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The disclosure on Thursday of dozens of previously secret emails involving Judge Brett M. Kavanaugh provoked pointed new questions on the third day of his Supreme Court confirmation hearings, as Democrats pressed him to explain fresh disclosures on abortion rights, affirmative action and previous testimony to the Senate. Much of the tumult surrounded one quotation from an email that Judge Kavanaugh wrote as a lawyer in George W. Bush’s White House concerning the landmark abortion decision Roe v. Wade: “I am not sure that all legal scholars refer to Roe as the settled law of the land at the Supreme Court level since Court can always overrule its precedent, and three current Justices on the Court would do so.” (Savage and Stolberg, 9/6)

The nominee told senators at the hearing that in the email he was evaluating how the Supreme Court might view a particular issue, not providing his own viewpoint on Roe. Judge Kavanaugh established a strongly conservative record on the D.C. Circuit Court. If he is confirmed to replace the retiring Justice Anthony Kennedy, it is expected by Republicans and Democrats alike to shift the Supreme Court’s jurisprudence sharply to the right. (Bravin and Tau, 9/7)

But his 2003 email pointed out what he hasn’t acknowledged in testimony on Roe — that the Supreme Court could reverse precedent. “To be very clear, Judge Kavanaugh personally highlighted that precedent can be overturned,” Sen. Patty Murray (D-Wash.), the ranking member of the health committee, said in a press conference Thursday. “And he was literally counting the number of judges who stand ready to overturn Roe v. Wade.” (Cancryn and Roubein, 9/6)

Democrats have fumed for weeks over the withholding of hundreds of thousands of pages of documents from Kavanaugh’s years in the George W. Bush White House, including a massive tranche of records that lawyers working for Bush had limited only to Judiciary Committee senators. That secrecy collapsed in dramatic fashion Thursday as Democratic senators vowed to begin releasing records they said were unfairly withheld and highly relevant to the confirmation. (Schor, 9/6)

Judge Kavanaugh’s abortion views created a stir outside the hearing room. Adding to the concerns of abortion rights advocates was a Kavanaugh reference to contraceptives as “abortion-inducing drugs.” He was answering a question from Senator Ted Cruz, Republican of Texas, about his dissent in a case involving Priests for Life, a religious organization that objected to a regulation under the Affordable Care Act requiring many employers to provide free insurance coverage for contraception to their female workers. The group had objected to an accommodation offered by the Obama administration that allowed it to obtain a waiver by completing a form. (Stolberg, Savage and Liptak, 9/6)

A newly released email by Brett Kavanaugh, weighing in on the future of abortion rights, is putting new pressure on two moderate Republicans who hold the keys to his confirmation. But Lisa Murkowski of Alaska and Susan Collins of Maine aren’t raising concerns yet. (Everett, 9/6)

Members of the Senate Judiciary Committee, including some Republicans, pressed Kavanaugh about the judge’s expansive views of presidential power and past writings that concluded civil suits and criminal investigations of presidents would be better delayed until the chief executive left office. Democratic senators said it was crucial to have an independent Supreme Court in what Sen. Richard J. Durbin (D-Ill.) called “the age of Trump.” (Barnes, Kim, Marimow and Berman, 9/6)

With Republicans in control of the Senate, Kavanaugh now appears on track to be confirmed by the end of the month. “You’re gonna get confirmed,” Sen. Lindsey Graham (R-S.C.) told him. “You’re gonna make it.” (Haberkorn, Savage and Wire, 9/6)

When a patient arrived this spring at the only abortion clinic in western Arkansas, the doctor had startling news: A new state law had gone into effect, and clinics could no longer perform abortions via medication in the state. “Wait — all of Arkansas?” the patient asked her doctor, Stephanie Ho. “Yes,” Dr. Ho remembered replying. (Tavernise, 9/7)

The questioning of Judge Brett M. Kavanaugh had not even begun Thursday morning when Senator Cory Booker, Democrat of New Jersey, threatened to release secret emails — even if it meant being expelled from the Senate. “This is about the closest I’ll ever come in my life to an ‘I am Spartacus’ moment,” the senator declared with a flourish. (Stolberg, 9/6)

Sen. Cory Booker (N.J.) on Thursday portrayed himself as a rebel willing to face expulsion from the Senate for releasing confidential documents from Kavanaugh, describing it as his “I am Spartacus” moment. In reality, the documents had already been cleared for release. Sen. Kamala D. Harris (Calif.) hinted that she might have hard evidence that Kavanaugh spoke about the special counsel investigation with someone at the law firm founded by Trump’s personal attorney. But she offered no such details when pressed. Booker and Harris, two of the Democratic Party’s most prominent African Americans, took the headline-grabbing but shaky steps to put their opposition to Trump and Kavanaugh on full display for the country. (Sullivan, 9/6)

The Trump administration moved on Thursday to remove court-imposed time limits on the detention of migrant children, proposing to end 20 years of judicial oversight and allow families to be held indefinitely in secure facilities as their cases wend through the immigration courts. The proposed new regulation reflects President Trump’s frustration that thousands of families from Central America and elsewhere are continuing to stream across the southwest border, assured in part by guarantees in the current legal process that migrants who arrive with children will not be held for long periods in detention. (Dickerson, 9/6)

Department of Homeland Security and Health and Human Services officials said Thursday that they want to circumvent the so-called Flores agreement, a 1997 court settlement that prevents authorities from detaining children for more than 20 days. The proposal, announced as a rule change in the Federal Register, signals that officials are looking for ways to detain families together until their immigration cases are decided amid the administration’s efforts to crack down on illegal border-crossers. The proposal is almost certain to face legal challenges. The administration earlier this year asked a federal judge in California to let officials detain families together beyond the 20-day limit and was denied. (Caldwell and Gurman, 9/6)

"Legal loopholes significantly hinder the Department’s ability to appropriately detain and promptly remove family units that have no legal basis to remain in the country," Homeland Security Secretary Kirstjen Nielsen said in a written statement. "This rule addresses one of the primary pull factors for illegal immigration and allows the federal government to enforce immigration laws as passed by Congress." (Hesson, 9/6)

The proposal has been in the works for months, as the Trump administration and congressional Republicans have sought ways to deal with the influx of families illegally crossing the country’s southern border. (Weixel, 9/6)

HHS is boosting the $1.3 billion originally earmarked this year for care of migrant unaccompanied minors by more than $100 million, a sign that the system's expenses are increasing under enhanced scrutiny following the Trump administration's halted family separation policy. "HHS is utilizing the secretary's transfer and reprogramming authorities to provide additional funds for the care of unaccompanied alien children," HHS Deputy Secretary Eric Hargan said in a statement, noting that the department used its transfer authorities to supplement program funding in 2012, 2013, 2014 and 2017. (Luthi, 9/6)

A group formed in the wake of outrage over the separation of immigrant families at the Mexico border criticized an investigation by the state of Arizona into reports that some of those children were sexually abused at shelters. The group Uncage and Reunite Families, composed of elected officials, community activists and religious leaders called on Gov. Doug Ducey to launch an independent investigation after the one conducted by the state health services department only found issues with personnel records and delayed background checks. (Galvan, 9/6)

President Donald Trump's administration should be held accountable for emotional trauma inflicted on children who were separated from their parents at the U.S. border, lawyers say in a lawsuit that could result in compensation for more than 2,000 immigrant families. The federal class-action lawsuit filed late Wednesday seeks unspecified monetary damages and the creation of a fund to pay for mental health treatment for children who were taken away from their parents after the Republican administration adopted a policy requiring anyone who crossed the border illegally to be prosecuted. (Richer, 9/6)

A Boston-based nonprofit is suing the Trump administration on behalf of children who were separated from their parents at the U.S.-Mexico border as a result of President Trump's now-defunct family separation policy. The class action suit asks the federal government to address the long-lasting ramifications of that policy, including the toll on the mental health of the children. (Dooling, 9/6)

The Trump administration’s restrictions on hiring foreign scientists are making it more difficult for the agency to attract top scientific talent, a top Food and Drug Administration official said Thursday. “[The policy] definitely has created an additional challenge, I think, for us,” said Melanie Keller, the FDA’s acting associate commissioner for scientific and clinical recruitment. She added that “the U.S. just doesn’t graduate the number that we need to fill our vacancies.” (Swetlitz, 9/6)

Millions of people covered under the Affordable Care Act will see only modest premium increases next year, and some will get a price cut. That's the conclusion from an exclusive analysis of the besieged but resilient program, which still sparks deep divisions heading into this year's midterm elections. (Hoyer and Alonso-Zaldivar, 9/7)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ Health Policy Goes To Court

A federal judge in Texas seemed sympathetic to the argument by GOP state officials that the Affordable Care Act soon will no longer be constitutional, since Congress eliminated the penalty for not having insurance. The case was filed by 18 state attorneys general and two governors. (9/6)

When writing environmental rules, one of the most important calculations involves weighing the financial costs against any gains in human life and health. The formulas are complex, but the bottom line is that reducing the emphasis on health makes it tougher to justify a rule. Last week the Trump administration took a crucial step toward de-emphasizing the life and health benefits in this calculus when the Environmental Protection Agency said it would rethink a major regulation that restricts mercury emissions by coal-burning power plants. (Davenport and Friedman, 9/7)

Republican and Democratic lawmakers pressed the Environmental Protection Agency on Thursday to act faster to bring more of the country's most hazardous industrial chemicals and substances under tighter regulation, saying agency action on the health risks was "bogged down." The hearing by a House environment subcommittee focused on one of the biggest rapidly emerging health threats to public water systems, a family of widely used industrial coatings now linked to some cancers and to development problems in children, among other health risks. (9/6)

Education Secretary Betsy DeVos has left it to Congress to decide whether states can use federal funds to purchase firearms for their schools, prompting congressional Democrats to begin a last-ditch effort to restrict those funds. Conservatives said Ms. DeVos’s stance was consistent with her championing of local school control. But Democrats and advocates denounced her decision as a tacit endorsement of federally funded firearms in schools, and federal policy experts saw the move as an abdication of the department’s core function to help districts navigate the federal bureaucracy. (Green, 9/6)

A series of attacks with a microwave weapon is the latest theory for what could have sickened or distressed roughly two dozen people associated with the U.S. Embassy in Cuba over the past two years. This hypothesis, advanced in recent days in several news reports, dominated a House Foreign Affairs subcommittee hearing on Cuba policy Thursday afternoon. But a panel of State Department officials said there is still no explanation for the reported injuries. (Kaplan and Achenbach, 9/6)

The U.S. Food and Drug Administration says new guidance about added sugars that will provide an alternate labeling option for pure maple syrup and honey will be released next year. The agency announced months ago that it was considering requiring pure maple syrup and honey to be labeled as containing “added sugars.” Members of the industries that produce those products protested the labels, saying they would be misleading and unfair. (9/6)

The Senate will vote next week on a package of bills aimed at curbing the nation's opioid epidemic, Majority Leader Mitch McConnell (R-Ky.) announced Thursday. McConnell's spokesman said that Democrats had dropped their holds on the legislation. Some Democrats had previously objected to a provision, calling it an earmark for a PhRMA-funded advocacy group. (Hellmann, 9/6)

The agreement comes after weeks of slowed negotiations between lawmakers over hot-button provisions like requiring Medicaid to cover treatment at more inpatient facilities and loosening privacy restrictions for substance-abuse patients' medical records. Neither provision made it into the final deal, but they are part of an opioid response package passed by the House earlier this year. (Ehley and Tahir, 9/6)

Authorities are ramping up their efforts to identify fentanyl flooding the U.S. from China, control the ingredients used to make the deadly synthetic opioid, and prosecute and eliminate the manufacturers. The U.S. State Department and the Drug Enforcement Agency are working with Chinese and Mexican authorities to bolster technology and training to facilitate real-time supply chain data sharing, improve detection of illicit opioids sent via mail, eliminate clandestine labs that produce the products, regulate the precursor drugs used to make the addictive painkillers, and better trace digital transactions. (Kacik, 9/6)

The number of lawsuits filed by states against Purdue Pharma L.P., the maker of prescription painkiller Oxycontin, continues to grow as Colorado’s attorney general on Thursday became the latest to sue the company for its role in the nation’s opioid crisis. Attorney General Cynthia Coffman, in a statement, accused Purdue Pharma of violating the state’s consumer protection law, saying the company ignited the epidemic through “fraudulent and deceptive marketing of prescription opioids.” (Seaman, 9/6)

Maryland authorities announced charges Thursday against an Arizona-based drugmaker that they say engaged in a nationwide scheme "characterized by extraordinary misconduct" to boost profits amid the coast-to-coast opioid epidemic. The office of Attorney General Brian Frosh filed charges against Insys Therapeutics alleging multiple violations of the state's consumer protection law. The pharmaceutical company makes a highly addictive opioid spray used to manage uncontrollable pain for adult cancer patients, but Frosh says Insys joined with local health care providers in a "calculated scheme" to target non-cancer patients, including those seeking relief from knee or back pain. (9/6)

Endo International Plc is seeking to resolve all lawsuits over its Opana painkiller in a deal that would cap its legal exposure and pull it out of talks with other drugmakers and distributors seeking an industrywide settlement of opioid litigation, according to three people familiar with the talks. No numbers have yet been proposed in the talks between lawyers for Endo and attorneys for states, cities and counties, but there have been discussions about changing the way the company markets drugs, according to people who asked not to be named because the negotiations are private. (Feeley and Hopkins, 9/6)

The largest health insurance company in Tennessee will stop covering OxyContin prescriptions next year as part of sweeping policy changes intended to combat opioid addiction and make pain pills less valuable on the black market. The shift is a major blow to one of the drugs that ignited the nationwide opioid epidemic. In place of OxyContin, BlueCross BlueShield of Tennessee will instead encourage doctors to prescribe two other painkillers that are engineered to be more difficult to abuse. (Kelman, 9/6)

The Claremont school board voted Wednesday to allow a needle exchange program to operate at Valley Regional Hospital. The program needed board sign-off because of the hospital’s proximity to a local elementary zone. (Greene, 9/6)

The hiring of Jack Stoddard brings a veteran business mind into the effort to shake up the U.S. health care system by Amazon, Berkshire Hathaway, and JPMorgan Chase — an entrepreneur with a track record of using digital tools to change the way services are delivered to patients while saving money. Stoddard, the Boston-based venture’s new chief operating officer, has worked in health care for 25 years, spending much of that time building companies focused on using data and technology to guide patients to the most appropriate and cost-effective care. Most recently, he led the reshaping of health benefits at Comcast Corp. (Ross, 9/7)

Cigna Corp. sold $20 billion of bonds to fund its takeover of Express Scripts Holding Co., making for the U.S. corporate-bond market’s second-biggest of the year. The health insurer issued senior unsecured bonds in 10 parts, according to a person with knowledge of the matter. The longest portion of the offering, a $3 billion security maturing in 2048, yields 1.87 percentage points above Treasuries, after initially discussing around 2.05 percentage points, said the person, who asked not to be identified because talks with potential investors are private. (Smith, 9/6)

Massachusetts Senator Elizabeth Warren sent a sharply critical letter Thursday to the nation’s secretary of veterans affairs, demanding new, high-level oversight of the agency’s Bedford medical center, which has been the subject of repeated complaints of abuse and neglect. Warren called on the VA to increase “senior level” monitoring of the facility, release agency inspection reports, and give federal lawmakers more oversight. (Estes, 9/6)

Two health care contractors running the federal government's Veterans Choice Program collected more than $101 million in overpayments during 2016-17, an audit released Thursday by the VA Office of Inspector General shows. ...The two VA contractors, Phoenix-based TriWest Healthcare Alliance Corp and Health Net Federal Services of California, allegedly collected $66.1 million in excess payments via duplicate bills, and $35.3 million more as a result of other errors. (Wagner, 9/6)

Passengers and crew on two flights arriving in Philadelphia from Europe on Thursday were screened by medical teams after 12 people aboard became ill with flu-like symptoms, a day after a similar outbreak on a flight from Dubai to New York. All 250 people on separate American Airlines flights from Munich and Paris were "held for a medical review" as a precaution, and the U.S. Centers for Disease Control and Prevention (CDC) was notified, Philadelphia International Airport spokeswoman Diane Gerace said. (Whitcomb, 9/6)

The sick passengers on the Emirates airline flight that landed at Kennedy International Airport in New York on Wednesday were most likely suffering from the flu and common cold, a spokesman for the Centers for Disease Control and Prevention said Thursday. (Pager, 9/6)

In the confusing first hour or two after an Emirates Airline jet was quarantined at New York’s JFK Airport on Wednesday, there was little certainty over how many people were sick or what was ailing them. But one thing was clear: A system years in the making to spot and halt importation of dangerous illnesses to the United States was set into motion. The system, involving federal, state, and local agencies across the U.S. at major ports of entry, is the country’s “hidden safety net,” Dr. Martin Cetron, director of the Centers for Disease Control and Prevention’s division of global migration and quarantine, told STAT. (Branswell, 9/7)

Half a century after Americans began fighting hunger with monthly food stamps, the nation’s physicians and policymakers are focusing more than ever on what’s on each person’s plate. In the 21st century, food is seen as medicine — and a tool to cut health care costs. The “food is medicine” concept is simple: If chronically ill people eat a nutritious diet, they’ll need fewer medications, emergency room visits and hospital readmissions. (Mercer, 9/7)

Scientists reported on Thursday that, in any one patient, untreated metastases are driven by the same genetic mutations, whether they’re in the lung or liver or anywhere else. That conclusion, based on the most extensive analysis to date of metastatic tumors, bodes well for targeted therapies, because it means a single drug should work against all of a patient’s metastases — and it is the metastases, not the primary tumor, that are responsible for 90 percent of cancer deaths. (Begley, 9/6)

The American Academy of Pediatrics is recommending that everyone older than 6 months get a flu shot for the 2018-19 season as soon as it is available, preferably before the end of October. The policy statement, published in the October issue of Pediatrics, states that the inactivated influenza vaccine, which is given as a shot, is best. Children with egg allergy, even severe allergy, can take the shot safely. (Bakalar, 9/6)

[Dr. Pieter] Cohen’s latest target is the stimulant higenamine, an ingredient listed on the labels of weight loss and sports supplements. Working with a public health team from the Netherlands and an international testing lab, the Harvard Medical School associate professor studied 24 products containing higenamine. The amount on the label was never the same as the amount found in the bottle, the team found in a study published Thursday, and the serving sizes also varied, from trace amounts to 110 milligrams per day. (Cooney, 9/6)

Do you think that the private thoughts in your head could influence how other people — or creatures — act? The answer is "Of course not," right? Because to say yes would be to admit you believe in mind control or telekinesis or some other phenomenon usually reserved for superhero comic books. But early in his career, a research psychologist named Bob Rosenthal wasn't so sure. So to test his hypothesis, he designed a devious experiment. (Simstrom, 9/7)

They have been pouring into emergency rooms around the nation all summer, their bodies bearing a blend of injuries that doctors normally associate with victims of car wrecks — broken noses, wrists and shoulders, facial lacerations and fractures, as well as the kind of blunt head trauma that can leave brains permanently damaged. When doctors began asking patients to explain their injuries, many were surprised to learn that the surge of broken body parts stemmed from the latest urban transportation trend: shared electric scooters. (Holley, 9/6)

There is no screening test for a disease that is expected to strike more than 22,000 women and kill more than 14,000 in the United States this year. Those figures are the American Cancer Society's projections for ovarian cancer, the deadliest gynecologic cancer and the fifth-leading cause of cancer-related death among women. Ovarian cancer used to be called "the silent killer" because its symptoms mimic other diseases and are treated as such. Consequently, it's often diagnosed in later stages, when there is a lower survival rate. But the news is getting better. (Molly Callahan, 9/6)

Do not panic, but there is a medical condition in which a person's tongue can take on a dark, woolly appearance — and it is appropriately called “black hairy tongue." Doctors in Missouri diagnosed a 55-year-old woman with the condition last year after she reported feeling nauseated and having a foul taste in her mouth — and a black, hairy-looking tongue, according to a study published Thursday in the New England Journal of Medicine. (Bever, 9/6)

Most nursing homes in Florida are still working to meet new backup-power rules, which were triggered by a dozen patient deaths after Hurricane Irma knocked out air conditioning at their residence a year ago. About 75% of Florida’s 684 nursing homes received a seven-month extension beyond a June 1 deadline to put in place a permanent emergency-power plan, according to state data. All of the nursing homes are still considered compliant because extensions require them to keep temperatures at or below 81 degrees for at least 96 hours after a power loss through temporary measures. (Kamp, 9/7)

In a 30-second television advertisement airing across Massachusetts, a nurse looks toward the camera and declares that government-mandated restrictions on nurses’ caseloads would put hospital patients at risk. ...The two factions warring over ballot Question 1, a measure that seeks to regulate nurse staffing in hospitals, have both released ads — and both are using nurses in scrubs to argue their case. (Dayal McCluskey, 9/6)

They call it Music City, but at its core, modern Nashville is really a health care city. Two of the largest hospital corporations in the nation are headquartered here, and Vanderbilt University Medical Center was recently named one of the best hospitals in the country. The local health care industry spans hundreds of companies and hundreds of thousands of employees and generates billions in revenue each year. But beyond all that business, between the pristine hospitals and corporate headquarters, Nashville knows surprisingly little about the health of everyday residents. And the little we know, unfortunately, isn’t very good. (Kelman, 9/6)

A powerful, if lame-duck, GOP lawmaker has renewed his beef that Gov. Greg Abbott is grabbing power at lawmakers' expense. On Thursday, House State Affairs Committee Chairman Byron Cook sharply criticized Texas' Health and Human Services Commission. He said the agency was about to underhandedly grant an influential anti-abortion-rights group a victory in the rule-writing process that the group couldn't secure in last year's special legislative session. (Garrett, 9/6)

For years, [Chelsea] Chism-Vargas was getting free birth control pills and annual reproductive health exams at Planned Parenthood through a federally-funded family planning program for low-income and underinsured Iowans. ...But Iowa’s Republican-majority Legislature replaced that program with a state-run system that excludes abortion providers. It blocked Planned Parenthood, UnityPoint Health and University of Iowa Hospitals and Clinics from participating. (Sostaric, 9/6)

Thirty-two Georgia health centers that lived through the worst of the 2017 hurricanes will receive $9.6 million in federal grants. The U.S. Department of Health and Human Services announced the awards Thursday. Hurricanes Harvey, Irma and Maria swept through Georgia last year, causing damage, maiming and killing people. (Hart, 9/6)

New findings by Rice University researchers show the stagnant water inside some flooded homes carried indications of antibiotic-resistant bacteria up to 250 times higher than even the floodwater outside. The same markers for the bacteria were found in the sediment left behind weeks after the water receded. The significance of the discovery is that such bacteria could lead to infections more difficult to treat, said Lauren Stadler, assistant professor of civil and environmental engineering at Rice and lead investigator for the study. (Deam, 9/6)

At a Texas Tribune event this Thursday in Laredo, Reps. Tracy King, D-Batesville, and Richard Peña Raymond, D-Laredo, talked with Tribune CEO Evan Smith about topics that affect the communities they represent in South Texas: the next legislative session, healthcare, border security and more. (Rodriguez-Ortiz, 9/6)

A child welfare investigator in Michigan found evidence a male caretaker had sexually abused a child, and the child's mother continued to allow the man — her live-in boyfriend — access to her children during the investigation. State auditors say the investigator didn't refer the case to a prosecutor or file a court petition, assessed far too low of a risk of future harm to the child and closed the investigation with no monitoring of the family afterward. (9/6)

Texas sophomore offensive lineman Patrick Hudson was treated in intensive care and remains hospitalized because of a heat-related illness at practice this week, the school said Thursday night. Hudson, who is 6-foot-4, 335 pounds, was being treated for "exertional heat cramps" Wednesday when medical staff noticed his body temperature rising and he was placed in a cold tub, Texas head athletic trainer Anthony Pass said in a statement. (9/6)

In what became one of the nation’s biggest Legionnaires’ disease outbreaks, 22 people fell sick with the dangerous lung infection last fall in Orange County, including one who died. Local health officials said the outbreak seemed connected to Disneyland, as 19 of the 22 people who were infected had visited the park. But they never pinpointed a cause of the infections. The California Occupational Safety and Health Administration in March cited the park and fined it more than $33,000 for failing to properly clean cooling equipment linked to the outbreak and for other related violations. Cal-OSHA didn't announce the fine. The Times requested and recently obtained the citation. (Karlamangla, 9/6)

Quincy housing officials aim to address properties built in 1942. Houses built before the 1978 federal ban on lead-based paint most likely contain traces of lead. The HUD funds will be used to hire a contractor to conduct testing and lead abatement for five properties, which contain a total of 254 units. (Chen, 9/6)

California’s expansion of Medicaid under the Affordable Care Act enabled many low-income HIV patients to get health insurance previously denied to them. Still, those with mental health needs, who had been receiving coordinated care through a separate federal program, suddenly faced gaps in treatment, payment disputes and doctors who had little understanding of life with HIV. A report on HIV patients is one example in a special California edition of the journal Health Affairs showing that though the state is often a national beacon in health care, some of its innovations fall short of expectations. (Gorman, 9/5)

A doctor was disciplined by Nevada state pharmacy regulators after they found he improperly accessed prescription records of the dead gunman in last October's mass shooting in Las Vegas, his lawyer said Thursday. Dr. Ivan Goldsmith could have lost of his ability to prescribe medications, but attorney E. Brent Bryson said he was instead ordered to pay a $10,000 fine; $16,000 in attorney fees and costs, and serve one year of probation. (9/6)

With few financial incentives to bring in new workers, the home-care industry is facing a labor shortage that is expected to worsen with time. Industry experts anticipate a need for at least 13 million new in-home caregivers by 2030. “We’re facing a shortage of qualified people to serve rapidly growing demand,” said Jeff Bevis, CEO of Ohio-based FirstLight Home Care. To fill in the gaps, agencies such FirstLight are tapping into an older work force willing to care for clients older or closer to them in age on a part-time basis. (Najarro, 9/7)

Recreational marijuana stores could open in Massachusetts in “early fall,” according to state Cannabis Control Commission chairman Steve Hoffman. The commission, which had initially aimed to have retail pot stores up and running by July 1, has issued provisional licenses to 30 existing medical marijuana facilities, including retail shops and cultivators. (Adams, 9/6)

This meta-analysis of 47 studies on 42 473 physicians found that burnout is associated with 2-fold increased odds for unsafe care, unprofessional behaviors, and low patient satisfaction. The depersonalization dimension of burnout had the strongest links with these outcomes; the association between unprofessionalism and burnout was particularly high across studies of early-career physicians. (Panagioti et al, 9/4)

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. (Zelman and Wulsin, 9/1)

The historical narrative on diversity, race, and health would predict that California’s population change from 22 percent racial/ethnic minority in 1970 to 62 percent in 2016 would lead to a massive health crisis with high mortality rates, low life expectancy, and high infant mortality rates—particularly given the state’s high rates of negative social determinants of health: poverty, high school incompletion, and uninsurance. We present data that suggest an alternative narrative: In spite of these negative factors, California has very low rates of mortality and infant mortality and long life expectancy. This alternative implies that racial diversity may offer opportunities for good health outcomes and that community agency may be a positive determinant. Using national-level mortality data on racial/ethnic groups, we suggest that new theoretical models and methods be developed to assist the US in achieving high-level wellness as it too becomes “majority minority.” (Hsu, 9/1)

Federal and state policymakers are weighing changes to federal programs that help low-income people meet their basic needs for food, medical care, and shelter. As policymakers consider these changes to the public safety net, they run the risk of increasing material hardship, which could have detrimental short- and long-term impacts on children and adults. (Michael Karpman, Stephen Zuckerman and Dulce Gonzalez, 8/28)

In this cohort study of data from a large commercial health plan from 2008 to 2015, emergency department visits per enrollee for the treatment of low-acuity conditions decreased by 36%, whereas utilization of non–emergency department acute care venues increased by 140%. There was a net increase in overall utilization of acute care venues for the treatment of low-acuity conditions and in associated spending. (Poon, Schuur and Mehrotra, 9/4)

As a federal court considers a challenge to the Affordable Care Act’s constitutionality, the public, including most Republicans, wants protections for people with pre-existing conditions preserved, the latest Kaiser Family Foundation tracking poll finds. Large majorities of Americans say it is “very important” to retain the ACA provisions that prevent insurance companies from denying coverage based on a person’s medical history (75%) and from charging sick people more (72%). This includes majorities of Democrats, independents and Republicans, as well as majorities of those with and without people with pre-existing conditions in their households. (9/5)

Tried-and-true Trump supporters will either dismiss these warnings as “fake news” or welcome them as the very sort of strong-man rule some of them clearly desire. But for Americans with a longer and more level-headed view, the message should be clear: We have as president a man radically out of keeping with previous norms and understandings that constrain executive behavior, a man who is mentally, temperamentally, and intellectually unfit to occupy the Oval Office. (Scot Lehigh, 9/6)

Two years ago, when the Editorial Board broke longstanding precedent and urged Americans not to vote for Donald Trump, we did so reluctantly and only out of myriad concerns about his fitness for office. Once voters had spoken, most Americans hoped he was capable of growing into the job. A ship, after all, has only one captain, and all passengers share a stake in his or her success. The mounting evidence, from people inside the White House itself, that Captain Trump may be erratically steering the nation toward an iceberg is both clarifying and somewhat terrifying. (9/6)

If the NYT op-ed is true in its claims that the president does not “fully grasp” what’s happening in his administration, is amoral, “engages in repetitive rants,” and that “his impulsiveness results in half-baked, ill-informed and occasionally reckless decisions that have to be walked back,” we are talking about something far worse than a president wanting a short break from the stresses of the office. If that op-ed is true, if the president is indeed acting “in a manner that is detrimental to the health of our republic,” we have confirmation that the country is being run either by someone totally unfit or by a secret coterie of un-elected advisers who collectively decided to run America behind his back — and ours. Either one of these scenarios is absolutely unacceptable. (K. Ward Cummings, 9/6)

Donald Trump’s fitness to hold office undoubtedly is in question; in a healthy democracy, bipartisan support for his removal would be a fait accompli. The time has long since past for the GOP — as it did with Nixon in 1972 — to compel Trump to resign. However, it’s unclear whether Senate Majority Leader Mitch McConnell or Florida Sen. Marco Rubio are inclined to do so. As it stands, Republicans seem content to let our democracy rot from its head. (Keith E. Noble, 9/6)

Like him or not, President Donald Trump has remained remarkably faithful to the agenda of his 2016 campaign. With the huge glaring exception of failing to address America’s $21 trillion federal debt with appropriate spending cuts, Mr. Trump has aggressively pursued the program he described before his election. In fact he’s kept so many of his significant promises that he’s now poised to keep one of his predecessor’s too. (James Freeman, 9/5)

A health-care case in federal district court in Texas has emerged as one of the focal points in the confirmation hearings for Supreme Court nominee Judge Brett M. Kavanaugh. Sen. Sheldon Whitehouse (D-R.I.) sought assurances from Kavanaugh on Wednesday that he would vote to uphold the constitutionality of the provision of the Affordable Care Act that requires health insurance companies to cover people with preexisting conditions. The disruptive demonstrators in the room have made this issue one of their screaming points. Quite properly, Kavanaugh declined to provide the requested assurance. He could be asked to rule on the case if it reaches the Supreme Court. It is a pity that Kavanaugh could not weigh in, because the answer is, or should be, clear. The Texas lawsuit is borderline frivolous. I say that even though the Justice Department, for reasons that escape me (unless they are purely political), has declined to defend the Obamacare law on this point. (Michael W. McConnell, 9/6)

Enter, stage-center, Judge Brett Kavanaugh, who is being grilled in Senate confirmation hearings as a nominee for the U.S. Supreme Court. After he put the Roe v. Wade question to rest — calling it "an important precedent of the Supreme Court that has been reaffirmed many times" — the attention of his opponents turned to ObamaCare. What would Kavanaugh do if the Texas lawsuit reached the Supreme Court? There even has been speculation by many opponents of his confirmation that, because of his dissent in the 2011 appeal to his U.S. Court of Appeals District Circuit Court (he felt the court had no jurisdiction to rule on a tax that hadn’t yet been collected), this somehow means he would rule the law to be unconstitutional without the individual mandate. In fact, what it actually demonstrates is Kavanaugh’s judicial restraint. (Marc Siegel, 9/6)

Last week, The Hill reported that the Congressional Budget Office is refusing to score a Medicare-for-All bill now before the House. That’s probably because the CBO doesn’t think it’s going to get a vote anytime soon — despite growing support from Democrats, 123 of whom have now signed on as cosponsors. The lack of reliable numbers from the CBO is hobbling the debate — which should be, like all policy discussions, essentially a cost-benefit analysis. We don’t know the costs. We do know the promised benefits: universal coverage. What is missing from the debate is the benefit we really want: care. Can we get it with Medicare-for-All? (Deane Waldman, 9/6)

We hear a lot these days that modern digital technology is rewiring the brains of our teenagers, making them anxious, worried and unable to focus. Don’t panic; things are really not this dire.Despite news reports to the contrary, there is little evidence of an epidemic of anxiety disorders in teenagers. This is for the simple reason that the last comprehensive and representative survey of psychiatric disorders among American youth was conducted more than a decade ago, according to Kathleen Ries Merikangas, chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health. There are a few surveys reporting increased anxiety in adolescents, but these are based on self-reported measures — from kids or their parents — which tend to overestimate the rates of disorders because they detect mild symptoms, not clinically significant syndromes. (Richard A. Friedman, 9/7)

The way mental health is perceived on college campuses must be changed to remove the difficulties men face when it comes to seeking help. A survey conducted by the Association for University and College Counseling Center Directors concluded that men represented about 43.6 percent of the student population but only 32.6 percent of clients at campus counseling centers. In addition, men are 3.5 times more likely than women to die by suicide, according to statistics from the American Foundation for Suicide Prevention. (Jihan Reksodiputro, 9/5)

Another parent has lost a child — this time a fourth-grader — to suicide. Appallingly, suicide is the second-leading cause of death for children in Kentucky. Mental-health issues, a growing sense of individual isolation and our children’s immersion in technology contribute to the increase in this tragic epidemic. Identification and treatment of risk factors — depression and other mood disorders, suicide ideation, chronic disease or disability, and substance abuse — are the primary aspects of suicide prevention. (Kathryn Hendrickson, 9/6)

“Panicked.” “Very, very scared.” “Constant anxiety.” These words describe immigrant families’ reactions to recent White House proposals to deny legal status to immigrants who have relied on public benefits. In recent days, many immigrant parents have called local health providers demanding to be dropped from federal nutrition programs in fear that accepting federal aid could keep them from getting a green card. This trend is not isolated to one community. According to news reports, agencies in 18 states have seen enrollment drops of up to 20 percent, which they attribute largely to fears about immigration policies. (Anna Gassman-Pines, 9/6)

Abortion does not ease pain; it causes it. As president of Missouri Right to Life, I was inundated with calls from concerned families who read the op-ed “Pro whose life?” (Aug. 23). The writer, Dr. Steven Rothman, indicated that some lives have more value than others and those with less value should be considered for abortion.One of those who contacted me was John Foppe, saying, “This doctor basically says that people with disabilities are a burden to society.” Foppe, executive director of the Society of St. Vincent de Paul, leads 3,000 St. Louis-area volunteers in service to the poor and needy — including the disabled. (Steve Rupp, 9/6)