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President Donald Trump is leaving Washington for the first time since House Democrats ramped up their impeachment inquiry -- and he’s heading straight into the warm embrace of a Republican stronghold. Trump is due to visit The Villages, a sprawling retirement hub about an hour north of Orlando that is a must-stop for GOP candidates. The president plans to announce an executive order to protect Medicare during his visit Thursday and address an invitation-only group. (Farrington, 10/3)

President Donald Trump's anticipated executive order on Medicare and prescription drug importation, which he plans to sign Thursday, is designed as a rebuttal of Democratic candidates' health care proposals. The high-profile signing ceremony in The Villages, a retirement community in Florida, indicates that politics will likely overshadow the order's policy. The move will help Trump contrast his administration's work with Democrats' calls to extend the program’s eligibility through plans including "Medicare for All" government-run care. (Clason, 10/2)

The government also gives federal employees information about what's to come for their health coverage in the upcoming open season -

Federal employees and retirees on average will pay 5.6 percent more for their health-care premiums in 2020, but will have more plans from which to choose, the government announced Wednesday. Officials said the increase is similar to what other large employers have reported or estimated for 2020 — in the 4.5 to 6.5 percent range. The hike also is in line with recent increases in the Federal Employees Health Benefits Program, although well above the 1.5 percent for 2019. (Yoder, 10/2)

And the Trump administration gets bad reviews on science -

Every president over the past two decades has, to some degree, undermined research and injected politics into science, the report said. But, it concluded, “Now, we are at a crisis point, with almost weekly violations of previously respected safeguards.” The report calls for stringent new standards to enshrine scientific independence. The study, to be formally released on Thursday, follows reports that President Trump’s acting chief of staff, Mick Mulvaney, pressured the commerce secretary to rebuke weather forecasters who appeared to contradict the president after he erroneously claimed a recent hurricane could affect Alabama. Earlier this summer a State Department intelligence analyst resigned in protest after the White House tried to edit scientific testimony about climate change and then blocked it from being entered into the permanent Congressional Record. (Friedman, 10/3)

In other administration news -

Sheltering migrant children has become a growing business for the Florida-based government contractor, as the number of minors in government custody has swollen to record levels over the past two years. More than 50 babies, toddlers and teens were closely watched on this day inside the clean, well-lit shelter surrounded by chain link fences. The children, many in matching black pants and gray sweatshirts, are officially under the custody of the federal government. But a joint investigation by The Associated Press and FRONTLINE has found that the Trump administration has started shifting some of the caretaking of migrant children toward the private sector and contractors instead of the largely religious-based nonprofit grantees that have long cared for the kids. (Burke and Mendoza, 10/3)

The federal government has halted efforts to establish an Atlanta-area shelter for unaccompanied immigrant children apprehended along the southwest border. The government solicited proposals this year for at least 96,000 square feet for classrooms, bedrooms, bathrooms, medical facilities and two acres of outdoor play area in southwest metro Atlanta for up to 500 of the children. (Redmon, 10/2)

Bernie Sanders’ campaign said Wednesday that the Democratic presidential candidate had a heart procedure for a blocked artery and was canceling events and appearances “until further notice.” The 78-year-old Vermont senator experienced chest discomfort during a campaign event Tuesday and sought medical evaluation. Two stents were “successfully inserted,” and Sanders “is conversing and in good spirits,” according to the campaign. He’s recovering at a Las Vegas hospital. (Riccardi and Neergaard, 10/2)

The news comes as Sanders was preparing for Wednesday campaign events in Nevada, including a "Medicare for All" town hall in Las Vegas. It also comes less than two weeks before the next Democratic primary debate, on Oct. 15 in Ohio. As of January 2016, Sanders had "no history of cardiovascular disease," according to a letter from Sanders' doctor released as part of his 2016 presidential campaign. (Kurtzleben, 10/2)

Mr. Sanders later tweeted to thank well-wishers and said he was “feeling good.” He also said his experience underscored the need for his Medicare for All health-care proposal. (Collins, 10/2)

The medical problem Sanders experienced — though it can be serious if untreated — is a common affliction in men his age. And the procedure he underwent is one of the most routine performed by cardiologists. “This is a common procedure. It’s very safe. People recover quickly,” said Steven Nissen, chair of cardiovascular medicine at Cleveland Clinic. “I’ve treated businessmen who go back to work the next day. I’ve had patients in the U.S. Senate who have gotten right back to work. Although, if Bernie were my patient, I might tell him not to work 16 hours a day for a little while, just to make sure recovery goes well.” (Wan, 10/2)

The Democrats are vying for a chance to face President Trump, 73, who was the oldest person in history to be sworn in as president for the first time. Although Trump’s physicians have given him a clean bill of health — sometimes extravagantly — he pointedly enjoys fast food and avoids exercise, despite holding one of the highest-pressure jobs in the world. (Janes and Sullivan, 10/2)

Mr. Sanders has largely avoided scrutiny of his age and his health. But he and his rivals will now be under increasing pressure to release detailed medical records as Democratic voters try to settle on the best candidate to take on President Trump, who is himself 73. Mr. Sanders, Mr. Biden and Senator Elizabeth Warren, who is 70, have all said they would release their records before the first voting starts in February. (Ember and Martin, 10/2)

Presidential campaigns always reflect the hopes and fears — or, as political strategists call them, the “kitchen table conversations” — of the voters who cast the ballots. And this year, along with health care costs and college affordability, stagnant wages and immigration, the contest also reflects another issue, one that strikes at the heart of a country where the highest share of the electorate will be older than 65 since at least 1970: How old is too old? (Lerer, 10/2)

Presidential hopeful Bernie Sanders could be back on the campaign trail in a few weeks, after undergoing a cardiac procedure Tuesday night — but he may have to change his lifestyle, according to a top cardiologist at the New England Heart & Vascular Institute. Dr. Louis Fink, executive medical director at Catholic Medical Center’s NEHVI, said Sanders is now considered a cardiac patient, after two stents were placed in an artery to relieve a blockage. (Wickham, 10/2)

And on the campaign trail --

Democratic presidential candidates reiterated their call for gun control Wednesday and urged Americans to keep up the fight for change, sidestepping the issue of impeachment in Washington and whether it will divert lawmakers. (Ronanye and Price, 10/2)

Wednesday’s ruling comes as health experts have increasingly proposed supervised injection sites as a way to reduce drug overdoses, which health officials said killed more than 68,000 people last year, and an average of three people a day in Philadelphia. The Justice Department, which had sued Safehouse in February, vowed after the ruling that it would continue to try to block other cities from opening injection sites, which its lawyers have argued are illegal. (Bogel-Burroughs, 10/20)

Wednesday’s ruling could help lift a cloud that has hung over these planned sites, often known as supervised-injection sites, which cities such as New York, San Francisco and Philadelphia have supported as a way to stop overdose fatalities. The sites would allow drug use under supervision of people who can treat overdoses and potentially help steer drug users toward treatment. (Kamp, 10/2)

“No credible argument can be made that facilities such as safe injection sites were within the contemplation of Congress” when lawmakers adopted the initial drug law in 1986 or when they amended it in 2003, McHugh wrote. (Bernstein, 10/2)

Most studies show that the supervised injection sites can drive down fatal overdoses. These sites are credited with restricting the spread of infectious diseases. And advocates say the facilities help move more people into treatment. The American Medical Association has endorsed launching supervised injection site pilot programs. (Allyn, 10/2)

A Pennsylvania federal judge ruled Wednesday that a nonprofit’s plan to open the nation’s first safe injection site does not violate federal law. The ruling from U.S. District Judge Gerald McHugh is a blow to the Justice Department, which sought to prevent Safehouse from opening “consumption rooms,” which provide safe places for drug users to inject using sterile equipment under the supervision of medically trained staff. (Weixel, 10/2)

A federal judge ruled Wednesday that supervised injection sites designed to prevent overdoses do not violate federal drug laws, giving advocates in Philadelphia and perhaps elsewhere a boost in their efforts to open them. U.S. District Judge Gerald A. McHugh said there’s no evidence that Congress intended 1980s-era drug laws to cover sites where people could inject drugs and have medical help nearby if they need it. (Dale, 10/2)

A federal court ruling Wednesday that allows the nation’s first safe injection site to open in Philadelphia has boosted the hopes of advocates for a similar facility in Massachusetts. US District Judge Gerald McHugh ruled that operating a center where people can use illegal drugs under medical supervision does not violate federal law.Although the Philadelphia court does not have jurisdiction over Massachusetts, McHugh’s decision is expected to have an impact nationwide. (Freyer, 9/2)

Local government lawsuits against the family that owns Purdue Pharma should be allowed to proceed even as the company attempts to reach a nationwide settlement in bankruptcy court over the toll of the opioids crisis, according to a court filing on Wednesday. The filing by 19 cities and towns in Connecticut, Massachusetts, New Jersey and Virginia comes amid acrimonious settlement negotiations with the maker of the painkiller OxyContin that is now playing out in a bankruptcy court in White Plains, New York. (Mulvihill, 10/2)

An Oklahoma judge made a $107 million miscalculation when he ordered consumer products giant Johnson & Johnson to pay $572 million to help clean up the state’s opioid crisis, attorneys for the company argue in a court filing. The company also is asking for a reduction in the judgment based on pre-trial settlements totaling $355 million that the state reached with Oxycontin-maker Purdue Pharma and Israeli-owned Teva Pharmaceutical Industries Ltd. (Murphy, 10/2)

Prestigious universities around the world have accepted at least $60 million over the past five years from the family that owns the maker of OxyContin, even as the company became embroiled in lawsuits related to the opioid epidemic, financial records show. Some of the donations arrived before recent lawsuits blaming Purdue Pharma for its role in the opioid crisis. But at least nine schools accepted gifts in 2018 or later, when states and counties across the country began efforts to hold members of the family accountable for Purdue’s actions. The largest gifts in that span went to Imperial College London, the University of Sussex and Yale University. (Binkley and McDermott, 10/3)

As opioid addiction increasingly pushes users into emergency rooms with the advent of fentanyl into Baltimore’s drug markets, city officials are looking to address a gap created in part when people are released from the hospital after an overdose without any connection to follow-up treatment. The state has awarded the Behavioral Health System Baltimore $849,000 for fiscal year 2020 to address the problem, which the organization says stems from a lack of staff on the city’s Mobile Crisis Team. (Davis, 10/2)

A Virginia doctor who prescribed more than 500,000 doses of opioids in two years was sentenced to 40 years in prison on Wednesday for leading what prosecutors called an interstate drug distribution ring. The overprescription of painkillers is one of the roots of the nation’s opioid crisis, and patients of Dr. Joel Smithers traveled hundreds of miles from neighboring states to pick up oxymorphone, oxycodone, hydromorphone and fentanyl, according to law enforcement officials. They said he prescribed controlled substances to every patient in the Martinsville, Va., practice he opened in August 2015. (Hassan, 10/2)

The sentence is lighter than it could have been. Smithers was facing up to life in prison and a fine of more than $200 million, according to officials at the U.S. Justice Department. Smithers was convicted by a jury in May on more than 800 federal drug charges — including one count of possessing with the intent to distribute controlled substances and one count of maintaining a place for the purpose of unlawfully distributing controlled substances. (Booker, 10/2)

The league would “absolutely” like to add opioid testing for next season, said Dan Halem, the league’s deputy commissioner. Tony Clark, the executive director of the players’ association, said the union plans to work with the league to assess “all of our drug protocols relating to education, treatment and prevention.” The parties have discussed whether to loosen baseball’s restrictions on marijuana — not specifically as a trade-off for opioid testing, but as part of the annual review of the sport’s drug policy, according to three people familiar with the talks but not authorized to comment publicly on them. (Shaikin, 10/2)

The lung damage in some people who have become ill after vaping nicotine or marijuana products resembles a chemical burn, doctors from the Mayo Clinic reported on Wednesday. ... “All 17 of our cases show a pattern of injury in the lung that looks like a toxic chemical exposure, a toxic chemical fume exposure, or a chemical burn injury,” said Dr. Brandon T. Larsen, a surgical pathologist at the Mayo Clinic in Scottsdale, Ariz. “To be honest, they look like the kind of change you would expect to see in an unfortunate worker in an industrial accident where a big barrel of toxic chemicals spills, and that person is exposed to toxic fumes and there is a chemical burn in the airways.” (Grady, 10/2)

The results, based on lung biopsies from 17 patients from around the U.S., may help investigators narrow the long list of suspects in the mysterious outbreak that has sickened 805 people and killed at least 12. The study is among the first to examine a large group of biopsies from patients with lung injuries linked to vaping nicotine or THC, the ingredient in marijuana that produces a high. (Langreth, 10/2)

The study did not provide any clues as to the kind of chemicals that might be causing the condition, but the authors said signs of damage were consistent. ... Health officials have said that many people suffering from the condition have been vaping cartridges acquired from informal sources like dealers or friends. It’s possible that a contaminant or additive could be the culprit, though experts are still not certain that’s the case. (Joseph, 10/2)

New research from Mayo Clinic suggests that the nation’s outbreak of vaping-related lung injuries is due to people inhaling toxic substances — akin to workers who breathe fumes from chemical spills, or World War I soldiers exposed to mustard gas. The finding by Mayo’s consulting pathology lab in Arizona is based on a first-ever examination of 17 biopsies of patients with vaping-associated lung injuries. While the role of chemical inhalation might sound obvious, the finding is important because it contradicts a popular theory that these cases were caused by oil or lipid contamination in the lungs. (Olson, 10/2)

Banning the sale of vapes and their accouterments — as the governor of Massachusetts ordered temporarily — may send a clear warning message, but it doesn’t mean that those who are already addicted know how to quit. E-cigarettes might have been viewed as a way of giving up the old-fashioned equivalent, but it turns out the newfangled version can be just as hard, if not harder, to quit. (Boodman, 10/3)

As the Food and Drug Administration’s plan to restrict the e-cigarette industry takes shape, driven by a spate of vaping-related illnesses, cigarette sales aren’t yet reflecting smokers’ concerns that vapes might not be the safer alternative to traditional smoking that marketing campaigns were built around. Sales trends for the past month, including the period since the FDA’s Sept. 11 announcement that it would pursue a ban on flavored vapes, suggest that the combustible cigarette market has yet to see a boost in demand following the Centers for Disease Control’s public health warnings about vaping. (Sircar, 10/2)

More than half of consumers in a new poll believe that a ban on vaping devices would merely drive Americans to an unregulated black market. USA Today reported Wednesday that a survey conducted by the newspaper and Ipsos polling found that 59 percent of Americans polled, including 82 percent of those who say they use e-cigarettes regularly, believe that a ban on vaping products would drive consumers to purchase from unlicensed dealers. (Bowden, 10/2)

Utah health officials enacted an emergency rule Wednesday restricting the sale of flavored e-cigarettes and requiring warnings about unregulated THC products amid an outbreak of lung illness related to vaping. All tobacco sellers will be required to post notices about the danger of vaping unregulated THC, the high-producing ingredient in marijuana that’s been linked to most lung-damage cases in Utah. (10/2)

Stores throughout Michigan have stopped selling flavored electronic cigarettes to comply with a ban that started Wednesday. Court of Claims Judge Cynthia Stephens declined to stop the ban with an injunction Wednesday. But she says she’ll hold another hearing on Oct. 8. Store owners are suing, saying the prohibition will cripple their business. (10/2)

A national vaping group and its members have filed a federal lawsuit seeking an immediate end to the state’s four-month ban on the sale of nicotine and cannabis vaping products, ramping up industry pressure on the Baker administration just a week after the order went into effect. The Vapor Technology Association, which has more than 1,000 members, filed the lawsuit Tuesday asking a judge to immediately intervene and end the ban, imposed as part of a public health emergency. (Valencia, 9/2)

A national industry group has asked a federal judge to immediately end Massachusetts’ four-month ban on the sale of all vaping products. The lawsuit filed Tuesday by the Vapor Technology Association says unless it is ended, the ban announced by Gov. Charlie Baker on Sept. 24 will destroy the state’s $331 million nicotine vapor products industry and cause “irreparable harm” to many law-abiding retailers, manufacturers, and distributors. (10/2)

An Arkansas teenager who began vaping last year is suing a leading e-cigarette maker, accusing the company of deceptive marketing and fraudulently concealing the addictive nature of its products. (10/2)

For the first time in nearly 40 years, the twin birth rate in the U.S. is on the decline. According to a data brief published Thursday from the National Center for Health Statistics, twin births declined in the U.S. by 4% from 2014 to 2018. The decline follows decades of steady growth which began in the 1980s and lasted through the early 2000s. (Vaughn, 10/3)

“It is difficult to know for sure from the data in the NCHS report what the recent drop is linked to. However, given that declines are concentrated among older mothers, some would argue that changes in reproductive technology are likely playing a role,” said Gretchen Livingston, a senior researcher at the Pew Research Center who is an expert on fertility and family demographics. (Eunjung Cha, 10/3)

Researchers say the decline may reflect advances in reproductive technologies that improved the likelihood of single births. Having twins heightens health risks for both the babies and the mother, so specialists see the decline as good news. (Abbott, 10/3)

Walmart is rolling out a health care pilot program for its employees that will come up with a curated list of high quality providers but offer fewer choices than under the current plan. Through the program, Walmart will help employees connect with local doctors in areas like primary care, cardiology and obstetrics. It is working with Nashville-based data analytics company Embold Health, which will cull through vast amounts of data from public and private insurance plans to come up with recommended providers based on effectiveness and cost-efficiency. Walmart will in turn use that data to curate a list for employees. (D'Innocenzio, 10/3)

Kaiser Health News: Walmart To Give Workers Financial Incentives To Use Higher-Quality Doctors
Worried its employees aren’t getting good enough care from doctors in their insurance networks, Walmart next year will test pointing workers in northwestern Arkansas, central Florida and the Dallas-Fort Worth area toward physicians it has found provide better service. If the employees use these “featured providers,” they will pay less out of pocket, Walmart officials said Thursday. (Galewitz, 10/3)

Walmart Inc. will test a variety of new health-care programs for some of its workers next year, aiming to provide easier access and better care while also reducing its own expenses. The nation’s biggest private employer will use a data-analytics company to connect workers with select local doctors in a few regions, expand its tele-health program in other areas and offer health-care “concierges” to act as a single point of contact for staff in North Carolina and South Carolina, according to a statement Thursday. (Boyle, 10/3)

Some local doctors are about to face a new bit scrutiny in 2020: Are they Walmart approved? The world’s biggest retailer is testing a hands-on pilot program in the Tampa Bay region that will compile doctors’ histories of care to determine which have the best results the most often. Physicians who meet Walmart’s standards will become the in-network doctors for their employees, the retailer told reporters during a Wednesday conference call. (DiNatale, 10/3)

BJC HealthCare, the area’s largest employer, announced plans Wednesday to increase its minimum hourly pay to $15 per hour. The new rate is a nearly 50% increase from the organization’s current minimum rate of $10.10 per hour. The nonprofit health care organization will raise pay over the course of two years, first increasing its minimum wage to $12.65 per hour on Oct. 27. It will then increase to $14 in fall 2020, and hit $15 in fall 2021. (Merrilees, 10/2)

Thousands of physical, occupational and speech therapists have been laid off as skilled-nursing facilities transition to a new payment model that kicked in Tuesday. Dozens of these therapists have emailed Modern Healthcare saying they have been laid off or had their wages cut as a result of the new patient-driven payment model, which is akin to bundled payments and based on patient assessments and acuity rather than the volume of therapy services. (Kacik, 10/2)

The case highlights a more widespread problem: Because of a loophole, many religious organizations are not covered by a federal guarantee that protects most other workers' pensions, so the workers can get left with nothing. By one estimate, more than 1 million workers and retirees from religious organizations lack this federal protection. (Arnold, 10/3)

As concerns mount over a possible carcinogen found in popular heartburn medicines, the Food and Drug Administration noted that an outside laboratory that discovered traces of the contaminant used a method “not suitable” for testing. As a result, the agency is suggesting the lab may have generated higher levels of the carcinogen than what might have been found otherwise. In a brief statement, the FDA contended that Valisure, which alerted agency officials to the presence of NDMA in heartburn pills such as Zantac, used higher temperatures in its testing than methods used by the agency. (Silverman, 10/2)

Walmart Inc. plans to suspend the sale of all over-the-counter versions of Zantac, becoming the latest retailer to take such a step as concern over the presence of cancer-causing contaminants in the stomach drug increases. The world’s largest retailer said in a statement on Wednesday that it made the move after closely monitoring a recent alert from the U.S. Food and Drug Administration that the products, which are also sold under the generic name ranitidine, may contain low levels of the potential human carcinogen NDMA. (Annett, 10/2)

Walmart joins CVS Health, Walgreens and Rite Aid in announcing it will no longer sell the drug. Sanofi, the company that makes Zantac, said that the FDA has found that the amounts of the carcinogen in its drug “barely exceed amounts found in common foods.” “We are working closely with the FDA and are conducting our own robust investigations to ensure we continue to meet the highest quality safety and quality standards,” the company said. (Axelrod, 10/2)

With Medicaid costs soaring in New York, the Greater New York Hospital Association was pushing for the seemingly impossible: more state reimbursement money. It was a big ask, and for years, it had gone nowhere. Medicaid spending already represented a massive and ever-growing share of the state budget, and Gov. Andrew M. Cuomo had taken steps to keep the program in check. Then things changed. (Goodman, 10/3)

Kris Steele, a Republican who was speaker of the Oklahoma House during a period of intense GOP resistance to the Affordable Care Act, came out Monday night for a key feature of that health care law. Speaking at a forum on mental health care in south Oklahoma City, Steele endorsed Medicaid expansion. In fact, he recited the main points of those now pushing for a state ballot question on expanding the state-federal health care insurance. “When people are healthier, they tend to commit less crime,” Steele said. “When people are healthier, it tends to improve the quality of life. (Casteel, 10/2)

More than 150 people gathered Tuesday for the first of a series of public hearings on a plan to transform the funding model of Tennessee's Medicaid program, a forum where nearly every speaker expressed concern with the state's TennCare block grant proposal. ... Under the proposal, the state would receive a $7.9 billion block grant to use on some of its Medicaid services, rather than receiving an unspecific but unlimited amount of funding based on claims filed. The block grant amount would increase on a per-capita basis for each new member enrolled in the future, and would be adjusted each year for inflation. The state then hopes to split the cost savings for running the program more efficiently with the federal government. (Allison, Kelman and Wadhwani, 10/1)

Kaiser Health News: Tenn. Block Grant Experiment Would Boost Federal Funding, State Medicaid Chief Says
Tennessee wants to be the first state to test a radical approach for federal financing of Medicaid, the federal-state health care program for low-income people. The proposal, Tennessee Medicaid Director Gabe Roberts said, would increase the federal government’s contributions by millions of dollars and allow Tennessee to improve care for enrollees, perhaps offering additional services such as limited dental care for some people. But critics fear the plan will harm the poor. (Galewitz, 10/2)

New Hampshire officials are moving to quell concerns about the state’s “Medicaid to Schools” program, months after a federal agency issued new restrictions over how the program can be used. ... The Medicaid to Schools program allows New Hampshire schools to be reimbursed for services through Medicaid – a federal health care program primarily targeted to low-income people. The program was expanded under a 2017 law that allowed schools to use it for all students who qualify for Medicaid, not just those with Individualized Education Plans. But this spring, a new guidance issued by the federal Centers for Medicare and Medicaid Services (CMS), which oversees Medicaid, restricted that reimbursement. (DeWitt, 10/2)

The state has created an emergency rule to avoid the threatened loss of millions in federal funding over how New Hampshire delivers Medicaid services in public schools. Gov. Chris Sununu wrote to local school officials to assure them the state is revamping the program in compliance with guidance from the federal Center for Medicaid and Medicare Services. (Landrigan, 10/2)

After over a year of secret construction, Planned Parenthood announced its newest abortion facility on Wednesday: an 18,000-square-foot mega-clinic in southern Illinois. The new location is just 13 miles away from Missouri's last remaining abortion clinic, a facility in St. Louis fighting to keep its license. Since August 2018, Planned Parenthood has used a shell company to construct the facility, leaving no public trace that the former medical office would become one of the largest abortion clinics in the country. CBS News first visited the site in August, while it was still being built. (Smith, 10/2)

Planned Parenthood announced it will continue to provide "medication abortion and a full range of family planning services, including birth control, annual exams, cancer screenings, STI testing, and HIV prevention, including PrEP." The new facility will also provide access to surgical abortions, in addition to the services previously listed. (Zialcita, 10/2)

Missouri has some of the most severe abortion restrictions in the country, while neighboring Illinois has expanded access to its residents. Planned Parenthood operates the only remaining abortion provider in Missouri, located in St. Louis. That clinic will remain open, according to the organization. (Epstein, 10/2)

“While health care access in Missouri continues to hang on by a thread, Illinois is well-positioned to serve as a health care hub in the region,” said Yamelsie Rodriguez, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri. Planned Parenthood has been battling Missouri’s health department for months to try and keep open its St. Louis clinic. The state has refused to renew its license to perform abortions, citing concerns that include “failed abortions” that required additional surgeries. (Salter, 10/2)

Planned Parenthood is taking a step to increase access to abortions in the metro-east and the region with a new state-of-the-art center in Fairview Heights. Reproductive Health Services of Planned Parenthood of the St. Louis Region will expand abortion services in the new facility, providing both surgical and medication abortions. It is expected to begin seeing patients in late October. (Mansouri, Bustos and Cortes, 10/2)

With its sole clinic for abortions in Missouri facing a restrictive new state law, Planned Parenthood announced Wednesday it will expand across the border to Illinois with a new 18,000-square-foot facility. The new building, which cost about $7 million, will replace an existing “tiny storefront along a strip mall” in Fairview Heights, Ill., that offered only medication abortions, according to Jesse Lawder, spokesman for Planned Parenthood of the St. Louis Region and Southwest Missouri. (Thomas, 10/2)

One of the most difficult places to get an abortion is Missouri, a state home to just one abortion clinic and a bevy of restrictions for patients and their providers. CBS News was granted exclusive access to the lone clinic in St. Louis and spent weeks reporting on what it's like for women seeking the procedure. Sarah allowed CBS News to document her experience getting an abortion in the state, asking her real name not be used. "This has been a really emotional process for me," Sarah told CBS News correspondent Meg Oliver in June. "It's been really hard." (Oliver and Smith, 10/2)

Political strategists are readying a fight for seats in the Georgia Legislature next year where the debate over access to abortion will likely remain front and center, despite Tuesday’s decision by a federal judge to block the state’s new law. The judge’s decision to temporarily block Georgia’s new anti-abortion law from taking effect as scheduled in January sets up a legal battle that could play out while the Legislature is in session. The next filing deadline in the court case is Jan. 18, less than a week after lawmakers return to Atlanta for the 2020 legislative session. (Prabhu, 10/2)

Some states are trying to tackle their rural grocery gaps. Supporters of such efforts point to tax incentives and subsidies at various levels of government that have enabled superstores to service larger areas and squeeze out local independent grocers. Now, dollar stores are opening in rural regions and offering items at lower prices, posing direct competition to local groceries. Critics see that development as a threat to public health, since dollar stores typically lack quality meat and fresh produce. But every town and every store is different, making statewide solutions elusive. (Simpson, 10/2)

Homelessness experts say California’s low-income seniors are especially vulnerable because of the state's housing affordability crisis: With fixed income and high rent prices, an illness or job loss can quickly put them on the streets. The state already accounts for about a quarter of the nation's homeless population, according to the U.S. Department of Housing and Urban Development, and 69% of the 130,000 homeless Californians were unsheltered on a single night last year. (Lam, 10/2)

People of color, like Torres, are more likely to face medical debt because they lack health insurance coverage and have lower incomes, according to a report that the left-leaning Center for Public Policy Priorities published last month. Nearly 4.3 million Texans living in ZIP codes where more than 60% of the residents were not white had unpaid medical debt sent to a collections agency, according to an analysis of credit reports and 2017 U.S. Census data. (Méndez, 10/2)

There was a time when the diagnosis of H.I.V. was a death sentence, when thousands of New Yorkers, primarily gay men, succumbed to AIDS-related illnesses, and the end of the epidemic seemed both medically and mentally impossible. On Wednesday, however, Gov. Andrew M. Cuomo declared that New York is on track to meet its goal to end the AIDS epidemic in the state by 2020. (McKinley, 10/2)

The U.S. Department of Health and Human Services, through the Centers for Disease Control and Prevention, has awarded $492,370 to Georgia to conduct state and local planning and kick off community involvement for the proposed federal initiative, Ending the HIV Epidemic: A Plan for America, which seeks to reduce new HIV infections in America by 90% by 2030. The funding includes two parts. (Miller, 10/3)

The Trump administration ratcheted up its feud with California on Wednesday as the Environmental Protection Agency issued a notice accusing San Francisco of violating the federal Clean Water Act. Last month, President Donald Trump warned of a potential violation notice, saying the city was allowing needles and human waste to go through storm drains to the Pacific Ocean -- an allegation fervently denied by city officials. The violation notice came in the form of a letter to Harlan Kelly, Jr., general manager of the city’s Public Utilities Commission. (10/2)

Deaths from asthma are disproportionately higher among black patients than among white patients, but black patients constitute the minority of participants in trials informing treatment. As a result, recommended treatments might not work well enough for African Americans. (Clanton, 10/2)

A South Bay resident has died from a neuroinvasive illness caused by West Nile virus, marking the first confirmed death this year from the mosquito-borne disease in Los Angeles County. Public health officials confirmed Wednesday that the patient was hospitalized and died from a West Nile virus-associated illness that affects the central nervous system but did not provide details about the person’s age or when they got sick. (Cosgrove, 10/2)

Records from a health center that's accused of misdiagnosing Iberville Parish students as having serious mental health disorders will follow those students for years, authorities say, but the full impact of the false reporting — part of an alleged scheme to maximize Medicaid payments — remains unknown. Federal prosecutors allege that from 2011 to 2015, St. Gabriel Health Clinic Inc. officials gave schoolchildren bogus mental health diagnoses, without informing their parents, and offered group therapy sessions during classroom hours, all to collect Medicaid reimbursement. (Rddad and Lussier, 10/2)

A red liquid thrown by a protester from the visitors gallery of the California Senate chamber in an “unanticipated attack” on state lawmakers during the final night of the legislative session was found to be blood, according to the state Senate. Secretary of the Senate Erika Contreras sent an email to staff members on Wednesday that said “lab tests confirmed that the substance thrown from the Senate gallery was human blood.” Safety precautions were taken in hiring a company certified in hazard cleanup to sanitize the chamber, and the blood tested negative for any blood-borne pathogens or infections, Contreras wrote. (Luna, 10/2)

Gov. Greg Abbott on Wednesday threatened to send state troopers to Austin if the city’s inaction over tent camps for the homeless continues. In a letter to Mayor Steve Adler, Abbott promised state action that included posting Texas Department of Public Safety troopers in areas of the capital city “that pose greater threats” and deploying Texas Department of Transportation staff to clean up the encampments. (Jankowski, 10/2)

The incident prompted Mr. Robinson to start a volunteer ambulance corps in Bedford-Stuyvesant that has answered calls ever since, cutting response times to only a few minutes. The group, one of more than 30 volunteer emergency service agencies in New York City today and one of nearly that many certified to give basic life support, has also trained more than 1,000 emergency medical technicians. Mr. Robinson, who was known as Rocky, died on Friday at 79. The cause was heart failure, said a son, Antoine Robinson. (Barron, 10/2)

A sheriff's deputy in Perry, Ga., filed a lawsuit in federal court Wednesday against the county where she works for refusing to allow her health insurance plan to cover her gender-affirmation surgery. Sgt. Anna Lange came out as transgender in 2017, after working in the Houston County Sheriff's Office since 2006. (Landman, 10/2)

A man who says his donated sperm was used to father at least 17 children in violation of an agreement that allowed for no more than five has sued an Oregon fertility clinic. Dr. Bryce Cleary believes it’s possible that he has many more children from his sperm donations 30 years ago, the Oregonian/OregonLive reported. (10/2)

Colorado’s top federal prosecutor says that he would never tell banks working with legal marijuana businesses in the state that they are devoid of criminal liability. “As federal prosecutors,” Jason Dunn told The Colorado Sun on Tuesday, “we will never tell them that what they are doing is lawful under federal law. There’s always a risk, just like a retail marijuana business in Colorado, that they face federal prosecution. There is no carve out from federal prosecutions.” (Paul, 10/2)

Speaker Nancy Pelosi and President Donald Trump engaged in a real-time messaging war Wednesday as the president live-tweeted his responses to the California Democrat’s weekly press conference. Pelosi, who announced last week the House was conducting an “official” impeachment inquiry into Trump, opened the press conference by talking about legislation Democrats are crafting to address prescription drug prices. She said she hoped Trump would want to work on that despite the White House threatening to shut down the legislative process because of the impeachment inquiry. “I hope he doesn’t mean he doesn’t want to work together to lower the cost of prescription drugs,” she said.  (McPherson, 10/2)

Lawmakers who trekked to Rochester and the Mayo Clinic on Wednesday heard about skyrocketing prescription drug prices and offered assurances that stemming the rise will continue to be a top priority at the Capitol next year. Many of the lawmakers had boarded a coach bus at the Capitol in the morning, bound for the first legislative “mini-session” in more than two decades. The House-only event involves three days of hearings on topics from drug affordability to wastewater treatment to child-care shortages. (Van Berkel, 10/2)

Traditionally, Golden Tickets lead to chocolate rivers or everlasting gobstoppers. For biotech startups, though, Golden Tickets lead to something with (potentially) fewer pitfalls: money from major pharmaceutical companies. On Thursday, Pfizer (PFE) announced it would give two startups, Neutrolis and Mediar Therapeutics, so-called Golden Tickets to LabCentral, a noted Cambridge, Mass., biotech incubator. (Sheridan, 10/2)

In a boost for the pharmaceutical industry, a federal judge dismissed a pair of lawsuits that alleged two large drug makers devised schemes in which nurses were used illegally to promote their medicines and boost prescriptions, an arrangement that purportedly violated federal kickback laws. The ruling is also a win for the federal government as it attempts to implement a new policy for dismissing whistleblower lawsuits when declining to intervene, or join the case. A Department of Justice memo issued last year directed its attorneys to consider moving to dismiss lawsuits if they appear deficient or following an investigation of claims made by the whistleblower. (Silverman, 10/2)

With brain cancers, “normally chemotherapy gets in a little but not a lot,” said Dr. Graeme F. Woodworth, a neurosurgeon in the University of Maryland School of Medicine who is testing the method on Miller and 14 other people. "In the future, we’re hoping we can provide our drugs of choice a way to get in. We’re hoping we can use it for lots of things.” ...Radiation and chemotherapy are commonly used to slow new cancer growth, but usually aren’t effective for long with these brain cancers. Federal figures show the median survival is 15 to 18 months. About 15% of patients survive five years. (Cohn, 10/2)

Hospitals and health insurers may not see eye to eye on a lot, but they do agree that the federal government's proposal to make hospitals publicly post payer-negotiated rates for medical services would be bad for business and patients. In comments on the hospital outpatient prospective payment proposed rule, which were due Friday, they urged the CMS to abandon the plan. (Livingston, 9/30)

For decades, the brand-name drug industry has relentlessly promoted the message that any reduction in its government-protected monopolies would have detrimental effects on innovation. Members of Congress on both sides of the aisle have taken that message to heart, largely leaving pharmaceutical monopolies alone as drug prices have skyrocketed.But even as the innovation narrative is showing cracks in its foundation, and as House Democrats take aim at removing a provision in the United States-Mexico-Canada Agreement that gives drug companies 10 years of guaranteed market protection, the pharma industry continues to flog its stale innovation narrative. (Jonathan Kimball, 10/2)

Nancy Pelosi claims that her new bill to lower the price of prescription drugs would allow drug prices to be “negotiated by Medicare.” The media accepts her description of the bill as allowing for negotiations. Take this headline in the New York Times, from last month: “Pelosi’s drug plan would let U.S. negotiate prices of 250 medications.” A more accurate headline would have read: “Pelosi’s drug plan would give the U.S. government the power to set the prices of 250 medications.” (Michael R. Strain, 10/2)

Pelosi’s plan would not only result in lethal delays for patients seeking life-saving medicines, but it would also ensure that America steps away from leading the world in breakthrough medical innovation. This presents an ample opportunity for a number of other nations to pounce on our weakness and attempt to fill our patients’ needs. Indeed, Pelosi’s plan would create an opening for countries like China and Russia to step in a grab market share from American drug companies. Just at a time when we are trying through trade agreements to bring industries back to the United States, here we have Pelosi unwittingly maneuvering to send one of our brightest shining industries overseas. (Kent Kaiser, 10/1)

“The burden of out-of-control prescription costs is an issue that touches every family in America,” Pelosi said in her announcement of the new bill. And she’s right. But her bill goes so far that few, if any, Republicans will support it. (Avik Roy, 9/26)

Section 207 of the Lower Health Care Costs Act of 2019, one of the prescription drug pricing bills under consideration in Congress, would remove the requirement for adherence to public quality standards for all biologic medicines, like those used to treat cancer and autoimmune diseases, jeopardizing medicine uniformity and quality. (Melody Ryan, 10/3)

When the question of candidate age has bubbled up in the 2020 Democratic presidential race, it’s usually taken the form of murmurs about 76-year-old Joe Biden’s verbal stumbles and memory lapses. Unlike Mr. Biden, 78-year-old Bernie Sanders has seemed as focused and relentless as ever. But Wednesday’s news that Mr. Sanders is suspending campaign events after getting cardiac stents for an arterial blockage raises the age issue anew. (10/2)

Rest easy, Bernie Sanders supporters (and, you know, any other human with a conscience): Everyone’s favorite bespectacled democratic socialist appears to be doing just fine after a heart-related health scare Tuesday night while campaigning in Las Vegas. The senator from Vermont had two stents inserted — a routine procedure not at all exclusive to 78-year-old men who live life traveling from stump to stump across the country — and his team canceled future events until further notice. But all early signs point to a speedy recovery and a full return to the race.That’s a good news for everyone. (Brian A. Boyle, 10/2)

Here’s some good news for a change about cancer: Cancer mortality — the rate of death from cancer — has fallen substantially over the last four decades.There is also, however, some not-so-good news: Cancer incidence — the rate of cancer diagnoses — has been rising. This doesn’t reflect increasing dangers in our environment, but a danger in our medical system. In this week’s New England Journal of Medicine, two colleagues and I examined the last four decades of cancer statistics in the United States. The decline in cancer mortality is a good sign. Everyone, including the National Cancer Institute, agrees that a declining cancer death rate is the best measure of progress against cancer. (H. Gilbert Welch, 10/2)

Kudos to obstetricians and gynecologists. Doctors and the clinics they work for make money from patient visits. Yet an organization representing obstetricians and gynecologists is recommending women should not have to visit a doctor or obtain a prescription to get common forms of birth control. That shows a dedication to smart health care over finances. (10/2)

Where’s the Pepto Bismol? The medical-academic complex is experiencing a bad case of indigestion over new research this week in the Annals of Internal Medicine that rescinds the longtime recommendation to eat less red meat. Climate politics is now infecting even nutritional science. (10/2)

The growing threat of antimicrobial resistance, combined with the dwindling pipeline of novel antibiotic research, requires policies that prevent inappropriate use of antibiotics, and penicillin allergy testing should be considered an essential component of existing efforts to address this ominous threat to public health. The U.S. Department of Health and Human Services must do more to educate the public and health care providers regarding the importance of penicillin allergy testing and protect patient access to the medical advancements made possible by Alexander Fleming’s revolutionary discovery almost a century ago. (David M. Lang, 10/2)

A story with enormous implications for the health of all Americans is likely flying below their radar and that of their physicians. In a nutshell, it’s this: A proposed rule that sets data standards will make electronic health information more accessible to patients and doctors through smartphone-style apps and will transform health care. Most Americans are familiar with this scenario: During the “conversation” parts of a medical appointment, the doctor faces a computer screen and types information into an electronic medical record system. Such systems store data on hundreds of millions of Americans. (Kenneth D. Mandl and Isaac S. Kohane, 10/3)

Of the 13 people who will sit together on this night and share a meal, five have an eating disorder. For them, this is not just dinner. It’s also therapy. For the rest of us, it is a chance to see the hold that eating disorders can have on otherwise successful, smart people and to gain a better understanding of a psychological disorder that remains largely misunderstood, even as more people seek help for it. (Theresa Vargas, 10/2)