�Թϲ�����

Mayor Pete Buttigieg of South Bend, Ind., was repeatedly pushed onto the defensive in the sixth Democratic presidential debate on Thursday night, as several of his rivals challenged his political ascent by bluntly questioning his fund-raising practices and credentials for the presidency in a contentious and deeply substantive forum. Mr. Buttigieg has risen rapidly in the polls in Iowa and New Hampshire in recent months, after his persistent attacks on Senator Elizabeth Warren of Massachusetts and her support for single-payer health care. (Glueck and Burns, 12/19)

A pointed and personal clash over the corrupting influence of wealthy campaign donors dominated the Democratic presidential debate Thursday, as Sen. Elizabeth Warren and South Bend, Ind., Mayor Pete Buttigieg tangled over each other's ability to govern with integrity. The confrontation, which ignited after weeks of simmering disagreements between the two, provided the biggest fireworks in a night filled with elevated voices, waving arms and some of the most aggressive exchanges of any of the debates this year. (Viser, Scherer and Wang, 12/20)

Sen. Bernie Sanders (I-Vt.) and former Vice President Joe Biden sparred over the Vermont senator’s signature "Medicare for All" proposal on Thursday night, highlighting a major rift in the presidential race. “I don’t think it is realistic,” Biden said of Sanders’s Medicare for All proposal during the Democratic debate. He pointed to its roughly $30 trillion cost over 10 years, also saying others have said it is closer to $20 trillion, a jab at Sen. Elizabeth Warren (D-Mass.), who also backs the idea, but with a somewhat lower price tag.  (Sullivan, 12/19)

“Put your hand down for a second,” Biden teased Sanders, as the Vermont senator waved to the moderators to get a chance to respond. “Joe’s plan” would “maintain the status quo,” Sanders said, rattling off details about how much American workers currently pay for private health insurance. “I’m going to interrupt now,” Biden replied. “It’s going to cost $30 trillion over 10 years.” He called Sanders’ cost estimates “preposterous.” “At least before he was honest about it!” (Mason and Pearce, 12/19)

BERNIE SANDERS, on Biden's proposed health care plan: “Under Joe’s plan we retain essentially the status quo.” JOE BIDEN: “That’s not true.” (Alonso-Zaldivar, 12/19)

Sanders, turning and pointing directly at Biden, retorted: “It is exactly true. You asked me how we are going to pay for [the plan]? … Under Medicare for All, that family will be paying $1,200 a year because we're eliminating the profiteering of the drug companies and the insurance companies and ending this byzantine and complex administration of thousands of separate health care plans.” Raising his voice above the moderators, Biden yelled, “I’m the only guy who hasn’t interrupted. I’m going to interrupt now.” The exchange then escalated to the point that Klobuchar, who was called on next to speak, jumped in saying, “Whoa, guys, hey!" Klobuchar dismissed both Sanders’ and Biden’s arguments, saying bluntly, “This fight that you guys are having isn't real. Your fight, Bernie, is not with me or with Vice President Biden. It is with all those bunch of those new House members.”’ (Bice, Cammarata and Weaver, 12/20)

Ms. Klobuchar couched a disagreement with the Sanders single-payer health care proposal by saying that as president, she’d work to enact his legislation cracking down on the pharmaceutical companies. And Mr. Biden offered no real retort when Mr. Sanders brought up the former Delaware senator’s vote to authorize the Iraq war. The only people onstage who challenged Mr. Sanders were the moderators, by pushing him on questions about race, transgender rights, whether a woman should be president and if his health care proposal is realistic. (Epstein and Goldmacher, 12/19)

"At least before, he was honest about it, that it was going to increase personal taxes," Biden interjected. "That's right, we are going to increase personal taxes," Sanders snapped back. "But we're eliminating premiums. We're eliminating copayments. We're eliminating deductibles. We're eliminating all out of pocket expenses, and no family in America will spend more than $200 a year on prescription drugs." (Norvell, Coltrain, Opsahl, Akin and Morin, 12/20)

Massachusetts Sen. Elizabeth Warren pitched her own plan to move Americans to a Medicare-for-all system, which includes transitional steps under which she vowed millions would be covered but private insurance would not immediately be eliminated. An opponent of Medicare for all, Minnesota Sen. Amy Klobuchar, pointed out that the vitriol with which the Democratic candidates are attacking each other on healthcare could ultimately harm efforts to get more Americans covered. She noted that there is limited appetite in Congress, including among Democrats, for the plan Sanders champions. (Halper, 12/19)

In the final debate of the year, Democrats argued that regardless of low unemployment rates and other positive signs for the economy, too many working families have been left behind, struggling to afford medical bills and other costs. “Ordinary people are not growing,” said Mr. Biden, who has led in national polls throughout the race. “They’re not happy with where they are.” (Thomas, McCormick and Jamerson, 12/19)

When the topic in the Democratic debate turned to immigration, the candidates uniformly pilloried President Trump’s agenda of dramatically accelerating detainments and deportations. But one candidate went further. South Bend, Ind., Mayor Pete Buttigieg pledged that he would work to remedy the damage done to families separated at the border by providing payments to the children and moving them to the front of the line for American citizenship. (Halper, 12/19)

Before the Pete pile-on occurred, the PBS NewsHour/POLITICO debate at Loyola Marymount University was characterized by a policy-heavy first half devoted to a series of issues that hadn’t received much attention in the previous five Democratic debates. (Lizza, 12/20)

Kaiser Health News: Democrats Debate Whether ‘Medicare For All’ Is ‘Realistic’

But with six Democratic debates to go in the primary season, the candidates also waded into topics that focused more on care: the startling racial disparities in maternal mortality rates and the treatment of those with disabilities. Andrew Yang, a businessman who is mostly running on his proposal to institute a universal basic income of $1,000 a month, noted that black women are 320% more likely to die in childbirth. That disparity has prompted calls to extend Medicaid coverage, ensuring many new moms are not kicked off their health care shortly after giving birth. (Huetteman, 12/20)

The nearly all-white lineup of candidates at the first Democratic presidential debate in California on Thursday won’t reflect the state’s racial and ethnic diversity. But viewers can still hope for questions about issues that resonate with residents of the world’s fifth-largest economy. (Garofoli, 12/19)

“They should have a fast track to citizenship because what the United States did under this president to them was wrong,” the South Bend, Indiana, mayor said Thursday night. “We have a moral obligation to make right what was broken.” It’s not the first time that Buttigieg has discussed offering reparations for family separations: At a town hall in Iowa last month, he told voters that the US “owes something to kids in that situation” and should try to “make things right.” (Narea, 12/19)

Biden didn't dominate the debate, and, at times, he faded from view, but that's something of a win for him. The steadier he is, the fewer of Biden's supporters — and potential supporters — will be wringing their hands. (Montanaro, 12/20)

2020 Democratic presidential candidate Elizabeth Warren gives a strong retort when asked about her age at the PBS NewsHour/POLITICO debate. (12/20)

Democratic presidential candidates met for the final debate of 2019 Thursday in Los Angeles. Below is a transcript of what they said. (12/20)

Sheila Morrison was in Canada when she fell into her third diabetic coma. "My 90-year-old cousin thought we had a lunch date, and so she came with her daughter to pick me up," she says. "And I wouldn't answer the door." Her visitors were able to get inside and called an ambulance when they found her. Morrison remained in the coma for about a week. "When I woke up, they told me that another hour, too, and I wouldn't have survived," she recalls. (Blanchard and Shapiro, 12/19)

If you want to understand each major Democratic candidate’s theory of how they could win the nomination, look at their health care platform. Former Vice President Joe Biden is selling himself as the palatable moderate, pitching a public option that builds on Obamacare. South Bend, Indiana, Mayor Pete Buttigieg has a more progressive frame for his similar plan: Medicare-for-all who want it. Sen. Bernie Sanders, meanwhile, repeats that he “wrote the damn” Medicare-for-all bill in the Senate and presents himself as the only candidate actually committed to single-payer health insurance. (Scott, 12/19)

Former Mayor Michael R. Bloomberg of New York unveiled a health policy proposal on Thursday that would create a government-run health insurance plan but not provide universal guaranteed coverage, aligning himself with the more moderate wing of the Democratic Party in the 2020 presidential primary. The plan, which he announced at a campaign event in Memphis, is among Mr. Bloomberg’s first policy rollouts. (Kliff, 12/19)

“It's in the Biden-Buttigieg world rather than Sanders-Warren,” said John Holahan, a health policy expert with the nonpartisan Urban Institute think tank. Holahan reviewed an outline of the plan provided by the Bloomberg campaign. On health care, leading 2020 Democrats are divided between the step-by-step strategy favored by moderates like former Vice President Joe Biden and South Bend, Indiana, Mayor Pete Buttigieg and the “Medicare for All” plan envisioned by Vermont Sen. Bernie Sanders and seconded by progressives wanting a single, government-run system for all Americans. Massachusetts Sen. Elizabeth Warren has that as her ultimate goal. (Alonso-Zaldivar, 12/19)

Bloomberg also would seek to cap out-of-network medical charges at 200% of Medicare rates, and work to ensure the government could negotiate drug prices with pharmaceutical companies, capping prices at 120% of "the average in other advanced nations." A senior policy advisor for Bloomberg told reporters that it would cost about $1.5 trillion over 10 years to create a public insurance option and expand income-based subsidies for people beyond those created by the Affordable Care Act, or Obamacare. (12/19)

Bloomberg’s plan also takes aim at politically powerful health care providers, calling for an end to "surprise" medical bills by requiring hospitals to provide care to insured patients at their in-network rates, regardless of which doctors see them. He’d also limit what health care providers could charge insurers, pegging their out-of-network prices to just twice the typically lower rates that Medicare pays. Bloomberg also would boost resources devoted to rural health care by increasing federal grants to community health centers and requiring Medicare cover more telehealth visits, among other measures. (Diamond, 12/19)

Bloomberg’s plan was officially unveiled during a speech in Memphis, the same day the leading Democratic candidates were in Los Angeles for a debate. The proposal's rollout also comes amid a renewed threat to the future of ObamaCare. A federal appeals court on Wednesday ruled the law’s individual mandate was unconstitutional and sent the case back to a district court judge who previously declared the entire law unconstitutional. (Weixel, 12/19)

Ever since Judge Reed O’Connor of the Northern District of Texas ruled a year ago that the Affordable Care Act was unconstitutional, the country has been waiting for the next arbiter — a federal appeals court — to weigh in on the fate of the landmark health law. On Wednesday, that ruling finally came. But it offered little clarity. The judges from the Court of Appeals for the Fifth Circuit, in a 2-1 decision, ruled that one key element of the law — the mandate requiring people to have insurance — was unconstitutional. But they sent the rest of the case back to Judge O’Connor for what the dissenting judge called a “do-over,” asking him to give it another think on the question of whether other parts of the law should be struck down too. (Hoffman, 12/19)

The federal appeals court ruling striking down the Affordable Care Act’s requirement that people have health insurance left hanging key questions about what happens to other provisions of the law, like coverage for preexisting conditions. ... What happens next? It’s a bit uncertain. The appeals court told O’Connor to go over the ACA with a “finer-toothed comb” to determine which provisions of the legislation could be severed from the individual mandate, but Democratic attorneys general are weighing whether they want to appeal the case directly to the Supreme Court, which twice before has upheld the law. It’s a different court now, with a more conservative bent, but the same five justices who upheld the heart of the law in 2012 remain. (Santana, 12/19)

What’s the impact on 2020 Democratic candidates? It’s mixed. Had the court struck down the entire law, Democratic presidential and congressional candidates would have been confronted with a crisis and likely pivoted from discussions about “Medicare for All” to promoting ways they’d fortify Obamacare. Wednesday’s decision gives them another opportunity to voice support for the law while continuing to debate how best to achieve universal coverage. Democrats no doubt are mindful of the big gains they registered in the midterm elections by bashing Trump and GOP efforts to undermine the law. (Bettelheim and Luthi, 12/19)

An apparent setback for the Affordable Care Act is actually a win for health insurers. The Fifth U.S. Circuit Court of Appeals, in a 2-1 decision, struck down the law’s requirement that most people carry health insurance or pay a penalty. That seems like a problem given that health insurers have flourished ever since what is commonly known as Obamacare became law in 2010. (Grant, 12/19)

The 5th Circuit Court of Appeals' reluctance to decide the fate of the Affordable Care Act cuts a break for the Republican lawmakers who sought to topple it while sowing uncertainty into healthcare markets that only recently found their footing. The 5th Circuit ruled 2-1 on Wednesday that the already toothless individual mandate is unconstitutional but remanded the case back to a federal judge in Texas to determine how much of the landmark healthcare law must fall along with it. U.S. District Judge Reed O'Connor previously struck down the ACA in entirety. (Livingston, 12/19)

Kaiser Health News: KHN’s ‘What The Health?’: ACA Still Under A Cloud After Court Ruling

The fate of the Affordable Care Act continues to be in doubt after a federal appeals court ruling in New Orleans. By a 2-1 vote, the three-judge panel ruled that the “individual mandate” provision of the health law — which requires people to have health coverage — is unconstitutional now that Congress has reduced the penalty to zero. But the judges sent the case back to the lower court to determine how much else of the law can remain in light of that finding. (12/19)

Pepper Nappo-Mead, a young Derry mother with pre-existing conditions, said she finds “terrifying” the federal appeals court ruling that judged the Affordable Care Act to be unconstitutional. But during a conference call Thursday, health care advocates stressed a new state law ensures that even if Obamacare was thrown out in court, New Hampshire would still cover some but not all of its key provisions. (Landrigan, 12/19)

Attorney General Josh Kaul and Gov. Tony Evers were able to fulfill a campaign pledge earlier this year and get Wisconsin out of an Obamacare lawsuit. But in the wake of Wednesday's federal court decision to strike down a key part of the Affordable Care Act, there's little Kaul can now do but push from the outside. (Glauber, 12/19)

Connecticut Attorney General William Tong on Thursday said he will join other “blue” states in appealing a federal court’s decision that puts the future of the Affordable Care Act in jeopardy. “We will continue our fight against the attack on our nation’s healthcare system and the millions of Americans who have gained coverage and quality healthcare under the Affordable Care Act,” Tong said. The decision of the 5th U.S. Circuit Court of Appeals puts at risk health care coverage for 250,000 Connecticut residents who have benefited from the ACA’s expansion of Medicaid. (Radelat and Carlesso, 12/19)

The U.S. Senate, rushing to meet a looming deadline, approved and sent to President Donald Trump a $1.4 trillion package of fiscal 2020 spending bills that would end prospects of government shutdowns at week's end when temporary funding expires. By strong bipartisan margins and with White House backing, the Senate passed the two gigantic funding bills for government programs through Sept. 30. (Cowan, 12/19)

The legislation delivers Trump a victory on his U.S.-Mexico border fence and gives Democrats long-sought domestic spending increases and a repeal of Obama-era taxes on high-cost health insurance plans. It blends spending increases for both sides — reelection fodder for lawmakers — with tax and benefit add-ons that will mean a roughly $400 billion boost to the deficit over 10 years. (Taylor, 12/19)

The House and Senate have now passed a provision that would ban the sale of tobacco and e-cigarettes to anyone under 21, at a time when Congress and the Trump administration are facing public pressure to reduce the soaring rates of teenage vaping. President Trump has spoken in favor of increasing the age limit, and is expected to sign the measure into law as part of the overall spending package. Nineteen states and more than 500 cities and towns have already raised the age to 21. (Kaplan, 12/19)

If signed into law, the new restriction would take effect in September. Altria Group Inc. and Reynolds American Inc., the two biggest U.S. cigarette manufacturers, both supported the age restriction, as did Juul Labs Inc., the startup that has been blamed by health officials for the rise in teenage e-cigarette use. President Trump also supported the measure. He first voiced support for it in November after backing away from a plan to pull from the U.S. market all e-cigarettes except for those that taste like tobacco. (Maloney, 12/19)

However, major legislation to protect consumers from surprise medical bills and high drug costs was not included. The deal extended funding for several Medicare and Medicaid priorities for five months, which could be another vehicle for action on the issues in 2020. However, many lobbyists are skeptical that lawmakers will come together on bipartisan legislation just six months before a presidential election. (Cohrs, 12/19)

Although congressional leaders are months late in completing the fiscal 2020 bills, the deal came together with stunning speed in recent days. Top appropriators had only agreed in late November on how to divvy the funding among the dozen annual spending bills, leaving just over three and a half weeks for negotiating specific budgets and demands for the thousands of federal agencies and programs those measures fund. (Scholtes and Emma, 12/19)

The House of Representatives approved President Trump’s amended North American trade pact on Thursday in an overwhelmingly bipartisan fashion, a rare instance of legislative cooperation in an era of intense political divisions. The House approved legislation to implement the U.S. Mexico Canada Agreement, or USMCA, by a 385 to 41 vote, with 193 Democrats and 192 Republicans backing the pact. The Senate is expected to pass the legislation early next year, after which the president would sign it into law. (Mauldin and Andrews, 12/19)

A revamped North American trade deal nearing passage in Congress gives both the White House and Democrats a chance to claim victory and offers farmers and businesses clearer rules governing the vast flow of goods among the United States, Canada and Mexico. But the pact leaves at least one surprising loser: the pharmaceutical industry, a near-invincible lobbying powerhouse in Washington. (Wiseman, Johnson and Freking, 12/19)

One of the biggest national security threats in the U.S.-China trade war could be to the everyday medicines taken by millions of Americans. The U.S. relies on imported medicines from China in a big way. Antibiotics, over-the-counter pain meds and the stuff that stops itching and swelling — a lot of it is imported from China. (Palmer, Zhou and Bermingham, 12/10)

The Food and Drug Administration announced Thursday it has approved an Ebola vaccine developed by Merck, making it the first for the deadly disease approved in the United States. The vaccine, Ervebo, protects against Zaire ebolaviruses, the species of the virus that has been the most common cause of Ebola outbreaks. Ebola Zaire is the virus responsible for the current long-running outbreak in the Democratic Republic of the Congo. (Branswell, 12/19)

Cases of EVD in the US are very rare and have generally occurred when people already infected with the virus have traveled into the country or when health care workers have become infected treating those sickened by EVD. "While the risk of Ebola virus disease in the U.S. remains low, the U.S. government remains deeply committed to fighting devastating Ebola outbreaks in Africa, including the current outbreak in the Democratic Republic of the Congo," Anna Abram, FDA Deputy Commissioner for Policy, Legislation, and International Affairs, said in a press release. (Erdman, 12/20)

U.S. health regulators are warning that popular nervous system medications can cause dangerous breathing problems when combined with opioids and certain other drugs. The Food and Drug Administration said Thursday it would add new warnings to packaging for Neurontin, Lyrica and generic versions, which are used to treat seizures, nerve pain, restless leg syndrome and other conditions. (Perrone, 12/19)

U.S. Food and Drug Administration said on Wednesday it approved Astellas Pharma Inc and Seattle Genetics' experimental drug to treat advanced bladder cancer, about three months ahead of schedule. Shares of Seattle Genetics were up 6% at $119.05 after the bell. The drug, Padcev, is approved in the United States for patients with advanced or metastatic urothelial cancer, the companies said. (Martin, 12/19)

Shares of biotech companies have surged in recent months, boosted by innovation, a spate of deals and easing worries about political risks. The Nasdaq Biotechnology Index has gained 22% so far this quarter, far outpacing the S&P 500’s 7.7% gain. The recent rally has helped the biotech index recover from a third-quarter decline, bringing its year-to-date performance to 25%, nearly in line with the broader index’s 28% advance. (Langley, 12/20)

After eschewing venture capital for the better part of a decade, Watertown, Mass.-based FORMA Therapeutics is changing its tune. The company, which has a lead drug candidate that takes aim at sickle cell disease, announced Thursday it had raised $100 million in a Series D financing round from a group of venture investors that includes RA Capital, Cormorant Capital, Wellington Management, and Samsara BioCapital, among others. (Sheridan, 12/19)

Rebekah Gee, the head of Louisiana’s health department, was recognized by a New York Times columnist as one of five people who “spread hope in 2019” for her work spearheading an innovative deal to pay for hepatitis C treatment in an effort to eradicate the disease in Louisiana. Gee’s health department struck a “Netflix-style” deal with Asegua Therapeutics, a subsidiary of pharmaceutical giant Gilead, whereby the state pays about $58 million a year for unlimited access to Hep C drugs. Medicaid patients and people in the state’s prison system get the drug free through the arrangement. (12/19)

The Consumer Product Safety Commission (CPSC), whose job is to assure products Americans buy are safe, is inappropriately deferential to companies it investigates, according to a report done for Democrats on the Senate Commerce Committee released on Thursday. Settlements reached by the Trump CPSC "are at odds with traditional recall agreements negotiated by the CPSC," the report said. (12/19)

The federal agency in charge of protecting Americans from dangerous and defective products showed an inappropriate deference to industry in its actions involving the Britax B.O.B jogging stroller, the Fisher-Price Rock 'n' Play inclined infant sleeper and the safety of residential elevator systems, contends the report released by Cantwell and the Democratic-minority staff of the U.S. Senate Committee on Commerce, Science and Transportation. Although the Consumer Product Safety Commission approved recalls, it sometimes did so in a way that generated more business for affected companies, according to the examination of documents involved in three recent investigations by the safety panel. That's because rather than getting new, safe products or refunds following a recall, consumers are often offered discount coupons for new products. (Gibson, 12/19)

Members of the Senate Finance Committee Thursday requested an in-depth examination of the nation’s organ recovery and transplant system, raising questions about suspected financial fraud and criticizing the system for its “poor performance.” The request to the Office of the Inspector General comes one day after the Trump administration announced a sweeping proposal to boost the number of organs collected for transplant by dozens of underperforming organ collection agencies and increasing federal payments to living kidney donors. (Kindy and Bernstein, 12/19)

Every Senate Democrat wants the Department of Health and Human Services to rescind a plan that would allow recipients of HHS grants and contracts to discriminate on the basis of religion and sex. The entire caucus, led by Sens. Patty Murray (D-Wash.) and Ron Wyden (D-Ore.), signed onto the letter to HHS Secretary Alex Azar. According to the senators, HHS annually awards more than $500 billion in taxpayer-funded grants and contracts. (Weixel, 12/19)

The U.S. Indian Health Service’s latest effort to protect patients from abuse falls short, federal inspectors said in a report to be released Friday, despite a rush to overhaul policies this year following a sex-abuse scandal. The new policies are too narrow and haven’t been implemented at some facilities, according to the Office of Inspector General for the Department of Health and Human Services, which oversees the health care agency. (Frosch and Weaver, 12/20)

House Energy and Commerce Chairman Frank Pallone is calling for CMS Administrator Seema Verma’s resignation, becoming the highest-ranking Democrat so far to urge her to quit. Pallone told reporters today that he agreed with Democrats, including some on his committee, who have called for Verma to lose her job over questions about her stewardship of taxpayer funds. (Cancryn, 12/19)

The U.S. escalated its efforts to counter Chinese government programs to draw on the skills of top scientists in the U.S., requiring a Michigan research institute to pay $5.5 million to resolve allegations it made false claims about the Chinese grants its researchers received. The novel settlement announced on Thursday—the first of its kind—is part of a growing U.S. effort to try new legal avenues to address what it sees as threats from so-called talent programs run by the Chinese government. U.S. officials say the programs create conflicts of interest and offer incentives to bring intellectual property back to China. (Viswanatha and O'Keeffe, 12/19)

Suicide rates in the United States have climbed steadily over the past two decades, contributing, along with drug overdoses, to a decline in the average U.S. life expectancy for the third year in a row. The demographers who first identified this trend have called it “deaths of despair.” In response, Congress enacted the National Suicide Hotline Improvement Act of 2018, to encourage more people to seek help. It directed the Federal Communications Commission to study the feasibility of creating a three-digit suicide hotline number, like 9-1-1, that more people could remember. (Vestal, 12/20)

As government agencies, medical groups, hospitals, and pharmacies have tried to cut back on opioid prescriptions, they’ve wrestled with how to best do so. Should they restrict the number of days a prescription lasts? Should there be a cap on the total strength of the dose? What kind of exceptions should be made? A new report issued Thursday by the National Academies of Sciences, Engineering, and Medicine outlines a framework for prescribers and others to develop their own plans for acute pain, without offering any direct recommendations itself. (Joseph, 12/19)

McKesson Corp. allegedly concealed security flaws in its supply chain, which fueled the opioid epidemic, according to a recently unsealed whistleblower case. Former employees at the wholesale drug distribution giant claim that McKesson would hide the extent of its security issues from the federal government and falsely represented that it would comply with two settlement agreements. Millions of the addictive pain pills were diverted to the black market as a result, according to the lawsuit. (Kacik, 12/19)

Two weeks after Tufts University became the first major university to remove the Sackler name from buildings and programs over the family’s role in the opioid epidemic, members of the family are pushing back. A lawyer for some of the Sacklers argued in a letter to the president of Tufts that the move was unjustified and a violation of agreements made when the school wanted the family’s financial help years ago. (Taylor, 12/19)

The CMS will give seventeen states nearly $200 million over the next seven years to combat opioid misuse among expectant mothers and improve care for children impacted by the crisis. The agency on Thursday announced Colorado, Indiana, Louisiana, Maine, Maryland, Missouri, New Hampshire, Tennessee, Texas and West Virginia will be the first recipients of $50 million in total grant awards over the next five years through the CMS' Maternal Opioid Misuse model. (Johnson, 12/19)

A federal office tasked with managing U.S. drug-control policy isn't doing its job, according to a new report from the U.S. Government Accountability Office published Thursday. The government watchdog found that the Office of National Drug Control Policy failed to deliver a strategic plan in 2017 or 2018, even though its core function is to oversee and coordinate the development and implementation the federal government's drug-control policies. That's worrisome because nearly 70,000 people died from drug overdoses last year, and there's no comprehensive plan to address it. (Brady, 12/19)

A bankruptcy judge gave Purdue Pharma LP permission to hire Ernst & Young LLP as its auditor, overriding objections from a Justice Department watchdog that raised concerns about the firm’s work for the drugmaker’s controlling family, the Sacklers. (Biswas, 12/19)

New Hampshire received a grant to improve the way hospitals provide pregnancy and postpartum care to women with substance use disorders — and reduce the cost of care. The state Department of Health and Human Services will work with Elliot Health System to implement the grant from the Centers for Medicare and Medicaid Services to help pregnant women with substance use disorders who are on Medicaid. (Albertson-Grove, 12/19)

The CMS has temporarily shut down access to its Blue Button 2.0 data-sharing tool after discovering a bug that may have exposed some beneficiary information. The CMS suspended access to the Blue Button 2.0 API, or application programming interface, after a third-party app developer reported a "data anomaly" on Dec. 4. It's unclear when the service, which allows Medicare beneficiaries to share their claims data with third-party apps, will be restored, the agency shared in a blog post this week. (Cohen, 12/18)

Federal inspectors have warned a Kansas state mental health hospital that its Medicare payments will be cut off early next year without major improvements to patient care in one of its units. The Centers for Medicare and Medicaid Services found that the problems at Adair Acute Care – located inside Osawatomie State Hospital — “substantially limit the hospital’s capacity to render adequate care and services,” according to documents obtained by The Kansas City Star and The Wichita Eagle. (Shorman, 12/19)

When it comes to oral health, Medicare, the federal health insurance program for people who are 65 and older, covers only a small number of medically-necessary, non-routine procedures. Though some can access dental benefits through supplemental options like Advantage plans, all routine preventive or restorative procedures are excluded from original Medicare, save for some limited circumstances during hospitalization. (Grinspan, 12/20)

The Centers for Disease Control and Prevention this week warned distributors against selling hard-boiled eggs bought in bulk from a Georgia production plant that it said was the likely source of listeria contamination that had led to sicknesses in five states, including one death and four hospitalizations. Officials with the federal Food and Drug Administration discovered the strain during a routine inspection in February at Almark Foods in Gainesville, Ga. (Padilla, 12/19)

The peeled eggs were packaged in plastic pails by Almark Foods in Gainesville, Georgia, according the Centers for Disease Control and Prevention, which along with the US Food and Drug Administration is investigating. They were sold nationwide to food service operators, so consumers likely would find them in a store or a restaurant, the CDC said. Four of seven people who reported infections across five states have been hospitalized, and one death was reported in Texas, the CDC said. Those affected also were in Florida, Maine, Pennsylvania and South Carolina. The cases date from April 2017 to November 12. (Wolfe and Ahmed, 12/20)

The CDC said consumers with a higher risk for Listeria infection, such as pregnant women and their newborns, adults ages 65 or older, and people with weakened immune systems, should not eat these eggs and should take precautions. "Until we learn more, CDC advises that people at higher risk for Listeria infection throw away any store-bought hard-boiled eggs or products containing hard-boiled eggs, such as egg salad," the CDC said. "If you have these products at home, don’t eat them. Throw them away, regardless of where you bought them or the use-by date." (Brookbank, 12/19)

The FDA typically holds off on posting recalls on its website until the companies involved have issued a public recall. Business-to-business recalls are often not announced by the FDA because the companies behind the recalls are not releasing the information to the public at large. (Gibson, 12/19)

Doctors shared details Thursday about what happened to the brain of one diplomat who may be a victim of the so-called sonic attacks that have impacted dozens of people in Cuba and China. Researchers revealed the results of an independent brain analysis of Mark Lenzi, a US diplomat who was stationed in Guangzhou, China, in 2017 when he started experiencing unexplained symptoms including headache, difficulty reading, irritability, as well as memory and sleep problems. (Nedelman, 12/19)

A biotechnology company that is trying to create CRISPR-edited pigs so their organs could be safely transplanted into people has produced animals with a record number of genetic changes, the startup’s chief scientific officer and her colleagues reported on Thursday. The eGenesis scientists had previously used CRISPR-Cas9 genome editing to remove 25 potentially dangerous-to-humans viruses from pigs’ genome. In the new paper, CSO Luhan Yang and her team surpassed that milestone, creating cloned pigs with additional genetic changes — which she calls Pig3.0. (Begley, 12/20)

Late in 2009, a 28-year-old woman not long out of graduate school found herself in a stressful job at a Bronx hospital and decided it would be useful to talk to someone. �Թϲ�����ing online, she came across the name of a psychiatrist, Keith Ablow. Dr. Ablow was familiar to her from his writing, both his journalism and the best-selling thrillers he turned out — “Denial,’’ “Projection,” “Compulsion,’’ “Murder Suicide.’’ She had read all of those, as well as “Psychopath,’’ a book about a psychiatrist who prods the interior lives of strangers only to kill them, baroquely obscuring the distinction between patient and victim. (Bellafante, 12/20)

U.S. health officials said on Thursday two more deaths occurred since last week from a mysterious respiratory illness tied to vaping, taking the total toll to 54. The Centers for Disease Control and Prevention (CDC) also reported 97 more hospitalized cases from 50 states, the District of Columbia, and two U.S. territories, as of Dec. 17. The number of people hospitalized now stands at 2,506. (12/19)

Boys born small may be at risk for infertility in adulthood. Danish researchers examined birth and health records of 10,936 men and women born between 1984 and 1987. The study, in Human Reproduction, found that 10 percent of the babies were born small for gestational age. The health and behavioral characteristics of the mothers of low-birth-weight babies were similar to those of mothers of babies of normal weight, although they were more likely to be first-time mothers and to smoke and consume alcohol. (Bakalar, 12/19)

The most recent national estimates of drivers who operate a car under the influence of marijuana put the numbers in the millions, according to a new report from the US Centers for Disease Control and Prevention. Thursday's Morbidity and Mortality Weekly Report found that in 2018, 12 million American adults said they had driven under the influence of weed in the 12 months prior to the survey. About 2.3 million said they had driven under the influence of illicit drugs such as cocaine or methamphetamine. (Christensen, 12/19)

Jay Antenen feels a soft vibration on his wrist during a weekend yoga class. It is his Apple Watch, alerting him to an incoming message. Sometimes, it is his imagination. “I’ll glance at it, but there’s no message,” he says. “Is this a widespread thing? I thought I was just crazy.” The phenomenon has, in fact, become so common that mental-health experts have named it phantom phone syndrome: Smartphone and smartwatch users so alert to incoming messages they sometimes feel devices vibrate when they don’t. Some people detect a buzz even when the devices are put away. (Hernandez, 12/19)

Is the meaning of love truly universal? It might depend on the language you speak, a new study finds. Scientists who searched out semantic patterns in nearly 2,500 languages from all over the world found that emotion words — such as angst, grief and happiness — could have very different meanings depending on the language family they originated from. (Khan, 12/19)

As a health care professional, Dr. Erika Rangel is trained to know when things are going wrong. That alarm went off one day in her fourth year of surgical residency. Her son, just 3 months old, had developed a fever. She couldn’t be late for her operating shift, but his day care wouldn’t accept him if he was sick. So she did what desperate mothers do and got inventive: She slipped liquid Tylenol into his bottle, in the hopes of lowering his temperature, and dropped him off. (Goldberg, 12/20)

Susannah Gilbard, 61 years old, always knew she was adopted. As far as she was concerned, her life was complete and there were no missing elements in her Queens, N.Y., upbringing. “From the beginning of time everybody asked [me], ‘Don’t you want to know where you come from? And don’t you want to find out your health issues?’ and, you know, this endless list of questions, and my answer was always, ‘no.’ I’m not interested at all because, frankly, I have really good parents. I was really lucky. Everything was fine.” (Cousens, 12/19)

Kaiser Health News: A Veteran Started Vaping THC To Cope With Chronic Pain. Then He Got Very Sick. 

As vaping has grown more popular in recent years, the trend has been fueled by the habit’s pleasurable allure: Compared with smoking cigarettes or pot, vaping is discreet and less smelly. Vaping fluids come in hundreds of flavors. There’s no tar or other byproducts of burning. And vape pens are high-tech, customizable and sleek. But none of that mattered to Paul Lubell when he decided to try vaping. He wasn’t thinking about pleasure; he was trying to avoid pain. The retired Navy veteran turned to vaping marijuana, hoping it would help him cope with his chronic, debilitating musculoskeletal pain. (Harris-Taylor, 12/20)

The adults gathered in a hotel ballroom in Peoria — school employees, caregivers, health care workers — fell silent as their instructor, a muscled and tattooed mixed martial arts fighter, stared at them to demand attention. Over five days of training, the participants would learn how to physically control children who pose a danger to themselves or others. But first, Zac Barry focused on what he views as the most important lesson. (Richards, Cohen and Chavis, 12/20)

For much of this year, it seemed that nothing could stand in the way of progressive activists’ agenda in New York. Not conservative backlash, not big money’s lobbying, not even Gov. Andrew M. Cuomo’s hesitations. Then came the $6.1 billion budget gap. The looming fiscal crisis, revealed by state officials last month, is New York’s biggest since the Great Recession. And more than any of the other political forces that progressives toppled this year, it threatens to derail their momentum. (Wang, 12/20)

The state senators grilling the CEO of Pacific Gas & Electric Corp. were upset — like millions of other Californians, some spent days in the dark when the nation’s largest utility shut off power during windstorms this fall. The lawmakers demanded that the executive explain why blackouts intended to prevent downed power lines from sparking deadly wildfires caused so much trouble of their own. (12/20)

The would-be merger between Gundersen Health System and Marshfield (Wis.) Clinic Health System is a no-go. Seven months after the two Wisconsin-based systems announced they were exploring a potential merger, they announced Thursday they have decided to stay independent after all. In a joint statement, the systems said the decision came after months of "productive, collaborative discussions" about how to enhance care across Wisconsin, northeast Iowa and southeastern Minnesota. (Bannow, 12/19)

An Eastern North Carolina hospital that stopped offering labor and delivery services earlier this year will no longer offer gynecological services for lack of staff. Martin General Hospital discontinued its maternity services at the end of October and said at the time that it would continue offering gynecological services at the hospital and in its clinic, Roanoke Women’s Healthcare. But the hospital’s two obstetricians found other jobs, leaving the hospital without physicians who can offer gynecological care, hospital spokeswoman Heather Wilkerson confirmed. (Engel-Smith, 12/20)

When business groups hammered out a deal for the state’s new paid family and medical leave program, they pushed for a measure that would allow companies to find alternative coverage from the private sector. Smart move. Exemptions allowed by the new law have turned out to be popular, with nearly 3,000 employers applying for waivers by the Dec. 20 deadline to opt out, and 2,700-plus already receiving state approvals.But a division is emerging between big companies and small ones. (Chesto, 12/19)

Kaiser Health News: Loophole Averted After Surprise-Bill Brouhaha In Texas

It appears Texas will get one of the strongest laws in the nation against surprise medical bills after all. The law, which takes effect Jan. 1, wavered last month when the Texas Medical Board drafted the rules for its implementation. The board, made up of health care providers, tried to get a blanket exception to the law for virtually all nonemergency cases. (Lopez, 12/19)

Unaffordable housing is the root cause of homelessness. Cities with the highest homeless populations are those with the least amount of affordable housing. Miami ranks as the seventh least affordable housing market in the world, and is the second least affordable market in the United States. So I was astonished that the Herald would include a quote from the Miami-Dade Homeless Trust, the agency tasked with ending homelessness in our city, saying “philosophical” opposition to public restrooms, based on the belief that they “only encourage homeless people to stay on the streets rather than move to a shelter where they can receive a continuum of care, education, job training and financial support to make the transition to permanent housing.” (Peery, 12/19)

The state is facing mounting pressure to enforce parity laws that are supposed to guarantee equal care for physical and mental health issues — with a spotlight this week on mental health care problems at health giant Kaiser Permanente. This week, Kaiser mental health clinicians are on a five-day strike, protesting long patient wait times and strenuous working conditions for providers. They say children and adults with serious mental health needs, including schizophrenia, anxiety and severe depression, are often waiting 6 to 8 weeks — sometimes longer — to see a therapist. And they contend that Kaiser’s behavioral health services have in many ways worsened in recent years, despite being under a corrective plan overseen by the state Department of Managed Health Care. (Wiener, 12/18)

Renville County Hospital and Clinics is planning to merge with HealthPartners, the Bloomington-based health insurer that currently operates seven hospitals and dozens of clinics across Minnesota and western Wisconsin. RC Hospital & Clinics, as the health system is called, has headquarters in the west-central Minnesota city of Olivia, about 100 miles west of the Twin Cities. The city also is located about 40 miles north of Springfield, where Mayo Clinic announced this month that it would close a hospital next year. Allina Health System then said it would open a clinic in Springfield. (Snowbeck, 12/19)

Kaiser Health News: California Attempts To Revive Compassionate Cannabis Programs

For years, Richard Manning knew what he needed to cope with his physical pain, rage and PTSD — much of which he traced to a career-ending knee injury he suffered while on a domestic security detail with the Marines.Cannabis may not have been a cure-all, but it was the closest thing he’d ever had to one. (Kreidler, 12/20)

An increase in the number of teens and young adults diagnosed with a rare cancer in the southwest corner of Pennsylvania has caused the state to look for a link between fracking and the disease. The investigation was sparked by a spate of Ewing’s sarcoma cases in and around Washington County, which has more Marcellus Shale gas wells than any other county in the state. In April, the state Department of Health found that the cases didn’t constitute a statistically significant cancer cluster. But affected families and other residents lobbied the governor for an investigation. “We’re not pointing a finger,” said Kurt Blanock, whose teenage son died of Ewing’s sarcoma three years ago. His wife, Janice Blanock, was one of the parents who pushed for the study. (Maher, 12/20)

As the 21st century progresses, it seems clear society has gone cattywampus in an astonishing number of ways. Our elected leaders appear to be more bumbling, sinister, and narcissistic than ever before. Our waterways are choked with cup lids and chemicals. Our relationships are strained and distant. And technology is nudging us ever closer to blowing up the planet, whether literally or metaphorically. The way out of this global maelstrom, says author and podcaster Christopher Ryan, is to look closely at how our early human ancestors chose to live — and to tear down the structure of values, innovations, and social hierarchies that supports modern civilization. (Svoboda, 12/20)

As the sun begins to set on a blustery fall day, the rugged buttes of Navajoland glow red in the soft light and swift gusts spiral dust through the air. About 40 women, most draped in traditional dress, stand in a circle as Melissa Brown, an indigenous midwife, asks the group to reflect on the day just ending — and the mission still ahead. “We have talked about being safe here. That is our goal,” she tells them. “We’re going to cry, and we’re going to laugh. And that’s OK.” (Warren, 12/17)

Wayne LaPierre was sitting in a chair with his hands over his ears, looking straight down. “It was horribly painful,” he said of the nearly two years of investigations, intrigue and infighting that have roiled the National Rifle Association, which he has led since 1991. Now, a once-invincible organization, and its chief, are girding for a legal reckoning. “I mean,” LaPierre said, looking up, “it’s the most painful period of my life.” (Hakim, 12/18)

Bianca Davidson was 17 and still in foster care when she got pregnant. The baby, a boy, arrived a month-and-a-half early, and no one warned Davidson that being premature put him at risk for life-threatening illnesses and developmental delays. She hemorrhaged after delivering her second son, but the doctor simply told the nurses to “clean her up.” A family member insisted to staff that something was wrong and a second doctor ordered blood transfusions. “It was super-scary,” Davidson, 29, recalled. “Nobody talked me through … ‘Ok, you lost a lot of blood so you can’t be with your baby at the moment.’” Her third pregnancy, three years later, required an emergency caesarean section when her son’s heartbeat dropped suddenly. Davidson was afraid the next time she gave birth, either she or her baby would not survive. (Rab, 12/15)

My choices as a doctor in the emergency room are up or out. Up, for the very sick. I stabilize things that are broken, infected or infarcted, until those patients can be whisked upstairs for their definitive surgeries or stents in the hospital. Out, for everyone else. I stitch up the simple cuts, reassure those with benign viruses, prescribe Tylenol and send home. Up or out is what the E.R. was designed for. Up or out is what it’s good at. Emergency rooms are meant to have open capacity in case of a major emergency, be it a train crash, a natural disaster or a school shooting, and we are constantly clearing any beds we can in pursuit of this goal. (Siddiqui, 12/16)

Judge Carolyn Dineen King was a voice of reason on Wednesday as her fellow members of a three-judge appeals panel sustained a legal threat to the Affordable Care Act. In a 2-to-1 ruling, the United States Court of Appeals for the Fifth Circuit agreed with Judge Reed O’Connor of Federal District Court for the North District of Texas that the law’s requirement that Americans buy health insurance is unconstitutional. The majority ruling did not accept Judge O’Connor’s reasoning that the mandate’s unconstitutionality made the rest of the law void. (12/19)

The Fifth Circuit Court of Appeals decision on Wednesday holding the Affordable Care Act’s individual mandate unconstitutional does two things. First, it affirms the argument we’ve been making all along — that despite the promises and assurances all Americans received, Obamacare hurt families by taking away their insurance, taking away their doctors, limiting their choices and pricing them out of health care. And second, the decision reinforces the principle that the federal government’s powers are limited. It cannot force Americans to purchase products they don’t want and don’t need, nor can it consign their welfare to a system — whether it’s Obamacare of Medicare-for-All— that fails to meet their needs and even puts them at risk. (Robert Henneke, 12/19)

Wednesday’s ruling by the U.S. Court of Appeals for the 5th Circuit invalidating Obamacare’s individual mandate has raised the possibility that the entire bill might be struck down as a result. That’s highly unlikely to happen given legal doctrine and the Supreme Court’s makeup. Opponents should instead think about how to reform health policy rather than hope for a judicial lightning bolt to strike Obamacare down. (Henry Olsen, 12/19)

Almost exactly a year ago, a federal judge in Texas who is widely known for his anti-Affordable Care Act rulings wiped the entire health care law off the books. That’s right. Not only the quality-control measures and the requirements of coverage for pre-existing-conditions and that young adults can remain on their parents’ plans but also the Medicaid expansion, Medicare’s new drug benefits and countless other reforms. Many Americans don’t realize how many benefits they currently enjoy come from the Affordable Care Act, which has given tens of millions access to health care over the past decade. (Abbe R. Gluck, 12/19)

Health care is a major point of contention in the Democratic primary campaign. Bernie Sanders and Elizabeth Warren favor a single-payer system, while Joe Biden and Pete Buttigieg support a federal insurance program to compete with private insurers, also known as the public option. Some fans of single-payer have begun to deploy a dire-sounding argument: failing to implement Medicare for All, they claim, would be tantamount to murder. (Noah Smith, 12/19)

Unfortunately, Medicare Part A has a major gap in its coverage. As a senior citizen with Medicare Part A, I fell through that gap. I was diagnosed with prostate cancer, entered the hospital for a radical prostatectomy and spent the following two nights on a general surgical ward. Several weeks later, I was blindsided with a $25,334 bill for my hospitalization. The surgeon’s bill was an additional $4,695 that was not covered by Part A. Certain the bill was a mistake, I contacted the hospital billing department to remind them that I had Medicare Part A, and that Medicare Part A pays the cost of hospitalization. “That is correct,” the hospital representative replied. But I hadn’t been “admitted,” I was told; I had been hospitalized as an “outpatient” under “observation status.” (Andrew Taylor, 12/20)

In 2009, I checked into the surgical ward of Denver’s Rose Medical Center to have a kidney stone removed. It was a minor procedure, and I emerged from the hospital a bit groggy but otherwise seemingly unscathed. Little did I know that I was soon to be plunged into the shadowy world of drug diversion. About six weeks after the operation, I was overcome by a crush of debilitating symptoms — it felt like I had the flu on steroids. As a single parent of a 1-year-old, I was terrified it would get worse. When I went to a local urgent care center, the doctor sent me straight to Rose’s emergency department. Blood tests showed I had hepatitis C — a life-threatening condition that can lead to cirrhosis or liver cancer. (Lauren Lollini, 12/20)

Scholars at the nonpartisan Rand Corp. last year published the findings of a two-year study that assessed available scientific evidence on the real effects of gun laws and policies. One of their biggest takeaways was that there was no good evidence on key questions of gun safety and violence. Why not? Because many issues have gone unstudied as the result of congressional appropriations language that chilled U.S. government investments in gun research. Now this ridiculous situation is about to change. (12/19)

This year’s Clinical Trials on Alzheimer’s Disease meeting began in mid-December with a bang and ended a few days later with hallway conversations laced with worry. The topic, in both cases, was aducanumab, an experimental drug for treating people with Alzheimer’s disease. The meeting got off to celebratory start as a top Biogen scientist presented results showing that the highest dose of aducanumab may benefit people with mild cognitive impairment (MCI) and elevated amounts of a protein called amyloid in the brain. That presentation represented an about-face for the company, which had pulled the plug on two trials of the drug in March. (Jason Karlawish, 12/20)

Health coverage is foundational to good health, and in Kentucky no single insurer is as foundational as Medicaid. In a very real way, Medicaid is for all of us. From childhood, through our working years, to senior care, Medicaid covers all Kentuckians in all stages of life. For that reason, we have a lot to celebrate now that a proposed battery of barriers to Medicaid coverage has finally been rejected thanks to Gov. Andy Beshear. These barriers would have led to at least 100,000 Kentuckians losing their health coverage and finding themselves one accident or bout of sickness away from financial ruin or a health catastrophe. (Dustin Pugel, 12/19)