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Faced with a nationwide epidemic of heroin and prescription drug abuse, the Obama administration announced Wednesday that it will take steps to increase access to drug treatment and expand the training of doctors who prescribe opiate painkillers. The efforts ... are likely to have a modest effect on the steep increase in heroin and prescription drug overdoses, which now kill more people than car accidents each year, and the barriers to treatment that many addicts face. (Mufson and Zezima, 10/21)

Obama outlined a plan that includes better training for doctors and other health care professionals to handle drug abusers and easier access for treatment. The administration is also launching a media advertising campaign designed to make people aware of the dangers of heroin and abuse of prescription drugs. (Jackson, 10/21)

The White House memorandum will require federal agencies to train doctors and nurses who work for the government on how to properly prescribe opioid medications – an area where health care professionals often receive little training, which can lead to overprescribing. The agencies will also be required to identify and address any barriers in providing medication-assisted treatment to those with opioid addictions. (Zanona, 10/21)

President Obama came on Wednesday to a hotbed of one of the deadliest epidemics in American history and, as he had at a prison in Oklahoma in July, saw a life he might have led in the stories of drug addicts and their parents. “I did stuff, and I’ve been very honest about it,” he said, referring to his admissions of illegal drug use in his youth. “So when I think about it, there but for the grace of God.” (Harris, 10/21)

Traveling to a region in the throes of a drug-abuse crisis, President Obama promised Wednesday to use his bully pulpit and federal programs to try to combat the "epidemic" of heroin use and prescription-painkiller abuse that is upending communities across the country. "This crisis is taking lives; it's destroying families and shattering communities all across the country," Obama said at a panel discussion on opioid drug abuse. On stage at a crowded community center, Obama heard from advocates, health-care workers, law enforcement officials, and policymakers. (Hennessey, 10/22)

President Obama traveled to that [West Virginia] today, where he took part in a community forum on those very problems. High schoolers from our Student Reporting Lab in Richwood, West Virginia, attended the event. They interviewed members of the community affected by all this. (10/21)

The death toll from opioids in Massachusetts continues to rise unabated despite months of intensifying efforts to combat the substance abuse crisis, new data revealed Wednesday. Estimates from the state Department of Public Health show that during the first half of 2015, the number of deaths from opioid overdoses — 684 — increased about 6 percent from the same period last year. (Freyer, 10/22)

In addition to urging Congress to offer Puerto Rico the new type of bankruptcy protection, the administration is also recommending that Congress broaden access to the island’s Medicaid program, a move that would pump money into its teetering health-care system. It also wants the island workers to have access to a broader array of federal tax credits, including the earned-income tax credit, in an effort to pump up its dismal 40 percent labor force participation rate. (Fletcher, 10/21)

The White House made its most forceful call for federal intervention in Puerto Rico’s debt crisis on Wednesday, outlining legislation to restructure more of the $72 billion in debt issued by the commonwealth. ... The plan further recommends an overhaul of the island’s Medicaid program and access to the earned-income tax credit, a popular tax break designed to boost workforce participation among the poor, for Puerto Rico. (Kuriloff and Timiraos, 10/21)

The decision to back Ryan by the House Freedom Caucus, a group of nearly 40 lawmakers that has risen in power and stature since its founding this year, came after the Ways and Means Committee chairman spent much of his day courting its support. (DeBonis and Costa, 10/21)

Rep. Paul Ryan (R-Wis.) said Tuesday he would run for speaker of the House--under certain conditions. The job could yield many headaches, but he'll at least have the last laugh over Newt Gingrich, the former speaker who has criticized Ryan's proposals to overhaul Medicare. ... Throughout his 16 years in Congress, he has advocated steadily for profound changes in the way Americans receive help from the government. He has sought to introduce market forces into federal programs, give state authorities more say over how those programs are administered, and force recipients of welfare to submit to careful monitoring by state-appointed caseworkers. (Ehrenfreund, 10/21)

One of Paul Ryan’s conditions for becoming speaker is that he be able to spend time with his family. But when it comes to federal policies on family leave, Ryan has opposed virtually every measure proposed over the past several years. In 2009, for instance, Ryan voted against the Federal Employees Paid Parental Leave Act, which would have allowed federal employees to substitute up to four weeks of available paid leave to take parental leave. The bill passed a then-Democratic House with 24 Republican votes, but the legislation never made it to the Senate floor. (Levine, 10/21)

Rep. Pat Tiberi is planning to run for the top slot on the House Ways and Means Committee if Rep. Paul Ryan becomes the next speaker. The Ohio Republican's move could tee up a major battle for the powerful tax-writing gavel. Texas Rep. Kevin Brady is also expected to make another run for the position. (Palmer and Sherman, 10/21)

House Republicans are pursuing a more narrow version of an ObamaCare repeal bill, a move that the top budget leader says will ensure smoother sailing in the Senate. The House Rules Committee decided Wednesday night to limit the scope of its reconciliation bill – a budget tool rolls back ObamaCare – by adopting an amendment from Budget Committee Chairman Tom Price (R-Ga.). (Ferris, 10/21)

Meanwhile, House GOP leaders are considering scheduling a Friday vote on a debt limit bill produced by the conservative Republican Study Committee. It would establish procedures designed to force the House to vote on $3.8 trillion in spending cuts over the coming decade, to add teeth to the non-binding budget Republicans adopted this spring. It would also mandate a vote on a constitutional amendment to require a balanced budget and would impose a ban on new regulations. ... The White House has made it clear that any increase in the so-called debt limit must be "clean" of other policies that would make it appear that Obama is negotiating away concessions in exchange for the must-pass legislation. In 2011, before his re-election, Obama gave $2.1 trillion in spending cuts in exchange for a comparable increase in the debt cap. (Taylor, 10/21)

Hillary Rodham Clinton warned Wednesday that two major health insurers preparing multibillion dollar acquisitions could tip "the balance of power" too far away from consumers. The Democratic presidential candidate said in a statement she had "serious concerns" with the proposed acquisition of Cigna by Blue Cross-Blue Shield insurer Anthem, and plans by Aetna to acquire Medicare Advantage coverage provider Humana. (Thomas, 10/21)

In her statement, Clinton said the companies should "commit to passing on savings and efficiencies to consumers as lower premiums and out-of-pocket costs.’’ Her comments are part of a broader health care agenda focused on the need to lower prescription drug and other out-of-pocket health care costs. As she attempts to strengthen her position in the Democratic presidential field, Clinton is appealing to her party’s progressive base that has made reining in corporate excess, particularly on Wall Street, a top priority. (Przybyla, 10/21)

Based on enrollment alone, Anthem's $48 billion buy of Cigna would create the country's largest health insurer, covering about 53 million Americans. Rival Aetna, the nation's third-largest insurer, would also gain a significant market share with its proposed $37 billion acquisition of Humana, another Medicare Advantage coverage provider. Just this week, shareholders of Aetna and Humana approved the merger, despite consumer advocates' worries that the venture could threaten competition for health plans. "I am very skeptical of the claim that consumers will benefit from them because the evidence from careful studies shows that too often the companies end up pocketing profits rather than passing savings to consumers," Clinton said in her own indictment of the mergers. (Flores, 10/21)

Cigna Corp. and Anthem Inc., which agreed to a $48 billion deal in July, slipped in Wednesday trading along with other health insurers as Democratic presidential candidate Hillary Clinton said mergers in the industry deserve more scrutiny. Cigna fell 3.9 percent to $136.61 at the New York close, and Anthem dropped 3.7 percent to $142.79. Aetna Inc. and Humana Inc., which have struck their own deal to combine, declined as well. (Tracer and Mittelman, 10/21)

Both deals, which would reduce the number of nationwide for-profit health insurers from five to three, are being closely reviewed by the U.S. Department of Justice and state insurance regulators, and have been the subject of hearings in the U.S. Congress. (10/21)

Clinton also said that, as president, she would toughen antitrust regulation at the Department of Justice and the Federal Trade Commission and appoint “aggressive regulators” to take on industry concentration. ... Clinton said she had "serious concerns" the mergers would result in serious market concentration. (Radelat, 10/21)

Without Biden in the race, Clinton can more easily present herself as the heir to Obama's legacy and the candidate in the best position to preserve the president's health care law and pursuit of immigration reform. His decision also likely solidifies Clinton's position with the diverse coalition of black, Hispanic, female and gay voters who fueled Obama's winning campaigns. (10/21)

It's crunch time for thousands of small business owners who must comply with requirements of the health care law for the first time. Companies with 50 to 99 full-time employees must offer affordable insurance to employees and their dependents starting Jan. 1. They must also file tax forms with the government by Jan. 31 detailing the cost of their coverage and the names and Social Security numbers of employees and their dependents. While companies of all sizes are subject to the law must file the forms, smaller businesses without big staffs to handle the paperwork may have to hire someone to do it — at a cost of hundreds or thousands of dollars. (Rosenberg, 10/21)

A large majority of adults say "$100 a month or less" is the highest monthly premium they can afford to pay for health insurance in 2016, according to a survey released Wednesday. The HealthPocket.com report found that 57 percent of respondents named that price range when asked about coverage affordability. The second-most common answer was $200 per month, which was the response of just 17 percent of respondents. (Mangan, 10/21)

The last major piece of President Barack Obama's health care law could raise costs for thrifty consumers as well as large corporations and union members when it takes effect in 2018. The so-called Cadillac tax was meant to discourage extravagant coverage. A growing chorus of critics from Hillary Clinton and Bernie Sanders to the entire GOP field say it's a tax on essentials, not luxuries. It's getting attention now because employers plan ahead for major costs like health care. (10/20)

Three-hundred-and-sixty-one white wooden crosses were planted in the lawn of the Utah Capitol on Wednesday, representing the estimated number of people who have died because of the Legislature's failure to expand Medicaid, as advocates kept pressure on lawmakers to act. "If Utah has any great leaders lurking in this swamp of ineffectiveness, here is what he, she or they should do: First seize the moment before the federal-incentive window slams shut," said David Irvine, a former Republican House member and board member of Alliance For a Better Utah, a progressive advocacy group. "Second, stop wasting everyone's time and flimflamming the public with a secret policymaking process." (Gehrke, 10/21)

A Symbolic memorial service was held today for hundreds of Utahan's who statistically have lost their lives waiting for Medicaid expansion. ... The Capitol's south lawn was covered in crosses as legislators entered the building for meetings, a week after a closed-door caucus decided to kill the latest Medicaid expansion bill. The crosses were placed as a stark reminder that 126,000 Utahan's are waiting for leaders to come up with a plan that would help low income families find health insurance. (Hatch, 10/21)

Even without Medicaid expansion, Utahns are paying less in taxes related to President Barack Obama's health care law than they're getting back, the House Republican caucus heard Wednesday. "These are important numbers," House Speaker Greg Hughes, R-Draper, said. "I think many will be surprised by what the data says versus what we're hearing by way of narrative." (Riley Roche, 10/21)

In considering an expansion of Medicaid to make nearly 50,000 more state residents eligible for the program, South Dakota's proposal also focuses on improving access to care and boosting the health of the state's large Native American population. The Health Care Solutions Coalition met Wednesday in Pierre to discuss in part the proposal's impact on Native Americans, who make up nearly 9 percent of South Dakota's population. The plan under examination to expand the Medicaid program for low-income and disabled people would be funded through state savings by improving access to care though the Indian Health Service and a change in the classification of some services to have them fully paid for by the federal government. (Nord,10/21)

A “significant” number of the New Jerseyans who picked up health insurance due to the expansion in Medicaid eligibility could lose their coverage if they fail to file renewals, according to the state’s Medicaid director. Valerie Harr, director of the Division of Medical Assistance and Health Services, said that despite three mailed notices to every resident asking them provide their income and other relevant information to determine whether they are still eligible for coverage, a significant number of residents aren’t responding. (Kitchenman, 10/21)

On Tuesday, a policy analyst from the state Legislative Analyst's Office said the state has revised its 1115 Medicaid waiver request, trimming it from $17 billion to about $7.25 billion. LAO analyst Felix Su said federal officials have balked at some of the funding options laid out in the state's waiver request, and that officials from the Department of Health Care Services recently made it clear to stakeholders that the full plate of payment and delivery system reforms in the state's request have been scaled back. (Gorn, 10/21)

In a chaotic day of trading, once-highflying Valeant Pharmaceuticals International Inc. defended itself Wednesday against some of the most severe criticism yet of its business practices, denying allegations of improper accounting from an investor who is betting against the company. The short-seller’s report knocked Valeant’s stock down 40%—wiping some $20 billion from its market value—before the stock made up some of the loss after analysts expressed support and shareholder William Ackman jumped in to buy more stock. (Rockoff and Farrell, 10/21)

The stock at one point plunged below $90 per share, a more than 30% intra-day drop. The sell-off followed allegations in the report by short-seller Citron Research that Valeant might have created "phantom accounts" as part of a purported "fraud to create invoices to deceive the auditors and book revenue." ... Valeant issued a response that attempted to rebut the Citron Research report by calling it "false and misleading." The company said the allegations "appear to be an attempt to manipulate the market in an effort to drive down Valeant’s stock price." The high-stakes financial debate focuses on the Valeant's links to Pennsylvania-based pharmacy Philidor RX Services. (McCoy, 10/21)

A simple promise turned Valeant Pharmaceutical International Inc and some of its rivals into stock market darlings: we will buy more companies and make more money selling drugs. Now investors worry if they can still deliver. ... Valeant refuted the claims, but its shares still ended down 19 percent, as the report brought into the spotlight risks involved in its business model based on rapid expansion driven by acquisitions and aggressive price hikes. Mounting political opposition to rising drug prices combined with sliding shares, often used as currency to pay for acquisitions, are now casting doubt on whether specialty pharmaceutical firms such as Valeant can deliver promised brisk earnings growth. (O'Donnell, 10/21)

Back at you, Bill Ackman. Ackman, the billionaire hedge fund manager, has long maintained that Herbalife Ltd. is a house of cards -- a suggestion that’s drawn howls from the company. Now another Wall Street scold, Citron Research’s Andrew Left, says one of Ackman’s picks looks like the Enron Corp. of Big Pharma -- a claim the company, Valeant Pharmaceuticals International Inc., rebutted Wednesday. (Renick, Jackson and Ciolli, 10/21)

Shares of Valeant fell 19 percent on Wednesday after influential short-seller Citron Research accused the company of using specialty pharmacies, through a network led by its partner Philidor Rx Services, to inflate its revenue, an allegation the drugmaker denied. Specialty pharmacies are designed to deliver medications with unique handling, storage and distribution requirements, often for patients with complex conditions such as cancer, multiple sclerosis or rheumatoid arthritis. They can provide more detailed guidance for patients on how to take the drugs. Specialty drugs are often expensive, sometimes priced at over $100,000 a year. (Beasley, 10/22)

In September, a drug company executive named Martin Shkreli gave patients fits after hiking the price of a drug called Daraprim by more than 5,000% overnight. He also gave politicians a gift: a scapegoat. The high price of drugs isn't a new problem; 72% of respondents to a Kaiser Family Foundation tracking poll in August said that drug costs are "unreasonable." But since Shkreli's price hike became a national news story, several presidential candidates have spent weeks skewering his behavior and scrutinizing his company, Turing Pharmaceutical. (Diamond, 10/21)

Theranos Inc. founder and Chief Executive Elizabeth Holmes said Wednesday that the Silicon Valley laboratory company is in a “pause period” as it seeks to get its proprietary technology approved by the U.S. Food and Drug Administration. “We have to move, as a company, from the lab framework and quality systems to the FDA framework and quality systems,” Ms. Holmes said, speaking at the WSJD Live global technology conference in Laguna Beach, Calif. (Carreyrou, 10/21)

Assurant Inc. fell the most among large U.S. insurers in New York trading after saying that its health insurance unit posted a third-quarter pretax loss of at least $215 million. Assurant declined 3 percent to $79.72 at 12:41 p.m., the biggest drop in the 21-company Standard and Poor’s 500 Insurance Index. The health loss was driven by higher-than-expected claims on individual medical policies and could be as high as $230 million, the New York-based company said in a filing after markets closed Tuesday. (Chiglinsky and Boyden, 10/21)

Hospital operator Community Health Systems Inc. reported preliminary third-quarter results well below analysts’ projections and cut its outlook for the year, citing a decline in admissions and a deterioration in payer mix. Typically, commercial payers, Medicare and Medicaid, which all combined account for a larger share of the company’s revenue in the latest period, negotiate for lower rate increases. (Armental, 10/21)

It’s the world’s largest maker of multiple sclerosis drugs and the most highly valued company in Massachusetts. But size and status couldn’t shield Biogen Inc. from stumbling in the notoriously risky biotechnology business. On Wednesday, Biogen said that it will cut about 880 jobs, including 400 in its home state, and end several research programs in a restructuring driven by slower sales growth and a multiple sclerosis drug trial that fell short of expectations. (Weisman, 10/21)

Doctors are questioning the gospel of the annual mammogram to detect cancer -- a potential blow to the biggest maker of mammography equipment. Hologic Inc. shares slumped 2.8 percent Tuesday after the American Cancer Society published new guidelines calling for women to wait until age 45 instead of 40 to start annual mammograms, then slow the pace at 55 to screenings every other year. (Cortex, 10/21)

Consumer genetics testing company 23andMe said on Wednesday it was relaunching its personal DNA testing service with a limited menu of tests that have won the approval of the U.S. Food and Drug Administration. The announcement is a major step for the company, which in 2013 was ordered by the FDA to stop selling its Personal Genome Service because the regulatory agency had not approved the tests, which the company was offering directly to consumers. The Personal Genome Service, launched in 2007, analyzed a broad menu of genetic links to disease, including a predisposition to breast and ovarian cancer, certain heart conditions and Alzheimer's. (10/21)

Wages are still stagnant, yet employers have found something else to help attract and retain employees: health-care benefits. A good insurance plan has become a more vital tool than ever for hiring, according to a recent survey from the Society of Human Resources. ... Of all the perks, however, health care was by far the most frequently used for employee retention. A full 80 percent of HR professionals in the survey cited health benefits, more than retirement and vacation, as a way to keep talent, up from 58 percent in 2012. (Greenfield, 10/21)

A survey of human resource managers conducted earlier this year by the Society for Human Resource Management found that fewer than 1 in 10 thought their employees were “very knowledgeable” about the benefits available to them. ... Since it’s open enrollment season for many companies, now’s a good time to look over what your benefits package provides — and what you might be missing out on. (Moore, 10/21)

The demand for mental health service is growing nationally, and comprehensive mental health legislation is gaining momentum in Congress for the first time in years. But both forces could run up against a counter-force: a shortage of psychiatrists, psychologists, counselors and therapists in much of the country. More than half of U.S. counties have no mental health professionals and so "don't have any access whatsoever," according to Thomas Insel, director of the National Institute of Mental Health. (Sun, 10/21)

Telemedicine has been rapidly changing the way health care is delivered in the United States, giving doctors the ability to communicate with their patients through text and video messages from thousands of miles away in the event that an in-person consultation is either unnecessary or unattainable. (Braverman, 10/21)

The idea behind dental therapists – who fall between a hygienist and a dentist – is that these new mid-level providers would swell the ranks of people who can drill, fill and extract, making it easier for people to care for their teeth. That’s not how [Dr. Judith Fisch] and many dentists around the country see it. (Gorenstein, 10/21)

Many visitors bypass the shops and head straight for the pharmacies and dentists strategically located just a few steps from the border crossing. “Everything is at least 50 percent cheaper,” Jim Reed, 74, said. “It’s so expensive back home and it’s good quality we can afford here.” (D'Angelo, 10/21)

Public health officials are now estimating the number of people who contracted a bacterial infection after eating at a San Jose seafood restaurant exceeds 90, a dozen of whom wound up in intensive care. At least 93 patients suffered fever, abdominal pain and diarrhea after eating at Mariscos San Juan Restaurant No. 3 in the 200 block of North 4th Street over the weekend, according to the Santa Clara Department of Public Health. Many patients required hospitalization, and 12 needed intensive-care treatment. (Rocha, 10/21)

Two lawsuits were filed against a Mexican seafood restaurant in San Jose Wednesday after at least 93 people were sickened following meals there, with 12 hospitalized. The Santa Clara County Public Health Department issued a warning to people who ate at Mariscos San Juan on Friday or Saturday. The restaurant had its permit suspended and has been closed since Sunday. County deputy health officer Dr. George Han told a news conference Wednesday morning that tests confirmed that 24 people have contracted the shigella bacteria. (10/22)

Shigellosis is a contagious diarrheal disease caused by the Shigella group of bacteria and can be spread when people don’t wash their hands after using the bathroom. More than 500,000 cases are reported in the U.S. each year. The disease can cause severe dehydration or fainting and in rare cases may be fatal. Some health researchers and public health professionals believe consumer review sites like Yelp might just help them identify and investigate food poisoning outbreaks similar to this one. It’s not unlike using Google searches to track potential flu and Dengue outbreaks. (Feder Ostrov, 10/22)

An Ohio bill that seeks to divert more than $1 million in government funding away from Planned Parenthood cleared the state Senate on Wednesday after dozens of opponents told a legislative committee that the proposal could limit access to pregnancy prevention services and other needed health care resources. The proposal passed on a 23-10 vote. It targets taxpayer money that the organization receives through grant programs administered by the Ohio Department of Health. Those dollars, which are mostly federal, support programs on infant mortality, HIV testing, breast and cervical cancer screenings, and the prevention of violence against women. The bill would restrict such funds from going to entities that perform or promote abortions, their affiliates and those that contract with an entity that performs abortions. (Sanner, 10/21)

The Ohio Senate on Wednesday quickly passed legislation to block state funding for Planned Parenthood's health education and prevention programs. ... The bill would redirect about $1.3 million annually from Planned Parenthood to federally qualified health centers, health departments, and other clinics that don't perform or promote abortions or contract with facilities that do. (Borchardt, 10/21)

State senators advanced a bill on Wednesday that would eliminate state and federal funding for Planned Parenthood clinics. Ohio is among a string of states to consider cuts in response to undercover videos about the group’s handling of fetal tissue. The Republican-controlled Senate voted 23 to 10 on party lines to advance the measure, which would strip funding from Planned Parenthood clinics in the state and any organization referring patients to them. (10/21)

Texas Democrats are fighting a move by state officials to cut the last few taxpayer dollars going to Planned Parenthood clinics in the state. Rep. Sheila Jackson Lee of Houston called the action “awful and shameful,” as well as illegal Wednesday, asking for a federal investigation into the state’s reasoning for cutting off the women’s health care provider. (Ayala and Martin, 10/21)

The University of Missouri’s nursing school in Columbia has signed new agreements with two Planned Parenthood clinics to allow nursing students to obtain some of their training in women’s health services. A university spokesman said the agreements are not contracts, but will enable three students who requested it to perform their clinical training at Planned Parenthood. (Mannies, 10/21)

Some Florida lawmakers say the state’s pill mill crackdown has gone too far. Florida used to be known as a pill mill capital but the state cracked down on unscrupulous clinics, leaving legitimate patients to struggle with getting prescriptions filled. Sen. Aaron Bean, R-Jacksonville, has a bill that would lift some restrictions on drugs like oxycodone. He says the state's pill mill crackdown has been a success, but perhaps its been too successful. (Hatter, 10/21)

A Broward County lawmaker’s plans for a needle exchange program are gaining traction. The House Health Quality Subcommittee approved Representative Katie Edwards’ plan Tuesday for a pilot program at the University of Miami. By exchanging sterile needles for used ones, the program aims to slow the spread of blood-borne illnesses. Edwards says transmission prevention should be a matter of public health, and not only a matter of public safety. (Payne, 10/21)

A new union that has already negotiated benefits and working conditions for thousands of Minnesota personal care attendants came under new pressure Wednesday as federal appeals judges heard a pair of cases aimed at disbanding the labor unit. In back-to-back hearings on separate lawsuits with the same goal, two 8th U.S. Circuit Court of Appeals panels raised doubts about their power to overturn the union for home care workers assisting the disabled and elderly. Judges in both cases dwelled on the voluntary nature of the unions, where none of the covered workers is compelled to join or pay dues. (Bakst, 10/21)

To make sure people get necessary care, but don’t overspend, the Massachusetts Legislature set a goal for the state: Health care spending — from patients, organizations, and state government all together — shouldn’t grow any faster than the state economy. By that standard, 2014 was a disappointing year. Total health care spending actually grew 4.8 percent, according to a recent report from CHIA, the state’s official health care number crunchers. That’s a substantial jump from the year before and well ahead of economic growth. (Horowitz, 10/21)

The Philadelphia School District is scrapping a plan to offer private health services in schools, officials announced yesterday. The district issued a request for proposals in May to expand health services and explore different delivery models. Six entities responded, but the district decided that the plans were not feasible. (Leach, 10/22)

A bankruptcy court judge has approved the sale of Clayton County’s only hospital to Prime Healthcare Foundation. ... Prime Healthcare, based in California, submitted the only bid for the Riverdale hospital after Grady Health System backed off its own offer. Prime offered $18 million for the struggling Southern Regional, which has a high level of uninsured and indigent patients. (Miller, 10/21)

Wyoming's second largest health insurance company is closing down. The state Department of Insurance announced Wednesday that WINhealth will shut down Dec. 31 because of financial problems. The company has been in business since 1996. (Moen, 10/21)

A case before the Missouri Supreme Court could decide whether wrongful death should fall under the state's new law capping non-economic damages on medical malpractice lawsuits. Pat Hagerty represents the family of Shannon Dotson, who died in 2011 during what was described as a routine medical procedure at Mercy Hospital in St. Louis. In December 2013, Dotson's family was awarded $9 million in non-economic damages, but a trial court reduced that award to $350,000 after Gov. Jay Nixon signed the new law capping those damages. The state Supreme Court in 2012 had struck down the limits on malpractice cases. At issue was whether the limits remained in a wrongful death case. (Griffin, 10/21)

Mentally ill defendants like Bock, who are declared incompetent to stand trial, are supposed to be transferred to state mental hospitals for treatment within two or three months. But more than 300 of them throughout California are languishing in county jails because there's simply no bed space. (Shafer, 10/21)

As presidential candidates debate government-mandated paid family leave, the U.S. has a 39 million-person test lab. California in 2004 enacted the nation’s first such program, ensuring workers are paid for as long as six weeks when caring for a newborn or ailing loved one. The law is financed through an employee payroll tax, meaning companies in the world’s eighth-largest economy bear no direct costs. (Deprez, 10/22)

Gov. Rick Scott on Tuesday continued trying to increase pressure for changes in the hospital industry, calling on patients to submit information about experiences with "price gouging." Scott issued a news release saying patients should contact the state Commission on Healthcare and Hospital Funding with such stories. The news release came as the commission, created by Scott this year, met at the Capitol. (10/21)

A family member in prison. A mother who was treated violently. Emotional or physical neglect. Even simply growing up with just one parent. These are examples of "adverse childhood experiences," and they are ravaging Arizona. A national survey released last year found that 44.4 percent of Arizona children ages 12 to 17 suffered two or more such traumatic experiences, far surpassing the national average of 30.5 percent. (Vandell, 10/21)

It's open enrollment time for many people who have health insurance through their job, and Florida’s state employees are among those who are thinking about making changes to their plans. Monthly premiums for health insurance plans through employers, on average, went up about 4 percent in 2014, according to the Kaiser Family Foundation. (Watts, 10/21)

One of the nation’s largest drug testing laboratories will pay $256 million to settle allegations it over-billed the U.S. government for urine drug tests. The Justice Department found that Millennium Health billed the government for unnecessary urine drug tests and genetic testing. The whistleblower in the suit was Melbourne, Florida-based Omni Healthcare Inc. As a whistleblower, Omni Healthcare will get a cut of the settlement. (Aboraya, 10/21)

The California Public Employees’ Retirement System board on Wednesday ordered former Loomis Fire Chief David Wheeler to pay back more than $450,000 in pension benefits after an administrative law judge determined that Wheeler had violated state law. (Branan, 10/21)

Big donors, led by former Facebook president Sean Parker, are lining up to fund a 2016 California initiative to legalize marijuana for recreational use. But behind the scenes, legalization efforts are splitting California marijuana advocates with national drug-policy groups over such things as including initiative language to protect marijuana users from job discrimination or over how tightly to restrict pot cultivation or cannabis industry operations. (Hecht, 10/21)

A technique developed at the University of Washington to repair damaged hearts with stem cells is getting a $10 million boost from a little-known Seattle foundation. The grant from the Washington Research Foundation will allow scientists to answer several key questions and start the first human trials within a few years. If the approach works as well in people as it has in animals, it could lead to new treatments for heart disease — the No. 1 killer in the United States and around the world. (Doughton, 10/21)

Contrary to howls from the far right, [Rep. Paul] Ryan is no moderate. He was the architect of a Republican plan to replace Medicare with a system of voucher-like payments to seniors. But he has the common sense to pick his shots and is realistic in his tactics. He also has the good sense to ask for some rule changes that would make it harder for the speaker’s position to be constantly challenged. For a party being defined by its most impolitic presidential candidates and members of Congress, and a nation weary of partisan gridlock, Ryan would be an adult presence in a job second in line to the presidency behind the vice president. (10/21)

The problem with Paul Ryan as speaker of the House is that his actual voting record on the big issues is not as conservative as it is frequently portrayed. (Erick Erickson, 10/21)

[Donald Trump] is similarly vague on health care. In a Sept. 27 interview on “60 Minutes,” he said health care should be a universal, government-provided right. “Everybody’s got to be covered,” he said. “I don’t care if it costs me votes or not.” When the interviewer asked how, and who would pay for it, Mr. Trump answered, “I would make a deal with existing hospitals to take care of people,” and pledged that “the government’s gonna pay for it.” During the Aug. 6 GOP debate Mr. Trump praised socialized medical systems elsewhere. “As far as single payer, it works in Canada,” he said. “It works incredibly well in Scotland.” So how would TrumpCare operate? (Karl Rove, 10/21)

On the campaign trail, Hillary Clinton has charged pharmaceutical companies with “excessive profiteering”; Bernie Sanders routinely decries firms’ “outrageous profits.” And during the Democratic presidential debate this month Mrs. Clinton and Mr. Sanders were proud to declare their enmity of this lifesaving industry. Their solution to the problem of high drug prices is to give government more power to “negotiate” prices in programs like Medicare. But government price negotiation tends to be more like price setting. (Tom Coburn and Paul Howard, 10/21)

Don't worry so much, Wall Street: Hillary Clinton's criticism of health insurance mergers really amounts to little more than a helpful suggestion. The Democratic presidential candidate on Wednesday called for close scrutiny of two mega-mergers set to take the U.S. managed care industry from five major providers to three -- Anthem's $50 billion bid for Cigna and Aetna's $37 billion takeover of Humana. The stock market quaked as if on cue: After Clinton's comments, the spreads for both deals at one point widened by roughly $9 apiece to more than $40. "Spread" is arbitrage code for the difference between a target's current share price and the value of the takeover bid. A wider spread signals doubt that the transaction will close. (Brooke Sutherland, 10/21)

[Sen. Bernie] Sanders’s belief in certain basic and universal rights — to adequate health care and to education, for instance — is rooted in his social democratic worldview. But it’s also rooted in mainstream American liberalism, in Franklin Roosevelt’s 1944 Economic Bill of Rights, and in the two great universal programs that even Republicans can’t flat-out oppose: Social Security and Medicare. The centrist case against creating any more universal programs is most commonly rooted in the premise that we can’t afford them — though such arguments generally take for granted that sufficiently raising taxes on the wealthy isn’t really an option. ... Fundamentally, that’s an argument rooted in politics, not math. These arguments would be more serious if their proponents at least tried to explain why taxing the super-rich at significantly higher rates is a bad idea. (Harold Meyerson, 10/21)

Genetic tests are increasingly used for health care diagnosis and tailored treatments, especially in predicting the risk for certain diseases like breast cancer. But some say DNA analysis is too hastily applied to other health issues — like anxiety and depression — based on limited studies, some of which are conducted without regulation. Is the enthusiasm over genome-sequencing in medicine overblown? (10/22)

Like this newspaper, [Matt Roberts, president of Mental Health America of Greater Dallas] and his peers know that the foundation of mental health care must be to bring help to — not brand with stigmas — people who suffer from it. Despite recent headlines of mentally ill individuals committing heinous crimes against others, the fact remains that those who live with conditions such as bipolar disorder or schizophrenia are far [more] likely to be the victims of crimes than the perpetrators. (10/21)

New research indicates that the Affordable Care Act and other health policy developments in Ohio have cut in half the proportion of Ohioans without health care insurance. The Plain Dealer, citing Ohio Department of Medicaid survey findings, recently reported that the percentage of uncovered Ohioans is about 8.7 percent. The proportion was about 17.3 percent in 2012. Demonstrably, one key reason for that positive development is the expansion of Ohio's Medicaid program by Republican Gov. John Kasich. ... Kasich, despite criticism from partisan foes of the Affordable Care Act inside his own party, did the right thing for lower-income Ohioans, as well as for Ohio health care providers, who are now better able to serve those Ohioans. (10/21)