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But looming in front of the discussion is an obstacle no amount of careful messaging will help them overcome: Even the most modest Democratic plan would face intense opposition from health-related industries, not to mention Republicans. Already, powerful interest groups are mobilizing and pooling resources to undermine the Democrats’ plans. The Partnership for America’s Health Care Future—a lobbying group that represents insurance companies, drugmakers, hospitals, and other industry players—is running TV ads and commissioning polls designed to undercut support for any expansion of government-provided coverage. (Kapur, 8/23)

Democratic voters appear to be reassessing their approach to health care, a pragmatic shift on their party's top 2020 issue. "Medicare for All" remains hugely popular, but majorities say they'd prefer building on "Obamacare" to expand coverage instead of a new government program that replaces America's mix of private and public insurance. (Price and Alonso-Zaldivar, 8/23)

Kamala Harris offered her health care plan expecting to bridge the party’s divides and decisively answer doubts about her see-sawing positions. But in the month since, the California Democrat is still struggling to rebut attacks from her chief rivals who are poking holes in its specifics and accusing Harris of putting political calculation before true conviction. Joe Biden’s campaign dismisses it as a “have-it-every-which-way” plan while Bernie Sanders’ camp ripped it as “cobbled together to address various poll numbers.” (Cadelago and Diamond, 8/22)

The major battleground-state Democrats running to flip the Senate want nothing to do with Medicare for All. In states like Arizona, Iowa and North Carolina, challengers Mark Kelly, Theresa Greenfield and Cal Cunningham are staying tightly focused on the health care message House Democrats used in 2018: expanding Medicaid, protecting Obamacare and slamming Republican repeal efforts. (Ollstein and Arkin, 8/23)

Speaking to labor officials in Iowa this week, Bernie Sanders unveiled a new twist to his “Medicare for All” plan. His centrist Democratic rivals pounced, accusing the original champion of government-run health care of softening his signature policy in order to placate angry union members. Nonsense, his campaign responded. So what's the deal? (Ollstein and Otterbein, 8/22)

Sen. Kirsten Gillibrand (D-N.Y.) unveiled her plan to improve mental health care in the U.S. this week, arguing that the issue demands more attention from leaders. The Democratic presidential candidate wrote in a Medium post on Tuesday that she plans to invest in community-based approaches to mental and behavioral health, personalize the way the U.S. delivers mental health care and require insurance coverage for mental and behavioral health. (Manchester, 8/22)

Democratic presidential candidate Pete Buttigieg on Friday unveiled a $100 billion plan to expand access to mental health and addiction treatment that coincided with a campaign stop in Manchester, New Hampshire — a state hit hard by the opioid crisis. The wide-ranging plan calls for integrating treatment into primary care settings, increasing the number of available treatment beds, making it easier for patients to get access to medication for opioid addiction, investing in suicide prevention for veterans and addressing disparities in behavioral health care. (Ehley, 8/23)

Insurers are expanding their Affordable Care Act plan offerings for next year, with the once-troubled business now generating profits, even as the overall individual-insurance market has shrunk. Oscar Insurance Corp. is the latest to announce its expected growth for 2020, adding six new states, including Pennsylvania and Georgia, to its current roster of nine. Insurers including Cigna Corp. , Bright Health Inc., Molina Healthcare Inc. and Centene Corp. , the biggest seller of ACA plans, also plan larger footprints next year. Anthem Inc. is expanding in at least two of its states, California and Virginia. (Wilde Mathews, 8/22)

Oscar, a fast-growing, tech-based insurance start-up, will offer individual plans for 2020 through the Affordable Care Act's exchange for the first time in Houston, the company said Thursday. The New York insurer already has an established footprint in Texas with 60,000 members-- nearly a quarter of its overall national membership. It sells individual plans on the exchange in Austin, Dallas-Fort Worth, El Paso and San Antonio but has been absent from Houston. (Deam, 8/22)

WellStar patients in northwest Atlanta who had Anthem individual insurance policies through the Affordable Care Act will likely have two alternatives to get their care covered in 2020. But Anthem won’t be one of them. WellStar, by far the dominant health care provider in Cobb County, told the Atlanta Journal-Constitution Thursday that it had been unable to come to terms with Anthem after the carrier shocked its individual customers this year by dropping WellStar from their network. (Hart, 8/22)

Newly published data from the federal government shows that some of the health insurers enrolling the most people in coverage on the Affordable Care Act insurance exchanges have quality ratings below the national average. Most 2019 exchange plans, or about 64% of 195 plans listed in the CMS data, received an overall quality rating of four or five stars, with five being the highest rating, according to Modern Healthcare's analysis of CMS data released last week. Another 26.2% of plans received a 3-star rating. The rest—about 10 health plans—received a 1- or 2-star rating. (Livingston, 8/22)

Social issues are increasingly weighing on the credit ratings of American health-care companies. S&P Global Ratings, Moody’s Corp. (MCO) and Fitch Ratings Inc. warn that mounting public pressure to cut medical costs has recently threatened the industry’s credit amid a renewed political debate on drug pricing and national health insurance. For instance, health-care companies are under pressure from insurers to lower costs as Medicare patient volumes have surged against commercial patients, said Andrew Steel, global head of sustainable finance at Fitch Ratings Inc. (Holger, 8/22)

Health insurance premiums on the exchanges are leveling off as policy action fades and as more states establish reinsurance programs to keep costs in line. Colorado, Delaware, Montana and North Dakota all received the green light from the Centers for Medicare and Medicaid Services this year to subsidize high-cost claims that fall within a preset dollar amount, ranging from a minimum of $30,000 to a maximum of $1 million. Rhode Island is also awaiting approval for a reinsurance waiver the state applied for in June. (Clason, 8/22)

Georgia’s insurance commissioner is warning consumers of the potential financial risks of joining a Health Care Sharing Ministries program as an alternative to regular insurance. In these organizations, members agree to share one another’s health care costs. Members of an HCSM typically have a particular religious faith in common, and make monthly payments to cover expenses of other members. (Miller, 8/22)

Veterans Affairs Secretary Robert Wilkie insisted last week that the Trump administration is "on track" with a $16 billion project to connect medical records for the military and vets. But that’s not exactly the case — the project faces significant delays and unanticipated headaches, according to three sources with detailed knowledge of what will be one of the largest technology contracts in federal history. (Allen, 8/23)

Emails from senior Veterans Affairs staff released Thursday reveal the frustration and scorn they felt at having to deal with the intrusion of three wealthy members of President Donald Trump’s Mar-a-Lago club in the agency’s plans to create a new digital health platform. The 2017 and 2018 emails, which Citizens for Responsibility and Ethics in Washington obtained through a Freedom of Information Act request, show the outsized influence of the Mar-a-Lago members, Marvel Entertainment Chairman Ike Perlmutter, attorney Marc Sherman and internist Bruce Moskowitz. (Allen, 8/22)

The three arrests reported Thursday for threats of mass killings bring the total to at least 30 people detained on similar charges since the shootings in El Paso, Texas, and Dayton, Ohio, earlier this month. Even in a country where such attacks have become a fact of life – there have been 263 mass shootings in the U.S. this year, according to the Gun Violence Archive, which defines them as four or more people wounded or killed – those numbers are staggering. What’s behind them? (Ortiz, 8/22)

Wayne LaPierre, the chief executive of the National Rifle Association, has confronted threats from all sides this year. He faced a revolt from the N.R.A.’s top lobbyist, its president, its longtime advertising firm and several board members and donors that quickly became public. New documents reviewed by The New York Times show that the effort against him was even wider in scope, drawing in three outside law firms working for the N.R.A. and at least one in-house attorney. A wave of embarrassing leaks showed that Mr. LaPierre billed a contractor hundreds of thousands of dollars for bespoke suits and foreign travel, as well as some of his wife’s makeup costs. (Hakim, 8/22)

Northwell Health's leadership is trying to spur the hospital industry to take action on gun violence. Michael Dowling, president and CEO of New York-based Northwell Health system, said the need for the healthcare industry to break its collective silence on gun violence was the impetus behind a new national marketing campaign the system launched Thursday in the New York Times to call on providers to become more vocal in advocating for gun legislation. (Johnson, 8/22)

Virginia Beach will be opening a community center in October to provide free mental health counseling and other services to people impacted by a mass shooting earlier this year. The Virginian-Pilot reports the “VB Strong Center” is being funded through a federal grant. (8/23)

Concerns over whether expanding background checks on gun sales will diminish gun owners' constitutional rights are "frankly BS," Gov. Tony Evers said Thursday. Evers said Republicans are using "worn-out excuses" to avoid taking up legislation that would require background checks on most gun sales in Wisconsin and create a process through which family and police could ask a judge to confiscate firearms from anyone deemed a threat to others. (Beck, 8/22)

Federal health officials are proposing to revamp stringent patient confidentiality rules from the 1970s to encourage coordination among medical professionals treating people caught in the nation's opioid epidemic. The idea is to make it easier to share a patient's drug treatment history with doctors treating that person for other problems. That can stave off serious — even fatal — errors, like unwittingly prescribing opioid painkillers to a surgical patient with a history of dependence. (Alonso-Zaldivar, 8/22)

Senior officials described these regulations, known as CFR Part 2, as "so complex" they have deterred clinicians from getting involved in treating addiction despite the escalating need. Under revisions proposed by the Substance Abuse and Mental Health Services Administration and introduced by HHS Secretary Alex Azar and his deputies, records of a substance abuse disorder and treatment would no longer be subject to the extra privacy laws that pre-date HIPAA. (Luthi and Johnson, 8/22)

The change would allow hospitals and other providers to enter addiction treatment into a medical record as a standard element of patient history, Azar said. Under the new rule, doctors would also be given access to information about treatment through outside addiction care facilities for patients seeking addiction care. (Facher, 8/22)

“We do believe that the proposed changes that we are putting out today are very common-sense, responsive changes to concerns that both patients and providers have raised regarding providing holistic, collaborative, patient-centered care,” Health and Human Services Secretary Alex Azar said in a call with reporters Thursday. But Azar also alluded to a desire from some lawmakers and many in the health provider and insurance community to make broader changes that would make it less onerous to navigate the substance use treatment privacy requirements of Part 2 and the broader patient privacy rules set out by the federal law restricting release of medical information (PL 104-191), also known as HIPAA. (Siddons and Raman, 8/22)

Officials stressed that there are still privacy protections, for example maintaining protections that prevent law enforcement from using addiction treatment records against a patient. “Everything is done with a patient's consent,” Azar said. (Sullivan, 8/22)

As more lawsuits accuse Purdue Pharma of fomenting the opioid crisis, the Sackler family that controls the drug maker is increasingly being targeted, since some members were directors and executives for many years. But while holding directors liable for corporate conduct is rare, the points raised in an expert report filed in a case brought by the state of Utah may provide clues for winning the argument. (Silverman, 8/22)

With a nationwide prescription opioid lawsuit scheduled for trial in two months, attorneys for newborns suffering from exposure to opioids in the womb have made a last-ditch plea for special legal treatment for the infants and their guardians. Attorneys representing a group that may number more than 250,000 children have spent much of the past two years seeking a separate trial against drug companies but have been rebuffed twice by the judge who oversees the sprawling legal case. The children are still included in that lawsuit, along with about 2,000 other plaintiffs, against some two dozen defendants from the pharmaceutical industry. (Bernstein, 8/22)

Ohio’s top law-enforcement official warned Endo International Plc and Allergan Plc he hasn’t agreed to back their proposals for settlements totaling about $16 million to avoid trials in the first federal cases to be heard by juries over the public-health crisis caused by opioid painkillers. Ohio Attorney General Dave Yost said in separate letters to the drug companies that their tentative deals with two counties in the state won’t resolve the state’s allegations that Endo and Allergan wrongfully marketed their opioid-based pain medicines. (Feeley and Doherty, 8/22)

Nearly 2,000 cities, towns and counties across America are currently participating in a massive multidistrict civil lawsuit against the opioid industry for damages related to the abuse of prescription pain medication. The defendants in the suit include drug manufacturers like Mallinckrodt, wholesale distributors McKesson and Cardinal Health, and pharmacy chains CVS and Walgreens. Evidence related to the lawsuit was initially sealed, but The Washington Post and the Charleston Gazette-Mail successfully sued to have it made public. (Davies, 8/22)

Hundreds of lives could be saved in the 16 participating communities in Massachusetts as a result of this grant; ultimately, many more lives in other states will be saved if new services developed by clinical innovators are delivered to people who are addicted to opioids. But it will be challenging. Dr. Alex Walley, director of BMC’s Addiction Medicine Fellowship Program, compares the effort to the Apollo moon project, for which the goal to land a man on the moon was announced before the required rocket had been invented. If the study achieves its goals, it will be worth the cost. (Samet, 8/23)

The rate of buprenorphine prescriptions for treatment of opioid use disorder among Medicaid patients was far higher on average in Medicaid expansion states than non-expansion states, a new Urban Institute study found. Between 2011 and 2018, Medicaid prescriptions for buprenorphine maintenance treatment per 1,000 enrollees jumped from 40 to 138 in states that expanded Medicaid to low-income adults under the Affordable Care Act. In non-expansion states, the rate increased from 16 to 41. That includes the combination buprenorphine-naloxone form of medication-assisted treatment. (Meyer, 8/22)

Kaiser Health News: Addiction Clinics Market Pricey, Unproven Treatments To Desperate Patients

Jason was hallucinating. He was withdrawing from drugs at an addiction treatment center near Indianapolis, and he had hardly slept for several days. “He was reaching for things, and he was talking to Bill Gates and he was talking to somebody else I’m just certain he hasn’t met,” his mother, Cheryl, says. She remembers finding Jason lying on the floor of the treatment center in late 2016. “I would just bring him blankets because they didn’t have beds or anything.” (Harper, 8/23)

As a new wave of methamphetamine crashes over Washington, bigger than it’s been for decades, public health officials have struggled to spread an intervention for meth addiction that’s as effective as medication-assisted treatment has been for people using opioids. Contingency management, researchers like [Michael] McDonell say, is that thing: It works, patients like it, and it’s cost-effective. Literature reviews and analyses often agree: A review of 69 reports released from 2009 to 2014 found “high levels of treatment efficacy” in contingency-management treatment. On average, it increased a patient’s odds of reaching abstinence by 117%. (Greenspan, 8/22)

The U.S. Food and Drug Administration’s approval of a new tuberculosis antibiotic this month could be a significant win not only for TB patients, but for a burgeoning nonprofit model for developing prescription drugs. Tuberculosis kills about 1.6 million people per year worldwide, and drug-resistant strains of the disease are becoming more common, making it difficult to treat. (Rorhich, 8/22)

Federal regulators examining test data manipulation for a gene-therapy drug made by Novartis AG are zeroing in on the company’s two-month delay in launching a formal inquiry, according to documents and interviews. The drug, Zolgensma, is used to treat a sometimes fatal form of spinal muscular atrophy in children and costs about $2.1 million for a one-time infusion. The Food and Drug Administration said this month that it wasn’t informed about the data manipulation until after it approved use of the drug May 24. (Burton, 8/22)

Biotechnology companies often have both devoted fans and detractors. But there's one constituency they'd be wise not to anger: U.S. regulators. In the past few weeks, the Food and Drug Administration has dropped the hammer on pharmaceutical giants and biotech upstarts alike. The agency slammed Novartis for manipulating data and rejected what would've been Sarepta Therapeutics's second drug for a rare form of muscular dystrophy. A company that makes a fish-oil pill caught investors by surprise when it said the agency wanted a closer look at its data. Another had a jet-lag drug rejected after the FDA said its clinical merits weren't clear. (Spalding, 8/22)

GlaxoSmithKline said its experimental multiple myeloma treatment showed a meaningful response in patients that have run out of three previous treatment options, in a boost for the British drugmaker's cancer drug business. Two doses of belantamab mafodotin helped subdue the disease in adults who had received three prior treatments for multiple myeloma, a cancer of the white blood cells, GSK said on Friday, adding that it intends to seek market approval and submit data from the trial to regulatory bodies this year. (Burger and Aripaka, 8/23)

Giving people an inexpensive pill containing generic drugs that prevent heart attacks — an idea first proposed 20 years ago but rarely tested — worked quite well in a new study, slashing the rate of heart attacks by more than half among those who regularly took the pills. If other studies now underway find similar results, such multidrug cocktails — sometimes called “polypills” — given to vast numbers of older people could radically change the way cardiologists fight the soaring rates of heart disease and strokes in poor and middle-income countries. (McNeil, 8/22)

The pills contained two blood pressure drugs, a cholesterol medicine and aspirin. Many people can’t afford or don’t stick with taking so many medicines separately, so doctors think a polypill might help. A previous study testing one in India found it lowered cholesterol and blood pressure. The new study is much larger and gives stronger evidence because it tracked heart attacks, strokes and other problems — not just risk factors. (Cheng, 8/23)

"Given the polypill's affordability, there is considerable potential to improve cardiovascular health and to prevent the world's leading cause of death," said Dr Nizal Sarrafzadegan, of Isfahan University of Medical Sciences, Iran. The idea of the polypill has been around since 2001 but this is the first major trial to prove its effectiveness. (Gallagher, 8/23)

Washington state exited a federal family planning program Thursday over the Trump administration's new abortion restrictions. Washington's Department of Health notified the Department of Health and Human Services (HHS) on Thursday that it would withdraw from the Title X family planning grant program rather than follow new rules banning grantees from referring women for abortions.  (Hellmann, 8/22)

A federal appeals court has upheld an injunction allowing a South Bend abortion clinic to remain open without a state-required license until there is a final ruling in a lawsuit on the license. The 7th Circuit Court of Appeals issued the ruling Thursday, thwarting an attempt by Indiana Attorney General Curtis Hill to reverse the opening of the Whole Woman's Health clinic in June. (8/22)

Opponents of Missouri’s eight-week abortion ban have dropped their efforts to gather the needed 100,000 signatures to place a referendum on the November 2020 ballot. They claim Republican Secretary of State Jay Ashcroft did not give them enough time to do so by Wednesday, when the law takes effect. The abortion-rights coalition No Bans On Choice and the ACLU of Missouri have instead turned their attention to making sure state officials cannot block future referendums. (Fentem, 8/22)

New York City will no longer make burial records public that include the names of women who had stillbirths, miscarriages and possibly abortions, Mayor Bill de Blasio said. The practice has raised alarms among medical-privacy experts. The Wall Street Journal reported Thursday that women’s names had been included in burial records for infants and fetal remains on Hart Island, one of the country’s largest public cemeteries that serves as a potter’s field for the city’s unclaimed bodies and deceased low-income residents. (Riski, 8/22)

The Trump administration plans to detain immigrant children who enter the U.S. illegally with their families with no deadline for release, ending a long-standing settlement that capped the detention of immigrant children at 20 days. The government says holding children in the facilities is for their own safety and well-being. But child advocates and pediatric health experts are outraged and say these children and their needs are being neglected and whole families left traumatized. (Santhanam, 8/22)

The Trump administration's regulation allows the longterm detention of migrant children. But immigration and health experts warn this could have devastating impacts on the children's mental health. (Chatterjee, 8/22)

A federal judge in San Diego approved Thursday a request from the Department of Homeland Security to force-feed and hydrate an immigrant detainee on hunger strike. The San Diego Union-Tribune reported the 41-year-old man, a Russian citizen, has not eaten since Aug. 4 and has consumed only water, though he has refused to tell officials at the ICE facility how much. (Daugherty, 8/22)

Once it was called “hysterical” movement disorder, or simply “hysteria.” Later it was labeled “psychogenic.” Now it’s a “functional disorder.” By any name, it’s one of the most puzzling afflictions — and problematic diagnoses — in medicine. It often has the same symptoms, like uncontrollable shaking and difficulty walking, that characterize brain diseases like Parkinson’s. But the condition is caused by stress or trauma and often treated by psychotherapy. And, in a disparity that is drawing increased scrutiny, most of those deemed to suffer from it — as high as 80% in some studies — are women. (Armstrong, 8/23)

Smog isn't just annoying, it's also deadly: Exposure to even small amounts of toxic air pollutants is linked to increased cardiovascular and respiratory death rates, according to a new international study. The study, published Wednesday in the New England Journal of Medicine, is the largest ever undertaken to investigate the short-term impacts of air pollution on death. It was conducted over 30 years in 652 cities in 24 countries. (Rice, 8/22)

The medical journal BMJ published a report today that links higher levels of physical activity at any intensity to a lower risk of early death in middle-age and older people. Previous studies have repeatedly suggested that any type of sedentary behavior, such as sitting still, is not good for your health. Being sedentary for 9.5 hours or more a day, excluding sleeping time, is associated with an increased risk of death. (Kim, 8/22)

The trouble started when the Federal Bureau of Investigation attorney made a personal appeal to Bennett Greenspan. Mr. Greenspan, president of FamilyTreeDNA, was used to fielding requests from genealogists, customers, even friends of friends, seeking help with DNA testing. The FBI’s Steve Kramer wasn’t among them. The company’s database of over 1.5 million customers could help solve heinous crimes, the attorney said. He wanted to upload DNA data in two cases to see if there were genetic links to other users. Turning up matches to even distant relatives might generate leads. (Marcus, 8/22)

When Lalita Manrai went to see her doctor for treatment of kidney disease, she noticed that some of the blood test results had different "normal" ranges for African Americans compared with everybody else. When she asked her doctor which range applied to her — a woman born in India — he said the "everybody else" category was actually based on a study of Europeans, so neither category was right. (Harris, 8/22)

Executives and labor leaders at a group of skilled nursing homes in Connecticut that are set to lose Medicaid funding plan to challenge the state’s decision — they said otherwise, their nursing homes face severe financial cuts.“ The state has been trying to change the way that long-term care is done, and they’re trying to incentivize home care,” said Jesse Martin, vice president of labor union SEIU 1199NE. “There’s still a vital need for nursing homes in our society.” (Leonard, 8/22)

The state agency that oversees programs that deliver health care to about a quarter of Georgians isn’t ruling out job cuts to meet Gov. Brian Kemp’s edict to slash department budgets over the next two years.Kemp wants agencies throughout state government to cut spending 4 percent this fiscal year, which began July 1, and 6 percent next year. But he exempted big, enrollment-driven programs like Medicaid — which funds health care for the poor and disabled — and schools. He also exempted transportation and some other programs. (Salzer, 8/22)

A nearly quarter-of-a-million-dollar grant aims to increase the number of mental health and substance abuse providers who accept Medicaid across southern Colorado. The $242,758 grant from the Colorado Department of Health Care Policy and Financing seeks to replicate the success of a similar program that showed signs of promise across the Pikes Peak region. The program provided technical assistance to leery providers, ultimately leading dozens of additional clinicians to start applying to receive Medicaid patients. (Rodgers, 8/22)

The troubling scene inside the dingy Chicago apartment seems real: dangling exposed wires, open pill bottles near a sleeping baby and a kitchen strewn with dog feces and cockroaches. But the mock apartment — with a lifelike infant doll, candles emitting foul smells and plastic insects — is part of a new simulation lab to train workers who investigate child abuse claims across Illinois. “Sometimes textbooks, they sugarcoat things. Teachers sugarcoat things, but this is real life,” said Beth Brown of Murphysboro, who recently trained at the so-called “dirty apartment.” ‘’This is what you’re going to experience.” (Tareen, 8/23)

The latest report from the federal monitor overseeing the state Department of Children and Families shows that the agency is not complying with five of 10 key measures that are part of a court supervised plan to improve services for children in its care. Despite this, a lawyer for the plaintiffs expressed optimism that the 30-year-old case will be closed in the next few years because the agency has been making progress, particularly in its hiring and caseload goals, even though it did not reach target levels during the period covered by the report. (Megan, 8/23)

As many as 15 teenagers or young adults have now been hospitalized in Minnesota for severe lung injuries associated with vaping or e-cigarette use, the state Health Department said in an update Thursday. The department reported 11 new presumptive cases, on top of the four confirmed cases that were detected at Children’s hospitals in the Twin Cities in recent weeks. (Olson, 8/22)

Health officials showered accolades on the state health department’s newest psychiatric facility at an outdoor ribbon-cutting ceremony in Morganton on Wednesday. Officials touted the new Broughton Hospital’s roughly 477,000 square-feet structure’s sunny hallways, onsite pharmacy and dental clinic and bathrooms that offer patients a modicum of privacy. The red-brick structure’s debut came roughly five years late, as multiple construction delays derailed the $130 million project. (Engel-Smith, 8/23)

The University of Michigan is in talks with St. Joseph Mercy Health System to partner on a new hospital in Livingston County, the Free Press has learned. As part of the deal, Michigan Medicine would be a co-owner and minority partner in a plan to bring a new Catholic hospital to the Brighton/Howell area, according to internal emails obtained by the Free Press. The hospital would be governed by Trinity Health, a national Catholic health system that owns 92 hospitals in 22 states, including the St. Joseph Mercy System. (Shamus, 8/23)

The dialysis industry spent about $2.5 million in California on lobbying and campaign contributions in the first half of this year in its ongoing battle to thwart regulation, according to a California Healthline analysis of campaign finance reports filed with the state. Last year, dialysis companies poured a record-breaking $111 million into a campaign to defeat a ballot initiative that would have capped their profits. (Rowan, 8/22)

The arraignment for a Lake Charles man charged with manslaughter in the April death of a Baton Rouge General Medical Center nurse — the most serious of a series of attacks on health care personnel in Baton Rouge this year — was postponed Thursday after a judge was told the defendant was hospitalized. State District Judge Bonnie Jackson said she was advised by an East Baton Rouge Parish sheriff's deputy that Jessie Wayne Guillory, 54, is on life support at a hospital. (Gyan, 8/22)

Dean Higgins is now suing the Florida Department of Corrections and the officers involved in the encounter, alleging cruel and unusual punishment, violation of the Americans with Disabilities Act, use of excessive force and battery. It is the latest in a flurry of suits involving the prison system and inmates with disabilities, despite a lawsuit settlement two years back that purported to improve the treatment of prisoners with mental and physical frailties. (Penney, 8/22)

Hope Family Health will receive a $1.02 million loan from the U.S. Department of Agriculture to help combat the opioid crisis as part of the USDA's $52 million investment that will benefit nearly 200,000 rural residents in 16 states. USDA Rural Housing Service Administrator Bruce Lammers announced Aug. 21 that the USDA's investment benefits 45 community facilities projects throughout the country. Rural Development State Director Jim Tracy announced that Tennessee will invest more than $1 million in loans and grants to two projects, one of them, being Hope Family Health. (Nixon, 8/22)

Missouri’s medical marijuana program is still getting off the ground, but Lee’s Summit obstetrician and gynecologist Emily Gray has already had one patient tell her she wants to enroll. Gray wouldn’t sign the form the patient needs to submit, in part because her employer, Truman Medical Center, doesn’t allow it. But before the patient left to find a doctor who would, Gray made sure the woman, who had already had her baby, wasn’t breastfeeding. (Marso, 8/23)

Humans, once in constant motion as hunters and gatherers, are moving less than ever. At first, this trend seemed like progress: Transferring our heavy and dangerous work to animals, then machines, enabled more people to live longer. As recently as the 1950s, doctors considered exercise dangerous for people over age 40; for heart disease, which was then killing a record number of Americans, they prescribed bed rest. This was partly based on their concept of what “exercise” was: Early physiologists conducted studies on their (typically young, male) graduate students or on military servicemen — and in order to become more fit than they already were, these subjects needed to work out hard. “The mantra was, You have to go to a gym, you have to do high-intensity physical activity,” says Abby C. King, a professor of health research and policy and medicine at Stanford University: “this sort of ‘no pain, no gain’ phenomenon.” (Tingley, 8/21)

The fact is that adherence is a problem for every healthy diet out there. And given how imperiled our planet is, we should be applauding anyone who is helping in any way to reduce the unsustainable demands the cattle industry (and our national burger addiction) imposes on our land. Even setting aside the health implications, the ethical and environmental rationales for eating a plant-based diet are strong. Still, if once-disciplined vegans are now scarfing down meat and posting videos of themselves doing bacon taste tests with the reckless abandon of an Amish teen on rumspringa, what does that tell us about the hope for long-term compliance on even less restrictive diets? (Swidey, 8/20)

For most of the twentieth century, the definition of a drug was simple, because drugs were simple: they were typically small molecules synthesized in factories or extracted from plants, purified, and packaged into pills. Later, the pharmacopoeia expanded to include large and complex proteins—from insulin to monoclonal antibodies. But could a living substance be a drug? Thomas, who saw bone-marrow transplantation as a procedure or a protocol, akin to other organ transplants, would never have described it as a drug. And yet, in ways that Thomas couldn’t have anticipated, he had laid the foundation for a new kind of therapy—“living drugs,” a sort of chimera of the pharmaceutical and the procedural—which would confound definitions and challenge the boundaries of medicine, raising basic questions about the patenting, the manufacturing, and the pricing of medicines. (Mukherjee, 7/15)

Hate crimes are surging across the country, with racist slurs scrawled on schools and houses of worship, assaults on gay and transgender people, and white gunmen targeting Jews at a Pittsburgh synagogue and Latinos at an El Paso Walmart. In Washington, the number of attacks investigated by police as bias-motivated reached an all-time high of 204 last year. The District had the highest per capita hate-crime rate of any major city in the country, according to Brian Levin, director of the Center for the Study of Hate and Extremism at California State University at San Bernardino. (Miller and Rich, 8/21)

In the rural parts of Uganda, lab technicians spend hours each day on thankless and seemingly unceasing work. The most common tests they run are for malaria. A technician smears a blood sample on a slide, treats it with dye, and then slowly scans it for cells that contain malaria parasites. She then uses a handheld clicker to record how many parasites she sees. (Yong, 8/22)

Wendy Ramsey began her day as she often does, in the cool basement of Lincoln Avenue Baptist Church. It was a Thursday, and her first client was coming at noon. She flipped on the fluorescent lights. Racks of infant, toddler and maternity clothes neatly lined the waiting area. Formula and baby food were on the shelf, free for anyone who came. A flier for a local domestic violence shelter was taped to the cinder-block wall, one of its tabs ripped off. (Dias, 8/23)

After last year’s mass shooting at Marjory Stoneman Douglas High School, it quickly became clear that students who had survived the horror weren’t willing to let their murdered classmates and teachers become just another statistic in America’s unending carnage of gun violence. They demanded change and ignited a grass-roots movement that has given youthful new vigor to the fight for gun safety. Now, these young activists have put forward a bold gun-control proposal that aims to reframe the debate on gun policy. (8/22)

The debate over red-flag laws, which let police impound a person’s guns if a legal process determines he poses a threat, is playing out mostly in the abstract. How about a few real-life stories? An academic paper this week presents 21 case studies from 2016-18 in which California’s law was used “in efforts to prevent mass shootings.” ... More research and experience are warranted, and red-flag laws are no panacea for mass shootings. But only 17 states have these laws today and, if reasonably drafted, they appear to be a step forward: gun control for the dangerous and unstable. The genius of federalism is that the states can see what works, and useful lessons can be drawn and spread. (8/22)

On Aug. 3, my hometown of El Paso, Texas — one of the safest cities in America — was attacked in one of the deadliest mass shootings in our country’s modern history. This was an act of white nationalist terror, and one we could have prevented. All countries have video games. All countries struggle with mental health. All countries deal with hatred. But only America has more guns than human beings — 390 million firearms in a country of 329 million people — which kill nearly 40,000 people every year. (Beto O'Rourke, 8/22)

President Trump may ridicule reporters and deride his opponents on Twitter. But there is a group of people he treats even worse than his most visible targets: scientists in his own administration. Whatever the president says about the media or his online foes, they can all respond. After all, the First Amendment is still alive and well. But those who work for the government are not so lucky. When the president silences them, they have far less room for recourse. And this can have dire consequences for our democracy. Take the recent directive from the Department of Health and Human Services to the communications staffers at the nation’s premier health research institutions. After two mass shootings this month, they were told not to post anything on social media regarding mental health, violence or mass shootings without prior approval from the government, The Post reported Tuesday. (Robert Gebelhoff, 8/22)

On gritty streets where heroin, fentanyl and meth stride like Death Eaters, where for decades both drugs and the war on drugs have wrecked lives, the city of Seattle is pioneering a bold approach to narcotics that should be a model for America.Anyone caught here with a small amount of drugs — even heroin — isn’t typically prosecuted. Instead, that person is steered toward social services to get help. This model is becoming the consensus preference among public health experts in the U.S. and abroad. (Nicholas Kristof, 8/23)

The migrants in the detention centers may be dehydrated or malnourished and therefore more susceptible to influenza and its complications. The affinity for influenza to these centers is already in evidence as there have already been deaths reported at these centers as well as outbreaks of influenza that have interfered with daily operations. Without vaccination and compromised ability to practice hygiene, an influenza tinderbox is being created. The CBP policy is baffling as it seems almost crafted to spread influenza. (Amesh A. Adalja, 8/22)

Clinical trials in the United States have been plagued for years by two well-known problems: They don’t recruit enough people and they fail to reflect the diversity of our nation. The good news is that solving the diversity problem can resolve both issues. Two birds, one stone. Researchers whose job it is to fill clinical trials with participants have begun teaming up with tech companies to find modern solutions to this long-standing problem. This approach, however, is just a temporary patch to a problem that requires a longer, more sustained remedy. (Bobby Clark and Ronnie Tep, 8/23)

Thanks to greenhouse gases already emitted into the atmosphere, droughts, fires, heat waves, and cyclones have gotten worse, sea levels have risen, and the oceans have acidified, and worsening conditions are unavoidable. Every additional delay makes the situation much worse. Anthropogenic global warming is not a, but the defining issue of the 21st century. The DNC should act accordingly and dedicate a debate. (Jack Turner, 8/22)

One of the U.S. government’s most intriguing health programs is going to start bearing fruit soon. And the more people who join, the better. The National Institutes of Health’s “All of Us” project, launched last year, aims to collect genetic information from at least 1 million Americans and make it broadly available to researchers looking for medical breakthroughs. At least 230,000 people have enrolled in the free program, and 175,000 have contributed biologic samples. (Max Nisen, 10/22)

Buying a new car every year would be a very impractical expense. It would also be cheaper than a year’s worth of health care for a family. Why it matters: The cost-shifting and complexity of health insurance can hide its high cost, which crowds out families’ other needs and depresses workers’ wages. (Drew Altman, 8/23)

Health care is still the top priority for voters in America, according to a recent poll by Luntz Global. Of all the issues facing America today, 45 percent of those polled said they are most concerned about health care, with immigration a distant second (25 percent). An overwhelming number of those polled (82 percent) believed that seniors on Medicare should be able to keep contributing to their Health Savings Account if they already have one. In addition, 82 percent say seniors on Medicare should have the option to purchase a Health Savings Account if they want one. (Kevin McKechnie, 8/22)

Perhaps the assault on state Sen. Richard Pan (D-Sacramento) Wednesday by a professed anti-vaccination advocate was inevitable.In the four years that the pediatrician-turned-politician has been working to raise the state’s flagging vaccination rates, he’s been the target of such fierce anger from anti-vaccination advocates that their rhetoric at times crossed the line from harsh into violent. (8/23)

What should a parent do when a 2-year-old shrieks inconsolably because her string cheese wrapper tore “the wrong way”? Increasingly, the answer is “snap a photo, add a snarky caption and upload it to Instagram. ”Publicly laughing at your toddler’s distress has somehow become not only acceptable but encouraged. Websites offer “best of” compilations, or canned quips readers can use when posting tantrum photos and videos (“Metallica has a new lead singer.”). (Rebecca Schrag Hershberg and Daniel T. Willingham, 8/22)

I walked 114 miles the other week, according to my tracker. It would have been more but there were downpours, and I forgot the handy device on one of my outings. Oh, and I put in a full week at the office. Still, 114 isn’t shabby. That’s 16.3 miles a day—here, there and everywhere in between. Not my best weekly total, but considering I had a stress fracture on my right foot a few months ago, it will do. (Allan Ripp, 8/22)