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The Trump administration is urging states to tear down pillars of the Affordable Care Act, demolishing a basic rule that federal insurance subsidies can be used only by people buying health plans in marketplaces created under the law. According to advice issued Thursday by federal health officials, states should be free to re­define the use of those subsidies, which began in 2014. They represent the first help the government ever has offered middle-class consumers to afford monthly premiums for private insurance. (Goldstein, 11/29)

“For far too long, states have looked to Washington with a ‘Mother, may I?’ approach,” said Seema Verma, the administrator for the Centers for Medicare and Medicaid Services. “Today we are saying the states have the power to make the individual markets work through innovative policies that best meet the needs of your citizens.” (Tozzi, 11/29)

The Trump administration said Thursday that states could bypass major requirements of the Affordable Care Act by using federal funds for a wide range of health insurance programs that do not comply with the law. Federal officials encouraged states to seek waivers from provisions of the law that specify who is eligible for premium subsidies, how much they get and what medical benefits they receive. (Pear and Goodnough, 11/29)

States can use 1332 waivers to launch new financing options that resemble health savings accounts, according to CMS Administrator Seema Verma. But a former agency official warns that using any of the new flexibilities outlined could result in litigation. This new account-based program would help subsidize healthcare expenses. Under this approach, states would provide a cash contribution to an account that people can use to pay both premiums and any out-of-pocket health expenses. (Dickson, 11/29)

“The specific examples laid out today show how state governments can work with HHS to create more choices and greater flexibility in their health insurance markets, helping to bring down costs and expand access to care,” said Health and Human Services Secretary Alex Azar. The flexibility being offered to states marks a fundamental shift in approach, health analysts say. The Obama administration sought to make sure people had a minimum level of coverage, while the waivers show the focus now is on making sure people have access to some kind of coverage. (Armour, 11/29)

Trump administration officials emphasized on Thursday that the pre-existing protections written into the Affordable Care Act (ACA) will not be changed. “Critics of state flexibility will always assume the worst,” Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said on a call with reporters. “The ACA’s pre-existing condition protections cannot and will not be changed.” (Weixel, 11/29)

Kaiser Health News: Is Trump Pushing Health Insurance Innovation Or An ACA Rollback?

Policy experts predict the ideas would further foster a parallel market of cheaper, less robust coverage that could draw younger or healthier consumers, but drive up premiums for those who remain in ACA market plans. “Invariably, the coverage is going to be more expensive for people who really need comprehensive coverage,” said Timothy Jost, a retired Washington and Lee University law professor who follows the ACA closely. (Appleby, 11/29)

The rising cost of health care was the top issue on the campaign trail in Minnesota this year, and the new governor and state lawmakers expect to continue the conversation when the new legislative session starts in January. For DFL Gov.-elect Tim Walz, that means looking at giving Minnesotans the option to buy-in to a public insurance program known as MinnesotaCare, and he could get some support from new DFL House members. (Bierschbach, 11/29)

Republican lawmakers plan to pass a measure to protect coverage for pre-existing conditions as soon as Tuesday as part of a lame-duck session that could also curb the powers of the incoming Democratic governor. The move comes less than a month after Gov. Scott Walker and other top-of-the-ticket Republicans lost their election bids amid a wave of criticism for their fights against the Affordable Care Act, which is also known as Obamacare and guarantees coverage for pre-existing conditions. (Marley, 11/29)

Kaiser Health News: Short On Federal Funding, Obamacare Enrollment Navigators Switch Tactics

Enrollment is down sharply on the federal health insurance marketplace this fall, and the consumer assistance groups that help with sign-ups think they know why. They don’t have the staff to help as many customers as before because the Trump administration slashed funding. The federal government is spending $10 million this year on navigators who help individuals enroll in coverage. The government spent $36 million in 2017 and $63 million in 2016. (Galewitz, 11/30)

Kaiser Health News: Listen: Paying More For Your Health Insurance? Depends On Where You Live 

Open enrollment is underway in the sixth year of the Affordable Care Act’s insurance marketplaces, with some regions of the country experiencing unexpected drops in premiums and others weathering higher prices. In California, premiums for plans sold through the state’s health insurance exchange, Covered California, will rise an average of 8.7 percent next year, although individual rate increases — or decreases — depend on a variety of factors, including where you live, what plan you choose and your income. Many consumers can save money by switching plans. (11/29)

Slightly more than 11,400 New Hampshire residents have bought health insurance plans through the federal marketplace so far in the open enrollment period, and since this year has a relatively short sign-up period, it seems likely that the final tally will be lower than last year’s figure of about 51,000. New Hampshire’s experience is echoing that of many of the 39 states using the healthcare.gov platform, most of which have seen fewer sign ups than at this point last year. New Hampshire residents who want to purchase coverage on healthcare.gov, and thus be eligible for federal subsidies, must do so by Dec. 15. (11/29)

The Department of Health and Human Services (HHS) says it could take a month to retroactively fingerprint workers at the migrant tent city in Texas. The pledge comes days after an HHS watchdog report raised concerns that none of the staff at a refugee camp in Tornillo, Texas were subject to an FBI fingerprint checks. More than 2,300 teens are currently being held at the tent city, the AP reported. (Birnbaum, 11/29)

“These issues must be addressed and remedied without delay,” Rep. Jerrold Nadler, a New York Democrat, said in a letter to Health and Human Services Secretary Alex Azar. It was co-signed by other Democratic House members. They asked for a briefing before Dec. 11 and a hearing in the new Congress early next year. “Similar to building a wall from sea to shining sea, detaining kids in Tornillo is the most expensive and least effective policy approach that fails to address root causes of migration flows or make anyone safer,” said Rep. Will Hurd, a Texas Republican whose district includes the detention camp. (Mendoza and Burke, 11/29)

Juan is caught in a record backlog that has 14,000 children experiencing longer detention times in shelters across America, according to a Department of Health and Human Services official. About 11,900 children were detained in June, that number rose to 12,800 in September. As detention times increase, with some staying up to a year, caretakers have seen children exhibit mental health and behavioral problems, according to a source inside a large detention service provider. This source adds that the unaccompanied children are considered higher risk. And while, in years past, child shelters used to be mission-driven (to serve children), now they are at full capacity and more policy driven. (Flores, Edwards, Said and Schneider, 11/30)

The apparent birth this month of the first genetically modified babies is “a lesson in the potential for human hubris to overtake us,” Dr. Francis Collins, the director of the National Institutes of Health, told STAT Thursday, but he said there is little U.S. officials can do to influence how China sanctions the rogue scientist who claims to have led the ethically dubious scientific breakthrough. (Facher, 11/29)

Scientists working on the frontiers of medicine fear the uproar over the reported births of gene-edited babies in China could jeopardize promising research into how to alter heredity to fend off a variety of disorders. Researchers are rapidly learning how to edit DNA to fight such conditions as Huntington's, Tay-Sachs and hereditary heart disease, conducting legally permissible experiments in lab animals and petri dishes without taking the ultimate step of actually creating babies. Now they worry about a backlash against their work, too. (Neergaard, 11/30)

Anti-abortion leaders are seeking help from the Trump administration as they shift their political strategies now that the U.S. House will be controlled by Democrats who support abortion rights. Under Republican control, the House tried repeatedly, though unsuccessfully, to halt federal funding for Planned Parenthood, and it passed a bill that would have banned most abortions after 20 weeks of pregnancy. The Democratic-led House that takes office in January is likely to push legislation that would expand access to abortion, even if such measures die in the GOP-controlled Senate. (11/29)

Michigan’s Republican-led Senate approved legislation Thursday that would permanently ban doctors from prescribing abortion medication over an internet web camera or streaming video service. The upper chamber voted 24-12 to extend a "telemedicine" ban enacted as part of a 2012 GOP abortion law that was set to expire at the end of the year. (Oosting, 11/29)

A CNN investigation into the destruction of rape kits in dozens of agencies across the country found that police trashed evidence in 400 cases before the statutes of limitations expired or when there was no time limit to prosecute. The number is likely higher and was arrived at through an analysis of the departments’ own records. The destruction occurred since 2010 and followed flawed and incomplete investigations that relegated rape kits to shelves in police evidence rooms until they were destroyed. Dozens were trashed mere weeks or months after police took custody of the evidence, records showed. (Fantz, Hernandez and Vashi, 11/29)

In the era of #MeToo and stories about the alleged perpetrators of sexual violence, CNN's exclusive investigation "Destroyed" turns the spotlight on those responsible for protecting the public. An examination into the destruction of rape kits in dozens of agencies across the country found that police trashed evidence in 400 cases before the statutes of limitations expired or when there was no time limit to prosecute.The number is likely higher and was calculated by analyzing the departments' own records. (Fantz, Hernandez and Vashi, 11/29)

Lisa Binderow had envisioned her labor a thousand times. She bought a birthing ball, hired a doula and even practiced hypnotherapy. Her plan was to deliver at the Mount Sinai West Birthing Center, an area of the hospital marked by pastel curtains, family-size beds and large birthing tubs. Separated from the regular labor and delivery floor, it is for women who want a natural childbirth with minimal medical intervention. Yet after arriving in triage, Ms. Binderow, 35, was made to wait. And wait. (Satow, 11/30)

Kristen Philman had already been using heroin and prescription painkillers for several years when, one day in 2014, a relative offered her some methamphetamine, a chemical cousin to the stimulant amphetamine. "I didn't have any heroin at the time," says Philman, a resident of Littleton, Colo. "I thought, 'Oh this might make me feel better.'" It did, she says. Soon, she was using both heroin and methamphetamine on a regular basis. (Chatterjee, 11/29)

Bloomberg Philanthropies will donate $50 million to states fighting the opioid epidemic, an effort to support current programs and encourage new approaches. Former New York mayor Michael Bloomberg is scheduled to announce the three-year program Friday morning during the second day of a health conference in Washington hosted by another of his ventures, the Bloomberg American Health Initiative. (Bernstein, 11/30)

Companies making and distributing opioid painkillers opposed a proposal to separate lawsuits filed on behalf of addicted babies from local governments’ cases aimed at recouping costs of battling the public-health crisis spawned by the drugs. Attorneys for thousands of babies born to opioid addicts asked a panel of federal judges Thursday to carve their cases out of more than 1,400 suits consolidated before an Ohio judge. The suits, filed by U.S. cities and counties, seek billions of dollars in reimbursement for treatment and policing costs. Drugmakers, such as Purdue Pharma LP and Johnson & Johnson, along with distributors such as McKesson Corp. and Cardinal Health Inc., say the move is unnecessary. (Feeley, 11/29)

Clearwater is the latest Tampa Bay municipality to sue some of the country’s largest drug companies, alleging manufacturers lied about the risks of addiction to opioids through deceptive marketing while distributors flooded pharmacies and communities with the pills. (McManus, 11/29)

Florida Attorney General Pam Bondi has named the nation's two largest pharmacy chains in its massive opioid lawsuit, accusing Walgreens and CVS of racketeering in their "relentless campaign" to supply Floridians with opioids. The two pharmacy giants, which have more than 1,500 locations between them in Florida, broke Florida law by ignoring suspicious orders, "all while claiming misleadingly to the public that they were fulfilling their duties as pharmacists," Bondi's lawyers say. (Mower, 11/29)

US Attorney Andrew E. Lelling has sent letters to “a number of medical professionals” alerting them that their opioid prescribing practices “have been identified as a source of concern.” In a statement released Thursday, Lelling said that the professionals who received the warning had prescribed opioids to a patient within 60 days of that patient’s death or to a patient who subsequently died from an opioid overdose. (Freyer, 11/29)

Summit County Health and its partners have so far this year collected 8,000 pounds of unwanted pills for disposal in their efforts to combat opiate overdose deaths in Summit County, officials announced at a Thursday briefing. A similar effort last year collected 9,000 pounds of pills, not counting the weight of the containers, said Dr. Doug Smith, chief clinical officer of Summit County's Alcohol, Drug Addiction & mental Health Service Board. (Conn, 11/29)

In an unusual move on Thursday, a federal judge raised the prospect of not approving CVS Health Corp's deal to buy insurer Aetna Inc, which closed earlier this week, during a routine portion of the legal process. Judge Richard Leon of the U.S. District Court for the District of Columbia objected to what he said was the government’s and companies’ treatment of him as a "rubber stamp" for the deal, noting that CVS had closed its deal to buy Aetna for $69 billion on Wednesday. (11/29)

Bayer AG plans to cut 12,000 jobs and exit its animal health business in an effort to mollify Wall Street, which has punished the company over the tidal wave of lawsuits that came alongside the $63 billion takeover of Monsanto Co. The German company announced a rash of moves, including exiting the sun-care and foot-care segments, that it said would boost its core pharma and agricultural businesses. The cuts, including a significant number in Germany -- where layoffs are politically sensitive -- represent about 10 percent of the workforce. The shares fell 2.3 percent as of 5 p.m. in Frankfurt trading, erasing initial gains after the announcement. (Loh and Kresge, 11/29)

A federal judge is set to decide how much flexibility insurers that administer self-insured health plans have in limiting coverage for treatment of mental health and substance use disorders. The decision could have wide ramifications in terms of holding insurers to a standard in what has to be covered in the fast-growing behavioral healthcare segment. The case stems from two consolidated class action lawsuits filed in 2014 against United Behavioral Health, the nation's largest behavioral health insurer, that went to trial in October 2017 before U.S. Chief Magistrate Judge Joseph Spero in San Francisco. (Meyer, 11/28)

Past gun violence produced few lasting changes in Florida, but the Parkland mass shooting has prompted swift new laws and a high-profile committee that is generating action. When 14 students and three staff members were gunned down Feb. 14 at Marjory Stoneman Douglas High School near Fort Lauderdale, the state quickly raised the age for buying a rifle from 18 to 21, tightened other laws and formed a panel to investigate shortcomings in law enforcement and at the school — prompting personnel changes even before filing its initial report. (11/29)

Doctors brought their #thisisourlane Twitter feud with the National Rifle Association to the steps of Congress Thursday, pressing House Democrats to fund federal research into gun violence, pass background checks and ban assault weapons once they take power in January. Many physicians have long favored such regulations but were galvanized after the NRA dismissed the American College of Physicians’ recent call for sweeping gun control policies by tweeting the doctors should “stay in their lane.” (Ollstein, 11/29)

Researchers at the University of Miami, along with first responders and the military, have developed a new protocol that they say could save lives. Currently, firefighters must remain outside until police give the all-clear, explained Sunrise Fire Department Lieutenant and researcher Steven Carter. This process could take anywhere from a few minutes to hours. (Mulcahy, 11/29)

They were holding a regular brainstorming session on strategies to treat the epidemic of psychological trauma that overwhelms social agencies across Milwaukee and disables much of its workforce — a toxic side-effect in a city with near-daily exposure to violence, abuse, abandonment and drugs. As if to drive home the point in a way that no one could miss, a volley of gunfire rang out in the street outside Our Savior's Lutheran Church, even as the meeting was in progress. (Schmid, 11/29)

While a decision to stop selling assault-style weapons in the wake of the Parkland, Florida, school shooting dented its overall sales, Dick’s Sporting Goods says that the dip reflects a broader weakness in the world of firearms. The nation's largest seller of sporting goods reported that consolidated same-store sales were down 3.9% in the third quarter, due in part to double-digit declines in the areas of electronics and hunting. (Jones, 11/29)

Reported cases of measles worldwide surged by nearly a third last year, partly because parents did not vaccinate their children, health organizations said Thursday. The increase in measles, a highly contagious scourge that had been nearly eradicated in many parts of the world just a few years ago, was “deeply concerning,” the organizations said in a report on the fight to eradicate measles. (Gladstone, 11/29)

Nationwide, more than 47,000 Americans died by suicide last year, according to data released this week by the Centers for Disease Control and Prevention. That’s a nearly 5 percent increase over 2016, when close to 45,000 people died. And it’s a continuation of a nearly 20-year rise in suicide rates that, along with drug overdose deaths, has been a leading factor in an ongoing decline in the average American life expectancy. (Vestal, 11/30)

There's new evidence that mild pulses of electricity can relieve depression — if they reach the right target in the brain. A study of 25 people with epilepsy found that those who had symptoms of depression felt better almost immediately when doctors electrically stimulated an area of the brain just above the eyes, a team reported Thursday in the journal Current Biology. (Hamilton, 11/29)

A relatively new shingles vaccine that can dramatically reduce the likelihood of developing the painful condition has become so popular that clinics and pharmacies are having trouble keeping it in stock. Shingles is a blistery flare-up of the chicken pox virus, which lingers in nerve tissue after chicken pox goes away. (Zdechlik, 11/29)

Alkermes (ALKS) said Thursday that schizophrenia patients treated with an experimental tablet called ALKS 3831 reported significantly less weight gain compared to the most commonly prescribed antipsychotic currently in use. The ALKS 3831 results achieved the main goal of Alkermes’ Phase 3 clinical trial, clearing the way for the biopharma company to file for regulatory approval in the middle of next year. (Feuerstein, 11/29)

Post-traumatic stress disorder is often associated with military veterans. But civilians live with PTSD, too. And finding treatment outside of the Veterans Administration isn’t always easy. More mental health providers are starting to treat PTSD in the civilian world, and some are using lessons they learned from treating veterans. (Covington, 11/28)

“Mommy? I threw up.” The phrase is uttered so innocently, but it incites in me an immediate dark panic. I know right then — which way too often is in the middle of the night — that my vomiting child probably has a stomach virus, and that our family has just begun another weeklong round of ring-around-the-toilet. First it’ll be my son, then my daughter, then me, then my husband. My symptoms, for some reason, are the worst. The first time my husband saw me with a stomach bug, he said, “I really thought you were going to die.” (Moyer, 11/29)

A new invasive tick species capable of transmitting several severe diseases is spreading in the United States, posing an emerging threat to human and animal health, according to a pair of reports issued Thursday. The Asian longhorned tick is the first invasive tick to arrive in the United States in about 80 years. It’s native to eastern China, Japan, the Russian Far East and the Korean Peninsula and is now also established in Australia and New Zealand. (Sun, 11/29)

If life expectancy gives us “a snapshot of the nation’s overall health,” then new federal numbers released Thursday “are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable,” says Robert Redfield, the director of the Centers for Disease Control and Prevention. According to the government’s annual mortality report, life expectancy in the U.S. overall fell in 2017 for the second time in three years. (Santhanam, 11/29)

African-Americans are less likely than white people to get the newest stroke-preventing medicines for atrial fibrillation, a new study found. Atrial fibrillation, often called A-fib, is the quivering or irregular heartbeat that increases the risk for stroke and other heart problems. The standard treatment is oral anticoagulants, or blood thinners, to prevent blood clots. (Bakalar, 11/29)

Helping advanced cancer patients manage their symptoms and cope with their illness in an outpatient setting could help them live longer, according to a Tulane University study published in the Annals of Behavioral Medicine. A research team led by Michael Hoerger, assistant professor of psychology, psychiatry and oncology at Tulane, observed 2,092 patients with advanced cancers to examine the impact of outpatient palliative care on their survival and quality of life. (Clark, 11/29)

Under the law, the National Institute for Occupational Safety and Health, a federal agency that makes recommendations on work-related injuries and illnesses, had six months to review Evaskovich’s petition and recommend whether it should be approved or denied. A decade later, Evaskovich and his colleagues are still waiting for a final answer. (Moss, 11/30)

Kevin Love had always found refuge in basketball — a sport at which he excels. But his team, the Cleveland Cavaliers, was not playing very well early in the 2017-18 season. And the expectations had never been higher: Love and his Cavaliers teammates won an N.B.A. championship the year before and were widely expected to return to the N.B.A. Finals. (Stevens, 11/29)

The use of the IV method has not become a trend at the high school level, and there is no evidence to suggest its use creates a competitive advantage. Proponents believe it is the best way to protect at-risk athletes suffering from dehydration in select circumstances. Opponents express concerns about the methods and list potential hazards. (Krohn, 11/29)

Massachusetts' attorney general signed off on the merger between Beth Israel Deaconess Medical Center and Lahey Health with conditions, she announced Thursday. The conditions include a seven-year price cap, participation in the state's Medicaid and Children's Health Insurance Program MassHealth, and $71.6 million in investments supporting healthcare services for low-income and underserved communities in Massachusetts. (Kacik, 11/29)

Nearly two years after proposing the deal, Beth Israel Deaconess Medical Center and Lahey Health received final clearance to merge, striking a compromise with regulators who worried that the new health care giant would raise prices and impede access to care for low-income patients. ...The new organization — to be called Beth Israel Lahey Health — will provide the biggest challenge yet to Partners HealthCare, the state’s dominant network of doctors and hospitals. (Dayal McCluskey, 11/29)

"We share with the state and with the attorney general and her staff a real commitment to strengthening patient care but also to reducing health care costs," said Dr. Kevin Tabb, the CEO of Beth Israel Deaconess who will lead the new entity, Beth Israel Lahey Health (BILH). "This agreement with the attorney general does exactly that."(Bebinger, 11/29)

During the summer of 2017, Baylor St. Luke’s Medical Center posted a banner on its website, celebrating its liver and lung transplant programs as “#1 in Texas.” That declaration was based on the latest publicly available data, which showed stellar one-year survival rates for patients who received liver and lung transplants at St. Luke’s between 2014 and the middle of 2016. But soon after the hospital published those marketing materials in August 2017, both of those transplant programs began to see increases in patient deaths, an investigation by the Houston Chronicle and ProPublica has found. (Hixenbaugh and Ornstein, 11/30)

The long, laborious process of returning Paradise and neighboring towns to a safe state will begin next month when crews in masks, Tyvek suits and booties begin combing through every last property in this town that was decimated by wildfire. Their targets are things like burned bottles of bleach, melted cans of paint, and corroded car batteries, which will be tagged and removed. Next, they will test the surrounding soil and, if needed, scrape away layers to get to clean earth, free from oil and gasoline. “You’d be surprised how much of that stuff survives a fire,” said Adam W. Palmer, an environmental scientist with the California Department of Toxic Substances Control who is helping lead the cleanup. (Nir, 11/29)

A cold front that brought wind and heavy rain to California on Thursday unleashed debris flows in fire-ravaged neighborhoods, triggering evacuations and school closures as crews up and down the state rescued people trapped in homes and cars and, in one case, a man clinging to a tree in the Los Angeles River. (Fry and Tchekmedyian, 11/29)

A 26-year-old man from Yuba City, California revealed his new face to the world Thursday after undergoing a life-changing facial transplant in June 2018. Cameron Underwood was injured by a self-inflicted gunshot wound on June 27, 2016. Over the next year, he would undergo several "conventional" surgeries to try to reconstruct his face as he hid the damage to his cheeks, nose and mouth behind a medical mask.  (Pitofsky, 11/29)

Minneapolis-based insurer Bright Health said Thursday it has raised another $200 million to support ongoing expansion. Bright Health announced plans this summer to expand into portions of New York, Ohio and Tennessee. It already competes in parts of Alabama, Arizona and Colorado. Launched in 2016, Bright Health initially focused on selling individual market health plans that comply with the federal Affordable Care Act (ACA) and has since added Medicare Advantage plans for seniors. (Snowbeck, 11/29)

Some members of the Mitchell family claimed to speak with ghosts, court records say. They were shut-ins, they said. The mother, who reported hallucinations, was disheveled and mumbled words to herself. When her son was asked if he could brush his teeth, he said he didn't have any. His answer to a question about whether he's ever had surgery was a single word: Pizza. But it was all a ruse, federal agents say, to allow them to keep getting Social Security checks they weren't entitled to. (Krause, 11/29)

If Houston leaders and health advocates get their way, the city’s beloved Astros will join a growing number of Major League Baseball players barred from dipping and chewing tobacco during games at their home stadium. The Houston City Council is considering a ban on smokeless tobacco during games by “any person employed by a professional baseball team or league” at Minute Maid Park — including in dugouts, training rooms and locker rooms. (Scherer, 11/29)

People who live on low incomes are among the most vulnerable to climate change. For patients who are susceptible to increasing heat, health care needs — air conditioning and fans, not just medications — may not be covered by health care programs like Medicare and Medicaid. (Stein, 11/29)

A new program looks to pair Dartmouth medical students as mentors with LGBTQ youth in the Upper Valley. Qmmunity is a collaboration between the Dartmouth Geisel School of Medicine and the group Rural Outright. (Moon, 11/29)

Eleven months ago, a nurse at Vanderbilt University Medical Center accidentally selected the wrong medicine while attempting to give a patient a routine sedative, injecting the patient with a lethal dose of a paralyzing anesthetic. The error, which caused the death of an otherwise stable patient, briefly jeopardized the Medicare reimbursement status of one of Nashville’s largest and most prestigious hospitals. (Kelman, 11/29)

Vanderbilt University Medical Center is at risk of losing its Medicare reimbursement because federal officials discovered that a patient died last year after they were inadvertently injected with a powerful anesthetic. You can read the details here, but if you don’t have time for the whole story, here are three key things you should know about Nashville’s biggest hospital. (Kelman, 11/29)

Austin police officials have formed a task force to address the conclusions of an audit that found that the Police Department could do a better job interacting with people who are mentally ill, City Manager Spencer Cronk wrote in a memo Thursday. The audit found that there are not enough mental health experts to assist police when they interact with people who are mentally ill and that a third of the 24 people killed in Austin police shootings from 2010 through 2016 were having mental health crises. (Hall, 11/29)

The city of St. Louis plans to add more beds to its Biddle homeless shelter, north of downtown, starting on Monday. The shelter currently has room for 100 men to stay overnight. Mayor Lyda Krewson announced Thursday that Biddle House will make space for an additional 50 men until the end of March. (Lippmann, 11/29)

San Francisco is getting an unexpected $415 million windfall, and the mayor and supervisors already have plenty of ideas on how they might use it. More than half the money, which is coming from excess revenue in a county education fund, must go to budget reserves, the Municipal Transportation Agency, public libraries, tree maintenance, public schools and child care and youth services under rules set by the City Charter. (Thadani, 11/29)

The Affordable Care Act (ACA) made it easier for older adults and those with medical conditions to enroll in individual-market coverage by eliminating risk rating and limiting age rating. While the ACA also encourages young and healthy people to enroll through subsidies and the individual mandate, it’s not clear whether these incentives have been sufficient to prevent the risk pool from becoming disproportionately old and sick. (Glied and Jackson, 11/29)

Many low-income consumers who are eligible for federal financial help under the Affordable Care Act can get a bronze-level plan and pay nothing out-of-pocket in premiums in more than 2,000 counties next year, depending on their annual income, according to a new analysis from KFF (the Kaiser Family Foundation). Such plans come with higher deductibles and out-of-pocket maximums, however. (11/26)

Empirical study findings to date are mixed on the association between team-based primary care initiatives and health care use and costs for Medicaid and commercially insured patients, especially those with multiple chronic conditions. (Meyers et al, 11/26)

Behavioral health care has been slow to take up robust efforts to improve patient safety. This lag is especially apparent in inpatient psychiatry, where there is risk for physical and psychological harm. Recent investigative journalism has provoked public concern about instances of alleged abuse, negligence, understaffing, sexual assault, inappropriate medication use, patient self-harm, poor sanitation, and inappropriate restraint and seclusion. However, empirical evidence describing the scope of unsafe experiences is limited. (Shields, Steward, and Delaney, 11/5)

More than 60 years ago, the courts deemed school segregation unconstitutional, yet across the country many students still attend school primarily with students who look like them. Research shows that the racial composition of the public school student population has changed substantially over the past 25 years, but student racial sorting among schools has remained relatively stable. A growing body of research shows that school segregation matters for the educational and socioeconomic outcomes of students of color. To fix it, however, we have to understand why racial segregation has persisted. (11/28)

To be sure, it was a highly irresponsible step — an unnecessary and medically pointless experiment conducted upon two unwilling and unconsenting human lives. (There are far less risky ways to avoid HIV infection.) The widespread condemnation by ethics experts was warranted, yet we ought to also scrutinize the international scientific context in which it took place. (J. Benjamin Hurlbut , Sheila Jasanoff and Krishanu Sana, 11/29)

A Chinese scientist’s claim to have created the first genetically edited babies has evoked widespread condemnation from the scientific community. “This is far too premature,” one American genetic scientist told the Associated Press.But here is a larger question: Should we be doing this at all?The Chinese scientist, He Jiankui, used a gene-editing technique known as CRISPR to alter the DNA of two children in a petri dish and attempt to make them resistant to HIV. This is not what has American scientists up at arms. In fact, researchers in the United States have done the same thing. In 2017, scientists at Oregon Health & Science University used CRISPR to genetically alter human embryos to make them resistant to an unidentified disease. The difference is that He then implanted his edited embryos. The American researchers killed theirs. (Marc A. Thiessen, 11/29)

On Sunday (November 25), He Jiankui, a scientist at Southern University of Science and Technology in Shenzhen, China, announced that he was the “first” to use CRISPR to genetically edit twin babies to inactivate the gene for CCR5, a chemokine receptor that the HIV virus uses to infect human immune cells. There are many questions regarding this announcement: What were the medical motivations in using gene editing to “protect” these future twins from contracting HIV? Why weren’t embryos that carry fatal genetic mutations the targeted subjects for gene editing? How do we protect the “autonomous rights” of the unborn? Nonetheless, the visions of how this gene-editing technology could be abused unnerved scientists, medical ethicists, and legislators. The temporary halt to gene editing on humans ordered by the Chinese government is only an appropriate step if it leads to instituting intelligent ethical guidelines related to this technology. (John D. Loike, 11/29)

The ISSCR is aware of reports that scientists in China have used CRISPR-mediated genome editing during in vitro fertilization to modify the genetic material of two embryos that were subsequently implanted into a patient, leading to the birth of two babies. As ISSCR and a number of other organizations have previously stated, the use of nuclear genome editing technologies, such as CRISPR, during fertility treatment is premature and should not be attempted at this time. The safety risks associated with potential unintended genetic changes in embryos remain uncertain. (11/28)

The opioid epidemic is a national health crisis of historic proportion. Yet the federal government is still not tackling it with the urgency it requires. The U.S. has the highest drug overdose death rate in the world, and two-thirds of the deaths are attributable to opioids. According to data from the Centers for Disease Control, 47,600 Americans died last year from opioid overdoses. That’s about a 13 percent increase from 2016 — and it’s nearly as many Americans as were killed during the entire Vietnam War. (Michael R. Bloomberg and Gov. Tom Wolf, 11/30)

The increased deaths were greatest in the 25-44 age group. With respect to race, the increased death rates were greatest in non-Hispanic white men and women. An important factor is the now familiar epidemic of drug overdoses. Drug-related deaths, which occurred at a rate of 16.3 per 100,000 in 2015 and rose to 19.8 per 100,000 in 2016, rose again to 21.7 per 100000 last year. (John Rowe, 11/29)

If you’re trying to make sense of why an opioid epidemic is raging in the richest nation in the history of the world — and raging it is, with 174 overdose deaths a day in the United States in 2016, triple the rate from 1999, according to the Centers for Disease Control — we’d suggest you buy and read the book “Dopesick.” Written by former Roanoke Times reporter Beth Macy, it traces the history of the epidemic and shows Virginia’s uncomfortable association with it. It was in our Appalachian coalfields, in the late 1990s, that the high-dose, highly addictive narcotic painkiller OxyContin began expanding its reach beyond terminally ill cancer patients — for whom it was developed — and started being prescribed to people with more nebulous conditions, such as lower back pain. (11/28)

Some experts say these laws may be in response to several studies that indicated opioid overdose death rates were lower in states that permit medical marijuana, and that opioid prescribing was lower in Medicaid and Medicare Part D programs in states with legalized medical marijuana. But the studies show an association, not a cause-and-effect relationship, said Ajay Wasan, MD, MSc, vice president of scientific affairs for the American Academy of Pain Medicine. “A lot of those states had other … initiatives to decrease opioid prescribing at the same time,” he noted. (Rebecca Voelker, 11/28)

The 21st Century Cures Act, enacted in late 2016, opens the door for accelerated approval for regenerative medicine, creating the very real possibility of making stem cell therapy accessible to millions of people in the United States.I am living proof that our own cells have the power to improve the quality of life of anyone in need, not just athletes, who may be living with pain. There are countless people in Houston and beyond who need this therapy today, and my hope is to see professional sports leagues lead the way in helping players get the help they need in safe, clinical settings and without addictive side effects. (Jackie Sherrill, 11/29)

I am not advocating that one drug be required or preferred over another, but only to let the doctor make that choice in consultation with his or her patient. There is no scientific, clinical or economic reason why the state or insurers have selected only one type of MAT treatment drug and has functionally excluded all others. ...State bureaucrats and insurance company employees – the vast majority of whom will never treat a single patient in their entire career – need to allow those of us with years of classroom and thousands of hours of clinical training the tools we need to help end this crisis. Every two hours a Floridian dies from an opioid overdose. We need help now. (Amit Vijapura, 11/29)

Although the environmental costs of global warming may still seem distant to some Americans, there is a growing threat that many may find harder to ignore: infectious disease. As another new report, the Lancet Countdown on Health and Climate Change, makes clear, warming poses a great diversity of risks for human health. More and more, hot summers will increase mortality and limit our capacity for outdoor labor. Superstorms in some regions will cause flooding of sewage systems and thereby spread gastrointestinal disease, while severe droughts in other regions will increase rates of asthma. Food production will be severely reduced in many countries. Many regions will see increased risks of infection. Although environmental destruction may not scare us in an immediate way, infectious diseases very well could. (Fred Cohan and Isaac Klimasmith, 11/30)

The suicide rate has been rising in the United States since the beginning of the century, and is now the 10th leading cause of death, according to the Centers for Disease Control and Prevention. ...The trend most likely has social causes — lack of access to mental health care, economic stress, loneliness and despair, the opioid epidemic, and the unique difficulties facing small-town America. These are serious problems that need long-term solutions. But in the meantime, the field of psychiatry desperately needs new treatment options for patients who show up with a stomach full of pills. Now, scientists think that they may have found one — an old anesthetic called ketamine that, at low doses, can halt suicidal thoughts almost immediately. (Moises Velasquez-Manoff, 11/30)

Many colleagues in health care drive themselves beyond exhaustion and into depression, putting them at increased risk of suicide. Celebrity suicides sparked a national conversation about the complex causes that put people at risk. Meanwhile, health care is undergoing an all-but-silent epidemic: physician suicides. An estimated 300-400 physicians in the United States take their own lives each year. Suicides among male physicians are 40 percent higher than the general population, and among female physicians a staggering 130 percent higher. (Edward M. Ellison, 11/30)

The latest edition — released in 2015 — continues this theme. It recommends people eat relatively large servings of grains, including three to five servings of refined grains daily. And it lumps fats in with sugars as "empty calories." It advises Americans to limit their saturated fat intake to just 10 percent of daily calories — without presenting evidence to support this figure. This guideline advice contradicts modern nutrition science which shows that fats, including saturated fats, aren't unhealthy. A dozen major literature reviews demonstrate that fat intake has little to no effect on death from cardiovascular disease. (Sarah Hallberg, 11/29)

The way the CDC identifies a food-safety outbreak is by interviewing sick people and healthy people. If there is a big difference in their answers, the CDC zeroes in on a cause. There are 43 people known to be infected with the outbreak strain of E. coli 0157:H7. The CDC interviewed 25 of them. Eighty-eight percent of those 25 people, as opposed to 47% of the general population, said they ate romaine lettuce in the week before they got sick. So it probably was romaine that got those people sick—16 severely enough to be hospitalized. But what rational people should do with this information is much less certain. (Jim Prevor, 11/29)

As the whirlwind of the holidays descends, you may find yourself wishing that you could slow down time. Here’s the thing: You can.You just need to put down your cellphone. I first discovered this myself a few years ago when, as an experiment, my husband and I took a 24-hour break from all our screens starting at sundown Friday. Saturday morning we accomplished more by 11 a.m. than we’d normally get done in an entire day. We cooked. We talked. We cleaned. We read. I practiced guitar. We played with our daughter. I felt like I’d unlocked a time-stretching superpower that I hadn’t known I possessed. (Catherine Price, 11/30)

At the signing ceremony for the 1990 Americans With Disabilities Act, President George Bush observed that the legislation had much in common with the fall of the Berlin Wall the year prior. The new law “takes a sledgehammer to another wall,” Bush remarked, “one which has for too many generations separated Americans with disabilities from the freedom they could glimpse, but not grasp.” Our current president, infamous for mocking Americans with disabilities and unraveling the social safety net, plans to rebuild that wall, putting America’s promise of freedom again further out of reach for people with disabilities. (Elena Hung and Katherine Perez, 11/29)

As a transgender woman, I find it degrading to be constantly reminded that I am trans and that large segments of the population will forever see me as a delusional freak. Things like deadnaming, or purposely referring to a trans person by their former name, and misgendering — calling someone by a pronoun they don’t use — are used to express disagreement with the legitimacy of trans lives and identities. Defenders of these practices claim that they’re doing this not out of malice but out of honesty and, perhaps, even a twisted sort of love. ...If we want more and better speech on this topic, even among trans critics, Twitter’s policy gives us the framework we need to reset our thinking. To date, we’ve put semantics over substance. (Parker Molloy, 11/29)

A core challenge of management is to ensure that the organization’s priorities, strategies, and metrics are consistently embraced and that any impediments are identified and addressed quickly. At Salt Lake City-based Intermountain Healthcare, ensuring the alignment of all these things to provide extraordinary care requires a constant regimented focus across our 23 hospitals, 170 clinics, and 850,000-member health insurance plan. To achieve that, we have implemented a model of daily huddles on an extensive scale. In this article, I’d like to share the insights we’ve gleaned from the model’s first full year of operation, which hopefully organizations in health care and many other industries will find useful. (Marc Harrison, 11/29)

Too few individuals with a mental health issue get the care they need. Consider that in 2016 only one in 10 people needing substance use treatment were able to gain access to a specialty facility. California’s health care system — like the rest of the country — remains fragmented, with mental health being seen as a separate and distinct element from physical care. (Norris and Miller, 11/29)