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With 227 Republican votes, the House passed the most sweeping tax overhaul in three decades on Thursday, taking a significant leap forward as lawmakers seek to enact $1.5 trillion in tax cuts for businesses and individuals and deliver the first major legislative achievement of President Trump’s tenure. (Kaplan and Rappeport, 11/16)

Senator Susan Collins is back in the spotlight as a crucial swing vote in the U.S. Senate as she raises questions about how combining a Republican tax-cut plan with a partial repeal of Obamacare will affect middle-class Americans. ... She told reporters in the Capitol on Wednesday that her staff's research showed pairing tax cuts with an effective repeal of the individual mandate of Obamacare, formally known as the Affordable Care Act (ACA), could be a mistake. (11/16)

Senate Republicans remain generally unified behind repealing the penalty for individuals who don't maintain health insurance, but some worry the provision could endanger their ability to pass a tax code overhaul. Sen. Ron Johnson of Wisconsin is the first Republican to oppose the tax plan in its current form over issues relating to tax breaks for small businesses. Two more no votes would sink the measure if it doesn't get Democratic votes. (Clason, 11/16)

Repealing Obamacare's individual mandate might not be the devastating blow to health insurance markets that supporters of the law fear. Because the tax penalty for not having insurance is far less costly than what many Americans would have to pay for coverage, many have chosen to take the fine. (Haberkorn and Demko, 11/16)

On Nov. 14, Senate Republicans tacked a repeal of the Affordable Care Act’s individual mandate onto their tax bill. The mandate, which polls indicate is one of the most disliked aspects of Obamacare, requires Americans to pay a fine if they are uninsured for all or a portion of the year. During a news conference with Senate leaders, Sen. John Cornyn criticized the mandate, calling it a “tax on poor Americans” because “about half” make $25,000 or less. (Lewis, 11/17)

As congressional Republicans move forward with their tax legislation, there are growing concerns that the costs, which are projected to increase the deficit by $1.5 trillion over the next decade, will force a host of big cuts in government programs, including Medicare. The Medicare cuts alone are projected to hit $25 billion next year, according to the nonpartisan Congressional Budget Office, and would increase steadily by 2026. (Levey, 11/16)

Pope Francis on Thursday urged lawmakers to ensure that health care laws protect the "common good," decrying the fact that in many places only the privileged can afford sophisticated medical treatments. The comments came as U.S. lawmakers in Washington, D.C., have been debating how to overhaul the nation's health insurance laws. (D'Emilio, 11/16)

Republicans have added a tax credit to a modified version of the Senate tax bill, which aims to incentivize businesses to offer paid family and medical leave. Senate Finance Committee Chairman Orrin Hatch (R-Utah) included in his “modified mark” a proposal from Sen. Deb Fischer (R-Neb.) to give businesses offering full-time employees at least two weeks of paid family and medical leave each year a general business credit equal to 12.5 percent of the amount of wages they pay an employee if the employee is getting at least 50 percent of their normal wages. (Wheeler, 11/16)

Consumers here at first did not believe the health insurance premiums they saw when they went shopping for coverage this month on HealthCare.gov. Only five plans were available, and for a family of four with parents in their mid-30s, the cheapest plan went typically for more than $2,400 a month, nearly $30,000 a year. With the deadline for a decision less than a month away, consumers are desperately weighing their options, dismayed at the choices they have under the Affordable Care Act and convinced that political forces in Washington are toying with their health and well-being. (Pear, 11/16)

Monthly health-care insurance premiums increased all over America this year, but nowhere as dramatically as in Charlottesville, an analysis shows. Residents of the small college city and the surrounding Albemarle County who wish to purchase individual insurance from the federal marketplace will be paying for the most expensive plans in the country, a Kaiser Family Foundation review confirmed. (Itkowitz, 11/16)

The number of new customers signing up for health insurance through the Covered California exchange jumped 23 percent during the first two weeks of open enrollment compared with the same period last year, state officials said Thursday. (Ho, 11/16)

Americans will largely blame the Trump administration if fewer people sign up for health insurance this year, according to a new poll. The Kaiser Family Foundation poll found that over 60 percent of respondents believe the Trump administration and congressional Republicans are responsible for any and all future problems with ObamaCare. (Weixel, 11/17)

Kaiser Health News: About A Third Of Americans Unaware Of Obamacare Open Enrollment

While the Affordable Care Act’s fifth open enrollment season is off to a surprisingly good start, many uninsured people said they weren’t even aware of it, according to a survey released Friday. Nearly a third of people overall — including a third of people without health insurance — said they had not heard anything about the sign-up period for individuals who buy health plans on their own, according to the survey by the Kaiser Family Foundation (KFF). (Galewitz, 11/17)

The next head of the Department of Health and Human Services will be handed an agency facing criticism from state officials and internal strife. HHS, which employs about 80,000 people, oversees Medicaid, Medicare, the Affordable Care Act, and such agencies as the Centers for Disease Control and Prevention. It has been caught up in the fallout over the Republicans’ failure to repeal the law legislatively and an ethics scandal over government-funded travel that led to the resignation of Secretary Tom Price in September. (Armour, Radnofsky and Wilde Mathews, 11/17)

The Senate Health Committee will hold a hearing Nov. 29 on the nomination of Alex Azar by President Trump to lead the Department of Health and Human Services (HHS). On Monday, Trump tapped Azar to take over the post Tom Price vacated, after details were revealed about how he took repeated trips on government and private jets costing more than $1 million to taxpayers. (Roubein, 11/16)

The federal government’s management of three Indian hospitals that treat thousands of patients is crumbling, a failure that could jeopardize care on some of the nation’s poorest and most remote reservations. All three hospitals are run by the federal Indian Health Service, which was created to fulfill U.S. legal obligations to provide health care to members of Indian tribes. (Weaver and Frosch, 11/16)

The Food and Drug Administration on Thursday issued new guidelines to speed the introduction of treatments involving human cells and tissues, including gene therapy. But the agency also said it would crack down on rogue clinics offering dangerous or unproven versions of those treatments. The therapies aimed at diseases like leukemia are known as regenerative medicine and have quickly grown into a booming industry worldwide. (Kaplan and Grady, 11/16)

The Food and Drug Administration on Thursday unveiled a series of guidelines that aim to encourage the development of promising and legitimate stem cell therapies while distinguishing them from the largely untested stem cell treatments hawked by unregulated clinics around the country. The FDA’s guidelines have been expected and eagerly awaited by the stem cell community given the rapid proliferation of untested — and potentially unsafe — therapies around the country. Clinics promoting these therapies claim to be able to treat ailments from autism to neurodegenerative disorders to erectile dysfunction. (Joseph, 11/16)

The carefully worded guidelines underscore the narrow path regulators walk between allowing, and even hastening, approval of potentially life-changing cellular therapies and preventing providers from selling unproven and possibly dangerous cell products directly to patients. “The promise of this technology is why the FDA is so committed to encouraging and supporting innovation in this field,” agency Commissioner Scott Gottlieb said in a statement released with the guidelines. “But the rapid growth and promise of this field has increasingly sowed the ground for the entry of some unscrupulous actors.” (Allday, 11/16)

Scientists have attempted to cure a patient with a rare genetic disorder by rewriting the DNA inside his body, in a first-of-its-kind therapy they hope could one day be applied to numerous other conditions including hemophilia and sickle cell disease. The procedure, which took place on Monday at the University of California at San Francisco's Benioff Children's Hospital in Oakland, Calif., involved sending what the Associated Press described as “billions of copies of a corrective gene and a genetic tool to cut his DNA in a precise spot” into the patient's body. These edits are designed to enable the patient, 44-year-old Brian Madeux, to produce an enzyme that would counteract a metabolic disease he suffers from known as Hunter syndrome. (Cha, 11/16)

Despite high-profile failures of potential treatments for Alzheimer’s, experts say increased visibility and progress on the underlying causes of the disease are signs of hope. With a new case of the brain-debilitating disorder developing every minute in the U.S., the need for effective treatment is urgent both for patients and the medical system as the population ages. (Dixon, 11/16)

Researchers have identified the degenerative brain disease known as CTE in a living person, according to a report published this week in the medical journal Neurosurgery. The paper’s lead author, Bennett Omalu, told an audience last month in San Francisco that physicians discovered CTE in Fred McNeill, a former Minnesota Vikings linebacker, during initial testing of a new method to identify chronic traumatic encephalopathy in the living. (Almond, 11/16)

Using accelerometers to precisely measure physical activity, researchers have found that even very light exercise, well below the generally recommended levels, reduces mortality in older women. The scientists had 6,382 women ages 63 to 99 wear an accelerometer for seven consecutive days, waking and sleeping, except when bathing or swimming. (Bakalar, 11/16)

The claim contends that companies and individuals with Arizona ties have made money by arranging patients’ trips to Mexico for weight-loss operations and by receiving referrals from Mexican surgeons to see patients when they return home. While website testimonials praise these transborder relationships, some patients who have had unhappy outcomes say they were misled by middlemen who minimized the risks. (Alltucker, 11/16)

Eating nuts may lower the risk for heart disease. Researchers studied 210,836 men and women involved in three large prospective health studies from 1980 to 2013. They assessed nut consumption with food frequency questionnaires, updated every four years. Over the years, there were 8,390 cases of coronary heart disease and 5,910 strokes. (Bakalar, 11/16)

Preventable childhood deaths in Arizona are at their highest level in five years, according to an annual study released this week. That means more than one in four childhood deaths in 2016 could have been prevented, according to the Annual Arizona Child Fatality Review Program conducted by public-health and child-welfare officials. (Pitzi, 11/16)

A case report about the seizure and death of an 11-month old after exposure to cannabis has prompted headlines about “the first marijuana overdose death” this week. Except that’s not what the doctors meant. “We are absolutely not saying that marijuana killed that child,” said Dr. Thomas Nappe, an author of the report who is now the director of medical toxicology at St. Luke’s University Health Network in Bethlehem, Pa. (Silverman, 11/17)

Computerized brain-training exercises studied by Jerri Edwards, a professor in the Department of Psychiatry and Behavioral Neurosciences at the University of South Florida, are the first intervention of any kind to reduce the risk of dementia in older adults, according to the study, just published in the journal Alzheimer’s & Dementia: Translational Research & Clinical Interventions. The study followed more than 2,800 healthy senior adults in six locations for 10 years as they aged from 74 to 84, on average. (Griffin, 11/16)

The opioid crisis cost the economy $95 billion in 2016, with $21.4 billion spent on treating patients who suffer from opioid abuse, a new analysis from Altarum found. The report sheds light on the economic impact of the crisis that contributed to 53,054 overdose deaths in 2016. ...The vast majority of the economic burden — $43.2 billion — came from losses in the workforce due to deaths from opioids, the analysis found. Another $12.4 billion of the calculation stemmed from productivity losses from surviving opioid addicts. (Castelllucci, 11/16)

A new study finds that about 10 percent of Americans say they've had a drug or alcohol problem at one point in their lives, but overcame it. Researchers asked more than 39,000 people about their experiences with substance abuse. (Becker, 11/16)

Addiction specialists caution against reading too much into a new study released this week that compares two popular medications for opioid addiction. This much-anticipated research is the largest study so far to directly compare the widely used treatment Suboxone with relative newcomer Vivitrol. Researchers who compared the two drugs found them equally effective once treatment started. But there are fundamental differences in the way treatment begins, which makes these findings difficult to interpret. (Harper, 11/16)

The City of Hammond filed a lawsuit against a host of pharmaceutical firms asking a court to hold them responsible for their role in the opioid crisis. The lawsuit, filed Thursday relying on a federal racketeering statue, alleged the companies that manufactured and distributed pain killers and opioid-based medications helped fuel the abuse of those medications and contributed to a crisis being faced by Hammond and other communities, according to court documents. (Lyons, 11/16)

Fire departments with medical first responders have carried the overdose-rescue kits for years, but an increasing number of police departments are joining the fight. They are part of efforts locally and nationally to combat the growing opioid crisis. Overdoses of prescription painkillers and illegal opioids such as heroin killed 790 Arizona residents last year. (MacDonald-Evoy, 11/16)

In Minnesota’s latest effort to combat the abuse of prescription painkillers, a state task force has set new limits on opioid prescriptions by doctors who participate in the state’s Medicaid program. The rule, adopted Thursday by the state’s Opioid Prescribing Work Group, says that doctors who exceed a new state dosage limit for more than half their patients would receive warnings and training. (Olson, 11/16)

After several people in Orange County fell sick with Legionnaires’ disease in recent weeks, officials said two cooling towers at Disneyland had been linked to the outbreak. Those towers were shut down, and officials say they no longer pose a risk to park visitors. But a key question remains unanswered: How did four people who had not visited Disneyland become infected? (Karlamangla, 11/16)

The Texas Legislature's budget for the next two years includes $20 million more in funding for a controversial program that seeks to discourage women from getting abortions in the state. Alternatives to Abortion uses contracted providers to offer services such as financial counseling and support groups for new parents, as well as children's items such as car seats and infant formula. (Choi, 11/16)

Consumer advocates said Thursday the impact of a prolonged contract dispute between the insurer Anthem Blue Cross & Blue Shield and Hartford HealthCare, has been exacerbated by the rapid consolidation of hospitals, physician groups and clinics in Connecticut. (Pazniokas, 11/16)

Four people have been indicted on multiple counts of conspiracy to commit health care fraud and aggravated identity theft related to fraudulent claims filed with Medicaid programs in Georgia, Florida and Louisiana. U.S. Attorney Byung J. “BJay” Pak, in a news release Thursday, announced indictments against 42-year-old Matthew Harrell, of Atlanta; 42-year-old Nikki Richardson, of Fairburn, Georgia; 42-year-old Tomeka Howard, of Decatur, Georgia; and 42-year-old Andrea Barrett, of Virginia Beach, Virginia. (11/16)

A student group at Brandeis University wants to install a vending machine on the school’s Waltham campus that would dispense health care products like Plan B, the emergency contraceptive used to prevent pregnancy after having unprotected sex. (Annear, 11/16)

Horizon Blue Cross Blue Shield of New Jersey named Kevin P. Conlin to succeed Robert A. Marino as chief executive of New Jersey’s largest health insurer effective Jan. 1, the Newark company said Thursday. Marino has been Horizon’s president and CEO since March 2011 and chairman since March 2012. He is retiring on Dec. 31. (Brubaker, 11/16)

A Miramar doctor has been sentenced in federal court for his part in a $5.5 million healthcare fraud case. ... As medical director of Chatman’s Reflections Treatment Center, Mendez should have been responsible for patient diagnosis and care. Instead, Chatman “dictated the type and frequency of different types of lab testing that would be performed based upon the kickbacks and bribes that he was receiving from different clinical laboratories,” he admitted in court documents. (Neal, 11/16)

A Santa Clara County adult under age 65 is the first flu-related death reported in the county this flu season, public health officials announced Thursday. The victim, who died earlier this month, had not received this year’s flu vaccine and suffered from other medical conditions that placed the person at greater risk of severe complications from the flu, Santa Clara County health officials said. (Seipel, 11/16)

The cost of long-term care such as nursing homes or at-home care continued to rise both nationally and in Virginia from 2016 to 2017, one recent survey showed. The national, median cost of long-term care services increased an average of 4.5 percent from 2016 to 2017, with the national median, annual cost for a private room in a nursing home reaching $97,455, according to research conducted by Henrico County-based insurance company Genworth Financial Inc. (Reid Blackwell, 11/16)

Johns Hopkins University scientists will get a $65 million infusion of funding from a Wall Street investment firm that they hope will help bring more drugs and other medical treatments to market. The investment from New York-based Deerfield Management Co. comes as government funding for scientific research continues to decline and drug companies remain cautious about which studies they choose to invest in. Many funders want proof of a drug’s potential before they invest. (McDaniels and Cohn, 11/16)

A man who acknowledges killing a woman nearly 40 years ago said he needed to plot and carry out his escape from a Hawaii psychiatric hospital to prove that he could behave properly out in the community. Randall Saito told San Francisco television station KGO-TV in an interview that the Hawaii State Hospital wouldn't give him a chance. He says every time he applied for release, officials made him "sound like a bad guy." (11/17)

Summa Health System's recent struggles could be stabilizing, despite a downgrade by Moody's Investors Service. ... The largest employer in Summit County, Summa Health has had diminishing revenues and waning consumer confidence over the past year, triggered by a variety of factors. (Conn, 11/16)

A Denver-based mobile health care company has landed in Richmond through a partnership with Bon Secours Richmond Health System. Officially launched Tuesday in Richmond, DispatchHealth sends a medical team, including nurse practitioners and physician assistants, to a patient’s home once summoned through an app, website or phone call. (O'Connor, 11/16)

Dental visits and satisfying jobs help make the Twin Cities one of the happiest metro areas in the country. But poor body-mass-index scores and high smoking rates prevent it from topping the list, according to National Geographic Fellow and New York Times best-selling author Dan Buettner, a native of St. Paul. (Chavey, 11/16)

A former Iowa psychiatrist who served prison time for padding his bills to health-insurers has surrendered his medical license. Richard L. Hauser, 68, practiced psychiatry in Grinnell, Iowa City and Pella, state and federal records show. He surrendered his license last week to settle administrative charges of unethical conduct, which were brought by the Iowa Board of Medicine. (Leys, 11/16)

For insurers selling individual-market health plans, monthly premiums on average were 54 percent higher for their ACA-compliant plans in 2015 than for their noncompliant plans, in large part because of higher medical claims for compliant plans. This average experience masks a wide variation among particular insurers. For the quarter of insurers with the greatest difference in prices, ACA-compliant premiums were 82 percent to 123 percent higher than for noncompliant plans, and claims were 157 percent to 193 percent higher. (Hall and McCue, 11/15)

High-income countries are grappling with the challenge of caring for aging populations, many of whose members have chronic illnesses and declining capacity to manage activities of daily living. The 2017 Commonwealth Fund International Health Policy Survey of Older Adults in eleven countries showed that US seniors were sicker than their counterparts in other countries and, despite universal coverage under Medicare, faced more financial barriers to health care. (Osborn, Doty, Moulds et. al, 11/15)

Although Affordable Care Act (ACA) marketplaces were beginning to stabilize in 2017, policy uncertainty stemming from a potential repeal of the law, threats to cost-sharing reduction reimbursements, and questions about enforcement of the individual mandate led many insurers to re-evaluate participation for 2018. In this report, we examine six states that faced the prospect of counties without a single insurer for 2018: Iowa, Nevada, Ohio, Oklahoma, Tennessee, and Washington. Interviews with regulators and insurers offer insight into how a set of diverse states sought to preserve coverage options for consumers in the wake of considerable instability in federal policy. (Lucia, Hoadley, Corlette et. al, 11/9)

While the percent of the population without health coverage has decreased substantially since the major coverage expansion in the ACA, about 10% of the population is still uninsured. Some of those who remain uninsured are eligible for premium subsidies large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage people can buy to satisfy the individual mandate. Others could obtain coverage, after taking into account premium subsidies, for less than the penalty they would have to pay under the individual mandate. This analysis looks at the non-elderly uninsured eligible to enroll in a marketplace plan to determine how many of them would be financially better off enrolling in coverage than paying the penalty. (Rae, Levitt and Semanskee, 11/9)

Here we are again, talking about a Republican proposal that would rattle health insurance markets, increase overall premiums and leave millions without coverage ― all while freeing up money for tax cuts that would disproportionately benefit corporations and wealthy Americans. ... The GOP’s tax cut will end up costing somewhere in the neighborhood of $1.5 trillion, according to official government projections, and finding offsets that will get 50 votes has been difficult. Desperate to find a source of money that can work politically ― and, perhaps, to take a shot at Obamacare while they can ― Republicans have set their eyes on the Affordable Care Act’s individual mandate. (Jonathan Cohn, 11/15)

Earlier this week, Senate Republicans, in a last-minute effort move to lower the cost of their $1.5 trillion tax cut plan added a truly poison pill to the legislation: repeal of Obamacare’s individual mandate. While the move would save more than $300 billion over 10 years — and thus allow the tax bill to meet budgetary requirements in the Senate — it will also cause 13 million Americans to lose health insurance and, according to the Congressional Budget Office, will increase health care premiums by an estimated 10 percent. (Michael Cohen, 11/16)

President Trump and congressional Republicans want Americans to think that their proposed tax legislation is all about increasing economic growth. That’s their stated goal. But the stealth goal of GOP tax cuts is to start down the path toward gutting the New Deal and the Great Society — and if tax cuts pass, they might get away with it. (Bruce Bartlett, 11/16)

With every paycheck for 46 years, ever since I became self-supporting at age 21, I have diligently and faithfully paid into Medicare, glad to rest in the security of anticipation that Medicare would indeed care for me in my old age. Well, old age has arrived, and what now? Even though I now willingly pay monthly Part B premiums, Congress is chopping away at the oak's roots. (Trudy E. Bell, 11/16)

We know that where you live matters: There are huge disparities in health and costs across the country. The uninsured rate in Texas is six times higher than in Massachusetts. You’re four times more likely to be readmitted to the hospital in Maryland or New Jersey than in Hawaii. One-third of low-income adults in Texas forgo medical care because of cost, but only 9 percent in Vermont do. Alaska spends twice as much on health care per person as Utah does. (Dhruv Khullar, 11/16)

Recently, six states have taken the unusual step of using their legal authority to declare their opioid-overdose situation an emergency. ... On October 26, 2017, President Donald Trump directed the acting secretary of health and human services to declare the opioid crisis a national public health emergency under the federal Public Health Services Act. ... As the federal government determines the specific actions that will follow its declaration, and more individual states consider issuing their own emergency declarations, policymakers, health care providers, and emergency managers can learn from aspects of the state emergency declarations that have already been issued. (Lainie Rutkow and Jon S. Vernick, 11/15)

Six years ago, at age 49, Julie Gregory paid an online service to sequence her genes, hoping to turn up clues about her poor circulation, blood-sugar swings and general ill health. Instead she learned she had a time bomb hidden in her DNA: two copies of a gene variant, ApoE4, that is strongly linked to Alzheimer’s. Most Americans with this genotype go on to develop late-onset dementia. (Pagan Kennedy, 11/17)

The Wellcome Trust, the Medical Research Council, Cancer Research UK, and the Bill and Melinda Gates Foundation share a common vision for maximizing the value of data that are generated through the trials we fund. We are committed to ensuring that the data from published clinical trials can be accessed by researchers so they can validate key findings, stimulate further inquiry, and ultimately deliver lifesaving results. ... The recent announcement by the International Committee of Medical Journal Editors (ICMJE) on data-sharing statements for clinical trials3 is a step in the right direction but falls short of realizing our vision. The ICMJE has not mandated data sharing as a requirement for publication, and we find the example statements it provides to be vague and open to interpretation. (Robert Kiley, Tony Peatfield, Jennifer Hansen and Fiona Reddington, 11/15)

Kentucky raised its tax on cigarettes by 27 cents in 2005 and by 30 cents in 2009 to reach the current 60 cents a pack, one of the nation’s lowest. Given the state’s desperate need for new revenue, the legislature is likely to consider upping the excise tax on tobacco products in 2018. Unless the per-pack increase is $1 or more, it would just be a tax on poor people, doing nothing to protect Kentuckians’ health. (11/16)

The Obama administration took a largely hands-off approach to cannabis after Colorado and Washington legalized it for recreational purposes in 2012. But while President Trump campaigned on respecting state laws, his pick of longtime legalization foe Jeff Sessions as U.S. attorney general instilled fear and uncertainty in the industry. Last year, Sessions said that "good people don't smoke marijuana." If the Department of Justice moves against California's cannabis industry, can members of the state's congressional delegation be counted on to stand up for their constituents? (Tom Angell, 11/17)

At the end of an inconspicuous hallway and strategically placed far from the controlled chaos of the trauma room lies a dimly lit waiting area that we in the medical field call “the quiet room.” It is a bland spot; a few soft chairs surround a table that holds a box of crisp institutional tissues. There may be a picture or two on the wall, but generally it is an unassuming room where we physicians tell mothers about the deaths of their children, far too often because of firearm violence. (Peter T. Masiakos and Cornelia Griggs, 11/15)