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Millions of Americans who bought individual health insurance outside the Affordable Care Act's public exchanges may be leaving money on the table if they skip those marketplaces again in picking 2017 coverage, a new report says. The Department of Health and Human Services estimates that 2.5 million people who bought so-called off-exchange coverage for this year might have income levels that qualify them for tax credits to help pay the premium. (Murphy, 10/4)

About 2.5 million people are missing out on tax credits to lower the cost of their insurance, because they are buying health insurance plans off the federal and state health care exchanges, federal regulators said Tuesday. Those earning between 100 and 400% of the federal poverty level —  up to $100,000 for a family of four — are eligible for tax credits that lower the cost of their insurance premiums. People who make less than 100% of the poverty level were supposed to be eligible for Medicaid under Obamacare, but nearly 20 states have opted against expanding the program. (O'Donnell, 10/4)

Millions of people in the U.S. may be missing out on funds available under Obamacare to help them afford health insurance, the federal government said, as the fourth sign-up season for the program approaches. About 2.5 million people with individual or family insurance plans outside of Obamacare could be eligible for tax subsidies if they bought through the program, the U.S. Department of Health & Human Services said in a report Tuesday. In addition, about 9 million people who are uninsured may be eligible for subsidies to help them buy plans, according to the report. (Tracer, 10/4)

Tens of thousands of Tennesseans who buy individual health insurance plans directly from a carrier rather than using healthcare.gov may qualify for tax credits, new federal data shows. A report from the U.S. Department of Health and Human Resources concludes that there could be as many as 79,000 Tennesseans who would qualify for tax credits to offset monthly insurance premiums if they bought plans on the federally run exchange as opposed to shopping what's called "off-exchange" plans, which are not eligible for tax credits, according to a report from the U.S. Department of Health and Human Resources. (Fletcher, 10/4)

With four weeks left until the start of open enrollment, the federal government released estimates Tuesday that show millions of Americans could benefit from financial assistance if they shopped for individual coverage on HealthCare.gov as opposed to purchasing coverage off-exchange. The U.S. Department of Health and Human Services estimates that about 6.9 million Americans buy individual health care coverage off the exchange. Of that number, nearly 2.5 million may have income levels that qualify them for financial help to pay insurance premiums. That includes 83,000 people in Missouri and 130,000 in Illinois, HHS said. (Liss, 10/4)

As it enters its seventh year, the Affordable Care Act is facing challenges, leading some to speculate that the law will have to change in order to survive. From insurers leaving federal exchanges to problems getting young, healthy consumers enrolled, the Affordable Care Act has had a bumpy ride of late. Health and Human Services Secretary Sylvia Burwell acknowledged that changes are needed to improve competition, affordability and access. (Ochoa, 10/4)

The U.S. Department of Justice wants to escape two insurer lawsuits accusing it of shorting them of hundreds of millions of dollars in the Affordable Care Act's much-maligned risk-corridor program by claiming they weren't guaranteed the massive payouts in the first place. The DOJ asked the U.S. Court of Federal Claims to dismiss similar lawsuits from Moda Health and Blue Cross and Blue Shield of North Carolina that demand a combined $338 million in risk-corridor payments for 2014 and 2015. (Teichert, 10/4)

Individuals who obtained insurance through Obamacare in 2014 were much more likely to receive preventive services and have a usual source for obtaining medical care compared with the remaining uninsured, according to a new study by government researchers. About one in four (27 percent) previously uninsured people who did not have a regular source for care in 2013 gained one after obtaining exchange coverage, according to findings published Tuesday in Health Affairs. Similarly, 18 percent of previously uninsured individuals reported obtaining a regular care provider after signing up for Medicaid in 2014. (Pradhan, 20/4)

Getting surprise bills from doctors and other providers who are outside your health-insurance network is one of the more unpleasant trends in coverage these days, especially for plans purchased through the Affordable Care Act’s marketplaces. But a new study published Tuesday in Health Affairs makes clear that so-called narrow networks of physicians do come with lower premiums: 6.7 percent lower, on average. (Sapatkin, 10/4)

Iowans in 13 rural counties who want to buy subsidized health insurance under the Affordable Care Act will have just one option for 2017, the state insurance division reported Tuesday. Medica, a relatively small carrier based in Minnesota, is the only health insurer that has agreed to sell individual policies in all of Iowa's 99 counties, via the Affordable Care Act’s online marketplace. The marketplace is the sole place where consumers can buy individual health insurance that qualifies for subsidies under the federal law, also known as Obamacare. (Leys, 10/4)

Covered California has fixed its computer system to prevent pregnant women in a certain income range from being transferred into Medi-Cal without their knowledge or consent. The fix comes nearly a year after the problem began. Between October 2015 and May of this year, about 2,000 pregnant women were automatically dropped from their Covered California plans and placed into Medi-Cal, even though they had the right to stay with the state insurance exchange. (Bazar, 10/5)

Federal officials have approved Kentucky Gov. Matt Bevin's plan to dismantle the state health exchange. The exchange, known as kynect, was launched in 2013 and has been a way for Kentucky residents to shop for health insurance or enroll in Medicaid under the federal Affordable Care Act. After Nov. 1, people in Kentucky will use the federal health exchange to find coverage. (10/4)

While approving the plan, a top official with the U.S. Health and Human Services Department expressed concern about the impact of the transition on the about 500,000 Kentuckians who gained health coverage through kynect. "We remain concerned that kynect's transition to the federal platform may disrupt the seamless system of coverage that kynect established," Andrew Slavitt said in a letter to Bevin. (Yetter, 10/4)

The exchange was set up under the state’s former democratic governor, but when Republican Matt Bevin took office nearly a year ago, he said he would shift to using the federal platform. The change will take effect on Nov. 1, the same day as the start of the open enrollment sign-up period. CMS Acting Administrator Andy Slavitt said in a letter to Bevin that the state has met the required transition milestones required to date, but said the agency has concerns about how the transition will affect people who buy their insurance on the exchange or are covered by Medicaid or the Children’s Health Insurance Program. (McIntire, 10/4)

Former President Bill Clinton put his wife in a tough political spot by re-injecting Obamacare into a policy-free presidential race — with just 35 days until Election Day and the media intensely focused on Donald Trump’s tax returns. (Cook and Ehley, 10/4)

Former President Bill Clinton ignited a mini-firestorm on Monday when he slammed the post-Obamacare U.S. health care system as "the craziest thing in the world." The comment seemed to be a devastating attack on President Barack Obama's signature domestic achievement, which is strongly supported by his wife, Democratic presidential nominee Hillary Clinton. After a day of conservatives drawing attention to the lines, Republican presidential nominee Donald Trump tried to feed the furor with a tweet: "Wow, did you just hear Bill Clinton's statement on how bad ObamaCare is. Hillary not happy. As I have been saying, REPEAL AND REPLACE!" (Kapur and Tracer, 10/4)

Hillary Clinton sought to clean up after her husband who on Monday night referred to Obamacare, President Barack Obama’s signature legislative achievement, as a “crazy system.” “I think he made it clear what he was saying,” Clinton told reporters during a press conference on Tuesday in Pennsylvania, when asked about her husband's remarks. “With respect to the Affordable Care Act, I’ve been saying that we need to fix what’s broken and keep what works.” (Griffiths, 10/4)

Bill Clinton tried to avoid muddling his message again as he campaigned for his wife in battleground Ohio a day after he described President Barack Obama's health care law and the resulting insurance markets as "the craziest thing in the world." This time, Bill Clinton only briefly mentioned health care in multiple appearances Tuesday in eastern Ohio, clearly stating his support for the law and arguing that more still must be done to expand access to insurance. (10/4)

Former President Bill Clinton on Tuesday evening firmly declared his support for the Affordable Care Act, after causing a dust-up by referring to some of the effects of President Barack Obama's signature legislative achievement as “the craziest thing in the world." “I want to say this one thing about the healthcare law, because that’s another thing they’ve been trying to tangle in — I supported the Affordable Care Act. I support it today,” he said while campaigning for his wife in Steubenville, Ohio on Tuesday. (Saba, 10/4)

Donald Trump seized Tuesday on comments Bill Clinton made about the federal health-care law known as Obamacare, and he suggested the former president has “gone through hell” with Hillary Clinton on “many nights.” Trump said Bill Clinton “came out and told the truth” about the Affordable Care Act when he “absolutely trashed” it. (Sullivan, 10/4)

Republicans on Tuesday jumped on Bill Clinton’s reference to some of the gaps in the U.S. health system as an acknowledgment of shortcomings in the 2010 Affordable Care Act. The former president and husband of Democratic presidential nominee Hillary Clinton was speaking in Flint, Mich., on Monday, when he noted that while the current system works fine for lower-income people, and while 25 million more people now have health coverage, other people are seeing their premiums doubled and coverage cut in half. (Armour, 10/4)

Hillary Clinton sharply criticized Donald Trump for his comments on military veterans and post-tramautic stress, which have drawn criticism for his suggestion that "strong" veterans don't have to worry about the disorder." Donald Trump's comments are not just ignorant, they're harmful," she said, raising concerns that such remarks increase the stigma surrounding mental health. (Megerian, 10/4)

Democrats on Tuesday seized on comments Donald Trump made suggesting that military members and veterans with mental health issues are not “strong” and “can’t handle it,” remarks they said render him out of touch and unfit to be commander in chief. The Republican presidential nominee, speaking to a group of veterans in Virginia on Monday, said that some troops see things in combat that “a lot of folks in the room” have seen many times. “And you’re strong and you can handle it, but a lot of people can’t handle it,” Trump said. (Zezima, 10/4)

Senate Minority Leader Harry Reid (D-Nev.) ripped Republicans on Tuesday, arguing they could have passed legislation to boost support for veterans but instead left Washington to campaign for Donald Trump. “Republicans should be ashamed of themselves for knocking off work a week early to campaign for Donald Trump, who thinks veterans with PTSD are not ‘strong’ and ‘can’t handle it,’ instead of passing a critical bill to address the epidemic of suicide among America’s veterans," the outgoing Senate Democratic leader said in a statement. (Carney, 10/4)

Sen. Tim Kaine (D-Va.) defended his split with Hillary Clinton on the issue of abortion funding during a tense spat about religion during Tuesday night's vice presidential debate. Fending off criticism from Indiana's anti-abortion Gov. Mike Pence, Kaine stood by his support for the federal budget rule, called the Hyde Amendment, which his running mate, Hillary Clinton, has vowed to repeal. (Ferris, 10/4)

The question came at the very end of the debate: How have you grappled with your faith and public life? Sen. Tim Kaine of Virginia, the Democratic vice-presidential candidate, spoke about being opposed to the death penalty but allowing it to go forward in his state. Indiana Gov. Mike Pence, his Republican rival, discussed his opposition to abortion — which has been one of the defining issues of his political career. (Zezima, 10/4)

[Mike] Pence has been both for and against the Affordable Care Act at different times. He railed against it while in Congress, but one of his chief accomplishments as governor was Indiana's expansion of Medicaid under President Barack Obama's health care law. (10/4)

Both Hillary Clinton and Tim Kaine support building on the Affordable Care Act but neither supports a government-run single-payer health care system. Single-payer was actually a contentious subject between Clinton and Vermont Sen. Bernie Sanders during the Democratic presidential primary, because the latter made single-payer a central piece of his platform while Clinton said such a plan was not realistic. (Pradhan, 10/4)

In an effort to expedite her decision, the federal judge overseeing the U.S. Justice Department's antitrust challenge to Anthem and Cigna's $53 billion merger will split the trial in two. U.S. District Judge Amy Berman Jackson told the government and insurers on Tuesday that she will hear testimony about the massive merger's impact on national markets in late November before turning her attention to DOJ's concerns about local markets in December. (Teichert, 10/4)

In its court battle to block the merger of Anthem and Cigna, the U.S. Justice Department plans to use Connecticut’s market as a prime example of why increased consolidation in the health insurance field would hurt consumers. Depending on the area of the state, Anthem is the largest seller of individual and group policies, with either Cigna or Aetna in second or third place, said Connecticut Attorney General George Jepsen, who has joined the lawsuit along with his counterparts in 10 other states and the District of Columbia. (Radelat, 10/5)

The growth of free-standing emergency departments has raised concerns about the impact of these new facilities on healthcare costs, access, and quality of care. One fear is that free-standing EDs—unlike hospital EDs—may turn away uninsured patients in emergency situations because they are not required by federal law to accept all patients for emergency screening and stabilizing treatment regardless of ability to pay. (Meyer, 10/4)

The Food and Drug Administration is warning about the risk of reactivation of hepatitis B among patients who have had that disease and who are taking some prominent and expensive newer medicines for hepatitis C. The federal agency said it is requiring a so-called black-box warning in the labels for at least nine brand-name direct-acting antiviral drugs, including Sovaldi and Harvoni from Gilead Sciences Inc., Viekira Pak from AbbVie Inc. and Zepatier from Merck & Co. (Burton, 10/4)

U.S. food regulators need to take further steps to curb antibiotics use in livestock to maintain the drugs’ ability to defend human health, according to an advocacy group. By early next year, animal drugmakers have agreed to abide by U.S. Food and Drug Administration guidelines to stop using antibiotics used in human medicine to help livestock and poultry gain weight faster. Some antibiotics had been used for that purpose on farms for decades, alongside treating and preventing disease. (Bunge, 10/4)

Antitobacco groups on Tuesday filed a lawsuit against the U.S. Food and Drug Administration to push the agency to try again to require graphic warning labels on cigarettes. The lawsuit, filed in U.S. District Court of Massachusetts, urges the court to force the FDA to abide by the 2009 Family Smoking Prevention and Tobacco Control Act. Under the law, the agency was required to issue rules by late 2011 for color graphics on cigarettes that depict the harms of smoking. (Mickle, 10/4)

A lawsuit filed Tuesday in federal District Court in Boston aims to force the Food and Drug Administration to require cigarette packages to display images starkly depicting what tobacco can do to the human body. Dozens of countries already require such graphic warnings. In Canada, a smoker can’t open a pack without seeing an arresting picture, such as a sad-eyed child with an oxygen mask, or a pair of hands holding a diseased human heart, each with bold text about the risk of secondhand smoke and heart disease. In Australia, smokers have to stare down a photo of a gangrenous foot. (Freyer, 10/4)

Each time over the past decade or so that New York state increased its tobacco tax — now at $4.35 per pack of cigarettes — calls to the state’s Quitline spiked. And as high as the state tobacco tax went, in New York City, then-Mayor Michael Bloomberg hiked the tax even more. “I was so angry with him, I could hardly afford it,” says Elizabeth Lane, a Harlem resident who paid $12 a pack. “I had to beg, borrow and steal to get money to buy cigarettes. (Dembosky, 10/5)

The Department of Veterans Affairs hospital in Phoenix continued to commit scheduling errors leading to delays and lack of care, more than two years after a major scandal involving patient wait times, according to the department’s watchdog. Employees at the Phoenix VA Health Care System during 2015 improperly canceled or delayed hundreds of specialty-care consults, many times because they simply didn’t know proper scheduling procedures or failed to contact patients, oversights that could have led to the death of at least one patient, according to a report released Tuesday by the department’s Office of Inspector General. (Kesling, 10/4)

Patients in the Phoenix VA Health Care System are still unable to get timely specialist appointments after massive reform efforts, and delayed care may be to blame for at least one more veteran's death, according to a new Office of the Inspector General probe. The VA watchdog's latest report, issued Tuesday, says more than two years after Phoenix became the hub of a nationwide VA scandal, inspectors identified 215 deceased patients who were awaiting specialist consultations on the date of death. That included one veteran who "never received an appointment for a cardiology exam that could have prompted further definitive testing and interventions that could have forestalled his death." (Wagner, 10/4)

A controversial proposal could boost the role of advance practice registered nurses in the Veterans Health Administration in 29 states and has garnered record-setting public input — 174,411 responses during the open comment period — with interest groups trying to sway the Department of Veterans Affairs (VA) with the sheer volume of comments. (Ayala, 10/3)

Before hospitals in the rest of the country started seeing a surge in the number of infants born with severe drug withdrawal symptoms, this town of 50,000 was already facing a crisis. In 2010, babies born to mothers using heroin were filling up so many beds in the newborn intensive care unit at the city’s main hospital that little space was left for babies with other life-threatening conditions. The nurses who cared for these agitated and often inconsolable infants knew there was a better and less costly way to help newborns through the painful, weekslong process of drug withdrawal. (10/5)

On July 21, 2016, an FBI agent listened to the recording of a phone call between Dr. Shannon Ceasar, a family practice physician in Metairie, and a confidential federal informant. ... By then, the FBI, the DEA and the U.S. Department of Health and Human Services had been monitoring Ceasar for a year and a half. Multiple sources told investigators that the doctor handed out painkiller prescriptions in exchange for sex or cash payments. In a sworn affidavit, Peter Silessi, a special agent with the U.S. Department of Health and Human Services, said at least two people who received opioid painkillers from Ceasar later died of drug overdoses. (Lipinski, 10/4)

Ben Stiller has been treated for prostate cancer, he revealed on “The Howard Stern Show” Tuesday, after his doctors diagnosed him in June 2014. He is now cancer-free, and he credits his health to a controversial screening test that has divided experts because of its potential for overtreating slow-growing tumors. “Taking the PSA test saved my life,” Stiller wrote in a blog post on Medium Tuesday. The PSA test detects an enzyme, prostate specific antigen, that is released by prostate cells. Elevated levels of PSA could indicate cancer. (Love, 10/4)

Men hoping to avoid some side effects of prostate cancer treatment are shelling out tens of thousands of dollars for a procedure whose long-term effects are unknown and insurers, including Medicare, won’t pay for. Proponents say high-intensity focused ultrasound (HIFU) can have fewer negative side effects than surgery or radiation, while giving some patients another option between actively watching their cancer and those more aggressive steps. Critics, however, say the procedure is being oversold, leading some patients to get a treatment they don’t need. (Appleby, 10/5)

Just 3 percent of adult cancer patients participate in clinical trials of experimental treatments. In a novel effort to boost that number, a national nonprofit is launching an unusual study — one that allows patients to move easily between several experimental therapies, without spending precious time trying to find and qualify for a new trial if the first one doesn’t help.Once they’re in, they’re in.“The current clinical trials system doesn’t match what a patient needs,” said Julie Fleshman, president and CEO of the Pancreatic Cancer Action Network, which organized the $35 million “Precision Promise” platform announced on Tuesday. “This is all about doing that.” (Begley, 10/4)

By the time 8-year-old Ava Christianson got to the National Institutes of Health this summer, she had lost several grueling rounds to leukemia and was bracing for the next one. Intensive chemotherapy, which cures up to 90 percent of children with the most common type of leukemia, hadn’t kept her cancer from coming back. Neither had a painful bone-marrow transplant nor an experimental treatment. Her careworn father cried in the shower to hide his anguish. Her mother couldn’t help but wonder, “Why is this happening to our child?” (McGinley, 10/4)

In 2015, Norma Bauerschmidt sat in a doctor's office. Her husband, Leo, had recently died. And Bauerschmidt, of Michigan, was now facing a medical issue of her own; doctors had discovered a large mass, according to a Facebook post. Her daughter-in-law, Ramie Liddle, said in a phone interview that the diagnosis was uterine cancer. But as Bauerschmidt sat in the office, ostensibly to go over the possible course of treatment — surgery, chemotherapy, those kinds of procedures — she told the doctor that she would have none of it. (Larimer, 10/4)

A Michigan woman who decided to take a cross-country RV trip instead of undergoing cancer treatment has died at the age of 91. More than 400,000 people have followed Norma Jean Bauerschmidt’s journey with her son and daughter-in-law on her “Driving Miss Norma” Facebook page. Her final stop was San Juan Island, Washington, located in the northwest corner of the United States. (10/4)

The union that represents thousands of nurses who are on strike in Minnesota said Tuesday it is ready to return to the bargaining table after rejecting Allina Health’s latest contract offer. Minnesota Nurses Association spokesman Rick Fuentes said no date has been set to resume negotiations, but that he anticipates it will be soon. (10/4)

Oklahoma's highest court on Tuesday struck down a law imposing restrictions on abortion providers, including a requirement that they take samples of fetal tissue from patients younger than 14 and preserve them for state investigators. (Ax, 10/4)

Legislation that would allow doctors to help terminally ill District residents end their lives will face a crucial Wednesday vote before the D.C. Council. Advocates for physician-assisted suicide are hopeful that the nation’s capital will be the next jurisdiction where patients facing agonizing deaths will have the option to legally end their lives, and the first since California’s governor signed similar legislation exactly one year ago. (Nirappil, 10/4)

Residents of Flint, Mich., affected by the contaminated-water crisis have added a new complication to their lives: an outbreak of shigellosis, a bacterial illness that is easily transmitted when people do not wash their hands. Health department officials in Genesee County, where Flint is the largest city, said there has been an increase in the gastrointestinal illness, which can lead to severe diarrhea, fever, nausea, vomiting, cramps and stools containing blood and mucus, according to a statement issued last month. (Hauser, 10/4)

The Massachusetts Health and Hospital Association, the industry’s main trade group, didn’t address whether uneven pricing power pushes medical costs higher. But after examining the issue for months, it has issued a report that says “unwarranted variation among providers should be addressed.” For the first time, the association acknowledged that “market clout” — size and reputation — allows some hospitals to command higher prices, and said it was open to considering short-term limits on price increases for certain hospitals. (Dayal McCluskey, 10/5)

Maryland Health Care Commissioner Robert E. Moffit has recommended approval of the proposed Prince George’s County Regional Medical Center, clearing one of the last major hurdles in what has been a long and sometimes frustrating regulatory process for the project’s supporters. Moffit issued his decision Friday in a letter stating that the project planners, Dimensions Health Care System and the University of Maryland Medical System (UMMS), had complied with all state criteria. (Hernandez, 10/4)

Nearly 43 percent of children living in low to middle income communities around the world will not reach their potential because of conditions that affect their development such as poverty, exposure to violence, and lack of access to nutritional food, according to new research by the University of Maryland School of Medicine...The health disparities faced by some children can disrupt early brain development and lead to lifelong academic and behavioral problems and heart disease and other chronic health conditions, the study found. (McDaniels, 10/4)

An app-based home health provider called Honor entered the Texas market Tuesday with the official opening of its first pilot sites, located inside two Wal-Mart Supercenters in Dallas-Fort Worth. Honor uses app-based technology to link patients in need of non-medical home health services to local providers. The startup aims to reduce the administrative cost of providing home health care and allow for more competitive pay among providers. The founders have described the service as the Uber of home health. The company launched in the San Francisco Bay area and in Los Angeles in early 2015 and announced plans to expand to D-FW earlier this year. (Rice, 10/4)

University of Chicago Medicine and Ingalls Health System announced Tuesday they have officially merged after 10 months of planning and negotiation. The Illinois Health Facilities and Services Review Board approved the merger last month; the merger also was reviewed by the Federal Trade Commission. Ingalls’ Board of Directors voted Sept. 22 to approve the terms of the merger agreement. A week later, the University of Chicago Medical Center’s board also OK’d the merger. (Olsen, 10/4)

A collaboration between Georgia Tech and Children’s Healthcare of Atlanta, though, aims to develop new therapies for pediatrics. And a new $5 million grant from the Imlay Foundation will support that work. The grant will fund research at the Children’s Healthcare of Atlanta Pediatric Technology Center. It will bring physicians’ ideas for a new device or technique to the table for Tech’s engineers to develop, Ron Frieson, president of the Children’s Healthcare of Atlanta Foundation, told GHN in an interview Monday. (Miller, 10/4)

Four women who were born without uteruses have undergone a novel, yet controversial surgery in Dallas to receive a reproductive organ transplanted from a live donor. Baylor University Medical Center began conducting the uterine transplants in mid-September after two years of preparation. The medical center is now among only handful globally to test the surgeries, which took about five hours each. The aim is to ultimately give women who suffer from infertility the hope of delivering their own babies, whether via natural birth or cesarean section. (Rice, 10/5)

Moxe Health, a Madison software company, has raised $5.5 million from an investor group led by Safeguard Scientifics. The start-up company, founded in 2012, has developed software that makes it easier to transfer clinical and claims data for use in analytics, such as identifying patients at a high risk of being hospitalized. Moxe, which employs about 10 people, also helps health systems make use of that information. (Boulton, 10/4)

College freshman Mia Barone’s fingers are flying in the campus library, her eyes closed as she signs the words on her study list — tomorrow, free, champion, flirting...Barone is among the first cohort of college students in Colorado with Down syndrome and other intellectual disabilities, a result of the state’s delayed response to the 2008 federal Higher Education Opportunity Act that said people with intellectual disabilities have the right to attend college. Colorado was among the last four states to comply when the legislature and Gov. John Hickenlooper this year approved $75,000 per year for four years for each of three schools — UCCS, University of Northern Colorado in Greeley and Arapahoe Community College in Littleton. (Brown, 10/4)

A working group appointed by Gov. Sam Brownback unveiled Tuesday a host of recommendations for changing the way Kansas officials estimate the amount of tax revenue the state will receive each year. The recommendations include overhauling the group that makes the estimates and making a controversial change to the way monthly tax revenue is reported. The governor’s office and the Legislature use the tax revenue estimates as a guide to the amount the can spend for all services, including education, health care and transportation. (Marso, 10/4)

One of the state representatives caught up in the attorney general’s investigation of pot sales at the State House says he plans to file legislation to expand the state’s medical marijuana law. Republican state Rep. Joe Lachance of Manchester told investigators he used the marijuana to treat a spinal injury, gastrointestinal illness and PTSD he incurred in military service. Lachance was one of the most active legislators in the two-year push for medical marijuana in New Hampshire, and is now an approved patient with a state-issued registry card. (Solomon, 10/4)

The Good Earth Egg Company in Bonne Terre, Missouri has been identified by the Centers for Disease Control and Prevention as the likely source of the infections, although investigations are ongoing. The company has recalled all of its shell eggs with sell-by dates before Oct. 8, 2016. The cases are genetically similar to an outbreak in 2015 that was traced to the same distributor. (Bouscaren, 10/4)

[D]espite the growing political furor, the odds of significant federal action on drug costs this year or next are slim, experts say. That may surprise voters, given the torrents of rhetoric and promises from politicians. Yet the issue of how to make drugs more affordable for individual patients and society is so complex and sensitive—and drug industry opposition so formidable—that a comprehensive, politically viable approach to solving the problem has yet to emerge. (Meyer, 10/1)

Robyn Curtis, a staff adviser at the University of Southern Mississippi in Hattiesburg, has a 13-year-old daughter with diabetes. Each month, the girl’s insulin pump requires three vials of NovoLog-brand insulin, which cost $890 under her plan, Curtis says. Her daughter’s insurance has a $2,600 deductible. So Curtis was beside herself when she learned that NovoLog offers rebates -- almost always paid to insurance companies and drug-benefit managers, not patients -- that might have cut the out-of-pocket cost in half earlier this year. (Langreth, 10/5)

Four initiatives on this year's ballot regarding taxes, prescription prices and hospital fees account for $300 million of the total so far. That includes more than $100 million into Proposition 61, placed on the ballot by the AIDS Healthcare Foundation to limit what the state pays for prescription drugs for people insured on government-subsidized health programs to the same rated paid by the U.S. Department of Veterans Affairs. More than 30 companies that belong to the industry association Pharmaceutical Research and Manufacturers of America have contributed most of the $86 million against the initiative. (Noon, 9/30)

For pharmaceutical companies, there's more at stake on November 8 than whether Donald Trump or Hillary Clinton emerges victorious in the presidential election. Also to be decided in the voting booth is California's Proposition 61, a state ballot measure that would require state agencies to purchase drugs at prices close to those enjoyed by the Department of Veteran's Affairs. Recent polls performed by Field/IFS and USC/Los Angeles Times suggest the initiative, known as the California Drug Price Relief Act, is favored by voters. (Kawa, Damouni and Maloney, 9/29)

One of the 17 statewide propositions facing California voters on the November ballot is Proposition 61, which is intended to lower prescription drug prices. Below, Impatient breaks down this initiative, which besides being one of the most complicated ballot measures, has sparked by far this year's most expensive campaign fight over an initiative. (Plevin, 9/30)

The Ohio Drug Price Relief Act, a citizen-initiated statute slated for the November 2017 ballot, would require the state of Ohio to pay no more for prescription drugs than the U.S. Department of Veterans Affairs. The report from Vorys Health Care Advisors and Health Management Associates, two health policy consulting firms, concluded that would be nearly impossible to implement because what drugs the VA buys and how much they cost is unknown and drug manufacturers are unlikely to negotiate lower prices. The report was commissioned by Pharmaceutical Research and Manufacturers of America, a group that represents pharmaceutical companies and opposes the initiative. (Borchardt, 10/3)

Mylan chief executive Heather Bresch said one thing at a contentious hearing last week that should be music to the ears of people with life-threatening allergies: Her company will soon push to extend the shelf life for EpiPen. Currently, EpiPens expire 18 months from date of manufacturing. Facing criticism for the drug's rapidly rising price, Bresch said the company hopes the expiration date can be extended to a minimum of 24 months. (Johnson, 9/27)

The EpiPen allergy shot, enmeshed in controversy because it sells for almost as much as the latest iPhone in the U.S., costs less than its leather case in Britain. The price of an EpiPen two-pack has surged to more than $600 in the U.S., sparking a political outcry. While the manufacturer, Mylan NV, says it takes home about $274, in the U.K. a similar pair of injectors costs the state-funded National Health Service 53 pounds ($69). The numbers highlight the stark differences in the way drugs are priced in the U.S. and Britain, where the government negotiates with pharmaceutical companies to limit costs. (Paton and Kresge, 9/29)

The backers of a proposal to limit the amount the state pays for drugs for Medicaid, prisons and other state programs have won their fight to bring the plan to next year’s ballot. Secretary of State Jon Husted’s office has certified the petitions turned in by Ohioans for Fair Drug Prices, the group pushing the proposal that Ohio pay no more for drugs than the federal Department of Veterans Affairs does. (Kasler, 10/3)

Despite objections from his own regulators, President Barack Obama Friday signed into law a bill that will briefly extend a voucher program that rewards drug makers for rare pediatric medicines. As a result, the program will run through Dec. 31 while Congress attempts to further extend the effort for another few years. The focus will now turn to tucking such an extension into the 21st Century Cures Act, a sweeping piece of health care legislation that must still be negotiated by the House and Senate. (Silverman, 9/30)

In the latest instance of alleged insider trading in the pharmaceutical industry, a former Puma Biotechnology executive was charged with illegally making more than $1.1 million by taking advantage of confidential information about clinical trials for a cancer drug. (Silverman, 9/30)

After a yearlong, up-and-down ride, shares of Valeant Pharmaceuticals International Inc. are enjoying a period of relative calm. Since mid-March, the stock has traded between $36.23 and $18.73, a $17.50 range that’s the smallest band for any equivalent stretch of time since Jan. 7, 2013. That followed an eight-month period during which the shares dropped 86 percent, including a 51 percent drop on March 15. (Hopkins and Renick, 10/3)

Alex Gorsky, chairman and CEO of Johnson & Johnson, speaks to WSJ’s Laura Landro about the challenge of balancing perception against profit when it comes to drug prices. (9/29)

The gray zip-up sweatshirt, priced at $495, is emblazoned with a mock label for prescription extended-release pills. So is the $995 dress and the shiny, orange $950 purse in the shape of a prescription pill bottle. It’s all part of a cheeky new fashion line designed by the Italian brand Moschino and sold online by Nordstrom and Saks Fifth Avenue — and it’s generating a small torrent of online criticism from people who believe it’s in poor taste amid a raging opioid crisis that has been fueled in part by overprescribing potent painkillers. (Robbins, 10/3)

Here's one thing you and Big Pharma probably have in common: being on edge about the U.S. presidential election. A single tweet by Hillary Clinton last November about high drug prices helped sink the Nasdaq Biotech Index by 4.4 percent. A similar tweet in late August this year had a similar effect. But there's a quieter upcoming vote that should arguably worry biotech and pharma companies more. In a little place called California, the sort of price-control legislation seen as a potentially negative (though unlikely) result of a Clinton presidency actually looks like it might pass. (Max Nisen, 9/30)

California may soon drive a hole through Washington’s tolerance for — and protection of — price gouging on drugs. A measure on the November ballot, Proposition 61, would bar state agencies from paying more for prescription drugs than the U.S. Department of Veterans Affairs does. Congress generally prohibits the U.S. government from negotiating prescription drug prices. The VA is an exception. Federal law ensures that it obtains a discount of at least 24 percent off a drug’s list price. (Froma Harrop, 10/3)

Blatant price-gouging by EpiPen-maker Mylan and other pharmaceutical companies has stoked public outrage about the high cost of prescription drugs. Meanwhile, the emergence of a new class of exceptionally expensive specialty drugs has caused budget nightmares for state governments. But in California, even modest efforts to require drugmakers to reveal more about how they set their prices have been stymied by lawmakers sympathetic to the industry. (10/4)

[W]e must oppose Prop. 61, despite our disgust with the industry-bankrolled disingenuous advertising blitz. It is important to note that an array of consumer and health-advocate organizations that have no love for the pharmaceutical industry are opposed to Prop. 61. A link between Medi-Cal and the VA is not necessarily a good corollary; their respective patient bases have different demographics and medical needs. Also, the fear of reduced access to certain drugs is legitimate: It would rely to some extent on the good faith of an industry whose greedy practices were the inspiration for this initiative. (9/22)

California voters can expect to be hit with tens of millions of dollars in prescription drug industry-funded political advertising warning that passage of Proposition 61 — a measure to cap drug prices — will stifle the industry’s ability to develop new life-saving drugs. This is a well-worn scare tactic used by drug-industry giants whenever the exorbitant prices of their drugs are challenged. It is a claim that is factually shaky, if not fraudulent. I can say this because I worked for more than three years as government-affairs director for Gilead Sciences, the patent holder of the two hepatitis C drugs whose huge price tags have shaken Medicaid budgets nationwide and put the cost of treatment for many patients out of reach. (David W. Poole, 9/30)

If you want to know why nurses across California are campaigning for Proposition 61, here’s one thing Long Beach nurses increasingly see. Patients provided a heart stent for serious coronary disease sent home with directions to take anti-platelet drugs for continuing therapy, are returning to the ER with serious chest pain. Or dying before they get there. Why? They can’t afford the high out-of-pocket cost for their medication. (Margie Keenan, 9/30)

There’s much about the business of medicine that is praiseworthy and inspiring. From fighting superbugs, to trying to solve Alzheimer’s, to exploring our many microbes, there are a lot of big, important problems out there for drug companies to solve. But medicine is big business and sometimes drug companies, in the pursuit of profits, pull shenanigans. (Luke Timmerman and Meg Tirrell, 9/29)

Three groups will be especially hard hit by today's inflated drug prices: the uninsured, people with high-deductible health insurance plans and those with large co-payments for their prescriptions. Because Congress shows little interest in addressing the issue, individuals must devise their own strategies to decrease their drug bills. (Clif Cleaveland, 10/4)

Americans love their prescription drugs, and aren’t shy about having plenty on hand. Last year, U.S. pharmacies filled more than 4 billion prescriptions, up from 3 billion in 2001. But how do people feel about drug prices? Let’s just say the pharmaceutical industry shouldn’t pack up its army of lobbyists and public relations people just yet. In fact, they might want to hire a few more. According to a new Kaiser Health Tracking Poll, 77 percent of Americans said the cost of drugs was “unreasonable”—up from 72 percent a year ago. (John Russell, 10/3)

Go online today, and there’s a pretty good chance you’ll be bombarded with ads for “cheap prescription drugs” from online pharmacies promising bargain basement prices. Consumers can’t be blamed for clicking on these advertisements in attempts to find the best deals available for themselves and their families. But oftentimes these sites are distribution centers for unregulated, illegally imported, and even counterfeit prescription medications. (Sally Greenberg, 10/4)

For weeks, rumors have been flying that WikiLeaks would deliver an “October surprise” for Hillary Clinton’s campaign, a bombshell revelation that she would struggle to recover from in the short weeks remaining until the election. (So far, it's a dud -- surprise!) But Clinton should be worried about a “November surprise” -- the wave of policy cancellations and rate hikes that will attend the debut of Obamacare’s fourth open-enrollment period, on Nov. 1. Just a week before Election Day. (Megan McArdle, 10/4)

Again proving himself both a campaign asset and liability, Bill Clinton muddled his wife's healthcare message and emboldened Affordable Care Act critics Monday when he described one of the law's affordability problems as “the craziest thing in the world.” (Harris Meyer, 10/4)

Throughout the 2016 presidential campaign, Donald Trump has made it clear he opposes the Affordable Care Act – a.k.a. Obamacare. He also has stated repeatedly that he wants to “take care of everybody,” and has offered up a few ideas of what that might mean. But those ideas would fall far short of taking care of everybody; indeed, they would substantially increase the number of Americans without health insurance. (James C. Capretta, 10/4)

Donald Trump continues to be hammered for suggesting that soldiers and veterans who suffer from post-traumatic stress disorder are somehow weaker than those who do not. Experts say that view further stigmatizes the illness and that it’s wrong — although they agree with Trump’s comment about the skyrocketing number of vets who die by suicide every day: “That should never be.” What was left out of the presidential candidate’s comments to a group of veterans on Monday, and what has been left out of many of the discussions since then, is how little we understand PTSD. (Amy Ellis Nutt, 10/4)

In July, Sgt. Brandon Ketchum, a young veteran and father, did what many of us have trouble doing when in need — he asked for help. As a result of multiple tours in Iraq and Afghanistan, Sgt. Ketchum suffered from post-traumatic stress disorder. These wounds may be invisible to others, but any veteran who suffers from a mental health crisis has sacrificed too much to ever feel alone when trying to heal. Sgt. Ketchum was in crisis. (Rep. Dave Loesack, D-Iowa, 10/4)

The Department of Veterans Affairs has called it a public health crisis — an estimated 20 veterans commit suicide every day. So it is no trivial matter that a suicide hotline run by the VA is failing to answer the phone. The former director of the Veterans Crisis Line told the Associated Press that an average of 35 to 40 percent of the calls to the hotline in May went unanswered by the crisis-trained health science specialists at the VCL’s location in Canandaigua, N.Y. The calls rolled over to backup centers run by a contractor and staffed by workers, sometimes volunteers, who lack specialized training. (10/5)

A congressional roasting of Mylan and its CEO Heather Bresch over EpiPen price hikes was just the beginning. Since then, we have learned Mylan potentially misled lawmakers in that Sept. 21 hearing about EpiPen's profitability by using unrealistic tax assumptions. The Senate is joining the House in investigating Mylan, focusing on potential Medicaid fraud. And Monday, the company revealed the half-priced "authorized generic" EpiPen it has promised may not arrive until the end of the year. Mylan said in August it expected to launch the cheaper EpiPen within "weeks." (Max Nisen, 10/4)

The Comprehensive Addiction and Recovery Act (CARA), passed by Congress and signed by the president in July, authorized $181 million in additional funding for programs related to prevention and treatment, including medication-assisted treatment. This was a good start, but Congress should and must act through the appropriations process, including state block grants, to ensure the programs authorized in the bill have the resources necessary to be fully be implemented.  However, the fight around funding should be put in context — taxpayer-funded grants are a temporary bridge over a fundamental barrier to addiction recovery: the lack of meaningful access to recovery medication. (Newt Gingrich, Patrick J. Kennedy and Van Jones, 10/4)

The perseverance to live fully with a profound disability comes, I think, in part from honestly facing your own powerlessness and frailty, and recognizing how much worse things have been and could still be. This can instill a delight in the now. In living with a disability, you’ve already dealt with much of what other people fear most, and if you come out on the other side you are, by definition, a survivor. The resolve required, and begrudging acceptance of what you can’t change, may bring a kind of wisdom. (Ben Mattlin, 10/5)

Over the next 15 years, our nation's senior population will nearly double, approaching 73 million by 2030 and accounting for more than one in five Americans. Philadelphia and Pennsylvania stand at the forefront of this dramatic demographic transformation. Philadelphia already has the highest proportion of senior citizens among the nation's 10 largest cities, a position it is unlikely to cede anytime soon. At the same time, the number of older adults in Pennsylvania now exceeds 2.1 million, the fifth-highest of any state in the country. (Allyson Y. Schwartz and Anand Parekh, 10/5)

Since the start of the new millennium, the Center for Health Care Services has played a big role in the county’s jail diversion program, providing much-needed treatment as an option for those who become tangled in the criminal justice system and are struggling with mental illness. It has reduced incarceration costs for the county and benefited people who otherwise might not have received the treatment they needed. The program has become a national model and is frequently visited by representatives from communities across the country who want to emulate it. (10/4)