the streets. He was also grappling with mental illness, according to his family. The 51-year-old couldn’t afford about $2,500 in municipal court fines and fees accumulated over three years for infractions such as driving without a license that he owed in Kemper County, a rural Mississippi community roughly 125 miles east of Jackson. So a judge sentenced Johnson to a two-day stint in jail instead. Johnson never made it out alive. (Bellware, 10/16)

Johns Hopkins All Children’s Hospital in St. Petersburg is bringing back a prominent heart surgeon, calling it the “first step” to restoring its shuttered heart institute. Dr. James Quintessenza will return as chief surgeon and co-director of the heart institute, which stopped performing surgeries this past year amid fallout from a Tampa Bay Times investigation that found serious problems with the department. (Colombini, 10/16)

If you are among the Californians who buy your own health insurance, a surprise may await you as the enrollment period for 2020 coverage opens this week. Starting Jan. 1, California will become the first state to offer subsidies to middle-income people who make too much money to qualify for the federal tax credits that help consumers buy health coverage through Covered California, the state’s Affordable Care Act insurance exchange. (Wolfson, 10/16)

Missouri has more than 10,000 untested rape kits sitting on shelves in police departments and hospital — some have been there for decades — but the state is finally set to have a full inventory of those kits by the end of the month. Once the inventory is complete, Attorney General Eric Schmitt’s office can move forward with creating an electronic database to not only keep track of the untested kits, but to help prosecute rapists and provide justice for victims. (Driscoll, 10/16)

A prisoner who suffers from several mental health disorders and has been held in solitary confinement for more than 12 years is one of four who filed a class-action lawsuit against the state of North Carolina on Wednesday, saying the treatment violates the state constitution's ban on cruel and unusual punishment. (10/16)

More than $490,000 is being doled out to seven Florida counties, including Hillsborough and Pinellas, as part of a national effort to try to eradicate HIV and AIDS in the next 10 years. The funding is made possible as part of the Ending the HIV Epidemic initiative, which was announced by the Trump administration this year. Money became available for counties to spend Oct. 1. (Sexton, 10/16)

A proposed ban on so-called conversion therapy in Utah is in danger of being derailed after the influential Church of Jesus of Christ of Latter-day Saints came out Tuesday night in opposition, just months after it said it wouldn't stand in the way of a similar measure under consideration. The church said in a statement that the regulatory rule prohibiting Utah psychologists from engaging in the discredited practice with LGBTQ minors would fail to safeguard religious beliefs and doesn't account for "important realities of gender identity in the development of children." (10/16)

Another case of a mosquito-borne illness called Jamestown Canyon Virus has been identified in New Hampshire. The diagnosis, which was made in the Lakes Region, is the second case of so-called JCV in the state this year. The first was in Kingston in August. (Ropeik, 10/16)

In a state where advocates for transgender health still shudder remembering HB2, the “bathroom bill” of 2016, area hospitals have stepped up in their treatment of LGBTQ patients. North Carolina boasted 24 “leader” hospitals which received a perfect score in the 2019 Health Equality Index, a survey from a national LGBTQ advocacy group. Two other N.C. hospitals were “Top Performers” with scores of 80-95, and three other hospitals in N.C. also participated and received lower scores in the Human Rights Campaign index. (Duong, 10/17)

A northwestern Indiana hospital system is warning more than 68,000 patients that their personal information, including Social Security numbers and health records, may have been exposed during a data breach. Methodist Hospitals has been mailing letters to patients detailing the steps they can take to safeguard themselves against possible fraud, The (Northwest Indiana) Times reported Wednesday. (10/16)

The Medical College of Wisconsin and Froedtert Hospital announced Wednesday the public launch of a wide-ranging Hope to Health Campaign. The aim is to raise $225 million by December 2020 to "drive health innovation" in Milwaukee and across the state. (Glauber, 10/16)

The city of Covington has called for a company to shut down its local medical sterilization plant until it can reduce its emissions of a cancer-causing gas. In a Wednesday news release, the city said preliminary data from air pollution testing found ethylene oxide levels that were particularly high in two neighborhoods close to the BD sterilizing plant in Covington, 35 miles east of Atlanta. (Miller, 10/16)

The Affordable Care Act (ACA) has substantially reduced the number of uninsured Americans, increased access to care, reduced uncompensated care for hospitals and other providers, and largely eliminated discrimination against the sick in private health insurance markets. Still, significant problems remain: 30 million people in the United States remain uninsured, while many others are underinsured — meaning they lack adequate financial protection against high health care costs. (Blumberg, 10/16)

Two days ago, Vice published a story about Tamara Adrine-Davis, a resident of Cleveland Heights, Ohio, who is facing jail time because of housing code violations. Adrine-Davis, who is 57 and uses a wheelchair, hasn’t been able to raise the $8,000 needed for home repairs, such as fixing a step on her front porch. The story raises questions about housing code enforcement, which we studied in Memphis, Tennessee, last year. What are these codes meant to promote—the health of occupants and the public or community aesthetics? How do these codes vary from place to place? And who is affected by these codes and decisions about how to enforce them? (Stacy and Schilling, 10/9)

In settings in which reimbursement depends on test location, increasing hospital-based payments correlated with greater proportions of outpatient NCTs performed in the hospital-based outpatient setting. Site-neutral payments may offer an incentive for testing to be performed in the more efficient location. (Masoudi, 10/14)

Ample research has documented the lower visibility and success of women compared with men in academic medicine. Against this setting, social media platforms such as Twitter offer academics opportunities to promote their research, network professionally, gain visibility, and, in turn, foster opportunities for career advancement. These opportunities are particularly critical in health policy and health services research, in which dissemination of policy-relevant research and engagement with health care decision-makers impacts academic influence, recognition, and promotion. Herein, we describe gender differences in Twitter use and influence among health services researchers. (Zhu, 10/14)

On August 14, 2019, the Trump administration published a final rule to broaden the programs the federal government will consider in public charge determinations to include Medicaid coverage for non-pregnant adults and certain previously excluded nutrition and housing programs. (Tolbert, Artiga and Pham, 10/15)

Can eating tomatoes improve sperm quality? In a randomized placebo-controlled trial, British researchers tested the effect on sperm of lycopene, a red pigment found in tomatoes, watermelons, pink grapefruits and other red-tinted fruits and vegetables. The scientists divided 56 men ages 19 to 30 into two groups. For 12 weeks, one group took a daily pill containing 14 milligrams of lactolycopene, a combination of whey protein and lycopene that makes the lycopene easier to absorb. (Bakalar, 10/15)

Polls lately have begun to suggest that Sen. Elizabeth Warren (D-Mass.) might have found a glide path to the Democratic presidential nomination. But on Tuesday night, she hit some turbulence. What’s troublesome for Warren is not the fact that she found herself the chief target of attacks from her rivals in the fourth Democratic debate; that was, in a sort of backhanded way, a tribute to her newfound status as a leader — perhaps the leader — in a crowded field of candidates. More ominous was her repeated evasion of a question put to her by moderator Marc Lacey of the New York Times: Would her Medicare-for-all proposal require an increase in taxes on the middle class? (Karen Tumulty, 10/16)

Tuesday’s Democratic debate showed that Bernie Sanders still has some pep in his step, Joe Biden needs a better answer on his son Hunter’s business dealings, and Minnesota Senator Amy Klobuchar deserves more media respect. But the most important news was Senator Elizabeth Warren’s determined refusal to say if her plans would require taxes to increase on the middle class. Ms. Warren, the new leader in the polls, was given at least six chances to answer yes or no. She ducked every time. “Will you raise taxes on the middle class to pay for it, yes or no?” asked one of the media questioners. (10/16)

Eventually, Elizabeth Warren is going to need to find a different way to answer the Medicare question. A central part of last night’s debate was the criticism she received from rivals over her unwillingness to talk about whether middle-class taxes will rise under her plan. Warren refused to answer the question, implicitly arguing that it’s irrelevant. (David Leonhardt, 10/16)

Sesame Street has a new puppet and a new human character, both of whom have parents with a “kind of sickness called addiction.” The puppet’s name is Karli and, according to Elmo, Karli’s mommy was away for a while and is home now. Sesame Street's new human child character, Salia, explains that drug use disorder is “Getting attracted to something so you keep doing it over and over again. It makes people feel like they need drugs and alcohol to feel ok. And they can’t stop doing it.” (Marjorie S. Rosenthal, 10/16)

Matthew Knowles, the father of the artists Beyoncé and Solange, recently announced that he had been told that he has a breast cancer caused by a BRCA2 gene mutation and that his children have a 50 percent chance of inheriting it. In 2007, my mother was in a similar position. She learned after receiving a breast cancer diagnosis at age 42 for a second time — her first bout with cancer came when she was 28 — that she carried a BRCA2 mutation. It meant that as her daughter, I had even odds of having inherited it from her. (Erika Stallings, 10/16)

As the country delves into the throes of an impeachment inquiry and a tumultuous election year, another threat to our communities looms large. The 5th Circuit Court of Appeals is currently deliberating whether the Affordable Care Act (ACA) is unconstitutional, leaving over 130 million Americans’ health care hanging in the balance. The decision could be made as early as this month. The impact will be devastating to communities around the country, and hits home particularly hard. If the ACA is repealed, millions of Pennsylvanians’ access to affordable health coverage is at stake. (Rosalina Jowers, 10/17)

Surprise medical bills can have a long-lasting, financially devastating effect on patients’ lives.No one who visits an emergency room with a life-threatening medical crisis, or who is recovering from a major surgery, wants to be blindsided with a massive bill weeks later. But these bills arrive all too often, and I agree with President Donald Trump: Congress should act to end surprise medical billing. (Scott DesJarlais, 10/16)

The federal government regulates methadone—limiting distribution to specialized clinics, which are mostly in cities. Yet over the past two decades, opioids have spread rapidly to the suburbs and rural communities. (Steve Hamm, 10/16)

It’s common sense to look under the hood of a used car and at least drive it around the block before you buy it. So, why take at face value what politicians say about plans they propose? Just like with any consumer transaction, you have to look beneath politicians’ claims about a proposed program or policy and see what you will really get. (Anne Ferrell Quillen, 10/17)

Each patient’s caregiving must be individualized to meet the specific needs of that person. This is why nursing staff ratios are such a fiercely debated topic in the health care industry. It is not a question of whether patients are receiving the high-quality care they trust our nurses to provide, but rather of why the voices of nurses are not being heard when they say their patients are not being properly cared for. (Jacqueline Rivera, 10/17)