�Թϲ�����

The Trump administration most likely separated thousands more children from their parents at the Southern border than was previously believed, according to a report by government inspectors released on Thursday. The federal government has reported that nearly 3,000 children were forcibly separated from their parents under last year’s “zero tolerance” immigration policy, under which nearly all adults entering the country illegally were prosecuted, and any children accompanying them were put into shelters or foster care. (Jordan, 1/17)

Ann Maxwell, assistant inspector general for evaluations, said the number of children removed from their parents was certainly larger than the 2,737 listed by the government in court documents. Those documents chronicled separations that took place as parents were criminally prosecuted for illegally entering the country under President Donald Trump's "zero tolerance" policy. "It's certainly more," Maxwell said. "But precisely how much more is unknown." Maxwell said investigators didn't have specific numbers, but that Health and Human Services staff had estimated the tally to be in the thousands. (Long and Alonso-Zaldivar, 1/17)

The administration of President Donald Trump implemented a 'zero tolerance' policy to criminally prosecute and jail all illegal border crossers even those traveling with their children, leading to a wave of separations last year. The policy sparked outrage when it became public, and the backlash led Trump to sign an executive order reversing course on June 20, 2018. But the auditor said in a report that prior to the officially announced 'zero tolerance' policy, the government began ramping up separations in 2017 for other reasons related to a child's safety and well-being, including separating parents with criminal records or lack of proper documents. (Rosenberg, 1/17)

Although previous administrations also separated minors at the border in some instances — usually when they suspected the child was smuggled, or if the parent appeared unfit — the report said the practice appears far more common under Trump and began nearly a year before administration officials publicly acknowledged it. (Goldstein, 1/17)

The first separations began in 2017 and were seen as a trial balloon for the “zero-tolerance” policy announced by then-Attorney General Jeff Sessions in May 2018, an HHS official not involved in conducting the audit told POLITICO. A federal investigator declined to say whether senior Trump administration officials were told about those early separations, but suggested that could be addressed in the upcoming reports. "We did not, in this report, address who knew what, when," said Assistant Inspector General Ann Maxwell on the press call. The inspector general report said some family separations continued, even after President Donald Trump in June 2018 ended the policy amid uproar and a federal court ordered his administration to reunify the families. The June 2018 court order called on the administration to reunify about 2,500 separated children in government custody. Most of those families were reunited within 30 days. (Diamond, 1/17)

The audit noted that DHS sometimes separates children from parents for the child's safety or well-being, such as when parents are found to pose a danger or can't care for the child because of illness or injury. These children are held in government custody along with migrant children who arrive without parents. (Phillip, 1/17)

HHS has since reunited or otherwise released most of those children, but there are thousands more who were separated before that point. The total number is unknown, and officials also don’t know how how many of those children have been reunited. The efforts to reunite separated children were impeded by the department's lack of a centralized database to track children. (Weixel, 1/17)

The Food and Drug Administration plans to furlough more people and suspend lower-priority tasks to preserve money for drug reviews, including for new treatments for depression, diabetes and several types of cancer. With money for drug reviews rapidly diminishing as the government shutdown drags into its fourth week, FDA Commissioner Scott Gottlieb said in an interview Thursday that he plans to curtail “discretionary activities” and call for additional furloughs in areas in which workloads have been reduced due to the shutdown. (McGinley, 1/17)

A furloughed federal worker who is diabetic said she resorted to rationing her insulin medication because "the thought of having more debt was scarier than the thought of dying" in her sleep. "I thought, no end in sight for the shutdown. I can't afford an ambulance bill. I can't afford to go to the emergency room right now, because I know there's more bills coming our way," Mallory Lorge explained on CNN's "Anderson Cooper 360." (Barrett, 1/17)

Servings of fresh fruits and vegetables are disappearing from school lunch trays in rural Vance County, N.C. The Prairie Hills school district in Kansas is worried about not being able to feed kids at all. On top of that, there are thousands of new kids nationwide eligible for free or low-cost school meals because their parents have been furloughed by the federal government. (Hefling and Quilantan, 1/17)

Three schools on the Wind River Reservation are offering free lunches to people affected by the government shutdown. Owen Saint Claire, the superintendent of Fremont County School District 14, said more than a thousand people on the Wind River reservation are not getting their paycheck right now. (Edwards, 1/17)

The long tentacles of the partial federal government shutdown are reaching especially deep into food and agriculture. Here’s an update on some of the impacts in the fourth week of the longest shutdown in history. (Mayer, 1/17)

Kaiser Health News: Pain From The Government Shutdown Spreads. This Time It’s Food Stamps 

Antoinette Martinez was relieved when she heard she would receive her food stamps for February about two weeks early. Her cabinet was nearly empty after the holidays, and now she could stock up on groceries to feed her family. But Martinez also feared she wouldn’t be able to make the funds last. “I know I’m gonna spend them and I’m gonna be struggling next month,” 31-year-old Martinez said late Wednesday as she loaded her car with bags from a Food 4 Less market in Los Angeles. (Gorman, 1/18)

Kaiser Health News: Furloughed Feds’ Health Coverage Intact, But Shutdown Still Complicates Things

Joseph Daskalakis’ son was born New Year’s Eve, a little over a week into the current government shutdown, and about 10 weeks before he was expected. Little Oliver ended up in a specialized neonatal intensive care unit, the only one that could care for him near their home in Lakeville, Minn.But air traffic controller Daskalakis, 33, has an additional worry: The hospital where the newborn is being treated is not part of his current insurer’s network and the partial government shutdown prevents him from filing the paperwork necessary to switch insurers, as he would otherwise be allowed to do. He could be on the hook for a hefty bill — while not receiving pay. Daskalakis is just one example of federal employees for whom being unable to make changes to their health plans really matters. (Appleby, 1/18)

The Trump administration on Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue. The roughly 1 percent increase could feed into the Democratic argument that the Trump administration is trying to "sabotage" coverage for millions. The administration said the proposal is intended to improve the accuracy of a complex formula that affects what consumers pay for their premiums. (Alonso-Zaldivar, 1/17)

The proposal, released by the Centers for Medicare and Medicaid Services, would raise the out-of-pocket maximum that people with employer-sponsored coverage pay in 2020. The individual maximum would increase by $200 to $8,200 annually, and the maximum for family coverage would increase by $400, analysts said. The plan would also change a calculation that determines how much people pay if they buy insurance from the ACA exchange and get credits to reduce their monthly premiums. The change could raise premiums next year for many of the roughly 9 million people who get the credit. (Armour, 1/17)

The CMS also noted that the Trump administration supports a legislative solution that would appropriate funding for cost-sharing reduction payments, which the administration ended in 2017. It also supports ending the practice of "silver-loading." The agency asked stakeholders to comment on ways the federal government might address silver-loading in future rules no sooner than 2021. Silver-loading refers to when health insurers loaded premium increases into the popular silver-level exchange plans to make up for the loss of CSR payments. Loading premium surcharges onto silver plans boosted the size of the premium tax credits available to people with incomes below 400% of the federal poverty level. (Livingston, 1/17)

The Trump administration has taken steps to undermine the Affordable Care Act since Republicans in Congress failed to repeal it. (Armour, 1/17)

Members of the security detail tasked with protecting senior leaders at the Department of Veterans Affairs followed questionable procedures that put officials' safety at risk, abused rules governing overtime pay, and acted as chauffeur for former Secretary David Shulkin’s wife, according to a new investigation. The alleged failures, documented by VA Inspector General Michael Missal in a report released Thursday, detail missteps that went on for years and came to a head under Shulkin. The investigation was commissioned after “various complaints” alleged broadly that VA’s protection division was being grossly mismanaged, the report says. (Mettler and Rein, 1/17)

The report concluded Shulkin "violated ethical regulations by permitting his VA employee driver to use a personal vehicle and personal time to provide transportation services to the Secretary's wife." The inspector general cleared Shulkin of allegations he had abused his authority by having agents protect him when not on government business, because he relied on advice from department staffers and "no one raised any concern that his use was inappropriate." (Wallace, 1/17)

Using government vehicles for unofficial purposes was prohibited in this case, and the personal transportation services would have qualified as a gift, the inspector general concluded. Federal ethics rules bar employees from accepting gifts from subordinate staff. “Secretary Shulkin was aware that these services, which benefited him at least indirectly, were being offered to his wife,” the inspector general’s report said. “Accordingly, he had an ethical obligation to decline the gift.” (Slack, 1/17)

Senate Republicans on Thursday failed to muster the 60 votes needed to approve a permanent ban on federal funding of abortion, a largely symbolic effort timed to coincide with the country’s largest annual anti-abortion demonstration in Washington this week. The Senate vote was the first on an anti-abortion measure since Republicans narrowly expanded their majority in the chamber in the 2018 midterms, and it marked a sharp contrast with House Democrats' plans to loosen restrictions on taxpayer support for the procedure. (Ollstein, 1/17)

Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) broke with their party to vote against the measure while Democratic Sens. Bob Casey (Pa.) and Joe Manchin (W.V.) voted with Republicans. Democrats criticized McConnell for holding a vote on the bill instead of voting on House-passed measures to end the government shutdown. "We know that a bill opening the government would pass the Senate, yet we're voting on a bill attacking women's health," tweeted Sen. Patty Murray (D-Wash.). (Hellmann, 1/17)

The legislation (S 109), introduced by Sen. Roger Wicker, R-Miss., would permanently prohibit federal funding for abortion, with exceptions for rape, incest and to protect the woman’s life. It is similar to the so-called Hyde amendment, an annual appropriations rider that bans federal funding of abortion, but Wicker's bill would not have to be renewed and is broader in scope. Unlike the Hyde amendment, the bill also would bar funding for health benefits that cover abortion that are authorized or appropriated under federal law, would ban abortion from being subsidized and would mandate that tax credits under the 2010 health care law (PL 111-148, PL 111-152) not be used to pay for plans that cover abortion. It also would ban abortion in all federal health facilities. (Raman, 1/17)

Thousands of abortion opponents will take to the streets on Friday for the nation’s largest annual anti-abortion rally, coinciding with a flood of anti-abortion action from government officials that underscore the movement’s priorities for 2019. The March for Life is held every January to protest the anniversary of Roe vs. Wade, the 1973 landmark Supreme Court case that guaranteed a woman’s right to an abortion nationwide. (Raman, 1/17)

The country's largest annual march against abortion comes to Washington on Friday, and this year there’s a new sense of urgency and frustration from a voting bloc that helped put President Trump in the White House. With virtually no chance of moving abortion restrictions through a divided Congress, anti-abortion activists are re-applying pressure on the Trump administration to take executive action ahead of the 2020 elections. (Hellmann, 1/18)

A new bill in the Massachusetts Legislature could make it easier for minors to get an abortion. The bill, An Act to Remove Obstacles and Expand Abortion Access, known as the ROE Act, does many things, but front and center is a provision to eliminate the need for parental consent. (Wasser, 1/17)

A nonprofit group that had been denied a state license to open a South Bend abortion clinic reapplied for one Thursday instead of challenging the decision in court. Texas-based Whole Woman's Health Alliance reapplied for the license Thursday, avoiding what it feared would be a lengthy legal battle, the South Bend Tribune reported. (1/17)

A federal appeals court panel on Thursday lifted a lower-court ban that prohibited Texas from eliminating Planned Parenthood from the state's Medicaid program. The 5th U.S. Circuit Court of Appeals in New Orleans issued the ruling that removes the preliminary injunction U.S. District Judge Sam Sparks of Austin imposed on the state of Texas in February 2017. (1/17)

U.S. District Court Judge Sam Sparks wrote in that ruling that the state had acted "without cause" in terminating the reproductive health care organization from the program that provides health care to low-income Americans. But a three-judge panel of the 5th U.S. Circuit Court of Appeals said that Sparks did not use the correct standard in making his decision. The case now returns to Sparks for further consideration. (Steele, 1/17)

The case stems from a long-running flap over a misleading video released in late 2015 by the anti-abortion group Center for Medical Progress, which suggested that abortion providers at Planned Parenthood sold fetal tissue for profit. The sting video included edited clips of Planned Parenthood officials discussing the use of fetal tissue for research. A string of investigations that followed the video’s release were unable to confirm its claims, but it energized a crusade against the health care provider and sparked outrage from the state’s Republican leadership. (Platoff, 1/17)

Financial challenges, government mandates, patient safety and quality and personnel shortages topped hospital executives' concerns in 2018, according to an annual survey from the American College of Healthcare Executives. The top four spots have stayed the same since at least 2015. This year's respondents were directed to rank 11 challenges in order of how pressing they are. A new category, behavioral health and addiction issues, ranked fourth on the list. Within that category, 82% of respondents cited access to counseling as an area of concern, according to ACHE CEO Deborah Bowen. (Bannow, 1/17)

The Medicare Payment Advisory Commission on Thursday recommended that Congress pass legislation to consolidate most of Medicare's value-based quality programs and boost payments for high-performing hospitals. The panel voted unanimously to recommend Congress place the hospital quality initiatives into one program called the Hospital Value Incentive Program (HVIP), which would link Medicare payments to the quality of care hospitals provide. The new incentive program would consolidate the existing programs to dispel confusion and overlapping requirements. (King, 1/17)

In 2009, Massachusetts became the first and only state to ban ambulance diversions. Since then, other areas have moved to eliminate the practice, but ambulance diversion still occurs in most of the nation’s largest cities, a review by the Milwaukee Journal Sentinel found. Two-thirds of the largest 25 cities allow diversion or practices similar to it, including nine of the top 10. (Diedrich, 1/17)

The Sackler name is emblazoned on the walls at some of the world's great museums and universities, including the Smithsonian, the Guggenheim and Harvard. But now the family's ties to OxyContin and the painkiller's role in the deadly opioid crisis are bringing the Sacklers a new and unwanted kind of attention and complicating their philanthropic legacy. The Sackler family owns Purdue Pharma, the privately held drug company that has made billions from OxyContin, and Sacklers hold most of the seats on the board. (Richer, 1/17)

Health officials are looking into a possible link between prescription opioids and a horrific birth defect. When a baby is born with its intestines hanging outside the stomach, due to a hole in the abdominal wall, it's called gastroschisis. Most are repaired through surgery. Roughly 1,800 such cases are seen in the U.S. each year, but the number has been rising and officials don't know why. (Stobbe, 1/17)

Nearly a century after the film “Reefer Madness” alarmed the nation, some policymakers and doctors are again becoming concerned about the dangers of marijuana, although the reefers are long gone. Experts now distinguish between the “new cannabis” — legal, highly potent, available in tabs, edibles and vapes — and the old version, a far milder weed passed around in joints. Levels of T.H.C., the chemical that produces marijuana’s high, have been rising for at least three decades, and it’s now possible in some states to buy vape cartridges containing little but the active ingredient. (Carey, 1/17)

In the welter of daily demands upon physicians, it might be easy to imagine that weaning the world off its reliance on fossil fuels is asking a bit too much. But preventing sickness and averting premature death are squarely in a physician’s wheelhouse. And dramatic increases in both are projected for the foreseeable future as the world’s continued reliance on fossil fuels results in more air pollution, infectious diseases, malnutrition, wildfires, extreme heat and increasingly powerful weather events. (Healy, 1/17)

Pain is a complicated experience. Our skin and muscles sense it, just like they sense softness or warmth. But unlike other sensations, the experience of pain is distinctly unpleasant. Pain has to hurt for us to pay attention to it, and avoid hurting ourselves further. But for people in chronic pain, the pain has largely lost its purpose. It just hurts. While it has long been understood how nerves signal pain to the brain, scientists haven't known how the brain adds a layer of unpleasantness. (Lambert, 1/17)

Millions of Americans have taken genetic tests to help them learn more about who they are or how sick they could become. In a crowded field of firms selling DNA tests — 10 new products enter the market each day by one estimate — many of the companies are racing to sort out their own identities. Color Genomics Chief Executive Officer Otham Laraki, a former product manager at Google, likens genetic testing today to the early days of smartphones. When location data came on the scene, he said, everyone thought check-in apps like Foursquare would be a hit. But the killer app turned out to be a completely different use of GPS data: Uber. (Brown, 1/18)

[One] game maker, Akili Interactive Labs of Boston, hopes its video game will become the first one approved by the Food and Drug Administration, and then prescribed for kids with ADHD. Akili sees the video game as the delivery system for targeted algorithms that act as a medical device to activate certain neural networks.A little over a year ago, Akili reported results from its study of 348 preteens diagnosed with ADHD. Some of the kids were assigned to play Akili’s game on a tablet over four weeks. Other kids were given a different action-packed video game designed as a placebo. The kids who played Akili’s game saw statistically significant improvements on metrics of attention and inhibitory control, compared to the control group. (Robbins, Garde and Feuerstein, 1/18)

When his chemotherapy patients leave the hospital to continue treatment at home, Edward Greeno faces a new challenge. He can no longer ensure they’re taking their medicine. Greeno, the medical director of the Masonic Cancer Clinic at the University of Minnesota, has come to realize that some patients, like children hiding naughty behavior from a parent, will fudge the truth to avoid his disapproval, even when their health is at risk. (Holley, 1/17)

The Department of Homeland Security wants more lay people trained to control life-threatening blood loss. They're spreading the word through a national awareness campaign and a course called Stop the Bleed. (Watson, 1/17)

Rates of youth suicide are higher in states with high gun ownership, according to a new study published in the American Journal of Preventive Medicine. Researchers studied 10 years of teenage suicide rates and found that gun ownership "is a factor that really is highly predictive for what the youth suicide rate is going to be," said Dr. Michael Siegel, a professor at the Boston University School of Public Health and one of the paper's authors. (Bandlamudi, 1/14)

The discovery of alleged sexual abuse of a teenage patient 15 years ago has prompted the Minnesota Board of Psychology to revoke the license of a Minneapolis psychologist — even though he has since retired and his license has expired. The board order, issued last month, prohibits Herman Thompson, 70, from practicing psychology in the state. Records show he was accused of multiple sexual incidents from 2003 through 2005 with a male teenage patient who had suffered a childhood of parental abuse, behavioral problems and multiple foster care placements. (Olson, 1/17)

State senators passed a bill Thursday to bar the death penalty for the seriously mentally ill. The same bill was tabled last year to be studied by the Virginia State Crime Commission. But the commission didn’t address it, and the legislation sponsored by Sen. Barbara Favola, D-Arlington, now heads to the House of Delegates after passing the Senate 23-17. (Wilson, 1/17)

St. Anthony Regional Hospital's leaders couldn't bring themselves to do what eight other rural Iowa hospitals have done in recent years: Shutter their psychiatric unit. The Carroll hospital's board nearly pulled the plug several years ago. The inpatient mental-health program was losing money, and it struggled to keep psychiatrists and other professionals on staff. (Leys, 1/17)

The campus is a joint project with the Texas State Health and Human Services Commission (HHSC) and The University of Texas Health Science Center at Houston (UTHealth). It is being funded by $125 million from the state that the 2017 Legislative Budget Board approved and sent to Gov. Gregg Abbott with the goal of improving mental health care statewide. Stephen Glazier, the chief operating officer of the UTHealth Harris County Psychiatric Center and future COO of the new campus, explained that the name for the hospital comes from the continuing care that UTHealth and HHSC aim to provide once it opens, giving their patients better health. (Maness, 1/17)

It looks as though Gov. Brian Kemp will indeed pursue a Medicaid “waiver’’ proposal to expand health coverage in Georgia. Kemp, in his State of the State speech Thursday — three days after he was sworn in as Georgia’s new chief executive — said he will seek “to expand access [to care] without expanding a broken system.’’ (Miller, 1/17)

The 44-year-old excavator was taken to the emergency room with shortness of breath. Breathing trouble also sent a 64-year-old woman to the same hospital. A third patient, a 79-year-old woman with health problems, was transferred from an assisted care facility. Now their relatives allege each died because employees at a hospital in Ohio either negligently or intentionally gave them inappropriately large doses of powerful pain medicine. (Franko, 1/17)

Abrazo, a network of five hospitals in the Valley, already runs a family medicine residency program at the Abrazo Central Campus in Phoenix. The new programs will be based at the Abrazo Arrowhead Campus in Glendale, but residents will rotate among several campuses. (Fiflield, 1/17)

Surrounded by friends, family, supporters and lawmakers, Gov. Bill Haslam outlined his vision for the state on Jan. 15, 2011. Standing on a stage across the street from the state Capitol, the Knoxville Republican touted the need to improve Tennessee’s standing in education and personal health while vowing to have state government operate within its means. And he promised to listen. (Ebert and Allison, 1/18)

In Florida, changing climate and a lack of good diagnostic tools, make it easier for insect-borne diseases like Eastern Equine Encephalitis to spread. The personal and financial costs of even one case of this disease can be catastrophic. (Prieur, 1/17)

In her first budget as governor, Democrat Laura Kelly aims to inject cash into what she calls critical state services. The proposal unveiled Thursday also would start to wean the state off money diverted for years from highway construction and upkeep. But the bill met a predictably harsh reception from some Republicans. They argued the spending plan would lead to budget deficits. (Koranda, 1/17)

While the state's Republican leaders appear in sync on issues like school finance and property taxes, they clearly see things differently when it comes to at least one thing: prison health care. In the budget proposals the Texas House and Senate released this week, the amount of money allocated to the Texas Department of Criminal Justice to care for sick inmates varies drastically. (McCullough, 1/18)

A new law in California allows home cooks to prepare and sell meals out of their personal digs as of January 1. But would-be household hash slingers shouldn't grab their aprons and chef hats just yet. The law — the first of its kind in the country — has a major caveat: counties have to opt in, and so far, none have. (Romero, 1/17)

New Hampshire’s first transgender state representatives, Democrats Lisa Bunker of Exeter and Gerri Cannon of Somersworth, were in Representative’s Hall on Thursday, but not for a House session. They were there to support House Bill 446, which would make it easier for transgender people to get a new birth certificate without having to obtain a court order. The bill states, “If an individual requests a birth certificate reflecting a sex other than that which was assigned at birth, a new birth record shall be prepared to reflect a change in the individual’s sex upon receipt of a certification affirming the individual’s gender identity by a licensed and qualified health care provider.” (Solomon, 1/17)

A state district judge Thursday ordered the Texas Health and Human Services Commission to accept reimbursement requests from in-home monitoring service providers after the agency had denied the requests since the beginning of the year. Court documents filed on behalf of four home health agencies allege that the estimated 300 home health agencies in Texas were on the brink of collapse because they had to foot the bill for work typically reimbursed under Texas Medicaid. (Downey, 1/17)

Reports of flu cases are coming into Minnesota's health department from all corners of the state. In its weekly update on flu activity released Thursday, the state Department of Health announced that influenza activity is now considered widespread. (Enger, 1/17)

Microsoft’s promise to pony up $500 million for Seattle-area housing has Silicon Valley buzzing, full of hope that tech titans here will pour similar sums into the housing shortage in their own back yards. The Redmond-based software giant will dole that money out as loans for low and middle-income housing, and as grants to fight homelessness, the company’s answer to its hometown’s rising prices and jobs-housing imbalance. (Kendall, 1/17)

Seton Healthcare Family broke ground Wednesday on a health center in Elgin that officials say will address the unmet health care needs of the growing community. The $2.5 million clinic, which will be licensed as a rural health clinic, will offer primary and after-hours urgent care, a laboratory, X-ray services, nine examination rooms and access to Seton’s telemedicine network. (Mulder, 1/17)

Efforts to end homelessness could get a major boost this year in New Hampshire. Cathy Kuhn, the director of the New Hampshire Coalition to End Homelessness, says there is bipartisan support for a proposed $20 million investment over two years into the state’s affordable housing fund. (Tuohy, 1/17)

As the Trump administration considers weakening Obama-era safeguards for the disposal of toxic coal waste, a new report shows that groundwater near all of Texas’ 16 monitored coal-fired power plants is contaminated with pollutants — including known carcinogens — linked to so-called coal ash. The report by the Washington D.C.-based Environmental Integrity Project, released Thursday, analyzed on-site groundwater monitoring data that power companies are now required to report to the U.S. Environmental Protection Agency under an Obama-era regulation known as the “Coal Ash Rule.” (Collier, 1/17)

Jackson, a former six-year councilor who ran unsuccessfully for mayor of Boston in 2017, is the chief executive of cannabis firm Verdant Medical, which is seeking approval to open a hybrid medical dispensary-recreational pot shop on Blue Hill Avenue in Mattapan Square. The facility would be built in a storefront currently occupied by a check-cashing business and a laundromat. (Adams, 1/18)

Gov. Ron DeSantis announced Thursday that he has asked the Legislature to change the law to allow smoking medical marijuana. If it doesn’t by mid March, he’ll drop the state’s appeal of a court decision that says banning it violates a constitutional amendment. (Gross, 1/17)

Imagine, for a minute, that you are a cardiologist working in the emergency department of a busy hospital. You have several patients with chest pain: some of them are having heart attacks, or are about to; others have heartburn or muscle strains. It would be great to have a diagnostic tool that quickly and accurately tells one from the other. Physicians outside the U.S. could already have access to this type of diagnostic test. But in the U.S. it’s still pending clearance by the Food and Drug Administration. FDA-required processes for a new commercial test to gain approval for marketing and use can be costly and take years, depending on how complicated a test is. (Rina Wolf, 1/18)

The recent clampdown has had harmful consequences. Some patients told researchers that they were forced to quit working or go on disability when their medication was denied. Others are now homebound. Many mentioned the possibility of suicide.Patients also said that they were turning to alcohol or illegal substances to treat their pain.What began as an effort to protect patients may be morphing into one that is harming them. (Kate M. Nicholson, 1/18)

Most Americans perceive climate change as a distant problem that will not affect them personally. Others simply feel powerless. As trusted sources of health information, physicians can educate our colleagues, patients, and students about the health effects of climate change and the need for rapid reductions in fossil fuel use. We can help motivate people to act by clarifying the links between environmental degradation and tangible problems, such as air pollution, insectborne diseases, and heatstroke. We can also emphasize the health benefits that will accrue as we move to alternative sources of energy. (Caren G. Solomon and Regina C. LaRocque, 1/17)

Medicare Part D was critically important to ensuring access to life-saving medications for people living with HIV and helped put us on track to end the epidemic. It created a protected class of drugs that ensured enrollees living with serious, chronic and in the case of HIV — infectious health conditions can directly access the best treatments as prescribed to them by their medical providers. These protections have helped millions and contributed to the significant reductions in new HIV diagnoses we’ve seen across the country. In November, the Trump administration proposed eliminating this protected class status for approximately 45 million people receiving drug coverage through Medicare Part D, including over 250,000 people living with HIV. (Jesse Milan, 1/17)

“Cuba’s example is important since for decades ‘health care for all’ has been more than a slogan there,” said Dr. Paul Farmer, the legendary globe-trotting founder of Partners in Health. “Cuban families aren’t ruined financially by catastrophic illness or injury, as happens so often elsewhere in the neighborhood.” (Nicholas Kristof, 1/18)

High charges for out-of-network care are demonstrably unfair when health plans have inadequate networks and when patients are treated by providers they don’t choose. An integrated approach for addressing both circumstances could involve streamlined dispute resolution. (Mark A. Hall, Loren Adler, Paul B. Ginsburg, and Erin Trish, 1/17)

Ten states and the District of Columbia have legalized recreational marijuana use, and another eight look likely to do so in 2019. I favor the move but am troubled by the gateway to it: All these jurisdictions first passed laws permitting the use of “medical” marijuana. We should set the record straight, lest young people (and old ones) think marijuana is good for you because it is wrongly labeled a medication. (Peter B. Bach, 1/17)

In the right light, my 15-year-old son is on the fuzzy cusp of a glorious mustache. The spacing is natural, the length manageable and the hue a perfect complement to the golden bangs sweeping across his forehead. It is as thick as shadows allow. He has no plans to shave it. However, chance seems to find him sitting on the countertop every time I get the itch to run sharp, hot metal along my steam-soaked cheeks. Conversations tend to fall easier there, first with the grain and then against it. The topics are ever changing, from school to movies, politics and charity, serious and funny, with an occasional dip into the awkward unknown. The faucet is fairly intermittent. (Whit Honea, 1/17)

California’s new governor, Gavin Newsom, wants it understood that he’s not declaring war on Big Pharma, all appearances to the contrary notwithstanding. Yes, he wants to give Medi-Cal more power to negotiate drug prices and, yes, he wants to make those prices significantly lower. But Newsom was surprisingly candid when we spoke Wednesday about his healthcare agenda. (David Lazarus, 1/17)

A state surgeon general could be more than another figurehead in the morass of state government, using the position to push for a system that promotes health instead of managing sickness. California is a unique state, with the world’s fifth largest economy and a larger population than Canada. (Robert Ross, 1/18)

Kansas Gov. Laura Kelly on Wednesday devoted as much attention to Medicaid expansion as any other issue. “I’ve made no secret that expanding this program is one of my top priorities,” she said in her first State of the State address. But no issue, including school funding, will prove to be as big a test for the new governor as this one. Conservative leaders in both the Kansas House and Senate have stacked committees that deal with this issue with anti-expansion lawmakers. (1/16)

By showing an openness to changing his mind, Mayor Marty Walsh of Boston is sending the message that he is serious about fighting the opioid crisis ravaging the city. Walsh had been a staunch opponent of safe injection sites, one of the most controversial tools to address the epidemic. ...It appears now that the policy intrigues Walsh enough that he is touring a few city-run safe injection sites in Toronto on Thursday and Montreal on Friday. “I went from a hard no on safe injection sites to, am I in the right place on that?” Walsh said last week. “We have to look at it all.” (1/17)