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The lone U.S. county still at risk of leaving shoppers with no choices next year on the federal health law's insurance marketplace has landed an insurer. Ohio-based insurer CareSource will step up to provide coverage in Paulding County, Ohio, in 2018, the company and the state Department of Insurance announced Thursday. (Smyth and Murphy, 8/24)

Although insurers could still defect in the next month, before they must sign federal contracts to sell ACA coverage for the coming year, the move by CareSource to sell marketplace health plans in Paulding County, on the western edge of Ohio, appears to end a recent scramble by officials in seven states to persuade insurance companies to participate in a total of 81 counties. Those potential bare spots emerged mainly as large, nationwide insurers have withdrawn from all or most of the ACA marketplaces they once served — a result of sicker and more expensive customers than they had expected and uncertainties bred by Republican efforts to overturn much of the 2010 health-care law. (Goldstein, 8/24)

CareSource’s chief executive, Pamela Morris, said the decision “was the right thing to do as a mission-driven company.” CareSource was able to agree to offer exchange plans in Paulding County because it has a presence in a neighboring county in the adjacent state of Indiana and thus has a network of health-care providers there. Ms. Morris said CareSource, which offers exchange plans in four states, was “fully committed” to those marketplaces, despite uncertainty about federal decisions related to the health-law marketplaces. (Wilde Mathews, 8/24)

Despite President Donald Trump's claims that Obamacare is "dead" and repeal efforts in Congress, the Ohio announcement is the latest evidence that the health care law's insurance markets are proving to be resilient. (Demko, 8/24)

Insurers such as UnitedHealth Group Inc, Aetna Inc and Humana Inc have exited most of the states where they sold Obamacare plans, leaving hundreds of U.S. counties at risk of losing access to private health coverage in 2018. ... But other insurers, like Centene Corp, have filled those gaps, expanding into new counties that had lost their coverage options. (Erman, 8/24)

The Trump administration downplayed the news, arguing that competition is lacking on the exchanges with many counties slated to have only one insurer next year. “On ObamaCare’s exchanges premiums continue to surge, insurers continue to abandon wide swaths of the country, and choices continue to vanish,” HHS spokesman Matt Lloyd said in a statement. (Hellmann, 8/24)

Even though all counties are now covered, consumers still face few or no choices in some places because of the pullbacks. About 23 percent of Obamacare customers, or 2.5 million people, live in counties where only one insurer plans to offer coverage next year, according to data compiled by Bloomberg. Another 26 percent are in counties with two options. (Tracer and Recht, 8/24)

Earlier this year, more than 40 mostly rural counties across the country faced the prospect of having no options for their exchanges. Insurers who withdrew cited steep losses and a lack of clarity over the future of President Obama’s Affordable Care Act. Many counties still have only one insurer, and premiums in many regions will increase significantly next year due to the financial pressures facing insurers. (Ross, 8/24)

"Working through this challenge has been a priority for the Department and our staff in recent weeks and I'm proud of the collaborative approach insurers have been willing to take so that we could come together and solve this problem," Jill Froment, director of the Ohio Department of Insurance, said in a statement. "There is a lot of uncertainty facing consumers when it comes to health insurance and these announcements will provide important relief." (Koff, 8/24)

People buying health insurance through the state health exchange are about to get an idea of how much more they will have to pay for their plans next year — and there is likely to be sticker shock. There are two carriers left selling Obamacare plans in the state after three exited the market, and the Maryland Insurance Administration is expected to announce Friday how much they will be allowed to charge. (Cohn, 8/24)

But that repeal and replace plan would increase the number of uninsured nationwide, restructure Medicaid and have an especially harmful impact on Connecticut and a handful of other states, a liberal-leaning Washington D.C.-based think tank said. ... The plan would eliminate the ACA’s marketplace subsidies and the increased federal Medicaid funds states like Connecticut received to expand that health care program for the poor to more people – including single adults who did not earn more than 138 percent of the federal poverty rate. That federal money, which helped states cut the number of uninsured, would be replaced by block grants that would grow at the annual inflation rate — not the higher medical inflation rate. (Radelat, 8/24)

Citing financial losses wrought by inaction and uncertainty in Washington, New York State’s biggest hospital system is shuttering its four-year-old health insurance division that sold coverage, some of it via Obamacare. The division, CareConnect Insurance Co., insures 126,000 New Yorkers who will have to purchase coverage elsewhere when the hospital system, Northwell Health, phases out its insurance operation next year. (Nir, 8/24)

New York State’s biggest hospital system plans to stop selling Obamacare plans, blaming a costly part of the law and uncertain prospects for a fix amid a wider Washington brawl over health care. Northwell Health said in a statement that it will wind down its four-year-old CareConnect Insurance Co. business over the next year, after it suffered financial losses linked to a program designed to steady the exchanges where consumers can buy coverage. ( Zachary, 8/24)

"It has become increasingly clear that continuing the CareConnect health plan is financially unsustainable, given the failure of the federal government and Congress to correct regulatory flaws that have destabilized insurance markets and their refusal to honor promises of additional funding," Northwell President and CEO Michael J. Dowling said in a statement. (Livingston, 8/24)

Two legal organizations say health insurer Aetna revealed the HIV status of patients in several states by mailing envelopes with a large, clear window that showed information on purchasing HIV prescriptions. The Legal Action Center and the AIDS Law Project of Pennsylvania say some patients' relatives and neighbors learned of their HIV status as a result. (8/24)

The beginning of the letter, informing patients about options under their Aetna plan when filling their HIV prescriptions, was in some cases visible below the person’s name and address on the envelope, through a large plastic window, according to the Legal Action Center and the AIDS Law Project of Pennsylvania, which first revealed the mailing problem. (Tracer, 8/24)

It's been five months since federal antitrust regulators threw cold water on the marriage between Advocate Health Care and NorthShore University HealthSystem, dashing hopes of creating one of the biggest hospital networks in the nation. Will Presence Health and Ascension, respectively the largest Catholic hospital systems in Illinois and in the U.S., succumb to the same fate? It's not likely, experts say. (Schorsch, 8/23)

After the swift rise and sudden crash of California’s ambitious single-payer legislation, complete with melodramatic fallout, universal health care is back — not on the floor, but on the table. Assembly Speaker Anthony Rendon, D-South Gate — who in June famously blocked Senate Bill 562 from advancing in his chamber, calling the proposal “woefully incomplete” — announced on Thursday that a special committee would hold hearings on universal health care this fall, after the legislative session ends on Sept. 15. (Murphy, 8/24)

Rendon has been under fire from the California Nurses Association and supporters of U.S. Sen. Bernie Sanders for refusing to bring Senate Bill 562 to the Assembly floor earlier this year. The bill, by state Sens. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego, sought to reorganize California’s health care financing under a government-run system operated by the state. Known as single-payer health care, the approach would eliminate the need for insurance companies. There would be no copays, deductibles or other out-of-pocket costs. (Hart, 8/24)

"I have called for these hearings to determine what approach best gets us there — what gets us to ‘yes’ when it comes to health care for all,” Rendon said in Thursday's statement. No dates have been set, but the hearings will be held after Sept. 15, the last day for bills to be passed and the beginning of California's legislative interim. (Colliver, 8/24)

The HIV rate among state and federal inmates is at its lowest point since 1991, the Department of Justice announced Thursday. The agency said the number of prisoners in state and federal facilities who have human immunodeficiency virus (HIV) dropped from 17,680 prisoners in 1991 to 17,150 prisoners by the end of 2015. In 1998, DOJ said, the HIV rate peaked at 25,980 inmates. (Wheeler, 8/24)

References to "climate change" have been wiped from parts of The National Institutes of Health's (NIH) Environmental Health Science division website, according to a report by the Environmental Data & Governance Initiative. In one of the changes, for example, an article formerly titled "Climate Change and Human Health," now reads, "Climate and Human Health." Another drop-down menu now reads "Climate and Children's Health," instead of "Climate Change and Children's Health." (Manchester, 8/24)

The changes were revealed in a report by the Environmental Data and Governance Initiative, a group of nonprofits and academics who monitor what they call “potential threats” to federal policy and scientific research on energy and the environment. But Christine Flowers, the NIEHS director of communications, downplayed the changes Wednesday. She said she made them as she added and moved information on the site over a period of months. “It’s a minor change to a title page,” Flowers said of one headline alteration, “but the information we provide remains the same. In fact, it’s been expanded.” (Bernstein, 8/23)

Officials with the VA hospital in White River Junction are stressing this week that veterans are welcome at the hospital regardless of gender or sexual identity. Details of new White House guidelines for the Pentagon emerged Wednesday and were confirmed by NPR. (Greene, 8/24)

Mary and Joe Mullin had no doubt they would put the circumstances of their son’s death in his obituary. The only question was what words they would use.“We wanted it truthful,” Joe Mullin said.“Mullin, Patrick Joseph, Irondequoit: Tuesday, March 7, 2017, at the age of 32 after a long battle with addiction.” (Singer, 8/24)

In 2015, state officials reported at least 1,451 men, women and children died from drug overdoses in Tennessee - but that's far from an accurate count. There are likely hundreds more. No one knows the true number. Drug deaths reported in Tennessee are fundamentally flawed and represent an under-count of the toll taken by opioids, the nation’s most deadly drug epidemic, a USA TODAY NETWORK-Tennessee investigation found. (Wadhwani, 8/25)

Two weeks ago, in response to a reporter’s question, President Trump proclaimed that he considered the opioid crisis to be “a national emergency,” leading many news organizations to report that a national emergency had been declared. But the Trump administration, perhaps caught off guard by the president’s statement, has not yet taken the legal steps to give those words force. (Katz, 8/24)

A panel of outside experts has already begun its review of the opioid prescribing practices of a physician at the Clement J. Zablocki Veterans Affairs Medical Center. ... Investigators said they "substantiated that a provider prescribed opioid medications for some patients in a manner that varied from clinical guidelines and other providers at the facility." (Glauber, 8/24)

New data on vaccination rates among U.S. teenagers provide some heartening news — but also pose a bit of a mystery. The report, from the Centers for Disease Control and Prevention, shows parents of teenagers are in the main following the CDC’s advice and keeping their children up to date on vaccines that should be administered in the early teens. (Branswell, 8/24)

When Taylor Porco's brother, Jordan, died by suicide during his freshman year at college in February 2011, people told her to be strong for her parents who were incapacitated by their grief. Hardly anyone seemed to notice that Porco, only 14 at the time, was suffering and suicidal. "I was really depressed and in such extreme pain. Nothing literally mattered to me after he died. All I wanted was my brother back. I never loved someone as much as I loved him," she says. (Weinstock, 8/25)

The roots of hair loss run deep: It’s linked to hormonal balance, immune response, stem cell signaling, and now, according to new research from University of California, Los Angeles — metabolism. The study, published in Nature Cell Biology, finds that the metabolism in the stem cells embedded in hair follicles is different from surrounding cells. When they tinkered with that metabolic pathway in mice, they could either halt hair growth — or make it proliferate. The UCLA researchers are now testing out a duo of drugs to try and prompt that hair to grow. (Keshavan, 8/25)

Here’s a generalization about millennials you may not have heard before: They struggle mightily to take their daily pills as prescribed. Commercially insured young adults are significantly less likely than their older counterparts to be adherent to their diabetes medications, concludes a report released Friday by Express Scripts (ESRX), the nation’s largest pharmacy benefit manager. Just 40 percent of women and 48 percent of men between the ages of 20 and 44 had access to their prescribed diabetes medication at least 80 percent of the time, according to the report, which looked at 1.4 million patients in plans managed by Express Scripts. (Robbins, 8/25)

The use of antibiotics among Americans with commercial health insurance has decreased during the past several years, according to a new analysis that nevertheless shows lingering variations for different ages and in different parts of the country. The study released on Thursday provides the latest evidence of how doctors and patients have begun to heed warnings that excessive antibiotic use breeds dangerous drug resistance and “superbug” bacteria. (Goldstein, 8/24)

In Tanzania, not far from the Serengeti, live the Hadza, a community of about 1,300 people. For such a small group, they attract a lot of scientific attention. Many of the Hadza live solely on the animals they kill, along with honey, berries and a few other wild foods. For the first 95 percent of our species’s history, there was no other way to live. (Zimmer, 8/24)

[Kevin] Blum was explaining why infants born in need of the vessel would require several operations as they age if surgeons use synthetic vessels that don’t grow as children grow. But a new procedure at Nationwide Children’s Hospital seeks to ensure that children need surgery only once. That’s because researchers are growing vessels, using a biodegradable tube onto which they place a patient’s own bone marrow cells. (Viviano, 8/25)

Studies have shown that obese women give birth to larger babies who are at risk for obesity and other metabolic problems later in life. Some have thought that the reason may be that obese mothers, whose bodies are rich in nutrients, somehow “overfeed” the fetus during gestation. A new study has found that this is unlikely. (Bakalar, 8/24)

Life-threatening allergic reactions to foods have increased by five times over the last decade, according to a new analysis of private insurance claims by FAIR Health, an independent nonprofit that collects and analyzes data on privately billed health insurance claims. (Young, 8/24)

It's not just what you say that matters. It's how you say it. Take the phrase, "Here's Johnny." When Ed McMahon used it to introduce Johnny Carson on The Tonight Show, the words were an enthusiastic greeting. But in The Shining, Jack Nicholson used the same two words to convey murderous intent. Now scientists are reporting in the journal Science that they have identified specialized brain cells that help us understand what a speaker really means. These cells do this by keeping track of changes in the pitch of the voice. (Hamilton, 8/24)

New research examining the link between common flame retardant chemicals and fertility rates finds that women with higher levels of the chemicals in their bodies have lower chances of fertilization, pregnancy and live birth compared with women who have low levels of the chemicals in their bodies. (Almendrala, 8/25)

In a complaint sent to two California district attorneys this week, the nonprofit Truth in Advertising, also known as TINA, says it conducted an investigation into Goop’s “inappropriate health claims” and “deceptive marketing” tactics, and it is calling on the lawmakers to make the site stop. (Shapiro, 8/24)

When Lynn Scozzari wrote the beginning lines of [the] poem “The Offering” in 2013, she was staring at a photo of a naked woman seated on a rock, her arms thrust open to a valley below. Scozzari herself was in a conference room of the cancer center at Scripps Green Hospital in La Jolla, Calif., seated at a table stocked with coffee and tissues. The year before, Scozzari had finished treatment for stage 4 breast cancer. Now, she was meeting with other patients and survivors who were also writing about their cancer experiences. (Jacewicz, 8/25)

Maryland is seeking federal approval to expand a hospital cost-savings program to include doctors, rehabilitation facilities, skilled-nursing centers and others who treat patients insured by Medicare. The 10-year program, which would take effect in January 2019, aims to provide an incentive for health care providers to work more closely with hospitals to improve quality and reduce Medicare costs. The plan calls for Maryland to save $300 million in annual Medicare costs by the end of 2023. (Gantz, 8/24)

A new report released Thursday shows the 25 million people living in Appalachia — which includes residents of 32 Ohio counties — have fallen further behind the rest of the nation for premature deaths and other key health factors. The 13-state region, stretching from Mississippi through eastern and southern Ohio to New York, has higher rates than the rest of the nation in seven of the 10 leading causes of death, including heart disease, cancer, diabetes and stroke. (Candisky, 8/25)

An Iowa agency that advocates for the elderly and people with disabilities will no longer send staff to visit nursing homes because of budget cuts. The Iowa Long-Term Care Ombudsman's office has eliminated in-state travel after losing a quarter of its nearly $2 million budget this fiscal year, The Des Moines Register reported . In-state travel can cost up to $85,000 annually. (8/24)

For 46 hours, Andrew Holland’s legs and arms were shackled to a chair in the San Luis Obispo County jail. The inmate, who suffered from schizophrenia, was left in his own filth, eating and drinking almost nothing. He was naked, except for a helmet and mask covering his face and a blanket that slipped off his lap, exposing him to jail staff who passed by his glass-fronted cell. (St. John, 8/24)

After about four months and 79 cases, the Minnesota measles outbreak may finally be over. The Minnesota Department of Health has scheduled an announcement Friday afternoon where — if no new cases pop up — officials will deem the outbreak finished. (Nelson, 8/24)

The U.S. Food and Drug Administration and city restaurant and convenience store organizations will attempt to have a New York City law requiring calorie counts on menus for certain food establishments overturned during a Friday hearing in federal court. The New York City calorie-labeling law was first established in 2008, making the city the first in the country to require restaurant calorie counts. Under current city provisions, chains with 15 or more stores must provide patrons with calorie counts and nutritional information on their products. (Alfaro, 8/24)

Providence Health & Services began a series of layoffs last week as the giant health system attempts to bring its costs in line with revenue. ... The cuts at Providence are more evidence that hospitals are facing challenging times. The enormous nonprofit saw its financial position deteriorate markedly in 2016. (Manning, 8/23)

The second-highest ranking member of the Florida Senate pledged a legislative review of a state law that has allowed injured undocumented workers to be arrested and potentially deported rather than paid workers’ compensation benefits. ... Flores spoke in response to a recent NPR and ProPublica investigation and a subsequent statement by the nation’s largest insurance fraud group, which called on Florida lawmakers to change the law. (Berkes and Gravell, 8/24)

New research from Case Western Reserve University may offer a way to pinpoint Alzheimer's at its beginning stages. If it proves effective, this would allow patients to receive treatment earlier and live normal lives for a longer time. (Washington, 8/23)

Obstetrician Rebekah McCurdy agreed to provide assistance this summer to the Philadelphia Zoo if there were complications with the impending birth of an endangered gorilla. ... Whether dealing with newborn babies, broken teeth, diabetes, or cancer, veterinarians don’t hesitate to consult dentists and medical doctors to get their patients the best possible care. (Schaefer, 8/24)

After an armed robbery at a Natomas tobacco shop, Councilwoman Angelique Ashby is calling for more restrictions on businesses that specialize in tobacco and smoking paraphernalia. At Tuesday’s City Council meeting, Ashby showed her fellow council members a photo of a masked assailant armed with a gun who allegedly was one of a trio that tied up a store employee during a Friday night robbery at the Tobacco Plus store on Club Center Drive in North Natomas. (Chabria, 8/24)

Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. ...Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes. (Glied, Chakraborty and Russo, 8/22)

Health systems often lack resources to support intensive efforts that emphasize prevention. A contributing factor is the continued dependence on fee-for-service reimbursement. All-payer global hospital budgeting is a promising innovation that departs from fee-for-service reimbursement by assuring a hospital receives a prospectively set amount of revenue over the course of the year. This assurance creates an incentive to reorganize care delivery and invest in services to address preventable health conditions. ...To be successful, all-payer global hospital budgeting requires a vision for transformation, an operational strategy, and an environment conducive to success. Key considerations for adopting this approach include whether alternative payment methods can accomplish the same goals, whether a sufficient reference population can be defined to guide year-over-year budget adjustments, and whether a strong governance structure can be established and sustained. (Shargstein et al, 8/16)

In the United States, prices for therapeutically similar drugs vary widely, which has prompted efforts by public and private insurers to steer patients toward the lower-priced options. Under reference pricing, the insurer or employer establishes a maximum contribution it will make toward the price of a drug or procedure, and the patient pays the remainder. ...Implementation of reference pricing was associated with significant changes in drug selection and spending for a population of patients covered by employment-based insurance in the United States. (Robinson, Whaley and Brown, 8/17)

Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care. ...Specialty access standards did not lead to widespread improvements in access to specialist physicians. Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions. (Ndumele et. al, 8/14)

In health care, information security has classically been regarded as an administrative nuisance, a regulatory hurdle, or a simple privacy matter. But the recent “WannaCry” and “Petya” ransomware attacks have wreaked havoc by disabling organizations worldwide, including parts of England’s National Health Service (NHS) and the Heritage Valley Health System in Pennsylvania. These events are just two examples of a wave of cyberattacks forcing a new conversation about health care information security. With the delivery of health care increasingly dependent on information systems, disruptions to these systems result in disruptions in clinical care that can harm patients. Health care information security has emerged as a public health challenge. (William J. Gordon, Adam Fairhall and Adam Landman, 8/24)

East Africa now has the world’s most advanced drone delivery system for medical supplies. The question for America is whether we will follow these countries’ leads, thereby reducing costs and increasing efficiency of life-saving services in our own rural and remote areas. (Robert Graboyes, 8/25)

Charlotte doctors tell the Observer editorial board that every week, they see a person die from overdosing on prescription painkillers or heroin. ... There is much to be done, though legislators took an important step this summer. The House and Senate unanimously approved the STOP Act to more tightly regulate the prescription of painkillers. The law limits doctors to prescribing a five-day supply for acute pain and a seven-day supply after surgery. It also requires them to use a statewide database that tracks whether patients have multiple prescriptions from multiple doctors. But much more needs to be done. (8/24)

On our infectious diseases (ID) consult service, we recently cared for Mr. C., a young man with Staphylococcus aureus tricuspid valve endocarditis, septic arthritis, and empyema that were consequences of his opioid use disorder (OUD). Several years earlier, he had started taking oxycodone at parties, and eventually, when the cost of pills became prohibitive, he’d progressed to injecting heroin. His days were consumed by the logistics of obtaining heroin to stave off the exhausting cycle of opioid withdrawal. Despite his deep desire to stop using, he was initially ambivalent when we offered to start treatment with buprenorphine, which is commonly coformulated with naloxone as Suboxone (Reckitt Benckiser). “Doc,” he said, “you gotta understand that as an addict, the scariest thing right now is the idea of putting another opioid in my body, even if it’s going to help me.” (Alison B. Rapoport and Christopher F. Rowley, 8/24)

Orange County seniors need our support now more than ever. ... Indeed, by 2035, nearly one in four Californians will be age 60 or older, and today in Orange County, 622,907 of our residents are already there. (Reuben Franco, 8/24)