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This is an unhealthy place. Its residents die younger than all but a few other counties in this important swing state. The suicide rate is well above the national average. Brown County saw a 50 percent increase in drug overdose deaths over two years. In one barn at this year’s fair, people stop to learn how to administer Narcan, the opioid overdose medication. On a wet September afternoon, the booth still had visitors. About 130 miles west of here, not far from Indiana Governor Mike Pence’s office, nearly 200 people in a town of 4,000 have been diagnosed with HIV, acquired while they injected heroin and liquefied prescription painkillers. (Scott, 10/11)

Hillary Clinton calls the scourge of heroin and opioid addiction a "quiet epidemic." Donald Trump marvels that overdoses are a problem in picturesque American communities. "How does heroin work with these beautiful lakes and trees?" he said recently in New Hampshire. "It doesn't." Both presidential candidates agree drug addiction is a major problem in America, but only Clinton has offered a detailed plan to tackle it as part of her campaign. (Ronayne, 10/10)

After Donald Trump brought up MIT economist Jonathan Gruber in Sunday night’s debate, Gruber struck back, calling Trump’s health policy plans “garbage salad.” Gruber helped write the Affordable Care Act, which Trump railed against during the debate. “My only comment is that last night showed the difference between a candidate with a strong and coherent health care agenda (Clinton) and one with a garbage salad of right wing talking points (Trump),” Gruber wrote in an email to the Boston Business Journal. (Owens, 10/10)

Jonathan Gruber is firing back at Donald Trump after the Republican presidential nominee called him out for comments about ObamaCare. “My only comment is that last night showed the difference between a candidate with a strong and coherent health care agenda (Clinton) and one with a garbage salad of right wing talking points (Trump),” Gruber, a professor at MIT, wrote in a statement, as first reported by Boston Business Journal. (Sullivan, 10/10)

Republican presidential nominee Donald Trump once again touted the idea of allowing health insurance to be sold across state lines at the second general election debate Sunday, despite multiple analyses that show such a policy could substantially damage the individual market and roll back protections that consumers have come to rely on. Trump has not provided details for how selling insurance across state lines would be regulated. (Muchmore, 10/10)

Health care finally came up as an issue in the second presidential debate in St. Louis Sunday night. But the discussion may have confused more than clarified the issue for many voters. During the brief exchange about the potential fate of the Affordable Care Act, Republican Donald Trump said this: “Obamacare is a disaster. You know it. We all know it. It’s going up at numbers that nobody’s ever seen worldwide. Nobody’s ever seen numbers like this for health care. (Rovner, 10/10)

Three doctors who have led a task force that evaluates preventive medical services say the group's recommendations shouldn't be tied by law to insurance coverage. The former chairmen of the U.S. Preventive Services Task Force say the link between medical recommendations and insurance coverage leads to financial incentives that can corrupt the process and distort people's health care decisions. (Kodjak, 10/10)

The worst appears to be over for Mylan NV and its EpiPen controversy. It took a $465 million settlement with the U.S. Justice Department and a grilling from Congress for its chief executive officer to get there. The drugmaker’s shares rallied Monday following Friday’s settlement with the Justice Department, resolving claims by Medicaid that Mylan overcharged the government health program for the allergy shot. That helped erase some of the stock’s 26 percent slide since August, when lawmakers began asking why Mylan had raised the EpiPen’s price sixfold since 2007, and whether it ripped off the government along the way. Meanwhile, the cost of the shots hasn’t changed. (Armstrong, 10/10)

Shela Bryan, 63, has been comparing prices for individual health insurance plans since May, and she can’t believe what she sees. “They cost a thousand, $1,200 [a month], and they have a deductible of $6,000,” she said. “I don’t know how they think anyone can afford that. (Anderson, 10/11)

The 12.7 million people who enrolled in coverage on Healthcare.gov last year make up a small portion of the population, but their insurance costs seem to be the most in flux. “That simply may be that health insurers don’t know how to price policies yet," said Sidney Watson, a health law specialist at St. Louis University. "They don’t really understand the risk pool; they are learning trial by error.” Her research shows that the premium changes vary widely from city to city. In Missouri, last year pre-subsidy premiums for the benchmark plans rose by more than 20 percent in some areas, but declined in Hannibal, Mo. (Bouscaren, 10/10)

The “public option,” which stoked fierce debate in the run-up to the Affordable Care Act, is making a comeback — at least among Democratic politicians. The proposal to create a government-funded health plan, one that might look like Medicare or Medicaid but would be open to everyone, is being reconsidered at both the federal and state levels. (Bartolone, 10/11)

Providers say the CMS isn't doing enough to protect consumers from receiving surprise bills and ensuring low-income exchange enrollees have access to care. Surprise medical bills come when consumers get care at an in-network facility by an out-of-network specialist. Many times this happens because their insurer hasn't properly informed its customers. In a proposed rule that outlines coverages policies for plans in 2018, the CMS suggested that plans should count enrollee cost sharing for care provided by an out-of-network provider at an in-network facility toward the enrollee's annual deductible . The agency proposed the policy for plans both and off the exchange. CMS received 664 comments on the proposed rule by its Oct. 6 deadline. (Dickson, 10/10)

UnitedHealthcare, the nation’s largest health insurer and former potential suitor to merge with Cigna, provided the Justice Department with a large amount of sensitive, proprietary and confidential information to help the government investigate and block the mergers by its rivals. In filings in the DOJ’s antitrust lawsuits against the mergers of Anthem-Cigna and Aetna-Humana, UnitedHealthcare said “the sweeping scope of the DOJ’s concurrent investigations required United (Healthcare) to produce extensive, highly confidential documents and data." It is now trying, so far unsuccessfully, to prevent its rivals from gaining access to that information in court. (Radelat, 10/10)

One of Theranos Inc.’s biggest financial backers has sued the embattled startup and its founder for allegedly lying to attract its nearly $100 million investment, according to a fund document and people familiar with the matter. Partner Fund Management LP, a San Francisco-based hedge fund, filed the suit in Delaware Court of Chancery Monday afternoon, a letter to the hedge-fund’s investors says. (Weaver, 10/10)

If you’re feeling sick and you want to know what’s wrong with you, there’s an app for that. But the diagnosis won’t be as accurate as the one you’d get from a doctor — not by a long shot. In a head-to-head comparison, real human physicians outperformed a collection of 23 symptom-checker apps and websites by a margin of more than 2 to 1, according to a report published Monday in the journal JAMA Internal Medicine. (Kaplan, 10/10)

Among the tech on the way from companies large and small: Socks designed to monitor diabetics’ feet for signs of injury. A bandage-like sensor that continuously measures their glucose levels. An app meant to predict how the sandwich they had at lunch is likely to affect their blood sugar. ... But there’s also reason for caution. Some of the new tech could carry high price tags, and even those that don’t will add expenses for patients already grappling with the soaring costs of insulin. Patients by and large haven’t embraced the most promising technologies already on the market. And devices that were touted as transformative in years past have fallen flat. (Robbins, 10/11)

The storm's disruption of mosquito-control efforts in the Miami area could also provide an opportunity for the Aedes aegypties mosquito population, which spreads the Zika virus, to multiply. For areas still grappling with flooding, standing water can be a concern, especially if sewers start to overflow. Debris and bacteria can hide in floodwaters, raising the risk of health infections for those who wade in. (Mahoney, 10/10)

With Hurricane Matthew bearing down on Georgia, a pair of coastal hospitals swung into action. Starting Thursday, both campuses of Southeast Georgia Health System (SGHS) – in Brunswick and St. Marys – moved all 190 patients to other hospitals in the state prior to the storm’s arrival. The SGHS hospitals are in low-lying areas near the water. (Miller, 10/10)

It was the breast implants Silverman had had put in two years prior to her diagnosis that ended up saving her life. She has no history of cancer in her family and later tested negative for the BRCA gene mutation, which increases your risk of contracting breast cancer. So on a vacation to Georgia, when she felt the painful lump, Silverman’s first thought was an implant-related issue. And when doctors found a tumor pushing out of her breast, she assumed the implants would have to come out. Turns out, they did not, nor did Silverman have to undergo a mastectomy. (Huffaker Evans, 10/10)

A new report from the CDC outlines how the nation and individual states are progressing toward the Healthy People 2020 breastfeeding objectives. Texas has met the CDC target of 81.9 percent of mothers ever having breastfed, but still falls behind in other key metrics. Texas medical facilities lag behind the national average in the percentage of live births taking place at baby-friendly facilities, as well as in implementation of procedures that can help encourage breastfeeding. These procedures are outlined by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) as the optimal level of care for breastfeeding and mother-child bonding. (Schroeder, 10/10)

The term "bioidentical hormone" doesn't really have a standard definition. In general, it's taken to mean hormones that have the same chemical and molecular structure as hormones produced in the human body... Studies show that up to a million or more women take the custom-made hormone medications, and the number is increasing. But the trend frustrates and even alarms many doctors because custom-compounded varieties aren't FDA approved, nor do they carry labels detailing the risks and possible side effects of all types of hormone therapy. (Zimmerman, 10/11)

Children are dying less often from cancer, with substantial declines in all races and age groups, according to a new report from the National Center for Health Statistics. From 1999 to 2014, the overall deaths from childhood cancer fell by 20 percent. The rate among 1- to 19-year-olds went down to 2.28 per 100,000 population, from 2.85. Adolescents 15 to 19 were the most likely to die, but their rate fell by 22 percent. (Bakalar, 10/10)

The [Beating Anxiety] workshop advises students to tackle anxiety by exercising, getting enough sleep and reframing catastrophic thoughts (if my friend doesn’t text me back right away, she hates me) in more logical ways (maybe she’s studying) among other strategies. It is one part of Ohio State’s effort to cope with the dramatic increase in the number of its 59,000 students on the Columbus campus seeking help for mental-health issues. (Petersen, 10/10)

Influenza data released by the U.S. Centers for Disease Control and Prevention last week showed that during the 2015 to 2016 influenza season, vaccination rates dropped 1.5 percentage points among the general population, with 46 percent vaccinating against the flu. Rates dropped by 3 percentage points among adults over 50, and Hispanic and African American adults continued to experience lower vaccination rates than white adults. Older adults are more severely affected by the flu than younger people and are more likely to be hospitalized if they catch it, said Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases, in a news release. (Caiola, 10/10)

Trichophagia, the eating of hair, is a subset of trichotillomania, which is the compulsive pulling out of one’s own hair. And trichotillomania, in turn, belongs to a broader group of disorders, called body-focused repetitive behaviors, or BFRBs, that include skin-picking and are estimated to affect one to three percent of the population... Cognitive behavioral therapy is currently the gold-standard for treating disorders like mine, but near-term prospects for a cure are bleak: 80 to 90 percent of hair pullers never recover from their disorder. (Koppel, 10/10)

According to the American Association of Professional Hypnotherapists, hypnosis is “simply a state of relaxed focus” that is experienced in daily life. For example, it’s the dreamy phase people pass through when they fall asleep or awaken. It is also known as a trance. Using relaxation techniques, hypnotherapists induce clients into a trance to help them overcome problems or make desired changes in their personal lives. (Goldstein, 10/10)

Each of the nation’s 4,600-plus Walmart stores will provide free health check-ups and low-cost immunizations on Saturday, Oct. 15 as part of Walmart Wellness Day, believed to be the nation’s largest one-day health event. Dubbed “America’s Biggest Health Fair” last year, Walmart changed the name for this year’s event, but the services provided will remain the same. From noon to 4 pm, health professionals will provide free blood glucose screenings, blood pressure screenings and even vision screenings at some locations. More than 10,000 of the company’s licensed pharmacists will also provide low-cost immunizations during the event. (Pugh, 10/10)

Allina Health and its nurses reached a tentative agreement around 4 a.m. Tuesday after a 17-hour negotiating session called together by Gov. Mark Dayton at his residence... More than 4,000 nurses from five Allina hospitals will now vote whether to accept the contract. Nurses have rejected three prior contracts, most recently in an Oct. 3 vote. But this time their union, the Minnesota Nurses Association, will recommend the contract’s approval, according to the statement from the governor’s office. (Olson, 10/11)

Connecticut officials, concerned that graduates of its medical schools are fleeing the state, are looking for ways to encourage those freshly minted doctors to remain. State Rep. Prasad Srinivasin, a board-certified allergist and the only physician in the General Assembly, said he's worried Connecticut is losing both home-grown and out-of-state medical students to other states where there may be more doctor-friendly medical malpractice laws and affordable costs of living. (10/10)

As part of a federal quality improvement effort, Kansas hospitals are reducing the odds that patients will get certain types of infections. And while that effort provides information on hospital quality throughout the state, finding information about the quality of care at individual hospitals remains a challenge. The Kansas Healthcare Collaborative runs a hospital engagement network that includes 106 of the state’s 133 hospitals. Through a federally funded program, hospitals in the network are working to reduce patient harm and hospital readmissions by sharing their best practices. (Wingerter, 10/10)

TriStar Health and Maury Regional Medical Center are planning an in-patient behavioral health facility in Columbia. The availability of behavioral health beds to treat has been highlighted by state and industry officials as an obstacle to treating people with substance abuse and addiction, for example. The proposed $24.4 million facility would have 60 beds for adult and adolescent patients. (Fletcher, 10/10)

Sutter Care at Home is cutting 154 jobs in Northern California, part of a reorganization of its visiting nurses program, officials announced Monday. The cuts, which affect administrative and medical coding positions, include 15 jobs in Sacramento, 20 in Roseville, eight in Yuba City and 14 in Modesto. Sutter Health officials said the job losses do not affect staffers who provide patient care, such as home health care or hospice. The positions are either being consolidated or outsourced. (Buck, 10/10)

Aiming to attract and keep top-notch talent, a growing number of companies are dangling family-friendly perks such as lengthy paid leave for new moms and dads, back-up child care and onsite infant vaccines. But the attention-grabbing headlines — such as “IBM plans to ship employees’ breast milk home” — obscure the reality that for many workers, basic benefits such as guaranteed parental leave, even unpaid, is unavailable. (Andrews, 10/11)

Weinstein, 64, leads the AIDS Healthcare Foundation, an organization he willed from a 25-bed hospice near Dodger Stadium to a global powerhouse that rivals the American Cancer Society. AHF, as it is known, has a projected $1.3 billion budget, more than 600,000 clients and operates in 37 countries. Weinstein still can’t be described as beloved, and his latest attempt to curb drug prices isn’t helping his cause. (Cadelago and White, 10/10)

The staff of Clinica Sierra Vista, which has health centers throughout the Central Valley, screened its mostly low-income patients last year for mental health needs and determined that nearly 30 percent suffered from depression, anxiety or alcoholism. Christopher Reilly, Sierra Vista’s chief of behavioral health services, said he was concerned about the high percentage of patients afflicted, but even more so about the clinic’s ability to treat them. (Gorman, 10/11)

Drew Gutenson loves to talk about his collection of prescription eyeglasses and his fondness for playgrounds — slides, swings, trampolines and zip lines. Gutenson, who describes himself as a high-functioning adult with autism, knows that some skills are particularly challenging for him, such as sensing when people don’t want to talk to him. He also understands that his fondness for playgrounds can be a source of concern for those who don’t know him. (Barnes, 10/10)

Folks in two New Hampshire towns are wrapping a Weare family in love and prayers, after one of their twin baby girls contracted bacterial meningitis and needed emergency brain surgery....A surgeon performed an emergency craniotomy on the tiny girl to try to clean out the infection in her brain, then sewed her up, leaving a portion of her skull missing to accommodate swelling. (Wickham, 10/10)

I’m on a panel this morning talking about the impact of the Affordable Care Act on the broader economy. My rap starts from the perspective that the ACA, while not perfect, is working remarkably well. The ACA debate, on the other hand, has become inseparable from intense partisan politics and this has led to incessant hand-waving and smoke-blowing such that it’s impossible to get the straight dope on its impact. (Jared Bernstein, 10/11)

On healthcare, Trump pledged to repeal the 2010 Affordable Care Act and replace it with “something absolutely much less expensive.” His prime tool for lowering costs, he said, would be to let insurers offer policies across state lines. That’s a change that Republicans have been touting for years, premised on the idea that an insurer in a state with light regulation could undercut the premiums of those in states with tougher rules. But Trump either overlooked or ignored that insurers can’t offer policies in a new state unless they strike deals with the doctors, hospitals and other providers in every community they plan to sell coverage. (10/11)

Private, non-government employers provide health care coverage to more than 55 percent of Americans, according to the Census Bureau. Many of these companies are already carrying out their own do-it-yourself, market-based health care reform. The formulas they use are both simple and sophisticated. Here’s how it works. First, you need an integrated database coupled with data analytics so you can understand what’s going on with your work force and how your policies on pay, health plans, sick leave, and disability time may provide incentives, for better or for worse. Then you can overhaul benefit programs to align workers’ goals with those of the business. After that, you need to focus resources where the real health care costs and waste are. (Hank Gardner, 10/10)

It has become one of the Great Questions of Our Age: Why have so many prime-age American men dropped out of the labor force? The percentage of American men ages 25 through 54 who are neither working nor looking for work has been growing for decades. ... On Friday, Bloomberg Businessweek's Peter Coy reported on new research by Princeton University economist Alan Krueger that explored another possibility -- maybe men have given up on working or looking for work because they really don't feel good. (Justin Fox, 10/10)

The future of the U.S. healthcare system will be influenced to a large extent by a company that makes weapons of war. Defense giant Northrop Grumman has signed a nearly $92-million contract with the Centers for Medicare and Medicaid Services to build the second phase of a computer system that’s currently focused on reducing fraud but down the road will play a greater role in anticipating beneficiaries’ medical disorders. (David Lazarus, 10/11)

The leading cause of preventable death nationwide and in California, tobacco exacts a grave toll on communities, families, health care systems and businesses. Tobacco kills more Californians than car accidents, guns, alcohol, illegal drugs and AIDS combined, and harms the health of nonsmokers through secondhand smoke. This is a public health crisis. (Michael Ong, 10/10)

“Doctors, especially residents, are so tired and so overworked that we don’t realize that the person on the other end of the phone is also tired and overworked,” a surgery resident at a Boston-area hospital told me. Exasperation with the medical system and sheer exhaustion, she said, “comes out as rudeness.” Yet lashing out just makes a bad situation worse. And a body of research shows it hurts patients, too. (Allison Bond, 10/10)