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Still smarting from congressional Republicans’ abject failure to repeal the Affordable Care Act by legislative means, President Trump now reportedly is plotting a backdoor attack aimed at gutting the act’s most important consumer protections. An executive order expected to be issued sometime this week would expand the ability of small businesses to band together and create “association health plans.” On the surface, the idea looks like a means of offering employees of those businesses more options for health coverage; in reality, according to health reform experts, it would strip the ACA’s consumer safeguards from those plans. (Michael Hiltzik, 10/9)

President Donald Trump has already done a lot to sabotage the Affordable Care Act, whether it’s slashing the program’s advertising budget or threatening to cut off some payments that insurers need to cover their costs. Now Trump is thinking about using his executive authority to do something that could be even more damaging to the law ― and, arguably, more threatening to people who depend on it for coverage. Sometime in the next few days, according to a report in The Wall Street Journal, Trump is likely to instruct three key agencies to rewrite a series of regulations that affect health insurance. (Jonathan Cohn, 10/9)

President Trump has strongly hinted that new rules may be forthcoming imminently that would let many more people purchase "Short Term Health Insurance" and "Association Health Plans" instead of being largely confined to higher-priced plans that conform to all the requirements of the Affordable Care Act. Critics of this proposal argue that it would result in healthy people exiting the Exchanges established by the ACA, resulting in major insurer losses for 2018 and higher premiums or, frankly, collapse of many markets by 2019. Supporters of the proposal note that Obamacare has left individual health insurance unaffordable for large segments of the American public and that some alternative needs to be provided. ... There actually is a middle ground, though. ... Make the insurance alternatives (short term plans, association plans) more widely available, but do so only to persons for whom the Obamacare market has indeed become unaffordable. (Seth Chandler, 10/9)

Promising efforts to get a grip on medical costs have lately run into resistance from the Trump administration. The federal agency in charge of Medicare is moving to curtail new requirements that hospitals "bundle" medical charges for hip and knee replacements, rather than assess separate fees for each appointment. Efforts to arrange similar lump-sum payments for other procedures are to be stopped altogether. These changes are misguided on two counts. (10/9)

In a new rule about coverage of contraception, the Trump administration argues against the positives of birth control and highlights potential harms. But those claims don’t stand up to scrutiny. The new rule weakens the mandate for health coverage of contraception under the Affordable Care Act, giving more leeway to employers with religious or moral objections. (Aaron E. Carroll, 10/10)

Large majorities of Americans believe first-trimester abortions should be legal. But once pregnancy moves into the second trimester — that is, at 12 to 24 weeks — only 27% of Americans have a pro-choice position. These Gallup poll results mirror policy in most European nations, where abortion is legally restricted early in the second trimester. For years now, anti-abortion activists in the United States have been trying to establish similar restrictions at 20 weeks’ gestation. (Charles C. Camosy, 10/9)

Primary fights to the death over single payer will accomplish nothing good — including for those who want to pass single-payer. Parties do not expand through purges. (Richard North Patterson, 10/10)

The United States health care system has many problems, but it also promotes more innovation than its counterparts in other nations. That’s why discussions of remaking American health care often raise concerns about threats to innovation. But this fear is frequently misapplied and misunderstood. (Aaron E. Carroll and Austin Frakt, 10/9)

Who ultimately should be in charge of care at our nation’s hospitals — physicians or businesspeople? In January 2016, the board of directors at Tulare Regional Medical Center, a small community hospital in central California, voted to terminate the elected leaders of its medical staff office. Medical staff offices help ensure that patient needs are kept separate from business imperatives, such as increasing hospital profits. They have historically operated independently of hospital administrators. (Sandeep Jauhar, 10/10)

Generally speaking, according to World Health Organization statistics for 2015, the American rate of mortality from interpersonal violence is four times higher than the British. Americans are also 10 times more likely to die from cocaine use, and between two and three times more likely to die from drug abuse, poisonings, and intentional injuries. ... In any case, the Brits have their own idiosyncrasies when it comes to death. In 2015 they were five times more likely than Americans to die of the lung cancer known as mesothelioma, nearly three times more likely to die of oesophageal cancer, twice as likely to die of stomach cancer, and nearly twice as likely to die of prostate and bladder cancer. These figures are in line with a variety of studies showing that Britain is not the best place in the developed world to be diagnosed with cancer. (Niall Ferguson, 10/10)

Unfortunately, the doctor shortage will get worse quickly if the Deferred Action for Childhood Arrivals (DACA) program is ended .... the move could also be debilitating for our health-care system. DACA recipients are nurses, physician assistants, medical technicians, respiratory therapists and yes, doctors. In fact, more than 25 percent of America’s doctors are immigrants, and if DACA continues, the program will add roughly 5,400 physicians who would otherwise be ineligible to work in the United States over the next few decades. (Anirudh Rao, 10/10)

California doesn’t have enough doctors. By 2025, the state will be short about 4,700 primary-care physicians, according to a recent report from the UC San Francisco Healthforce Center. This will result in more people turning to costly emergency-room visits for routine care, it predicts. One solution is to expand the role of well-trained nurse practitioners, who can meet the basic healthcare needs of our growing population at a fraction of the cost of doctor visits. That’s what many other states are doing. (David Lazarus, 10/10)

While our medical system can usually fix the physical trauma, it is largely unprepared to address the emotional trauma that follows being a victim of an assault. Young patients are often discharged back into the same environment in which the injury occurred, with an ongoing risk for retaliation, re-injury, and sometimes even death. Boys and young men of color experience a disproportionate burden of assaults. (Rachel Myers, 10/9)

Another overdose issue is playing outside their shadow: the misuse of over-the-counter pain medicines like acetaminophen, aspirin, ibuprofen, naproxen, and others. These widely used “safe” medications can cause serious gastrointestinal bleeding; create stomach ulcers; damage the esophagus, intestine, and liver; and even kill. In the United States, misuse of these medications sends nearly 200,000 people to the hospital each year. (Charles Melbern Wilcox, 10/9)