�鶹Ů��

The bitter campaign over high drug prices in California is heating up as it’s winding down. New polls show Californians deadlocked over a ballot proposition that would cap the amount some state health plans pay for medications. In an 11th hour bid to rally support for the measure, Senator Bernie Sanders is canvassing the state Monday with events in Los Angeles and Sacramento. Meanwhile, his allies in the “Yes” campaign just put out a series of brutal online “Wanted” ads painting pharma execs as criminals. (Robbins and Keshavan, 11/7)

This year, Mary O’Connor and her father made voting a family affair. O’Connor’s father is a Vietnam veteran, so she was especially interested in his views on Proposition 61, a California ballot measure that would peg the state’s payments for prescription drugs to prices paid by the Department of Veterans Affairs. It’s widely believed the federal program for military personnel gets some of the deepest discounts in the country. (Bartolone, 11/7)

Tomorrow, millions of us are planning to go to churches and schools, and cast our ballots on Election Day. But what if you get sick and end up in the hospital? In at least 13 states — including Pennsylvania, Michigan and Texas — patients can access what’s called an emergency absentee ballot, said Debra Cleaver with the nonprofit, nonpartisan Vote.org. (Gorenstein, 11/7)

In the June 7 presidential primary, roughly 59 percent of 8.5 million California voters used vote-by-mail ballots, according to the secretary of state’s office. Under state election laws, any voter who missed the absentee ballot deadline but cannot get to the polls “because of illness or disability” can make a signed, written request for an absentee ballot. That request can be delivered by someone they designate, such as a family member or hospital staffer, to the county elections office where they’re registered to vote. (Buck, 11/7)

Hillary Clinton has promised to preserve and expand the ACA's coverage expansions and delivery system reforms. Donald Trump says he wants to repeal them, without offering much detail about what he would put in their place. The fate of the victor's proposals, however, will depend heavily on the partisan makeup of Congress. The clearest scenario is if Trump wins and his party retains control of both the House and the Senate, which would enable conservatives to repeal or roll back the ACA and implement at least some of the proposals outlined in the GOP party platform and the House Republican leadership white paper on healthcare. But there are divisions even among conservatives over issues such as Medicare restructuring and how to help Americans afford health insurance. And Senate Democrats almost certainly would use their filibuster power to block major ACA changes. (Meyer, 11/7)

Much more is at stake on Election Day than the White House. State by state, district by district, neighborhood by neighborhood, candidates and campaigners are making their last pitch for Congress, state legislatures, governor’s offices, ballot questions, judgeships, city councils and lots more. A nationwide look at important, interesting and occasionally odd matters that go before voters on Tuesday. (11/7)

New York City's former mayor is spending $1 million in Illinois to support the effort to impose a penny-an-ounce tax on sugary drinks in Cook County. Michael Bloomberg is paying for a campaign of television and online advertisements in the Chicago market to counter the spending on advertising by the American Beverage Association, which opposes the tax. The ads supported by Bloomberg feature images of children and suggest money generated by the tax could be used to fund anti-violence initiatives. (11/8)

Experts in mental health, trauma and grief say this political season has inflicted deep wounds on the individual and collected consciousness of many, even some who may not even recognize their pain. According to Philip Cushman, a Seattle-area psychotherapist, the nation is already working its way through the stages of grief described by Elizabeth Kubler-Ross in her landmark work on death and dying: denial, anger, bargaining, depression and acceptance. (Clarridge, 11/7)

HealthCare.gov has been straining to handle this year’s would-be enrollees, who are frequently being placed in holding areas on the site to avoid crashing the sign-up system, enrollment workers around the country say. Online “waiting rooms,” where people are sent at times when the site’s capacity is stretched, have been deployed regularly since the new sign-up period began last Tuesday, Nov. 1. (Radnofsky, 11/7)

In a letter from her health insurer just over a week ago, Tawni Phelan of Oklahoma City learned the cost of her family’s coverage, which they buy themselves, would nearly double next year. The new premium, about $974 a month, “would be a struggle” for Ms. Phelan, a 43-year-old who is self-employed, and her husband. Instead, they may try to get a small-business plan tied to her company. (Wilde Mathews and Armour, 11/7)

One prediction of the Affordable Care Act was that health care prices would drop when more people became insured... But six years in, the price of health care continues to increase along with insurance premiums. It takes time to get the newly-insured to visit their physicians for preventative care instead of visiting the emergency room when something is wrong, said Florida Blue market president Penny Shaffer during a recent interview with Health News Florida’s Tom Hudson. (11/7)

In one of President Obama’s last major health care initiatives, the administration is stepping up enforcement of laws that require equal insurance coverage for mental and physical illnesses, a move officials say will help combat an opioid overdose epidemic. A White House task force on Oct. 27 said insurers needed to understand that coverage for the treatment of drug addiction must be comparable to that for other conditions like depression, schizophrenia, cancer and heart disease. (Pear, 11/7)

Deaths from opioid overdoses continue to surge in Massachusetts, as an influx of illegal fentanyl outpaces the decline in the use of heroin and prescription drugs, according to the state’s latest data. The quarterly report on overdoses from the Massachusetts Department of Public Health, released Monday, shows the same deadly trends that have alarmed policy makers for several years persisted from July through September. (Freyer, 11/7)

Fentanyl, an opioid 50 times more potent than heroin, is present in an increasing number of overdose deaths across Massachusetts. It appears be the reason why more men and women are dying even though heroin use and prescriptions for opioid pain medications are down. (Bebinger, 11/7)

New legislation and guidelines aim to reduce and track the opioid market, but the availability of illegal alternatives, insufficient treatment centers and poor prescribing habits threaten to perpetuate the crisis of opioid abuse. (Schroeder, 11/7)

State health officials are warning first responders, friends and family members using the generic nasal mist version of naloxone, the opioid overdose reversing drug, that a piece in the kit might be faulty. Naloxone, if used properly, can rapidly reverse an overdose of opioids, including heroin, fentanyl and other prescription painkillers in the same drug family. (Zeltner, 11/7)

The U.S. Drug Enforcement Administration wants an appeals court to overturn a judge's ruling that requires federal agents to get a search warrant to access information in an Oregon database that tracks doctors and the narcotics they prescribe to patients. The federal drug agency's "administrative subpoenas" are valid and sufficient to get the information, said Samantha Lee Chaifetz, a lawyer for the U.S. Department of Justice. The subpoenas don't require probable cause or a court order ahead of time. (Bernstein, 11/7)

A federal judge in Mississippi issued an order Monday temporarily blocking a new rule from the Obama administration that gives patients at federally funded nursing homes the right to settle disputes in court. Judge Michael Mills of the U.S. District Court for the Northern District of Mississippi granted a request from members of the nursing home industry to stop the rule from taking effect on Nov. 28 while it’s being challenged in court. The new rule from the Centers for Medicare and Medicaid Services (CMS) prohibits any nursing home that accepts Medicare or Medicaid funds from putting pre-dispute arbitration clauses in resident contracts. (Wheeler, 11/7)

The rule, announced in September by the Centers for Medicare & Medicaid Services, would ban so-called pre-dispute binding arbitration clauses in nursing home contracts, which require patients and families to settle any dispute over care through arbitration, rather than the court system. The rule was supposed to take effect Nov. 28, but the American Health Care Association, an industry group that represents most nursing homes in the U.S., filed a lawsuit in October to block the rule, which it called "arbitrary and capricious." (Hersher, 11/7)

The AHCA argued that the rule exceeds the CMS' statutory authority and is wholly unnecessary to protect the health and safety of residents. In a 40 page-decision released Monday, Judge Michael Mills said he agreed. “As sympathetic as this court may be to the public policy considerations which motivated the rule, it is unwilling to play a role in countenancing the incremental 'creep' of federal agency authority beyond that envisioned by the U.S. Constitution,” Mills wrote. (Dickson, 11/7)

Federal efforts to crack down on nursing homes' use of mandatory arbitration agreements suffered a setback today, after a U.S. district court halted implementation of the new policy. Judge Michael Mills in a ruling issued this afternoon questioned CMS' authority to place the sweeping restriction on facilities that receive federal funds, saying it raises "serious legal questions" about the power that federal agencies wield. He granted a preliminary injunction preventing the arbitration ban from taking effect until a broader lawsuit against the rule is resolved. (Cancryn, 11/7)

A group of senators wants to know if Mylan Pharmaceuticals will refund $50 million for charging the Department of Defense “exorbitant rates” at retail pharmacies for the EpiPen emergency allergy device. Their demand followed a Reuters report last week that Pentagon spending on EpiPen rose to $57 million over the past year from $9 million in 2008. The increased spending was due to price hikes and increased sales volume, but also due to lower rebates Mylan paid the Defense Department. And Mylan paid lower rebates because the company misclassified the device as a generic instead of a brand-name product. (Silverman, 11/7)

Three members of the U.S. Senate Judiciary Committee, ahead of a planned hearing late this month, said Mylan NV appears to have greatly overcharged the military for its lifesaving allergy treatment EpiPen and asked the pharmaceutical company when it plans to reimburse the Department of Defense. (Pierson, 11/7)

A trio of Senators called on Mylan Pharmaceuticals Monday to reimburse the Department of Defense for overcharging the department for EpiPens for years. Sens. Chuck Grassley (R-Iowa), Richard Blumenthal (D-Conn.) and Amy Klobuchar (D-Minn.) say they are “alarmed that Mylan may have overcharged our military for this life-saving drug.” (McIntire, 11/7)

Lawmakers continued criticizing Mylan NV over its EpiPen injector, with two leaders of the Senate Judiciary Committee calling for the Federal Trade Commission to review whether Mylan engaged in anticompetitive practices. Committee chairman Sen. Charles Grassley (R., Iowa) and Sen. Patrick Leahy (D., Vt.) said in a letter to the FTC that the agency should look into issues including school contracts that restricted purchases of EpiPen competitors. (Beckerman, 11/7)

The U.S. Senate Judiciary Committee urged federal antitrust regulators on Monday to launch a probe into whether EpiPen maker Mylan NV broke the law by preventing schools from purchasing competing allergy treatments. The bipartisan request to the Federal Trade Commission by Senate Judiciary Chairman Charles Grassley and Ranking Member Patrick Leahy comes just a few weeks before the committee is slated to convene a hearing to scrutinize a pending $465 million settlement that Mylan has said will resolve claims it underpaid rebates to state and federal Medicaid programs. (Lynch, 11/7)

In a move that should settle a highly contentious legal issue, the US Supreme Court on Monday declined to hear an appeal of a ruling that said cash payments are not the only litmus test for determining whether a patent settlement between drug makers deserves antitrust scrutiny. The case focused on a so-called pay-to-delay deal between Teva Pharmaceuticals and GlaxoSmithKline. In these arrangements, a brand-name drug maker reaches a settlement with a generic rival in exchange for ending patent litigation and an agreement for launching a copycat medicine at a future date. The Federal Trade Commission has argued the deals are anti-competitive and cost Americans about $3.5 billion annually in higher health care costs. (Silverman, 11/7)

It may not be Game 7 of the World Series, but biotech and patent law wonks, mark your calendars: Oral arguments in the fight over who deserves the key patent on the CRISPR-Cas9 genome-editing technology are set for next month. Come 10 a.m. on Dec. 6, the parties in the case will be able to present 20-minute arguments — as well as rebut the other side for five minutes — before three US Patent and Trademark Office judges in Alexandria, Va. The judges will also be able to grill the parties on what they have filed in their voluminous motions. (Joseph, 11/7)

United Parcel Service Inc. said Monday it agreed to acquire clinical logistics company Marken Ltd., deepening its push into the profitable business of medical deliveries. The move by UPS into the highly specialized industry could help it expand its express delivery business at a time when many of its traditional industrial and retail customers opt for slower, cheaper shipping options. (Esterl, 11/7)

Sandy Springs-based UPS is acquiring medical shipper Marken in a move to boost its position in the healthcare logistics and supply chain industry. Marken, which is based at the Research Triangle Park in Durham, N.C., specializes in logistics for clinical trials. It is privately-held and has 44 locations around the world and more than 650 employees who manage drug and biological shipments. (Yamanouchi, 11/7)

Federal scientists have launched another test in human volunteers of a Zika vaccine. This one uses a more traditional approach than an experiment that started in August. Federal officials are eager to develop a vaccine as quickly as possible, which is why they are pursuing multiple approaches. This experimental vaccine, called ZPIV, has already proved effective when designed to target a virus similar to Zika, called Japanese encephalitis. (Harris, 11/7)

With Florida health officials reporting more mosquito-borne Zika infections in Miami-Dade, including one new case confirmed Monday, scientists with the Walter Reed Army Institute of Research (WRAIR) launched the first of five early stage clinical trials that they hope will lead to the development of a vaccine against the virus. (Chang, 11/7)

Janet Reno sat in a wheelchair with a blanket over her knees, her fingers curled inward so she could not shake hands. She was skinny — very skinny — almost unrecognizable as the prosecutor who had shot to fame as President Bill Clinton’s attorney general, the first woman to hold that position. Her family had consented to let us meet Ms. Reno this summer for an article about a Parkinson’s fund-raising event she has long participated in. They agreed because one of us, Marilyn, also has Parkinson’s, and the article was to be as much about her journey coming face to face with what her health is likely to look like a few decades from now as it would be about Ms. Reno. (Garateix and Robles, 11/7)

Children born in deliveries planned just a week before the end of a typical pregnancy may be more likely to experience health, learning and behavior issues by the time they're ready for school than kids born at full term, a study suggests. Plenty of previous research has found premature infants often have difficulty breathing and digesting food. Some preemies also encounter longer-term challenges such as impaired vision, hearing, and cognitive skills as well as social and behavioral problems. (11/7)

When patients have a disease that can’t be diagnosed, they get sent to Wendy Chung. Dr. Chung heads the Discover program at New York Presbyterian/Columbia University Medical Center, which uses genetics to diagnose rare and complex diseases that have eluded traditional doctors and specialists. (Reddy, 11/7)

Scientists have finally scratched the surface about why, exactly, poison ivy makes people so itchy. About 10 million Americans suffer from an allergic reaction to poison ivy every year. It’s a serious threat to firefighters, farmers, and others who work outdoors; poison ivy is to blame for 10 percent of the US Forest Service’s lost-time injuries. Now, researchers looking for clues about how poison ivy causes allergic reactions have stumbled upon a key chemical that offers some answers — and points to a potential treatment. (Thielking, 11/7)

Anesthesia during early childhood surgery poses little risk for intelligence and academics later on, the largest study of its kind suggests. The results were found in research on nearly 200,000 Swedish teens. School grades were only marginally lower in kids who'd had one or more common surgeries with anesthesia before age 4, compared with those who'd had no anesthesia during those early years. (11/7)

Certificate and master’s degree programs in patient safety have sprung up over the past decade, and the first PhD track specifically focusing on patient safety and quality of care was launched in 2012 at the Northwestern University Feinberg School of Medicine. Its first graduate completed the program this summer. The programs target clinicians and hospital administrators who want to learn more about how to improve patient safety. While medical residents nowadays are learning more about patient safety than their predecessors, older doctors have to play catch-up. (Swetlitz, 11/7)

When Patrick Geagan goes to sleep, his wife Sue knows he can change dramatically after drifting off. Patrick has REM sleep behavior disorder, a condition in which the body refuses to go into lockdown while the brain is creating physically active dreams. (11/7)

Women should see a doctor, nurse or trained midwife at least eight times during each pregnancy, with five of those visits in the last trimester, the World Health Organization said Monday as it issued 49 recommendations to prevent deaths in childbirth. Previously, the agency had advised women to visit clinics four times per pregnancy. It also acknowledges the important role of local midwives in poor countries where mothers must travel long distances to see doctors or nurses. (McNeil, 11/7)

Since the mid-1800s, laughing gas been used for pain relief, but it’s usually associated with a visit to the dentist. In the early 20th century, women used it to ease the pain of labor, but its use declined in favor of more potent analgesia. Now, a small band of midwives is helping to revive its use in the U.S. (Espeland Gourlay, 11/8)

The chief executive of NYC Health & Hospitals, which runs New York City’s public hospitals, is stepping down from his post atop the nation’s largest municipal health care system, a move that City Hall officials described on Monday as voluntary and expected. (Goodman, 11/7)

Six years ago, only a few U.S. cities had food policy directors — strategists tasked with connecting communities with local farm products and improving access to food in underserved neighborhoods. Now, in line with a national push to improve access to healthy foods and support urban agriculture, nearly 20 cities have them. (Breitenbach, 11/7)

San Francisco Bay Area companies say Sutter Health is strong-arming them into a contract that would help the hospital system secure its power over prices and potentially raise the cost of medical care for their employees in the future. Dozens of companies have received a letter, via their insurance administrators, asking them to waive their rights to sue Sutter. If they don’t, a fact sheet included in the letter says, the companies’ employees who get care through Sutter’s network of hospitals, doctors and medical services will no longer have access to discounted in-network prices. (Dembosky, 11/8)

Kindred Rehabilitation Hospital in Arlington will lay off 92 people and close its doors at the end of the year. All positions will be eliminated at the facility, at 2601 W. Randol Mill Road, said Russ Bailey, vice president of operations, in a letter to sent to the Texas Workforce Commission last Wednesday. “We will try our best to transition employees to our South Arlington campus, or other opportunities within the Kindred organization, as available,” Bailey said. Operations will be consolidated with the Texas Rehab Hospital of Arlington, a $15.8 million facility that opened at 900 W. Arbrook Blvd. in July 2015. (Rice, 11/7)

A federal judge sentenced former surgical technologist Rocky Allen to 6-1/2 years in prison Monday for his theft of a syringe filled with powerful painkillers from Swedish Medical Center in Englewood...Allen and his lawyer, Timothy O’Hara, an assistant public defender, had sought a sentence of 2-1/2 years in prison. O’Hara argued his client had not actually infected anyone despite a health scare prompted when Swedish warned 2,400 patients to seek medical testing because Allen was HIV positive. (Osher, 11/7)

Tansi A. Casillas, 51, of Fresno, alleged that her employer, Central California Faculty Medical Group, eliminated her position at University North Medical Specialty Center in retaliation for the fraud complaints she made and for refusing to perform medical services outside the scope of her respiratory care license. In her lawsuit, Casillas said doctors left the responsibility to her to have face-to-face evaluations with patients on continuous positive airway pressure, a treatment that keeps the airways open for people who have sleep apnea and other breathing problems. The patient and Medicare were later billed for a doctor’s visit, even though the patient was not seen by a doctor, the lawsuit said. (Anderson, 11/4)

A New Jersey man who falsely claimed his young twin sons had lengthy hospital stays so he could collect more than $140,000 from his insurer is now headed to prison. State officials say Steven Herder received a three-year sentence Monday and must pay restitution to the insurance company. The 41-year-old Lindenwold man pleaded guilty last month to insurance fraud. (11/7)

City Passport, jointly operated by the city of St. Paul and HealthEast Care System, has provided people ages 50 and older a social and support network. It has been in operation in some form for 27 years. Programs include trips, games, safety classes, health screenings, medical insurance assistance and discounts. The Passport program will be shut down because it is not economically sustainable and not enough people use it, according to HealthEast. From last fall to the end of this summer, about 250 people used the center, located in the Alliance Bank Center in downtown St. Paul. (Sanchez, 11/7)

Air quality regulators are investigating metal-processing facilities in the city of Paramount after detecting a potent cancer-causing metal at 350 times normal levels. (Barboza, 11/7)

We are nearing the grand finale of our long and disheartening election opera, one we dare not ignore because the outcomes matter so much. While the election results will not be determined by public reactions to the Affordable Care Act, the ACA’s fate will be mightily determined by Tuesday’s outcomes. What have we learned about our collective health future over the past 18 months and what might this mean for our health system’s future? (John McDonogh, 11/7)

The ACA marketplaces aren’t the only health insurance markets to have faced turmoil. As we document in a recent report for the Robert Wood Johnson Foundation, the Medicare Advantage (MA) markets were roiled with health plan exits in the late 1990s and early 2000s. Between 1998 and 2002, close to 50 percent of MA plans cancelled their contracts, causing between 300,000 and 1,000,000 Medicare beneficiaries annually to lose their private plans. ... How government officials – primarily from the George W. Bush Administration and a Republican Congress – responded to that crisis could hold lessons for policymakers’ response to developments in the ACA’s marketplaces. (Sabrina Corlette and Jack Hoadley, 11/7)

Many people have to wait too long to see a doctor. And it could get worse. If, as many people believe, we have a shortage of doctors in the United States, then it follows that we can fix this only by training and hiring more physicians. As with almost everything in our health care system, though, it’s complicated. Some people think there’s no shortage at all — just a poor distribution of the doctors we have. (Aaron E. Carroll, 11/7)

As I rode my bike home the morning after finishing my first 28-hour shift at the hospital where I had just started as an intern, I made a confident turn onto a one-way street. But I was going the wrong way, smack into the path of a car heading in the right direction. Luckily, everyone was fine:  The driver honked, I swerved, then made it home and fell asleep. When I woke up that evening, I was shaken by the certainty with which I had biked directly into oncoming traffic. What other unsafe things could I have done after being awake for more than a day? ... The work schedule of medical residents and interns (first-year residents) is the subject of a fierce debate in academic medicine. Some say that making medical decisions after being awake for long periods is not good for patients or their doctors. Others argue that long shifts help interns and residents become better doctors by understanding the course of patients’ illnesses. At the center of this issue is a question for which we have surprisingly little data: What is best for our patients? (Mara Gordon, 11/7)

Caring for an aging parent is no easy task. ... That’s why having an engaged community that provides resources and support for older adults and the family members taking care of them is so important. Many communities in the East Bay have these resources and support systems already in place, but many residents don’t know about them. (Eileen Nevitt, 11/7)

This Veterans Day, Tennesseans will stand united in saluting our nation's heroes for their service to our country. However, many may not know that thousands of our state's veterans are living every day without access to healthcare coverage. Some are surprised to learn not all veterans are able to access healthcare through the Veterans Affairs (VA) system. Even for those who have access to VA care, there may be additional fees for treatment of a non-service related illness or injury. Here in Tennessee, there are an estimated 24,000 veterans struggling without healthcare, and they deserve a comprehensive coverage solution. (Adam Nickas, 11/7)

Regular readers already know that I am opposed to the statewide ballot measure, which would legalize recreational use of marijuana. I don’t like it because I fear the costs will outweigh the benefits, in particular the impact on our state budget, which already is stitched together with Band-Aids. ... Now a different side of me wants to make an appeal: the child of the ’80s who grew up with Nancy Reagan’s “Just Say No” to drugs seared in my brain. (Shirley Leung, 11/7)

As an eating disorder therapist, I hear from virtual pen pals who are so distressed by the measure of things — pounds lost and regained, dress sizes before and after kids, calories consumed and burned -– that they email me to save them from themselves. I offer therapy for local clients and Skype eating-awareness training for those who live farther away. But even when I can’t help, I exchange unsecured emails as willingly as I once answered phone calls. ... At least I did, until early last January. ... Only in hindsight can I see this e-relationship for what it became: an exemplary case about the pitfalls of treatment-related email. (Jean Fain, 11/7)