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Republicans are focused on cutting taxes instead of deficits as they look to power a $4.1 billion budget plan through the House on Thursday. The 2018 House GOP budget promises deep cuts to social programs and Cabinet agency budgets but its chief purpose is to set the stage for action later this year on a comprehensive Republican overhaul of the U.S. tax code. The tax overhaul is the party’s top political priority as well as a longtime policy dream of key leaders like Speaker Paul Ryan. The plan calls for more than $5 trillion in spending cuts over the coming decade, including a plan to turn Medicare into a voucher-like program for future retirees, slash Medicaid by about $1 trillion over the coming decade, and repeal the “Obamacare” health law. (Taylor, 10/5)

Senate Democrats say Republicans plan to slash Medicare spending by more than $470 billion in the proposed budget resolution, breaking a campaign promise by President Trump not cut Medicare. According to a new report prepared for Democrats on the Senate Budget Committee, the budget would cut Medicaid by more than $1 trillion and Medicare by more than $470 billion. (Weixel and Ellis, 10/4)

The AARP is calling on the House to reject potential cuts to Medicare, Medicaid and food stamps in the current budget resolution. In a letter sent to lawmakers Wednesday, AARP CEO Jo Ann Jenkins said the proposals in the budget that could result in cuts to Medicare, or change it to a defined contribution model, should be rejected. (Weixel, 10/4)

Republicans are confronting a growing revolt from their top donors, who are cutting off the party in protest over its inability to get anything done. Tensions reached a boiling point at a recent dinner at the home of Los Angeles billionaire Robert Day. In full view of around two dozen guests, Thomas Wachtell, a retired oil and gas investor and party contributor, delivered an urgent message to the night’s headliner, Senate Majority Leader Mitch McConnell: Just do something. (Isenstadt and Debenedetti, 10/5)

In the wake of nursing home deaths cause by Hurricane Irma, House Democrats are asking the Centers for Medicare and Medicaid Services to let nursing home residents take facilities to court over allegations such as abuse. Over the summer, CMS announced it intended to change the rule under President Obama that banned nursing homes accepting Medicare or Medicaid funds from requiring a third party to settle disputes. (Roubein, 10/4)

Like any new technology, Watson poses unknown risks; for example, what if its advice is wrong and harms a patient? But IBM argues that its machine doesn’t need to be regulated because it’s different from other medical devices. It’s not like a pacemaker or a CT scanner, so the company shouldn’t have to prove to the government that it’s safe and effective. Now, as federal regulators prepare to weigh in on that issue, a STAT examination shows the lengths to which IBM has gone to shield its prized machine from government scrutiny. (Ross and Swetlitz, 10/4)

Senate Republicans want to follow the House and vote to ban abortions after 20 weeks. But doing so would likely reopen an internecine fight over the filibuster with the lower chamber — and the president. Sen. Lindsey Graham (R-S.C.) on Thursday will reintroduce his bill to ban abortions nationwide after 20 weeks of pregnancy, which failed on the Senate floor two years ago, 54-42. It’s sure to fail again if Senate Majority Leader Mitch McConnell brings it up. (Everett, 10/5)

Rep. Tim Murphy of Pennsylvania, an opponent of abortion, will not be seeking reelection at the end of his current term, ending speculation about his future a day after a news report claimed the married Republican had asked a woman with whom he had an extramarital affair to get an abortion. “After discussions with my family and staff, I have come to the decision that I will not seek reelection to Congress at the end of my current term,” Murphy, 65, said in a statement. (Hui and DeBonis, 10/4)

Rep. Tim Murphy of Pennsylvania announced Wednesday that he will retire at the end of his term, after allegations that the married Republican lawmaker, who opposes abortion rights, asked his mistress to terminate a pregnancy. Murphy admitted several weeks ago to an affair with forensic psychologist Shannon Edwards — news that came to light during the woman’s divorce proceedings with her husband. (Bade, Schneider and Bresnahan, 10/4)

More than two thousand miles away from the healthcare debate in Washington, President Donald Trump's threats to let Obamacare collapse are sowing confusion about its fate and dampening 2018 enrollment expectations. The uncertainty here in Arizona, echoed in interviews across the country, shows that even though they have not been able to repeal former President Barack Obama's signature healthcare law, the Republican effort to undermine it is gaining traction. (Gershberg and Tobin, 10/4)

Advocacy groups that support the Affordable Care Act are taking matters into their own hands. With the Trump administration cutting back on advertising and outreach, outside groups are mobilizing for a massive, nationwide campaign for the next ObamaCare enrollment period. They say it’s up to them to get the word out. (Hellmann, 10/5)

Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are still trying agree on how states can alter insurance market rules, which was always expected to be the most controversial element of the deal. Republicans are insisting on giving states “meaningful flexibility” on some of the health law’s requirements in exchange for funding Obamacare’s cost-sharing program for two years. (Haberkorn, 10/4)

Gov. Jerry Brown signed two measures Wednesday to help Californians who buy health insurance under Covered California, the state's Obamacare marketplace. The measures ensure a longer enrollment period and continued treatment for some patients even if their insurer leaves Covered California. The first measure, AB 156 by Assemblyman Jim Wood (D-Healdsburg), was spurred by a Trump administration policy that established a 45-day window for shoppers on Obamacare marketplaces to buy new insurance policies for the coming year. (Mason, 10/4)

Some consumers who buy their health insurance through the Massachusetts Health Connector could see their premiums rise by more than 25 percent next year if the federal government makes good on threats to end certain subsidies, or if the fate of those subsidies remains unclear next week. (Young, 10/4)

Because multiple doses of the vaccine are needed, and they can be up to $200 a pop, HPV vaccination rates have traditionally been lower than other recommended vaccinations. But the ACA’s prevention and wellness mandates may have changed that, says study author Rosemary Corriero, MPH and Oak Ridge Institute for Science and Education fellow in the CDC’s Immunization Service Division. (Hensley, 10/4)

The first tip came from a casual conversation with a source back in May: Health and Human Services Secretary Tom Price was using private jets for routine travel, possibly in violation of federal travel rules that allowed such flights only when commercial options weren’t available. But it was a tip and little else – no times, no names of charter services and not even a schedule from a notoriously secretive cabinet secretary. (Diamond and Pradhan, 10/4)

The top Democrat on the House Oversight Committee wants details from the White House about any private jet trips counselor Kellyanne Conway took with former Health and Human Services (HHS) Secretary Tom Price. In a letter to Conway, Rep. Elijah Cummings (D-Md.) asked for documentation related to all of the private, noncommercial, or military flights she’s taken since joining the Trump administration. (Weixel, 10/4)

While the entire state of Nevada has only one Level 1 trauma center, determining whether it or other cities can cope with a disaster like Sunday's Las Vegas shooting rampage there depends on more than mere numbers. Health care systems' ability to treat mass injuries and casualties depend upon the number and type of hospitals, their capacity and preparedness and system wide plans to coordinate the response, emergency care experts say. (O'Donnell, 10/4)

Kaiser Health News: Las Vegas Faced A Massacre. Did It Have Enough Trauma Centers?

Las Vegas is not only a glittering strip of casinos and hotels but a fast-growing region with more than 2 million residents — and one hospital designated as a highest-level trauma center. The deadly shooting Sunday that killed at least 59 and sent more than 500 people to area hospitals raised questions about whether that’s enough. (Appleby and Galewitz, 10/4)

Dr. Christopher Fisher was working at Sunrise Hospital and Medical Center just off the Las Vegas strip on Sunday evening when the patients starting arriving. "It did look a bit like a war zone, can't say that it didn't," he remembers. "Frantic families, blood in the hallways." People came in so grievously injured and so many at a time that Fisher, who is the medical head of trauma services for the hospital, and his colleagues used markers, writing directly on patients, to do triage. (Hersher, 10/4)

It happens after every disaster, whether natural or human-made. Before the floods recede or the crime tape is removed, hundreds will line up to donate their blood. Less than 24 hours after the mass shooting in Las Vegas, a line of people twisted from a blood center around several city blocks. According to one woman's tweet, it took seven hours or more to get to the front of the line. Time and time again it's the same story. When two bombs shredded scores of runners and fans at the 2103 Boston Marathon, media outlets reported that some participants who had crossed the finish line kept running — right to Massachusetts General, around the corner, to donate blood. (Nutt, 10/4)

Nevada’s mental health system was already overstretched before the carnage on Sunday night at a country music festival here. Now, thousands of victims, survivors, and their loved ones — as well as first responders and local workers who witnessed the horror — are expected to need mental health services in the coming weeks and months. ... Nevada ranked last in the U.S. by measures of access to mental health care in a report released last year by the nonprofit group Mental Health America. Mental health professionals in the state said they’re routinely forced to turn patients away or add them to the end of long waiting lists. (Robbins, 10/4)

The health insurer Cigna on Wednesday announced it will no longer cover OxyContin prescriptions for customers on its employer-based health plans, the second major announcement in two weeks from an industry group billed as an effort to slow the opioid epidemic. Cigna also announced its intent to reduce opioid use among its consumers by 25 percent by 2019. Insurance consumers who have started OxyContin use for cancer or hospice care are exempt from the policy change. (Facher, 10/4)

There's about 10 feet between Judge Craig Hannah's courtroom bench and the wooden podium where a defendant stands to be arraigned here in Buffalo City Court. But for 26-year-old Caitlyn Stein, it has been a long, arduous 10 feet. "This is your first day back! Good to see you!" Judge Hannah says as he greets her. (Westervelt, 10/5)

A Texas county is suing pharmaceutical companies over their role in the opioid epidemic. The suit, filed on Sept. 29 by a Dallas lawfirm on behalf of Upshur County, is the first of its kind in Texas, and joins a growing number of legal actions taken by governments amid a worsening national health crisis related to painkillers. It accuses more than a half-dozen pharmaceutical companies and their affiliates of using "now-debunked studies" to push for more access to powerful painkillers. (Downen, 10/4)

An East Texas county is suing a slew of prescription painkiller manufacturers and distributers in federal court, accusing them of fueling an opioid addiction epidemic that has gripped communities across the nation — in part by allegedly inflating the drugs' benefits in treating chronic pain and downplaying the addiction risks. (Malewitz, 10/4)

Inside the search for new drugs and techniques to replace habit-forming opioids, science correspondent Miles O’Brien discovers future pain treatments may rely on virtual reality. (O'Brien, 10/4)

Iowa’s attorney general has struck a new deal with a drugmaker to make an opioid overdose reversal drug more affordable. Public agencies in Iowa, including law enforcement and public hospitals, will pay less for naloxone through a rebate agreement with Amphastar. (Sostaric, 10/4)

A recent PBS NewsHour/Marist poll showed that Americans consider opioid addiction a “serious and growing” problem. And they don’t foresee the crisis improving without intervention. The poll, released in partnership with the Marist Institute for Public Opinion, also showed Americans are largely split on who is to blame for the epidemic — the government, the healthcare field or pharmaceutical companies — and are even less sure who should be responsible for solving the crisis. (Strum, 10/4)

The average smoking rate in the U.S. has declined significantly over the past several decades. That’s the good news. The bad news is that a group of 12 contiguous states in the Deep South and Midwest is lagging behind. Referred to as “Tobacco Nation” in a new report from the Truth Initiative, an anti-smoking group, the region consists of Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee and West Virginia.  In those states, 22 percent of adults smoke, compared with 15 percent in the rest of the U.S., giving the area the highest concentration of smokers in the nation. (Kaplan, 10/4)

A Finnish study suggests that regular sauna visits can reduce the risk for high blood pressure. The study, in the American Journal of Hypertension, included 1,621 middle-aged men with normal blood pressure who were followed for an average of 25 years. During that time, 251 developed hypertension. (Bakalar, 10/3)

Her symptoms pointed to cancer. She had sought medical attention for small lumps under her arms, but doctors in Australia discovered it was worse than that — enlarged lymph nodes were also in her chest and in the roots of her lungs. They suspected it was lymphoma, a type of cancer that attacks the lymphatic system, which removes toxins and other waste from the body. (Bever, 10/4)

Last year, Illinois passed legislation that requires cosmetologists to receive domestic abuse prevention training as part of their licensing process. Many people form strong bonds with their hair stylist. Now Wyoming is interested in turning to cosmologists for help spotting abuse in a similar way. (Mullen, 10/4)

Kaiser Health News: Moms Of Children With Rare Genetic Illness Push For Wider Newborn Screening

Kerri De Nies received the news this spring from her son’s pediatrician: Her chubby-cheeked toddler had a rare brain disorder.She’d never heard of the disease — adrenoleukodystrophy, or ALD — and she soon felt devastated and overwhelmed. “I probably read everything you could possibly read online — every single website,” De Nies said as she cradled her son, Gregory Mac Phee. “It’s definitely hard to think about what could potentially happen. You think about the worst-case scenario.” (Gorman, 10/5)

Under Gov. Greg Abbott, more and more top officials at Texas' social services superagency command big salaries. Not counting staff physicians, the Health and Human Services Commission has 11 administrators making $200,000 a year or more. A decade ago, there were none. When Abbott took office in January 2015, there were just three. Over the past 13 months, 10 top commission officials have received five-digit raises — of between $10,000 and $72,000 apiece, according to a review by The Dallas Morning News of open records. Most of the huge pay bumps, if not all, resulted from promotions. (Garrett, 10/5)

Twenty of the 28 hospitals in Connecticut had positive total margins — meaning they were in the black — in the 2016 fiscal year, up from 17 the year before, according to a report by the state Office of Health Care Access. Despite the clear majority with positive margins, however, some hospitals still struggled in the fiscal year that ended on Sept. 30, 2016. (Rigg, 10/5)

Michigan’s former head of disease control said Wednesday that an outbreak of Legionnaires’ disease in the Flint area was a sensitive topic at the same time that Gov. Rick Snyder’s administration was being challenged over water quality in the poor city. Corinne Miller returned to the witness stand at a key court hearing involving her former boss, Nick Lyon, the head of the Department of Health and Human Services. He’s charged with involuntary manslaughter in the death of an 85-year-old man who was treated for Legionnaires’ six months before he succumbed to congestive heart failure in 2015. (10/4)

Michigan lawmakers voted Wednesday to prohibit local taxes on food, drinks and gum in a pre-emptive strike against any municipality that might consider levying a tax on soda and other sugary and artificially sweetened items. No local government in Michigan is now considering such a tax. But majority Republicans said it is possible, pointing to Philadelphia and the Chicago area as places with soda taxes. Similar taxes have been approved in San Francisco and Oakland, California. (Eggert, 10/4)

Add 20 more cases and 22 more hospitalizations to San Diego County’s ever-growing hepatitis A outbreak.Tuesday afternoon the county Health and Human Services Agency raised the number of the outbreak’s confirmed cases to 481 from 461 and hospitalizations to 337 from 315. The death count associated with the outbreak, which started in November 2016, remained at 17 for a second straight week. (Sisson, 10/4)

U. S. District Court Judge Roslyn Silver granted class-action status in the litigation, filed 2 ½ years ago against the state, on behalf of a number of foster children. ... In August, 900 children entered the system when they were removed from their homes due to allegations of abuse and neglect, according to the Department of Child Safety. (Pitzi, 10/3)

A Michigan woman will spend seven days in jail after she defied a judge’s order to have her 9-year-old son vaccinated. Rebecca Bredow was sentenced for contempt of court Wednesday, nearly a year after an Oakland County judge ordered her to have her son vaccinated. Bredow had been given until Wednesday to get her son the medically allowed amount of vaccination, which would be up to eight vaccines. But the Detroit area mother, citing her religious beliefs, had refused to do so. (Phillips, 10/4)

A state-funded program that aims to help elderly low-income people and those with disabilities get care to stay in their homes has failed to fully protect them from potential harm, an audit by the Secretary of State's Office said Tuesday. The report said the Oregon Department of Human Services should take "immediate action" to improve oversight to guarantee "the safety and well-being" of those using the consumer-employed provider program. (Terry, 10/4)

Twice in recent years, chemists used by the state of Massachusetts to test drugs in criminal cases committed massive misconduct in their testing, affecting tens of thousands of cases. And twice, prosecutors in Massachusetts failed to act promptly to notify most defendants of the problem. Instead, the prosecutors have taken years to seek justice for the defendants affected by the bad drug testing in both episodes, causing some people to wrongly spend years in prison. (Jackman, 10/4)

Crowdfunding first got attention as a way for inventors, entrepreneurs and aspiring filmmakers to raise money to finance their projects. But in the past few years, another category has emerged and seen exponential growth: health care. Increasingly, people are asking friends and strangers on the Internet to help them pay their medical bills. (Ridderbusch, 10/3)

Little Company of Mary Hospital will join the Rush system under a nonbinding letter of intent announced Wednesday by officials of the two health care organizations. Little Company of Mary Hospital is an Evergreen Park, Ill. community hospital with 272 beds. The hospital is one of 12 locations in the south and southwest suburbs. It employs more than 2,000 employees. Little Company would remain a Catholic ministry, the organizations said. (Ruminski, 10/4)

The U.S. Justice Department has reached an $8.6 million settlement with a hospital company following whistleblower allegations that four of the company's Houston-area hospitals pressured ambulance companies into swapping cheap rides for some patients in exchange for lucrative opportunities to shuttle other patients, federal authorities confirmed. The hospitals area all affiliated with the Hospital Corporation of America, based in Nashville, which agreed to the settlement, according to a Justice Department announcement on Wednesday. (Banks, 10/4)

Claremont police have launched an investigation into sexual assault allegations against Dr. Eric Knight, the Claremont physician whose license was quickly suspended last month once a former patient told her allegations of unwanted sex to state medical investigators. Claremont Police Chief Mark Chase said he started the investigation after receiving material about Knight in the mail from the New Hampshire Board of Medicine. He stressed the investigation will take time. (Hayward, 10/4)

The US attorney’s office may be looking at whether Dr. David Samadi was in the operating room for “critical parts” of his surgeries. (Saltzman, 10/5)

Santa Clara County’s newest stab at reducing public drunkenness — a state-of-the-art “sobering station’’ — opened its doors in a room in county’s Reentry Center for former inmates, across from a police parking lot. Beginning with Sunnyvale, Campbell and the sheriff’s office, officers can drop off severely intoxicated but otherwise mellow people to dry out — at what officials hope will be a cheaper cost to taxpayers than an emergency room or jail. (Kaplan, 10/4)

That area of Euclid was just one of dozens of food deserts in Cuyahoga County. ...That leaves them vulnerable for illnesses like heart disease and stroke, health officials say. (Christ, 10/4)

Maybe Congress thinks that kids won't need to see the doctor. Asthma cases will clear up, tumors will spontaneously go into remission and sick days from school will become a thing of the past. That must be what's going on up in Washington, because we can't think of any other reason why Congress would have let the Children's Health Insurance Program expire at the end of last month. The federal-state insurance program helps guarantee that kids in low- and middle-income families don't go without important health care. (10/4)

The fate of the Affordable Care Act may be deeply divisive, but there’s one aspect of the health care system that retains broad support across the political spectrum — the Children’s Health Insurance Program. ... But Congress is so screwed up that, as of last weekend, it allowed the program to expire. A bipartisan deal was in the works in the Senate, but Republicans in both chambers got distracted by yet another attempt to repeal the Affordable Care Act, and the deadline to re-authorize funding for CHIP passed on Saturday. (10/3)

Our leaders allowed funding for the Children’s Health Insurance Program – in Arizona, we call it KidsCare – to expire on Saturday, the end of the federal budget year. While many states have enough in reserve to cover until next summer, Arizona is among 10 states set to run out of money by the end of the year, according to the Kaiser Family Foundation. (Laurie Roberts, 10/4)

Tomorrow the House will vote on its 2018 budget resolution. Leadership says it has the votes to pass. That’s unfortunate, as it signifies that a majority of House Republicans favor a Robin Hood-in-reverse budget that cuts programs for the poor and elderly to give tax cuts to the rich. ... One has to wonder why, at a time of the worst wealth and income inequality since the 1920s, the party in power wants to shower the top 1 percent and profitable corporations with tax breaks — paid for by slashing safety net programs. (Max Richtman, 10/4)

The Senate has quietly and unanimously passed a bill that would improve some Medicare benefits for people with chronic disease. The measure would do many good things but the most important is this: It would take important steps toward breaking down the wall between medical treatment and non-medical supports and services in Medicare, beginning a process that would make it much easier for frail seniors to receive the right care when they need it. (Howard Gleckman, 10/4)

Despite its importance to so many people, Medicaid has always been the health system's stepchild. Many doctors and dentists have avoided taking Medicaid patients saying the program didn't pay enough. Until recently, editors haven't been keen to feature stories about Medicaid believing that their audience was not interested in reading about people most likely to be on the program — the poor, the disabled, kids, and seniors who needed it to pay for their nursing home care. ... So what is this program that affects so many and will undoubtedly surface again either later this year or next as a political football? (Trudy Lieberman, 10/4)

The inherent architectural problems of the Affordable Care Act, coupled with the failure of the Trump administration to prop it up vigorously, has left the individual health insurance market in shambles in many states. One of the states suffering greatly is Iowa. The plan Iowa has developed to salvage its insurance market -- the Iowa Stopgap Measure -- suffers three major flaws, however. (Seth Chandler, 10/4)

Since Maria leveled the island, under a third of its residents have a sporadically working phone. Fewer than half of the hospitals are open. The majority of the island still lacks electricity, running water or food. People are spending hours in line to get gas to fill up their cars or diesel if they have generators. Others spend hours in line in front of supermarkets, trying to find water and something to eat. And lastly, many others are in towns still unable to communicate with anyone in the island, much less the rest of the world. Although it is our hope that this urgent situation can be quickly resolved, it is possible that this could be the beginning of a dire public health crisis for the island. (Jaime Farrant, 10/2)

Teachers noticed when some students at Southview Middle School in Ankeny were not eating lunch. When those teachers found out negative balances in lunch accounts were to blame, they started a fundraiser and donated about $1,500. Such initiative and generosity deserve recognition. It should serve as an example to all of us. Yet charity should not be necessary when it comes to school lunch. (10/4)

Five Nobel Prizes have now been awarded to science originating from fruit fly research. ... Learning about human health from fruit flies may sound like a stretch — indeed, Sarah Palin mocked it during the 2008 presidential campaign — but it exemplifies a type of scientific inquiry called “basic research.” ... Unfortunately, investment in this important work is under threat. This year, President Trump proposed budget cuts of 22 percent for the National Institutes of Health and 11 percent for the National Science Foundation. These two institutes fund most basic biological research in the United States. Congress pushed back, but some congressmen question the value of this kind of work, calling instead for funding that directly looks for cures for human disease. (David Bilder, 10/4)

Our topic for today is hypocrisy. The scene is — where else? — Congress. This week the House of Representatives voted 237 to 189 to make it a crime for a doctor to perform an abortion on a woman who has been pregnant more than 20 weeks. Victory for the anti-choice forces. One of whom was apparently very interested in maintaining all options when he thought his own girlfriend was expecting. Meet Tim Murphy, a Republican congressman from the Pittsburgh suburbs. ... Murphy is a co-sponsor of the anti-abortion bill. (Gail Collins, 10/4)

California families are struggling to afford the cost of their healthcare and many are being forced to make tough decisions about whether to take their medications or pay for rent, food, or other day-to-day expenses. A bill currently on the governor’s desk would make things worse by limiting access to critical coupons — assistance that could mean the difference between life and death for vulnerable patients. (Dr. Gustavo Alvo, 10/4)

These programs are making the opioid crisis worse by making recovery from opioid addiction harder than it already is. By turning their backs on people like me on medication-assisted therapy to kick opioid addictions, these programs are prolonging addiction and contributing to overdose deaths. (Elizabeth Brico, 10/4)