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Significant spikes in premiums, insurer dropouts and persistently low enrollment numbers are combining to make this fall’s sign-up period a crossroads for the Obama administration’s signature health law. Federal officials characterize the turbulence as temporary. At the same time, the administration is making a push in its final months to shore up the law by trying to sign up healthy people who are critical to the law’s sustainability but have so far rejected insurance. That push will take place against a backdrop of elections that will shape the law’s future. (Radnofsky and Armour, 9/7)

Blue Cross Blue Shield of Arizona will offer plans on the Affordable Care Act exchange in Arizona’s Pinal County next year, resolving a situation that drew a national spotlight because it represented a major challenge to the mechanics of the health law. When Aetna Inc. announced last month that it would withdraw from the exchange in Arizona, among other states, it left Pinal at risk of becoming the first U.S. county without a single insurer selling exchange plans. Aetna had been expected to sell exchange plans in Pinal County, where approximately 10,000 people had signed up for ACA plans. (Wilde Mathews, 9/8)

Nearly 10,000 Pinal County residents now enrolled in an "Obamacare" plan will have at least one option in 2017 after Blue Cross Blue Shield of Arizona officials confirmed the insurer will offer health plans there next year. Pinal County faced the prospect of no Affordable Care Act plans in 2017 when Aetna last month said it would exit the marketplace in Arizona and 10 other states. The fast-growing county became the only known U.S. county without a marketplace option — as well as a national symbol of the Affordable Care Act's struggle to retain health-care insurers for the upcoming year. (Alltucker, 9/7)

Arizona’s Pinal County will have an insurer offering ObamaCare coverage after all, as Blue Cross Blue Shield of Arizona announced Wednesday that it will step in to offer insurance there next year. The move averts what would have been an unprecedented situation for a county in the United States: having no insurer offering ObamaCare coverage, depriving people there the ability to sign up. (Sullivan, 9/7)

An Obamacare provision designed to inject a protective extra layer of competition into fledgling insurance markets fell into near-oblivion — and its failure has made Obamacare’s mounting challenges even more acute. Under the unwieldy name of the Multi-State Plan Program, the federal government was supposed to contract with two private health plans, at least one a nonprofit. Each is required to offer coverage in all 50 states by next year. But it’s fallen short, reaching fewer states than anticipated, and offering plans that mirror options people already have. (Pradhan and Demko, 9/7)

A group of Republican senators on Wednesday introduced a bill to exempt people from ObamaCare’s individual mandate if they live in a county with one or no options for coverage. The lawmakers, led by Sen. John McCain (R-Ariz.), argue that it is wrong for people to face ObamaCare’s financial penalty for lacking insurance if there is only one insurer offering coverage in their area, or none at all. (Sullivan, 9/7)

President Obama and his Democratic allies are seizing on the exodus of private insurers from ObamaCare markets to renew their push for a so-called "public option" -- but Republicans say more "government intervention" is not the answer to the latest Affordable Care Act woes. (Chakraborthy, 9/7)

The prospect of massive premium hikes in Minnesota's individual market has policymakers scrambling for solutions, but there's no agreement on a simple fix. Enrollment in individual health insurance policies, particularly through government-run exchanges like Minnesota's MNsure, has fallen far short of expectations. (Snowbeck, 9/7)

House Minority Leader Nancy Pelosi (D-Calif.) said Wednesday that Democrats are ready to compromise on funding levels to address the Zika virus, provided Republicans drop restrictions on Planned Parenthood using the money. Pelosi said Democrats will accept the Senate's $1.1 billion compromise — in lieu of the $1.9 billion requested by President Obama and demanded by Pelosi earlier in the year — but only if health agencies are underwritten for a full 12 months. (Lillis, 9/7)

Top senators from both parties are in talks with the White House about a stopgap funding measure to keep the government open past Sept. 30, and while it’s possible Zika funding could find its way into the legislation, the issues that have caused a months-long stalemate are still very much present. Pressure is building to pass Zika funding, and everyone on Capitol Hill knows it. But there doesn’t seem to be an obvious way to get House Republicans and Senate Democrats on the same page. While attaching Zika funding to a CR seems to be the most likely way forward, it’s unclear what form that will take. (McIntire, 9/7)

Nearly a year after the Zika virus grabbed global attention, it is still confounding the scientific community. It may not have wowed Congress, or the countries and foundations that normally fund the World Health Organization’s outbreak response efforts, but it has still left scientists scrambling for answers to critical questions. (Branswell, 9/8)

Some Republicans suggested Wednesday that the Congressional Budget Office has not provided enough useful information about the potential savings of demonstration projects from the Health and Human Services Department’s Center for Medicare and Medicaid Innovation. The center is charged with experimenting with different ways to lower health care spending without decreasing the quality of care. It was created under the Affordable Care Act. In addition, the CMMI is stepping on Congress’ lawmaking powers, members of the House Budget Committee said at a hearing about the agency. (McIntire, 9/7)

House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) is looking to the lame-duck session after the election for passage of his signature 21st Century Cures Act, acknowledging that there is not enough time to get it done before Congress leaves this fall. “Knowing that the Senate is likely to file their CR next week…and say see ya in November it’s darn near impossible to get a bill through both the House and the Senate [before Congress breaks],” Upton told reporters Wednesday. (Sullivan, 9/7)

The Obama administration's "cancer moonshot" took a major step forward Wednesday when a committee of top cancer researchers and patient advocates recommended an ambitious set of scientific goals designed to sharply accelerate progress against the disease. The 10 ideas, which were developed by a blue-ribbon panel, deal with an array of topics, including research, clinical trials, data mining, prevention and patient engagement. The recommendations were sent to a task force headed by Vice President Biden, who is leading the administration's moonshot campaign. (McGinley, 9/7)

The U.S. Food and Drug Administration will review Merck & Co.’s immunotherapy cancer drug Keytruda as a first-line treatment for patients with the most common form of lung cancer, the company said Wednesday. The FDA granted Keytruda, or pembrolizumab, breakthrough therapy designation and priority-review status with a target action date of Dec. 24. (Steele, 9/7)

Hospital ownership of physician practices has increased by 86% in the last three years, according to a new report. The analysis, conducted by healthcare consulting firm Avalere Health and the not-for-profit Physicians Advocacy Institute, found that from 2012 to 2015, hospitals acquired 31,000 physician practices in the U.S. (Castellucci, 9/7)

Operating rooms produce on average more than 2,000 tons of waste per day, and a significant portion of that waste is from disposable medical supplies. And those estimates come from a small sample since there is a limited research that measures OR waste and how it is accumulated, said James Yoon, an author of a recent study from the University of California, San Francisco that analyzed waste in the OR of the hospital's neurology department. (Castellucci, 9/7)

The University of Kansas Hospital and Hays Medical Center announced Wednesday that they have signed a letter of intent to join forces, bringing together the state’s only academic hospital and one of its leading rural hospitals. The agreement, which was announced at simultaneous news conferences at both hospitals, builds on a relationship established more than two years ago when the two institutions, along with more than a dozen critical care hospitals, partnered to treat heart and stroke patients in western Kansas. (Margolies, 9/7)

Lawyers for Exeter Hospital say they are close to reaching a settlement with staffing agencies that allegedly failed to warn hospital officials about hiring a former technician responsible for a widespread hepatitis C outbreak. The settlement with American HealthCare Systems would help contribute to legal settlements paid to 188 former patients who tested negative during the outbreak. An amount has not been disclosed. (Kimble, 9/7)

Blue Cross and Blue Shield of Illinois' parent company is offering buyouts to employees in Illinois and four other states after financial losses last year. Dana Holmes, a spokeswoman for Blue Cross and Blue Shield of Illinois, confirmed Wednesday that buyouts are being offered to employees age 50 and older in Illinois, Texas, Oklahoma, New Mexico and Montana, all states with health insurance plans that fall under parent company Health Care Service Corp. (Schencker, 9/7)

Horizon Blue Cross Blue Shield of New Jersey, the largest insurer in the state, said it paid doctors $58.9 million in care coordination and quality bonuses last year, up from $40.4 million in 2014. That money -  directed toward so-called patient-centered medical homes designed to improve quality and reduce costs -  was in addition to traditional fee-for-service payments. (Brubaker, 9/7)

Demanding explanations for a $1 billion cost overrun, a House panel Wednesday issued a subpoena to the Department of Veterans Affairs for documents on how the cost of a Denver-area VA hospital ballooned to almost $1.7 billion. That figure was nearly triple earlier estimates. The subpoena by the House Veterans Affairs Committee also seeks documents related to millions of dollars spent on artwork and ornamental furnishings at VA offices nationwide, including more than $6.4 million spent on the Palo Alto, California, health care system. (Daly, 9/7)

The U.S. is facing a stark shortage of mental health professionals, and the challenge is affecting local communities as well as high-profile populations like veterans and current military servicemembers. While the Department of Veterans Affairs has responded by boosting hiring, some associations are trying to recruit a promising cadre of new workers to the profession: military spouses. (Teichert, 9/7)

Authorities have identified the veteran who fatally shot himself Sunday outside the Veterans Affairs hospital in Des Moines. Steven Craig Albers, 72, of Des Moines had served during the Vietnam War as a U.S. Army captain, according to his obituary. He was a graduate of Drake University and of Des Moines' East High School. Albers had received care at the VA Central Iowa Health Care System for his physical health, but he did not actively seek treatment for mental health, said his sister, JoAnne Sandvig. (Haley, 9/7)

A county judge Wednesday ordered immunity from prosecution for anyone who turns in heroin or other potentially deadly drugs after a stunning surge in overdoses in the Cincinnati area. Hamilton County Prosecutor Joe Deters asked for the blanket immunity, which he and Common Pleas Court Presiding Judge Robert Ruehlman agreed was unheard of locally, but needed to help get the drugs out of homes after what authorities say was a recent blitz of the city by sellers who mixed heroin with the extremely powerful animal tranquilizer, carfentanil. (Sewell, 9/7)

Former U.S. Rep. Patrick Kennedy, a leading advocate for mental health and addiction treatment, joined providers, families that have struggled with drug abuse, and state officials Wednesday in Philadelphia for the first of six hearings around Pennsylvania on barriers to care. Kennedy, a Democrat from Rhode Island who has been public about his struggles with substance abuse, including prescription drugs, urged creating a registry for consumers to lodge complaints about problems accessing treatment, including insurance company denials, lack of availability or long waits for care, and other issues discussed at Wednesday's session. (Giordano, 9/8)

State Sen. Jeanie Forrester’s plan to use the National Guard to help fight New Hampshire’s drug crisis has been one of the most contentious issues so far in the Republican race for governor. But New Hampshire National Guard members have assisted local law enforcement and community organizations to keep drugs out of the state since long before hundreds of heroin and fentanyl overdoses started stacking up a few years ago. Starting in the 1990s, the federally funded National Guard Counterdrug Program has been working on investigations and community outreach across New Hampshire. (Nilsen, 9/7)

Where you live plays a big role in staying independent as you age. Now researchers say an innovative program that combined home fix-ups and visits from occupational therapists and nurses improved low-income seniors' ability to care for themselves in their own homes. Still to be answered is whether that better daily functioning also saves taxpayer dollars — by helping enough older adults with chronic health problems avoid costly hospital or nursing home stays. (Neergaard, 9/8)

A federally funded project that researchers say has potential to promote aging in place began by asking low-income seniors with disabilities how their lives at home could be better, according to a study released Wednesday. At the end of the program, 75 percent of participants were able to perform more daily activities than they could before and symptoms of depression also improved, the researchers said in the journal Health Affairs. Called Community Aging in Place, Advancing Better Living for Elders, or CAPABLE for short, the program was funded by the Center for Medicare & Medicaid Innovation. (Bluth, 9/7)

The growth of health care spending moderated in Massachusetts last year, the state reported Wednesday, a sign that its ground-breaking experiment to rein in medical costs is making tentative progress. Outlays rose 3.9 percent, a figure that is down from a 4.2 percent increase in 2014 and that matches the state’s economic growth, according to the new data. Spending most likely rose at a slower pace here than nationally, a change from years past — and an accomplishment given that Massachusetts has some of the most expensive hospitals and doctors in the country. (Dayal McCluskey, 9/7)

Massachusetts came really close last year. The goal was to hold the rise in health care spending to 3.6 percent, roughly the rate of increase for other goods and services. But the cost of medicine, surgery, an MRI and other health care went up 3.9 percent in 2015. (Bebinger, 9/7)

The federal government has sued Brentwood-based nursing home company Vanguard Healthcare LLC., alleging the company submitted false claims to Medicare and TennCare on behalf of its senior residents and failed to provide them with even basic nursing services. Moreover, the lawsuit alleges residents suffered "pressure ulcers, falls, dehydration, and malnutrition, among other harms" due to lack of care. (Buie, 9/7)

Psychologists from Louisiana and Mississippi admitted participating in a $25 million Medicare scam by billing for unnecessary or nonexistent tests on nursing home patients across the Southeast, federal authorities said Wednesday. As part of their guilty pleas, Beverly Stubblefield, 62, of Slidell, Louisiana, and John Teal, 46, of Jackson, Mississippi, admitted they're responsible for more than $5.6 million in fraudulent claims submitted to Medicare, according to a Department of Justice news release. (9/7)

A Slidell psychologist pleaded guilty Wednesday (Sept. 7) in a multi-million dollar  scheme to defraud Medicare by charging for services to nursing homes that were unnecessary or never performed. Beverly Stubblefield, 62, pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Carl Barbier of the Eastern District of Louisiana. (Chatelain, 9/7)

A Florida cardiologist accused of charging Medicare for medically unnecessary procedures is preparing to sell his business. Lawyers for Asad Qamar asked a bankruptcy judge to set an Oct. 7 deadline for buyers to submit bids for the Institute for Cardiovascular Excellence’s two locations in Ocala and Summerfield, according to court papers. (Stech, 9/7)

The striking Minnesota Nurses Association sent a letter to Allina Health’s board of directors Wednesday, requesting to meet and discuss the nurses’ concerns. Thousands of MNA nurses were on the third day of an open-ended strike at five Twin Cities-area Allina facilities, including United Hospital in St. Paul. The gist of the letter is that union officials say Allina executives may have misinformed the board regarding how the negotiations have been handled. (Cooney, 9/7)

Texas nursing homes, plagued by poor pay and wholesale staff turnover, are admitting that care is getting worse and danger of injury is rising for residents of their institutions. A new study shows that health-standard violations in Texas homes increased by 20 percent from 2010 to 2014. (Rice, 9/7)

Attorney General Eric T. Schneiderman on Wednesday took a large step toward making New York one of several states to allow late-term abortions in cases where the mother’s health is in jeopardy or the fetus suffers a fatal complication, relying on Supreme Court rulings he said overrode existing law. In a new legal opinion, Mr. Schneiderman said the 1970 state law, which criminalizes abortion past 24 weeks of pregnancy unless the mother’s life is endangered, did not square with the later Supreme Court decisions in Roe v. Wade and other cases. (Yee, 9/7)

Pennsylvania government auditors said Wednesday new funding is needed to cut into the state's backlog of untested rape kits, and they suggested penalties against police agencies that do not meet testing and reporting standards imposed by a law enacted last year. The auditor general's office released a report that followed the state Health Department's disclosure in May that there were more than 1,850 rape kits in Pennsylvania that had gone more than a year without being tested. There were more than 3,000 untested kits in all. (9/7)

For the second time in two weeks, New York State Department of Health officials sought to blame the Environmental Protection Agency for a contaminated water crisis in upstate New York, saying on Wednesday that they were confused and hamstrung by changing federal standards on perfluorooctanoic acid, a toxic chemical known as PFOA. But again and again, lawmakers at a joint legislative hearing seemed deeply skeptical of the state’s explanations about what happened in Hoosick Falls, a riverside hamlet where PFOA has been found in dangerously high levels. (McKinley, 9/7)

Child protection authorities were first asked to investigate an Appleton teenager’s decision to die more than a month ago, according to referrals obtained by USA TODAY NETWORK-Wisconsin. The disability rights groups that filed the referrals hoping to halt 14-year-old Jerika Bolen’s plans to enter hospice care and cease treatment of her incurable disease say they still have not received word from state or county officials on whether any action is being pursued. (Collar, 9/7)

The Cleveland Clinic has named Dr. Brian Harte as president of the newly formed Cleveland Clinic Akron General, the hospital system announced Wednesday. Harte, who most recently served as president of the Clinic's Hillcrest Hospital, is a hospitalist, a doctor who focuses on the care of hospitalized patients. He will replace Acting President Janice Murphy, who will return to her role as chief operating officer for the Clinic's Regional Operations. (Zeltner, 9/7)

It's the classically American health care structure of "service first, learn the cost later" that Paul Ketchel's MDsave is trying to fix. MDsave sits at the nexus of a growing health care conundrum: People need the care when they need it, but that pricey medical test doesn't always align with how close they are to meeting the deductible — if they have health insurance at all. Nor do they know what the total cost before heading into the lab or operating room. (Fletcher, 9/7)

In the last several years, New York, Los Angeles, Houston, Seattle and other U.S. cities have installed high-intensity, white LED streetlights. In all, at least 13 percent of outdoor lighting is now LED, and many communities that haven’t yet made the switch are rushing to do so. ... But health concerns, heightened by a recent warning by the American Medical Association (AMA), are giving pause to some local officials, spurring them to consider less-intense LED alternatives. (Ollove, 9/7)

Research from Santa Clara Valley Medical Center about reducing how long babies stay in hospital neonatal intensive care units will be presented this week at a national nursing conference. (Seipel, 9/7)

The number of suicide deaths increased 6 percent in Minnesota last year, with suicides among men driving most of the increase. The state counted 726 suicides in 2015 — 40 more than the previous year. Suicides among white males ages 25 to 34 account for half of the increase, the Minnesota Department of Health said. (Benson, 9/7)

The Center for Medicare and Medicaid Innovation (CMMI) is tasked with developing and testing new delivery and payment models for health care providers under Medicare, Medicaid and the Children’s Health Insurance Program. Under the 2010 health care law, Congress authorized CMMI to test models that have the potential to lower costs or improve outcomes. ... With CMMI, however, the secretary of Health and Human Services has implemented mandatory “demonstrations” that prevent program beneficiaries or providers from opting out of the experiment. (Rep. Tom Price, R-Ga., 9/7)

There’s a war raging in doctor’s offices— and in each case the winner’s decision can have a significant impact on the patient’s outcome. Increasingly insurance companies are overruling physicians’ recommended treatment plans in the name of cutting costs. This dynamic is problematic because in medicine, as trained and educated professionals, we doctors base our therapy decisions on the best available data, and apply what we know to be most effective to each individual clinical setting and patient. (Dr. Kevin Campbell, 9/8)

On May 25, 2016, Sen John Barrasso (R, Wyoming) introduced the Protect Continuing Physician Education and Patient Care Act of 2016, a measure intended to exempt pharmaceutical companies and medical device makers from reporting payments made to physicians for receiving continuing medical education (CME), medical journals, or textbooks. The legislation that this bill is designed to amend, the Physician Payment Sunshine Act, was the brainchild of Sen Charles Grassley (R, Iowa), and was passed as part of the Affordable Care Act. (Dr. Eli Y. Adashi, 9/7)

One of Donald J. Trump’s recent attack lines against Hillary Clinton focuses on her health: If she has nothing to hide, he asks in a tweet, why doesn’t she release her medical records to the public? For the moment, put aside Mr. Trump’s own revelations about his medical history, which consist of a hyperbolic, undated letter with little detail from his gastroenterologist. ... Instead, assume that Mrs. Clinton wished to take Mr. Trump’s request seriously, and release full and detailed medical records. It would not be easy, even for a V.I.P. with an army of staffers. (Margot Sanger-Katz, 9/7)

Sen. Jeanne Shaheen cares more about funneling taxpayer money to Planned Parenthood than she does about stopping the spread of the Zika virus. The Madbury Democrat made her priorities crystal clear again this week when she voted to block consideration of a $1.1 billion package to combat the virus. It’s the third time Senate Democrats have filibustered the bill. (9/7)

Biologic medications (“biologics”) have been described as miraculous given their potential to help patients suffering from a myriad of serious diseases in ways more traditional small molecule medicines cannot. These therapeutics provide the ability to treat many complex and life-threatening disorders including diabetes, rheumatoid arthritis, multiple sclerosis and a variety of cancers, and have become some of the most widely prescribed drugs. In fact, seven of the world’s top 10 selling drugs in 2015 were biologics. But biologics are expensive, costing on average 22 times more than traditional small-molecule medications. Indeed, drug spending for biologics accounts for 28 percent of all prescription drug spending, with both use and cost expected to grow. (Bert Liang, 9/7)

Frances Peabody’s timeless lecture to Harvard Medical School students, published in JAMA almost 90 years ago, spoke of the complex and deeply human experience of illness, as epitomized by the powerful observation “for the secret of the care of the patient is in caring for the patient.” Peabody emphasized how caring meant understanding for each patient how particular personal and emotional circumstances influenced his or her health. Today, clinicians encounter a level of complexity — co-occurring chronic and rare diseases, organ transplantation, artificial devices — that has completely altered the practice of medicine, while the personal experience of illness and the social context are as important as ever. (Donna M. Zulman, Nigam H. Shah and Abraham Verghese, 9/6)

Nearly a quarter century ago, the Supreme Court asked pro-choice and right-to-life advocates “to end their national division by accepting a common mandate rooted in the Constitution.” Nothing of the sort materialized. If anything, the social and political battles intensified, with states enacting 1074 abortion restrictions. The Court has not considered various appeals in the face of an avalanche of legislation, but on June 27, 2016, it struck down 2 onerous restrictions on physicians and clinics offering abortion services. (Rebecca B. Reingold and Lawrence O. Gostin, 9/6)

When I was pregnant with my first child, my ob-gyn referred me to a genetic counselor “just in case.” I have a condition called X-linked hypophosphatemia, or XLH, which results in a form of dwarfism. I was a spontaneous case; there had no been no history of XLH in my family before me. No road map. (Sheila Black, 9/7)

Reforms under the Affordable Care Act have reduced barriers to health care access by expanding insurance coverage to millions of individuals living in the United States. With primary barriers to access removed, secondary barriers, particularly related to transportation, have become increasingly important. In 2005, it was estimated that 3.6 million individuals failed to receive nonemergency medical care due to transportation barriers. These patients tended to be older, poorer, and ethnic or racial minorities. (Brian W. Powers, Scott Rinefort and Sachin H. Jain, 9/6)

Epinephrine is cheap. My office purchases a multi-dose vial for less than $10. That is why it is ironic that there has been so much discussion and debate recently about the increased cost of EpiPens, which are well-known auto-injectors for epinephrine. The reasons for the price uproar can be found in a combination of supply and demand, lack of competition, insurance deductibles and increasing allergies. (Dr. Robert Wiskind, 9/7)

Earlier this year, the U.S. Food and Drug Administration (FDA) announced that it was reflexively regulating the batteries, circuit boards, wires, and handful of constituents in e-liquids that comprise vapor technology products — as if they are the same as those leafy tobacco products infused with 5,000 chemicals and wrapped in cigarette paper.  “TAG!  You’re tobacco” the FDA said, as if that was all they needed to do to make the public safer.  Of course, nothing is further from the truth.  Much has been written about how the FDA’s tobacco regulations are so burdensome and so onerous that they make it nearly impossible for all but the largest tobacco corporations to seek much less secure approval for their products. (Tony Abboud, 9/7)

Here’s a shocking fact about your food: A company can decide for itself that a chemical is safe to use in food and doesn’t have to tell the Food and Drug Administration, the agency charged with protecting our food supply. If that same chemical was used to make a tennis racket, the company would have to notify the Environmental Protection Agency, giving the EPA the opportunity to review it for safety. Your sports equipment may be safer than what’s on your plate. (Tom Neltner, 9/7)