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In a pair of tweets casting doubt on the official estimate of nearly 3,000 deaths, the president clung to an outdated estimate, wrongly suggested that doubt over the figure emerged “a long time later” and inaccurately characterized the new figure as including all deaths on the island. (Qiu, 9/13)

“I’m flabbergasted,” said Irwin Redlener, director of Columbia University’s National Center for Disaster Preparedness, a think tank. “People need to understand we’re not just counting immediate fatalities. We have to understand what happens long-term with ongoing conditions.” (Shields, 9/13)

Public health experts have estimated that nearly 3,000 perished because of the effects of Maria. But Trump, whose efforts to help the island territory recover have been persistently criticized, was having none of that. He said just six to 18 people had been reported dead when he visited two weeks after the storm and suggested that many had been added later "if a person died for any reason, like old age." Trump's jarring comments, coming as the East Coast braced for a massive storm, offered fresh evidence of his resistance to criticism and his insistence on viewing large and small events through the prism of his own success or failure. (Lucey, Miller and LeMire, 9/14)

The researchers estimated the number of excess deaths by analyzing death certificates and other mortality data, and comparing the number of deaths during the designated period with past mortality patterns. They calculated the total number of deaths in the period was 22% higher than the number of fatalities that would have been expected, the researchers said. In analyzing Puerto Rico’s death-certification process, the study found that listed causes of death included cardiac arrest, respiratory failure and septicemia. But researchers concluded that such causes were sometimes misassigned, with physicians failing to link the deaths to the hurricane. (Ballhaus, 9/13)

Kaiser Health News: 4 Takeaways On Puerto Rico’s Death Toll, In The Wake Of Trump’s Tweet Storm 

Prior to the GWU study, other researchers and one newspaper released estimates that also garnered media attention. One study, published in the New England Journal of Medicine, put the number of excess deaths at 4,645 in the three months following the hurricane. A study by The New York Times used vital records from the government to calculate an excess of 1,052 deaths in the first 42 days after the disaster. (Heredia Rodriguez, 9/14)

Ever since the storm, Mr. Trump has pushed back against criticism that his administration was slow to respond to Puerto Rico, where the distribution of supplies, gas and food lagged and power outages lasted for months, particularly compared with a swift and efficient response to an earlier hurricane that hit Texas. It was six days after Hurricane Maria hit the island before Mr. Trump pledged to go there, even as he traveled to Texas four days after Hurricane Harvey made landfall. Full power was restored to homes only in August, nearly a year after the storm. Former Gov. Chris Christie of New Jersey, a Republican ally of Mr. Trump’s who was praised for his own leadership during Hurricane Sandy in 2012, said that Puerto Rico was an “extraordinary challenge” in part because the island’s infrastructure was in poor shape to begin with and that Mr. Trump resented being blamed for factors beyond his control. (Baker, 9/13)

Trump’s charge about the Puerto Rico storm — a humanitarian crisis that continues to affect life on the island a year later — baffled his advisers as well as officials at the Federal Emergency Management Agency, who have been working to prepare the Carolinas for Hurricane Florence, the potentially deadly storm forecast to make landfall Friday. Trump’s aides said they have tried to focus the president’s attention on Florence, noting that he has been engaged in daily disaster briefings and called governors, senators and other officials representing North Carolina and South Carolina. Officials have brought large, colored charts and graphs into the Oval Office to illustrate Florence’s dangerous path for Trump, who is a visual learner. And the president made a rare trip outside, to visit the staff of the National Security Council’s resilience office housed across the street in the Eisenhower Executive Office Building. (Rucker, Costa and Dawsey, 9/13)

Florida Republicans are angered by President Donald Trump advancing a conspiracy theory casting doubt on Hurricane Maria’s estimated death toll in Puerto Rico. Even Trump’s two top Florida allies, Gov. Rick Scott and GOP gubernatorial candidate Ron DeSantis, disagreed with his insensitive comments. (Caputo, 9/13)

Emails released Thursday by congressional Democrats show correspondence between first responders that appears to undermine the Trump administration’s public reporting of the human toll from Hurricane Maria last year. In one email, dated Sept. 29, 2017, a first responder — whose name has been redacted — describes “finding mass graves in mud slide areas,” and requests counseling support for federal first responders in the area. An unnamed Army National Guard general is included in the correspondence. (Wilhelm, 9/13)

When mandatory evacuation orders are issued for natural disasters like hurricanes, it poses a special challenge for those who are frail and in poor health. Patients with disabilities or who are in hospice care may be too ill to sit in cars inching along evacuation routes for hours, and their families must face the wrenching decision of whether it is better to stay or go. For people with dementia, evacuations can be especially disorienting and overwhelming. (Rabin, 9/14)

While people can move out of harm’s way as Hurricane Florence advances on North and South Carolina, their structures remain behind to face the storm’s full force. In the Carolinas this means not only homes, schools and towns but ponds of coal ash, Superfund sites, chemical plants — and thousands of industrial hog farms with lagoons filled with pig waste. Here is where the danger lies, and why. (Pierre-Louis, Popovich and Tabuchi, 9/13)

Behold the awesome power of water. Already the ocean is swallowing beaches, roads and anything else in the way of Hurricane Florence's monstrous storm surge. Storm surges aren't walls of water, like a tsunami, as commonly thought. Caused by a hurricane's winds pushing relentlessly on the shore, they are more like domes of high water that form as the ocean spreads inland. The high water has destructive waves on top, and it comes in addition to normal tides. (Borenstein, 9/14)

President Trump’s splashiest idea for lowering the cost of prescription drug prices was to force pharmaceutical companies to include the prices of their products in TV and other advertisements. But when Capitol Hill had a chance Thursday to help him achieve that goal, lawmakers failed. And counterintuitively, it was House members in the president’s own party who ultimately nixed the provision. In fact, it was a Democrat, Sen. Dick Durbin of Illinois, pushing the measure hardest. (Florko, 9/13)

Lawmakers and aides said that House Republicans objected to including the provision in the final version of the funding bill, which was finished by House and Senate negotiators on Thursday. Sen. Dick Durbin (D-Ill.), one of the sponsors of the provision, blamed pharmaceutical companies for exercising their influence to block the measure. “When are we going to stand up to Big Pharma?” Durbin asked. (Sullivan, 9/13)

GOP leaders believe they’ve found a way to thwart President Donald Trump’s latest shutdown threats: Send him a funding bill that’s impossible to resist. Capitol Hill leaders on Thursday announced a mammoth fiscal 2019 spending deal that achieves one of the Trump administration's top priorities — the Pentagon’s first on-time spending bill since 2008. But there’s a catch. The same package also funds some of the government’s most sprawling agencies at levels that are billions of dollars more than Trump requested. And if Trump refuses to sign it, much of the government, including parts of the Pentagon, would shutter. (Ferris, 9/13)

Government funding runs out on Sept 30. Congress is working to send Trump a number of must-pass spending bills for 2019 before then — including crucial measures funding the Pentagon and Health and Human Services Department. On Thursday, the House overwhelmingly passed a $147 billion three-bill package funding Veterans Affairs, military construction and numerous other programs, sending it to Trump for his signature. (Werner, 9/13)

The final appropriations bill for the departments of Labor, Education and Health and Human Services would provide nearly $178.1 billion in regular fiscal 2019 discretionary funding, splitting the difference between the two chambers with almost $1 billion more than the current year.The measure would provide $10.7 billion more than President Donald Trump requested for the agencies overall in fiscal 2019, more than three-fourths of which would have come from education programs. But Trump is expected to sign the measure, given it is packaged with the massive Pentagon appropriations bill, as well as stopgap funding to avoid a partial shutdown of government operations through Dec. 7, after the midterm elections. (Siddons, 9/13)

HHS Secretary Alex Azar sidestepped questions from two Democratic senators about whether his agency and the Labor Department have investigated and taken enforcement action against Anthem and other insurers that allegedly violated consumer rights by denying coverage for emergency care. In a letter to Sens. Ben Cardin (D-Md. and Claire McCaskill (D-Mo.), Azar said states are generally responsible for insurance regulation and enforcement, citing one investigation where federal officials probed denied emergency care case. (Meyer, 9/13)

Maryland's attorney general on Thursday filed a lawsuit against President Donald Trump's administration for recurring efforts he says are intended to dismantle the national health care law and chase people away from coverage. The lawsuit filed in U.S. District Court of Maryland comes as the latest push to scrap the Affordable Care Act has pressed ahead in Texas. (McFadden, 9/13)

The Maryland suit lands one week after the Trump administration told Fort Worth federal judge Reed O’Connor it has no qualms about his striking down the act, only that doing so too quickly could unleash "chaos." Twenty Republican-led states sued in Texas arguing the health care law became unconstitutional when Congress repealed the the tax penalty incurred for failing to comply with a requirement to obtain minimum qualifying coverage. (Harris, 9/13)

Illinois is getting 78 percent less federal money this year to hire Obamacare workers to help people enroll in health insurance plans, causing some advocates to worry that more Illinois residents will go without coverage. The federal Centers for Medicare & Medicaid Services is handing two Illinois organizations $389,216 this year, down from nearly $1.8 million distributed to five Illinois groups last year, the agency announced Wednesday. One of the largest groups that got grant money for navigators in the past, the United Way of Metro Chicago, won’t get any money this time around. (Schencker, 9/13)

Health insurance premiums for 5,700 small businesses in California — which employ roughly 47,000 workers — will go up 4.6 percent in 2019, Covered California announced Thursday. The increase applies to the small slice of California companies and workers that get their health insurance from Covered California for Small Business, the exchange created under the Affordable Care Act where companies with 100 or fewer workers can buy health plans for their employees. (Ho, 9/13)

Premiums for Connector plans will, on average, increase 4.7 percent in 2019 — far less than the increases that took effect at the beginning of 2018, officials said Thursday. The rates for 2018 soared 20 percent, on average, and 24 percent for the most popular plans, after the White House halted federal payments that help subsidize coverage for many lower-income individuals. (Dayal McCluskey, 9/13)

Georgia’s uninsured rate ticked up slightly, to 13.4 percent, in 2017, the U.S. Census Bureau reported this week. That’s the fourth-highest rate in the nation. (Miller, 9/13)

The Connecticut Insurance Department announced Thursday that premiums for individual and small group plans can rise only about 3 percent on average in 2019, lower than the increases approved in recent years. Insurance Commissioner Katharine Wade ruled that the average increase for individual plans is 2.72 percent, down from an average request of about 12 percent. (Rigg, 9/13)

The bitter Senate fight to confirm Brett M. Kavanaugh to the Supreme Court plunged into deeper chaos Thursday as a top Democrat disclosed she had referred “information” about President Trump’s nominee to the FBI. Sen. Dianne Feinstein (D-Calif.) issued a brief, cryptic statement about the referral, but the absence of any details only raised questions. The information came in a letter that describes an alleged episode of sexual misconduct involving the 53-year-old Kavanaugh when he was in high school, according to a person familiar with the matter. (Kim and Viebeck, 9/13)

The “individual strongly requested confidentiality, declined to come forward or press the matter further, and I have honored that decision. I have, however, referred the matter to federal investigative authorities,” Feinstein said in a statement. (Everett and Dovere, 9/13)

Several Democrats on the committee declined to talk about the contents of the letter on Thursday after a hearing in which a vote on Kavanaugh’s nomination was slated for Sept. 20. It was unclear whether they had seen it. Anyone can make a referral to the FBI and it does not mean Kavanaugh is under federal investigation. Kavanaugh’s nomination is under intense scrutiny by Democrats who argue he would be the fifth solid conservative justice on the Supreme Court, a lock for Republican priorities such as scaling back abortion rights. (Haberkorn, 9/13)

The Senate Judiciary Committee delayed its vote on Supreme Court nominee Brett M. Kavanaugh until next week, as the deeply bitter fight over his confirmation intensified and a handful of moderate senators continued to deliberate privately over whether to support him. (Kim, 9/13)

Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, resigned on Thursday amid reports that he had failed to disclose millions of dollars in payments from health care companies in dozens of research articles. The revelations about Dr. Baselga’s disclosure lapses, reported by The New York Times and ProPublica last weekend, have rocked Memorial Sloan Kettering, one of the nation’s leading cancer centers, in recent days. Its top executives scrambled to contain the fallout, including urgent meetings of physician leaders and the executive committee of its board of directors. (Thomas and Ornstein, 9/13)

The recent revelation that a leading official at Memorial Sloan Kettering Cancer Center failed for years to disclose lucrative financial conflicts of interest might have been surprising in its scale. But it’s old news that many researchers aren’t fully transparent when it comes to their financial relationships with industry. So why should we keep up the charade? And why, given the clarity of the problem, do medical journals continue to take authors at their word — only to wind up looking like dupes? (Oransky and Marcus, 9/14)

Dr. H. Gilbert Welch, one of the country’s top health care policy scholars, has resigned from his faculty position at Dartmouth College, after an investigation by the school concluded that he had committed research misconduct. ...STAT and Retraction Watch reported last month that an internal Dartmouth investigation found that Welch plagiarized material from a Dartmouth colleague and a researcher at another institution for a 2016 paper published by the New England Journal of Medicine. The paper concerned how breast cancer screening led to the overdiagnosis of tumors and unnecessary treatments. (Joseph and Marcus, 9/13)

More than two years after the federal government released controversial guidelines for prescribing opioids, a new analysis suggests the effort is having an impact as the number of prescriptions for the addictive painkillers has declined. Here are some numbers: In January 2012, nearly 6,600 opioid prescriptions were dispensed per 100,000 people, but by December 2017, that fell to 4,240. And from the time the guidelines were issued in March 2016 until last December, there were an estimated 14.2 million fewer prescriptions filled than if previous trends continued. There were nearly 1.3 million fewer high-dose prescriptions written as well. (Silverman, 9/13)

A bipartisan group of senators asked the CMS to expand the Medicare Advantage value-based insurance design model to include substance abuse disorder patients, saying it could help combat the opioid epidemic. Starting in 2020, the CMS should add substance use disorders to the specified clinical conditions identified in the current demonstration, Sens. Bob Casey (D-Pa.), John Thune (R-S.D.) and Chuck Grassley, (R-Iowa) wrote in a letter to CMS Administrator Seema Verma on Wednesday. (Dickson, 9/13)

Opioid powerhouse Purdue Pharma lied to the Oregon State Board of Pharmacy and targeted senior citizens, claims a lawsuit filed Thursday by the Oregon Attorney General Ellen Rosenblum. Rosenblum's office filed a notice June 27 in a first step toward suing the Oxycontin manufacturer over what the state says are 10 years of violations of a state settlement. The notice demanded Purdue abide by the terms of a 2007 settlement or Oregon would sue. (Harbarger, 9/13)

Leaders in organized medicine in California and nationally are expressing horror over the state medical board's "Death Certificate Project." "This is terrifying," said Barbara McAneny, MD, president of the American Medical Association and an Albuquerque, N.M., oncologist. It "will only discourage doctors from taking care of patients with pain." (Clark, 9/12)

Mayor Martin J. Walsh said Thursday that the city has filed a lawsuit against 13 drug manufacturers, four distributors, and a local doctor, blaming the prescription painkiller industry for an opioid epidemic that has ravaged families across the city and the state. The lawsuit, filed in state Superior Court, seeks reimbursement of more than $64 million the city has spent since 2014 in response to the epidemic, as well as payment for future costs and for rehabilitation services and programs. (Valencia, 9/13)

State officials project accidental drug deaths to remain virtually flat this year, marking the first break in the momentum of an epidemic that has shown double-digit increases year after year since at least 2012. Connecticut’s Office of the Chief Medical Examiner on Thursday announced a projected overdose death total of 1,030 for 2018 — almost identical to the 2017 total of 1,038. There were 515 overdose deaths in the first six months of 2018, the medical examiner reported. (Kara and Rigg, 9/13)

Some of Cuba’s top scientists and medical specialists denounced on Thursday claims that two dozen American diplomats in Havana had been the targets of mysterious attacks over the last two years. The experts were careful not to offer a definitive explanation for the episodes, in which the diplomats reported hearing strange noises that led to symptoms similar to those after a minor traumatic brain injury or a concussion. (Harris, 9/13)

U.S. and Cuban officials met at the State Department on Thursday to discuss the mysterious health problems that have affected more than two dozen American Embassy personnel, a situation that led to a reduction in staffing at the Havana mission and a chill in ties between the countries. "There's a briefing taking place between some of our colleagues from our various bureaus. They are having meetings with the Cuban government to discuss some of the medical issues that our people have experienced," State Department spokeswoman Heather Nauert told a briefing. (Johnson, 9/13)

Jeff Bezos, Amazon.com Inc's founder and the world's richest person, said on Thursday he will commit $2 billion (1.5 billion pounds) to helping homeless families and starting pre-schools for low-income communities. The announcement marks a deeper foray into philanthropy for Bezos, whose fortune has soared to more than $160 billion thanks to his stake in Amazon. Dominance in e-commerce and the nascent field of cloud computing has made Amazon the world's second-most valuable public company. (Vengattil and Dastin, 9/13)

Mr. Bezos’ increase in charitable giving comes as Amazon has faced criticism over the wages it pays to warehouse workers and broader societal effects tied to the e-commerce giant, for example, driving up property prices in its hometown of Seattle. Seattle recently tried to enact a tax to force the company to help with the city’s growing homeless problem, though the decision was later reversed. And Sen. Bernie Sanders introduced a bill aimed at taxing big companies whose employees rely on federal benefits to make ends meet, specifically targeting Mr. Bezos by contrasting his vast personal wealth with the compensation of the companies’ lowest-paid workers. (Stevens, 9/13)

When the new Apple Watch heart monitoring app can get a reading, it can accurately detect that a person has an irregular heart rhythm known as atrial fibrillation 99 percent of the time, according to a study of the new device that Apple submitted to the Food and Drug Administration. ...In one study, Apple tested the watch in more than 580 people, half of whom had atrial fibrillation. The app couldn’t read about 10 percent of the heart rhythm recordings in the study. When it looked at the rest, though, the app was very accurate: It caught more than 98 percent of people with atrial fibrillation, and correctly told people that they didn’t have the condition 99.6 percent of the time. (Sheridan, 9/13)

A public health expert is calling on the National Institutes of Health to change information on one of its websites to more accurately reflect scientific findings about the risk of alcohol. In a letter sent to NIH Director Dr. Francis Collins on Thursday, alcohol researcher Dr. Michael Siegel of Boston University School of Public Health called on NIH to retract and apologize for a statement on the website of NIH’s National Institute on Alcohol Abuse and Alcoholism that says, “Drinking too much alcohol can increase your risk of developing certain cancers,” especially as it regards breast cancer. (Begley, 9/13)

Swedish regulators have closed their investigation of a birth control app after finding that the rate of unwanted pregnancies, which had gained media attention, was actually in line with clinical data. The Swedish Medical Products Agency said Thursday a review found about 7 percent of women using the Natural Cycles app got pregnant in the first half of the year, equal to the "typical use" failure rate in the clinical study submitted for its European certification. (9/13)

She picked up the phone and repeated these words, which had grown familiar, like a refrain in a song she never wanted to sing: “We’re listening. We hear you. We’ve gone through similar things. ”The person on the other end of the line, she said, “had typically just come out to themselves and really wanted to talk to someone.” Isolation in that moment, said Greta Gustava Martela, can be dire. She would know. Martela, a transgender woman, has been hospitalized five times for “suicidality,” a term that encompasses suicidal ideation, planning, gestures, attempts and completed suicide. The first time was in 1995, said Martela, who is now 49. (Stanley-Becker, 9/14)

For years, eggs were synonymous with a healthy breakfast. Then the tables turned. Doctors and nutritionists started saying not to eat eggs, particularly if you wanted to avoid heart disease. The problem: Eggs contain unwanted cholesterol, and diners ingest more saturated fat when they consume eggs prepared in typical ways. But eggs also are rich in protein and other important nutrients, leading some scientists to argue that the benefits of eating eggs outweigh the risks. (9/13)

Government scientists have presented new evidence that the plastic additive BPA isn't a health threat. Low doses of the chemical given to hundreds of rats, "did not elicit clear, biologically plausible adverse effects," said K. Barry Delclos, a research pharmacologist at the Food and Drug Administration's National Center for Toxicological Research. (Hamilton, 9/13)

Previous studies have shown marijuana use is on the rise among young adults, but it’s also becoming more prevalent with a group on the other end of the age spectrum, according to a new report. (Parker, 9/13)

It's early in the morning and 20-year-old Aaron Reid looks like he's sleepwalking. His head nods forward and he shuffles a bit as he heads toward the pediatric clinic at the National Institutes of Health Clinical Center. Reid, who has been fighting leukemia since he was 9-years old, is experiencing intense pain. (Davis and Stein, 9/14)

Kaiser Health News: Discreetly Tracking Down Sex Partners To Stop A Surge In STDs

The U.S. is in the middle of a steep and sustained increase in sexually transmitted diseases.So how are public health officials responding? In northwest Oregon’s Clackamas County, health officials have decided to ask anyone who comes in with an STD who their sexual partners are — and then track those partners down. (Foden-Vencil, 9/14)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ A Detour On A Smoking Off-Ramp

The Food and Drug Administration declared Wednesday that vaping among teenagers has reached “an epidemic proportion.” The agency told five major e-cigarette manufacturers that they had 60 days to find ways to keep their products away from minors. “I use the word epidemic with great care,” FDA Commissioner Scott Gottlieb said in a Wednesday news release. “E-cigs have become an almost ubiquitous — and dangerous — trend among teens.” Yet, as the panel discusses, health advocates warned that the actions may not be strong enough. (Tribble, 9/13)

After more than a year of bickering, Colorado officials have settled a lawsuit with prisoners that accused the state of failing to provide sufficient access to hepatitis C treatments. And in doing so, Colorado may effectively become the first state in the U.S. to provide care to all chronically infected inmates. The deal is the second such settlement among several class-action lawsuits filed against state prison systems around the country over access to the pricey medicines. A lawsuit was settled earlier this year with Massachusetts officials, while others are pending in five other states — Indiana, Minnesota, Missouri, Pennsylvania, and Tennessee. (Silverman, 9/13)

Florida is one of seven states that bar people with a criminal record from receiving victim compensation. The laws are meant to keep limited funds from going to people who are deemed undeserving. But the rules have had a broader effect: An analysis of records in two of those states — Florida and Ohio — shows that the bans fall hardest on black victims and their families, like the Campbells. (Santo, 9/13)

Even if Democrats take back the governor’s mansion, don’t expect Medicaid expansion — let alone Medicare for all — in Florida any time soon. That’s the message from leaders of the Florida Legislature as the governor’s race between Democrat Andrew Gillum and Republican Ron DeSantis inches toward its November conclusion. (Koh and Wilson, 9/13)

Ads don’t always tell the whole story: Hurd was one of 20 Republicans who defected from his party at a pivotal moment last year — the repeal of the Affordable Care Act by a narrow margin in the GOP-run House. With or without details, Democrats across the country are unleashing a fusillade of commercials and campaign tactics tied to health care, the issue many see as the ticket to regaining control of the House in November. (Lambrecht, 9/13)

The $61.1 billion spent last year was just a 1.6 percent increase, well below a state imposed benchmark. But health insurance premiums rose at two to four times that rate, and the total we shelled out for deductibles, co-pays and other out of pocket expenses rose faster too: at almost six percent. (Becker, 9/13)

A former office manager and bookkeeper for a La Grande urologist is accused of embezzling about $1 million from the medical practice and then impersonating an IRS official in an effort to conceal the scheme. Anndrea D. Jacobs, 47, of La Grande made her first appearance in U.S. District Court in Portland after her arrest Thursday morning on a 15-count indictment. She entered not guilty pleas to four counts of wire fraud, five counts of filing false tax returns, four counts of aiding in the preparation of a false tax document, impersonation of a U.S. employee and aggravated identity theft.  (Bernstein, 9/13)

Rejecting a 2015 state law, a federal appeals court ruled Thursday that California cannot charge railroads a $45-per-car fee for carrying crude oil, gasoline and other hazardous materials into the state to help pay for cleanup costs resulting from environmental accidents. The fee, part of a companion bill to the state budget, was intended to raise up to $10 million a year to pay for state and local emergency-response programs for spills of hazardous substances. (Egelko, 9/13)

A federal Medicare investigation has found that Fairview Southdale Hospital violated the privacy rights of certain patients by taping them without their knowledge during psychiatric evaluations in the emergency department. The investigation centered on a woman who was taken to the emergency room of the Edina hospital against her will in May 2017 because police officers feared she might harm herself or others, according to a summary document released Wednesday by the U.S. Centers for Medicare and Medicaid Services (CMS). (Olson, 9/13)

Geisinger, Intermountain Healthcare and 39 other leading healthcare organizations announced Thursday they are joining forces to improve the quality of medical diagnoses. The coalition, called ACT for Better Diagnosis and led by the Society to Improve Diagnosis in Medicine, will focus on identifying the main causes of diagnostic errors and working toward solutions. The coalition is the largest effort to focus on the issue to date. The Society to Improve Diagnosis in Medicine formed a similar coalition in 2015 but it only included 14 organizations. (Castellucci, 9/13)

The study, called BabySeq, ran for four years and is now beginning to publish its findings. One of its first, out this week in the journal Genetics In Medicine: Ben's parents' willingness to have his DNA analyzed is looking very much like the exception, not the rule. Of the first 3,800 families of newborns that the researchers approached at top Boston hospitals, only 268 signed up. (Goldberg, 9/13)

The University of Kansas Hospital unit that treats blood cancers like leukemia and lymphoma is “bursting at the seams,” the head of the division said Thursday. In the last 10 years, Joseph McGuirk said, his division has gone from performing about 40 bone marrow transplants a year to 300 and become a regional destination for patients who want to try a groundbreaking immunotherapy called CAR-T because they’re out of other treatment options. (Marso, 9/13)

Minnetonka-based Medica plans to start courting business from health systems across the country that want to develop insurance policies for their regional markets, and will offer access to the Mayo Clinic for complex care as part of the deal. The initiative announced Thursday would let Medica partner with health care systems that increasingly are looking to create "accountable care organizations" where insurers and care providers share the financial risks and rewards of financing care for large groups of people. (Snowbeck, 9/13)

To date, 4 states (Arkansas, Indiana, Kentucky, and New Hampshire) have federal waivers to impose work requirements as a condition of eligibility for Medicaid (although a judge recently stayed Kentucky’s waiver), and 7 other states (Arizona, Kansas, Maine, Mississippi, Ohio, Utah, and Wisconsin) have submitted waiver applications. The governor of Kentucky claimed that excluding “able-bodied” adults will reduce Medicaid enrollment by 16%, ensuring the program’s “fiscal sustainability.” However, such claims may be overstated because many Medicaid enrollees already work, and waivers have specified that many others (eg, people with disabilities and caregivers of young children) will be exempted. To our knowledge, no studies have quantified the potential influence of work requirements on Medicaid spending. We estimated the number of Medicaid enrollees at risk of losing coverage if work requirements are implemented with the exemptions specified in approved waiver applications, and we calculated current Medicaid spending for those enrollees at the national level and among states with approved or pending waivers. (Goldman et al, 9/10)

Reference pricing is an emerging health insurance benefit design aimed at reducing health costs. In this model, an insurer establishes a maximum payment that it will contribute toward covering the price of a product or service in situations where there is wide price variation for therapeutically similar drugs, diagnostics, or procedures. Experiences to date indicate that reference pricing can influence patients and physicians to switch to less costly options within each therapeutic class, reducing overall drug prices. (Robinson, 9/10)

An estimated 40 percent of low-income Medicare beneficiaries spend 20 percent or more of their incomes on premiums and health care costs. Low-income beneficiaries with multiple chronic conditions or high need are at particular risk of financial hardship. High cost burdens reflect Medicare premiums and cost-sharing, gaps in benefits, and limited assistance. Existing policies to help people with low incomes are fragmented — meaning that beneficiaries apply separately, sometimes to different offices — and require Medicare beneficiaries to navigate complex applications. (Schoen et al, 9/12)

During the last century, California policy makers tried multiple approaches to achieve the goal of affordable health coverage for all: employer and individual requirements, single payer, and hybrids. All failed, primarily because of the amount of financing needed to cover the large numbers of uninsured Californians and the supermajority vote requirements for tax increases. These failures, however, provided important lessons for state and national reform efforts. More immediate success was achieved with incremental reforms, such as child health insurance, Medicaid section 1115 waivers, and the creation of purchasing pools. These reforms, as well as the experience derived from the broader coverage expansion efforts, contributed to the intellectual and policy frameworks that underlay major national reforms and created building blocks for the state’s successful implementation of the Affordable Care Act. That act allowed California to meet its greatest need: the financing required to make a truly sizable dent in the numbers of uninsured Californians. (9/4)

Benzodiazepine use among older adults is common despite evidence for many potential risks. While treatment guidelines recommend short-term use of benzodiazepines, up to one-third of use is long term, which is most common among older adults. To reduce benzodiazepine prescribing to older adults, one potential point for intervention is at the transition from new to long-term use, yet little is known about the factors that predict conversion to long-term use. (Gerlach et al, 9/10)

As a potentially catastrophic Hurricane Florence barrels toward the Carolinas, an extensive disaster recovery is likely no longer an “if” but a “when.”  Yet many flaws with our disaster preparation and recovery remain unaddressed, even after the wake-up call of  last year’s devastating natural disasters. The Urban Institute partnered with the Texas Low Income Housing Information Service to explore the chain of disaster recovery and data collection to identify areas where people might get left behind. (Martin, 9/11)

If you’ve stopped being surprised by the flagrancy of President Trump’s deceptions, you’re not alone. Yet the president’s effort on Thursday to deny the nearly 3,000 American lives lost in Puerto Rico in the aftermath of Hurricane Maria last year — and to accuse Democrats of inflating the death toll for political gain — should amaze even the most jaundiced Trump-watcher. (9/13)

When President Trump arrived in Puerto Rico in October, about two weeks after Hurricane Maria hit the island, the commonwealth was still in the early stages of its recovery. Days after he left, only 10 percent of the island had power, only a quarter of cellphone towers were operational and only half the island had running water. A report from the Government Accountability Office released this month noted various reasons for the slow recovery, including a lack of resources, difficult terrain and crippled infrastructure. (Philip Bump, 9/13)

On Sept. 20 last year, Hurricane Maria made landfall in Puerto Rico, tearing apart the island’s antiquated power grid, destroying homes, shuttering schools and hospitals, upending the water supply and leaving about 3,000 people dead according to the most recent, independent estimates. President Donald Trump and his administration didn’t convene a meeting in the White House’s Situation Room to discuss the federal government’s disaster relief response until six days after Maria hit. (Timothy L. O’Brien, 9/13)

A little more than a year ago, Houstonians looked out the window and glimpsed the apocalypse — and yet we still stand. We know you will stand strong, too. We also know what it can feel like to turn to the White House for leadership and compassion, only to get a paper towel roll to the face. If Houston can offer any lesson, it’s that you must grasp ahead of time how this recovery will be different than others. (9/12)

The most significant part of the Affordable Care Act, itself the most significant piece of social legislation passed in decades, was its expansion of Medicaid. The idea was that no one should go without health insurance because they can’t afford it, so the program was expanded to cover millions of Americans who, though extremely poor, weren’t eligible under the often restrictive rules set by states. But the fact that so many people now get insurance from the government stuck in Republicans’ craws. They quite literally would rather see someone go without health coverage than see them get that coverage from the government, and ever since it went into effect they’ve been trying to undo it. (Paul Waldman, 9/13)

In 1563, Elizabethan English law distinguished between the deserving poor, or those who wanted to work but could not because of infirmity or lack of available work, and the idle poor, or those who were judged able to work but would not. While the deserving poor were to be aided, the idle poor were to be punished. Four hundred fifty years later, the United States is still debating which of the poor are deserving and what they are deserving of. One of the current battlegrounds is work requirements for Medicaid recipients to receive health insurance benefits. The Centers for Medicare and Medicaid Services (CMS) announced a new policy in 2018 supporting state efforts to make work or other community engagement a requirement for Medicaid coverage. Thus far, 11 states have submitted work-requirement policies and CMS has approved 4 such waivers. (Dave A. Chokshi and Mitchell H. Katz, 9/10)

The Sanders plan of taxpayer-paid single-payer health care will not work for three reasons. It is built on a model of Medicare from a quarter-century ago; Medicare today is different. Medicare in 2018 no longer a single-payer plan — despite the attraction of that political slogan. (Thomas Heftly, 9/13)

Thirty years ago in December, the modern exchange of scholars between the U.S. and China began. Since then, Chinese academics have become the most prolific global contributors to publications in physical sciences, engineering and math. Recent attempts by the U.S. to curtail academic collaboration are unlikely to change this trend. For decades, China's growth was driven by shifting workers from agriculture to manufacturing. As the country started to approach the so-called Lewis turning point, when such shifts no longer raise overall productivity, the government made an increasingly concerted effort to build the scientific base to provide another vector for growth. The results of those efforts are showing up in both the rankings of Chinese universities (11 of the top 100 globally) and in scholarly output. (Peter R. Orszag, 9/12)

Recently, I was the hospital attending physician on service when the team admitted an elderly patient. Despite the obvious end-of-life status, the family wanted everything done to keep the patient alive. They made unrealistic demands, were disrespectful, and at times were outright hostile. They did not want to work with the medical student, who was Muslim. They also did not want to work with the intern, whom they felt was not a real physician. The senior resident, despite being from a neighboring US state, was not allowed to touch the patient because the family believed that the resident’s skin was too dark for an American. To say that this family was disappointed when they learned that I, the attending physician, was a woman would be an understatement. After a brief introduction, I let the family know that we work as a team, and they would be working with all of us. Later when I discussed this out-of-the-ordinary behavior with the team, I asked, “What did you do when you recognized the disrespectful behavior from this family?” (Amy Nicole Cowan, 9/10)

There isn’t a lot of good news coming out of the federal government these days. But we got some yesterday. The Food and Drug Administration announced it was cracking down on the epidemic of electronic-cigarette use by teenagers. The agency took a range of actions against manufacturers and retailers to reduce youth e-cigarette use and threatened to do more in the coming months. (David Leonhardt, 9/13)

When millions of kids and teens are at risk of becoming nicotine addicts, the feds certainly ought to get tough.The Food and Drug Administration rightly took a hard line with the five largest makers of flavored e-cigarettes, giving them 60 days to come up with plans to curb underage use of the increasingly popular devices — or risk having them pulled from the market. (9/13)

Wednesday’s announcement that the next iteration of the Apple Watch can both monitor the wearer’s heart rhythm and, if a suspicious reading emerges, perform an electrocardiogram, could be a boon for users and their doctors. Or it could be a massive headache for the health care system. (Anthony Pearson, 9/13)

What impresses me about the Apple Watch Series 4 isn’t the cool apps and watch faces or even how nice it looks on your wrist, but the fact that it can, literally, save lives. Apple has built-in a sensor that it says is “capable of generating an ECG similar to a single-lead electrocardiogram.” (Larry Magid, 9/12)

If someone you love is dying, how much are you willing to pay for just one more day with them?Doing the math, Melany Knott figured it cost about $1,100 a day. That got them 21 months. “No regrets,” Knott said. “I wouldn’t change a thing. And I won’t wonder about anything. ”The Knott family auctioned off chain saws, goats and guns to raise some of the $695,000 they spent. They raided their savings, college funds, maxed credit cards and doubled down on the double shifts. They did fundraisers at the county fair and ran online tote bag sales to pay for untested treatments offered at a medical clinic in Mexico. (Petula Dvorak, 9/13)

Wrong place, wrong time — “I was shot nine times,” a teenager, whom I’ll call J.B. to protect his safety, told me. “I got shot because they had a gun and they wanted to do something.” Somehow he survived. Drive-by shootings are commonplace in Chicago’s Englewood neighborhood, where the homicide rate rivals that of the world’s most murderous cities. One boy arrested for having a gun was asked why he carried it. “You need to be ready to defend yourself,” he said. “Two of my friends were shot. It was a drive-by, turf war.” (David L. Kirp, 9/13)

I didn’t notice my skipped period. I had switched birth control pills, and my menstrual cycle had always been a little irregular. It wasn’t like a movie, either. When I started vomiting, it didn’t even dawn on me that I was pregnant. I thought it was some symptom of cancer. Nor can I remember where or how I ended up getting a pregnancy test. I just know that at some point I figured I couldn’t take a home test for anything else, so I might as well rule this possibility out. (Marisa Meltzer, 9/13)

The marijuana industry is coming at us fast and furious, demanding we legalize another harmful drug. It’s an issue about to come before voters, and it will change our country. Every single state that has commercialized marijuana has seen a multitude of public health concerns. Below are just a few studies that prove that the social disease that is recreational marijuana is true and undeniable. Alcohol used to be the main culprit when it came to impaired driving, but that drug is getting a run for its money from marijuana. So much so that recently the National Highway Traffic Safety Administration launched an awareness campaign. (Kevin Sabet, 9/13)

While children’s hospitals lose money on Medi-Cal patients, they compensate by being aggressive with commercial insurers and building powerful fundraising operations. And like other interest groups, children’s hospitals have won taxpayer dollars through the ballot.In November, California voters are all but certain to approve Proposition 4, a $1.5 billion bond issue that is the third general obligation bond for children’s hospitals in the past 14 years. (Joe Mathews, 9/13)