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A federal judge in Texas struck down the entire Affordable Care Act on Friday on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it. The ruling was over a lawsuit filed this year by a group of Republican governors and state attorneys general. A group of intervening states led by Democrats promised to appeal the decision, which will most likely not have any immediate effect. (Goodnough and Pear, 12/14)

In a 55-page opinion, U.S. District Judge Reed O’Connor ruled that last year’s tax cut bill knocked the constitutional foundation from under “Obamacare” by eliminating a penalty for not having coverage. The rest of the law cannot be separated from that provision and is therefore invalid, he wrote. Supporters of the law immediately said they would appeal. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans,” said California Attorney General Xavier Becerra, who is leading a coalition of states defending the ACA. (Alonso-Zaldivar, 12/14)

“In some ways, the question before the Court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote. “The former enacted the ACA. The latter sawed off the last leg it stood on.” (Demko and Cancryn, 12/14)

In a ruling that could throw the nation’s health care system into chaos, Fort Worth-based U.S. District Judge Reed O’Connor on Friday ruled that a major provision of the Affordable Care Act is unconstitutional — and that the rest of the landmark law must fall as well. In February, a Texas-led coalition of 20 states sued the federal government to end the health care law in its entirety, arguing that after Congress in December 2017 gutted one of its major provisions, the rest of the law was unconstitutional. (Platoff, 12/14)

Kaiser Health News: Judge Strikes Down ACA Putting Law In Legal Peril — Again

It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015. (Rovner, 12/14)

Open enrollment was scheduled to end on Saturday in most states, and every year, a surge of people sign up at the last minute. The Centers for Medicare and Medicaid Services sent out an email to millions of Americans on Saturday trying to allay concerns, and HealthCare.gov displayed a red banner alerting people that the court’s decision would not affect open enrollment. “Are you covered yet?” HealthCare.gov tweeted on Saturday. “Hurry!” (Mervosh, 12/16)

The ruling by a federal judge in Texas striking down the Affordable Care Act has injected a powerful wave of uncertainty about recent changes woven into the U.S. health-care system that touch nearly all Americans and the industry that makes up one-sixth of the economy. The opinion, if upheld on appeal, would upend the health insurance industry, the way doctors and hospitals function, and the ability of millions of Americans to access treatments they need to combat serious diseases. (Goldstein, 12/16)

The White House confirmed that the law remains in effect pending appeal, even as President Donald Trump called the ruling “great news” and suggested Congress start working on a replacement. The ruling has “no impact to current coverage or coverage in a 2019 plan,” Seema Verma, the administrator for the Centers for Medicare and Medicaid Services, tweeted. (Tozzi, 12/17)

Expanded Medicaid for millions. Penalties for poorly performing hospitals. Even the Trump administration's own plans to lower drug prices. Those and many other initiatives would all be illegal under a federal judge’s sweeping decision that the entire Affordable Care Act must be struck down — the latest shock to the nation’s health system after a decade of upheavals, including two fights over the ACA that reached the Supreme Court. (Diamond, 12/15)

Practically speaking, nothing will happen right away. The judge didn’t immediately block enforcement of the ACA, so it remains in effect for now. The White House on Friday night said the law would stay in place during the appeals stage of the case, a process that could take many months. ... It is an open question whether some states may attempt to back away from administering the health law starting next month, once the elimination of the tax penalty goes into effect. If they do, it could spark additional litigation. (Kendall, 12/15)

Tim Jost, a professor emeritus at Washington and Lee Law School and an expert on the health law, told CQ on Saturday that the next procedural steps are unclear. A group of Democratic attorneys general that are defending the law will likely soon file an appeal, but because the judge filed a declaratory judgment, rather than an injunction, all parties involved may need to take more time to figure out the next steps. "The main effect right now is just a tremendous amount of confusion," Jost said. "I think we could possibly lose thousands or tens of thousands of people who need to sign up today." (McIntire, 12/15)

ObamaCare's latest open enrollment period ended Saturday with the future of the law facing uncertainty after a federal judge in Texas struck it down. Sign-ups for ObamaCare plans at healthcare.gov, the federal platform used by 39 states, had already lagged behind previous years, putting enrollment on track to drop for the second year in a row under the Trump administration. (Hellmann, 12/17)

U.S. health-care stocks are poised for a potentially ugly trading session Monday as investors weigh in on a judge’s ruling that Obamacare is unconstitutional. A judge sided with Texas late Friday in a lawsuit alleging that Congress’s decision in 2017 to kill a related tax penalty essentially voided the entire Affordable Care Act. While many analysts expect the ruling to be reversed by higher courts, the news adds to volatility in a sector that had barely recovered from political overhangs this year and yet remains the top performing sector in the S&P 500. (Darie, 12/16)

After the U.S. Department of Justice said it wouldn’t defend Obamacare in court, [Maryland Attorney General Brian] Frosh filed a case in September. It seeks what’s known as a declaratory judgment saying that Obamacare passes constitutional muster. The Justice Department is seeking to have Frosh’s suit thrown out, arguing that Maryland doesn’t have grounds to bring a case in the first place. Frosh acknowledged that the case was unusual but said it was important that Maryland fight in court. (Duncan, 12/15)

If you plan to get health insurance through MNsure or have already, nothing changes despite a federal judge’s ruling that the Affordable Care Act is unconstitutional. “Given the recent Texas court case, I wanted to remind Minnesotans that the Affordable Care Act is still the law of the land and that MNsure is open for business,” Gov. Mark Dayton said Saturday in a statement. (Stahl, 12/15)

Reaction in Georgia was swift to a ruling Friday night from a federal judge in Texas striking down the entire Affordable Care Act, also known as Obamacare.Chris Carr, Georgia’s attorney general, said the ruling was just what he and other Republican leaders had argued, when Carr in February added Georgia’s weight behind the lawsuit as one of 20 states challenging the law. (Hart, 12/15)

Could a federal judge in Texas be the catalyst that finally brings down the Affordable Care Act, a law that has withstood countless assaults from Republicans in Congress and two Supreme Court challenges? On the morning after Judge Reed O’Connor’s startling ruling that struck down the landmark health law, legal scholars were doubtful. Lawyers on both sides of previous A.C.A. battles said the reasoning behind this one was badly flawed, notably in its insistence that the entire 2010 law must fall because one of its provisions may have been rendered invalid by the 2017 tax overhaul legislation. Had Congress meant to take such radical action, they said, it would have said so at the time. (Hoffman, Pear and Liptak, 12/15)

“There’s really no American that’s not affected by this law,” said Yale law professor Abbe Gluck, who filed an amicus brief with other lawyers in the Texas case. The judge’s ruling, she said, flouts settled legal doctrine and places key acts of Congress in reverse order. By ignoring that Congress specifically declined to strike down the ACA in 2017 when it chose to alter only one portion of the bill, she said, the judge decreed that the 2010 Congress, which first passed the law, has more authority than the same legislative body in 2017. “It’s absolutely ludicrous to hold that we do not know whether the 2017 Congress would have wanted the rest of the ACA to exist without an enforceable mandate, because the 2017 Congress did exactly that when it zeroed out the mandate and left the rest of the ACA standing,” Gluck said. “He effectively repealed the entire Affordable Care Act when the 2017 Congress decided not to do so.” (Barrett, 12/15)

But where legal experts particularly criticize O’Connor is his next step, where he ruled that because the mandate is unconstitutional, the rest of the Affordable Care Act is also invalid. Experts say that violates the established legal standard that Congress’s intent should be the guide, and in this case it is obvious that Congress intended for the rest of the Affordable Care Act to remain when it repealed only the mandate penalty last year. (Sullivan, 12/15)

The decision by a federal judge in Texas to strike down all of the Affordable Care Act has thrust the volatile debate over health care onto center stage in a newly divided capital, imperiling the insurance coverage of millions of Americans while delivering a possible policy opening to Democrats. After campaigning vigorously on a pledge to protect patients with pre-existing medical conditions — a promise that helped return them to the House majority they had lost in 2010 — Democrats vowed to move swiftly to defend the law and to safeguard its protections. (Stolberg, Pear and Goodnough, 12/15)

Republicans, still stinging from their loss of the House in the midterm elections, are facing a fresh political quandary after U.S. District Judge Reed O'Connor said the entire 2010 health law was invalid. Warnings about the Texas lawsuit were part of the political narrative behind Democrats' electoral gains. Health care was the top issue for about one-fourth of voters in the November election, ahead of immigration and jobs and the economy, according to VoteCast, a nationwide survey for The Associated Press. Those most concerned with health care supported Democrats overwhelmingly. (Alonso-Zaldivar, 12/14)

Republicans are under greater pressure to produce an alternative to the law they have ardently opposed since its passage and a means to ensuring affordable health care coverage to some 52 million people with conditions such as diabetes, asthma and cancer. But they are still riven by the divisions that thwarted previous efforts to overhaul the law. (Sullivan, 12/15)

Republicans on Sunday said they wanted to maintain the 2010 law’s guarantee of insurance coverage for people with pre-existing conditions. But they also said they continued to oppose most or all of the law, such as its requirement that most people obtain health insurance, the so-called individual mandate. How they might accomplish both goals remained unclear. “There is widespread support for protecting people with pre-existing conditions. There’s also widespread opposition to the individual mandate,’’ said Sen. Susan Collins (R., Maine), speaking on CNN. She said the insurance-purchasing requirement, which is intended to ensure enough healthy people buy policies to make the plans economically viable, was particularly burdensome for low- and middle-income families. (Armour and Peterson, 12/16)

The result is likely to be a split GOP caucus that draws flak from both the right and the left. Republicans who survived the midterm elections by vowing to protect people with pre-existing conditions will find themselves in a particularly tough spot, feeling intense pressure to make good on that pledge. “It’s all the downsides,” a House GOP aide said. “Politically, I don’t think that it helps us at all.” (Demoko and Cancryn, 12/15)

“I’m not sure Republicans even know what they’re fighting for right now when it comes to health care,” said David Jolly, a former Republican congressman from Florida who now identifies as an independent. “Opposing Obamacare has become reflexive GOP orthodoxy, but they just spent six months saying they’d protect pre-existing conditions. Hard to square GOP campaign promises with the court victory by GOP attorneys general.” (Kapur, 12/15)

One day after a federal judge in Texas issued a decision in which he deemed the Affordable Care Act unconstitutional, a key Tennessee lawmaker expressed skepticism that the nation's high court would concur. In a statement issued Saturday, Sen. Lamar Alexander, who is chairman of the Senate Health Committee, said, "If the U.S. Supreme Court eventually were to agree that Obamacare is unconstitutional — which seems unlikely, however poorly the law was written — I am confident that any new federal law replacing it will continue to protect Americans with pre-existing conditions who buy health insurance." (Ebert, 12/16)

President Donald Trump on Saturday hailed a court decision against Obamacare as "a great ruling for our country," while a U.S. government official said the decision by a Texas judge would have no immediate impact on health coverage. (12/15)

"Mitch and Nancy, get it done!” Trump added, referring to Senate Majority Leader Mitch McConnell (R-Ky.) and expected incoming House Speaker Nancy Pelosi (D-Calif.). (Axelrod, 12/14)

The Senate’s top Democrat on Sunday said he plans to push for a vote to intervene in a federal court case over Obamacare after a judge in Texas last week ruled that the landmark health care law is unconstitutional. “We’re going to fight this tooth and nail,” Minority Leader Chuck Schumer of New York said in an interview on NBC’s “Meet the Press.” “And the first thing we’re going to do when we get back there in the Senate is urge, put a vote on the floor, urging an intervention in the case.” (O'Brien and Ollstein, 12/16)

House Minority Leader Nancy Pelosi (D-Calif.), who is expected to become speaker next month, issued a statement that said: “When House Democrats take the gavel, the House of Representatives will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act.” (Goldstein, 12/14)

Friday’s decision rattled top Democratic politicians, medical groups and health-industry leaders. Some advocacy groups called on Congress to immediately pass legislation protecting coverage for people with pre-existing conditions, and the American Medical Association vowed to work with other organizations in seeking an appeal. “This is a five alarm fire—Republicans just blew up our health care system,” Sen. Chris Murphy (D., Conn.) said in a statement. “The anti-health care zealots in the Republican Party are intentionally ripping health care away from the working poor, increasing costs on seniors, and making insurance harder to afford for people with preexisting conditions.” (Armour and Kendall, 12/15)

Sen. Amy Klobuchar (D-Minn.) on Sunday called it "absurd" that a Texas judge ruled that the Affordable Care Act is unconstitutional and called on Republicans to work with Democrats to improve the health-care law. “The ruling was absurd. [Supreme Court] Justice [John] Roberts in a conservative court has already ruled that the Affordable Care Act is constitutional," she said on CBS's "Face the Nation." (Burke, 12/16)

Obama responded on Saturday by saying in a Facebook post that “Republicans will never stop trying to undo” the health-care law and urging people to continue to get covered under the ACA as the decision makes its way through the courts in what could be a prolonged appeals process. As of early Monday, his Facebook post has received more than 28,000 reactions, and has been liked more than 72,000 times since he also shared it on Twitter. The former president tried to quell any dread that the ruling could ultimately strike down the entirety of his signature health-care law, which is commonly referred to as Obamacare. (Bella, 12/17)

Obamacare was struck down by a Texas federal judge in a ruling that casts uncertainty on insurance coverage for millions of U.S. residents, drawing sharp condemnation from some medical professionals and a vow for action by top Democrats. President Donald Trump termed the ruling “a big big victory by a highly respected judge” and an alternative path to the long-time Republican goal of repeal-and-replace. (Korosec and Mehrotra, 12/14)

The state’s Republican attorney general appears to strategically file key lawsuits in Judge O’Connor’s jurisdiction, the Northern District of Texas, so that he will hear them. And on Friday, the judge handed Republicans another victory by striking down the Affordable Care Act, the signature health law of the Obama era. Judge O’Connor, who was appointed by former President George W. Bush, has been at the center of some of the most contentious and partisan cases involving federal power and states’ rights, and has sided with conservative leaders in previous challenges to the health law and against efforts to expand transgender rights. (Fernandez, 12/15)

U.S. District Judge Reed O'Connor, who ruled the Affordable Care Act "invalid" Friday, is no stranger to the conservative resistance to Obama administration policies. O'Connor, 53, is a former state and federal prosecutor who was nominated to the federal bench in 2007 by President George W. Bush. He has been active in the Federalist Society, which describes itself as "a group of conservatives and libertarians interested in the current state of the legal order." (12/14)

Facing thousands of lawsuits alleging that its talc caused cancer, J&J insists on the safety and purity of its iconic product. But internal documents examined by Reuters show that the company's powder was sometimes tainted with carcinogenic asbestos and that J&J kept that information from regulators and the public. (Girion, 12/14)

The report said company officials fretted over the test results while keeping the information private and failing to disclose the test results to regulators and the public. Johnson & Johnson called the Reuters article “one-sided, false and inflammatory’’ and a “conspiracy theory.” (Rowland, 12/14)

In its statement Friday, Johnson & Johnson said “thousands of independent tests by regulators and the world’s leading labs prove our baby powder has never contained asbestos.” (12/14)

The memos were concise and direct. An executive at Johnson & Johnson said the main ingredient in its best-selling baby powder could potentially be contaminated by asbestos, the dangerous mineral that can cause cancer. He recommended to senior staff in 1971 that the company “upgrade” its quality control of talc. Two years later, another executive raised a red flag, saying the company should no longer assume that its talc mines were asbestos-free. The powder, he said, sometimes contained materials that “might be classified as asbestos fiber.” (Rabin and Hsu, 12/14)

Nearly 12,000 women have sued Johnson & Johnson, with most claiming the talc in its well-known product Johnson’s Baby Powder caused their ovarian cancer. They now have a new potential legal front.In a recent case, a group of plaintiffs argued that the talc was contaminated with asbestos, a carcinogen considered unsafe at any level of exposure. A jury agreed with them, and awarded them $4.69 billion in damages in July. (Rabin, 12/14)

Johnson & Johnson's stock tumbled 10% on Friday — wiping out close to $40 billion of its market value — after a Reuters report said the company knew for decades that asbestos was in its baby powder. The company has been grappling with lawsuits alleging some of its talcum powder products caused cancer. But the Reuters report cites documents and other evidence that indicate company executives, mine managers, scientists, doctors and lawyers knew about the problem and failed to disclose it to regulators or the public. It was J&J's worst day since 2002. (Meyersohn, 12/14)

The U.S. Department of Homeland Security's internal watchdog will investigate the death of a 7-year-old Guatemalan migrant which occurred after she was detained by U.S. border agents, officials said on Friday. The Trump administration defended the treatment of the child, identified as Jakelin Caal by a Guatemalan official, and said there was no indication that she had any medical problems until several hours after she and her father were taken into U.S. custody on Dec. 6. The Guatemalan government had earlier identified the girl as Jackeline Caal. (12/14)

Officials said the girl, Jakelin Caal Maquin, and her father were among 163 migrants who turned themselves in to the Border Patrol in a remote area of desert in New Mexico, shortly after the group crossed into the United States. Her death, which is under investigation, has been widely condemned as a consequence of the Trump administration’s hard-line immigration enforcement efforts on the southwest border against caravans of migrants traveling from Central America. (Nixon, 12/14)

The father of Jakelin Caal Maquin, the 7-year-old Guatemalan girl who died in United States custody this month, disputed on Saturday the assertion by authorities that his daughter had not eaten or consumed water for several days before being detained by the Border Patrol. Jakelin’s father, Nery Gilberto Caal Cruz, “made sure she was fed and had sufficient water,” Mr. Caal Cruz’s lawyers said in a statement read by Ruben Garcia, the director of a shelter in El Paso that serves recent border crossers. The shelter, Annunciation House, is caring for Mr. Caal Cruz. (Romero, 12/15)

Customs and Border Protection reported earlier this week that Jakelin hadn’t had any food or water for days before crossing the border. Mr. Caal said in the statement through his lawyers that wasn’t true. Mr. Caal, via his statement, also thanked emergency responders, including Border Patrol agents, who tried to save his daughter. Ruben Garcia, executive director of the El Paso aid group and migrant shelter operator Annunciation House, read the statement to reporters Saturday. Mr. Garcia said Mr. Caal was staying at one of the group’s shelters and wouldn’t be speaking publicly. (Caldwell, 12/15)

Shortly before a 7-year-old Guatemalan girl died in U.S. custody, her father signed a form stating that his daughter was in good health. But it's unclear how much the man understood on the form, which was written in English and read to him in Spanish by Border Patrol agents. (Watson, 12/16)

President Donald Trump's relationship with the truth tends to be borderline, at best, when it comes to the border. So it was this past week when he made a flurry of false or unsupported statements about immigration. He said, with no evidence, that migrants are plagued with disease. He asserted that Mexico has in effect agreed to pay for his border wall, even as he threatens a partial government shutdown if Congress doesn't approve billions of dollars to build it. He twisted federal statistics to claim the recent arrest of 10 terrorists who don't exist. (Woodward and Yen, 12/15)

Rep. Beto O'Rourke and four other Democratic members of Congress toured a remote tent city in West Texas on Saturday where they said that 2,700 immigrant teens are being held at a cost of roughly $1 million per day. The lawmakers urged the nonprofit running the facility not to renew a federal contract that expires Dec. 31, a longshot request that could effectively shutter the camp. (Weissert, 12/15)

Eric Weil, a gregarious 50-year-old painter who lives in a wooded neighborhood hugging the shores of Lake Winnipesaukee, never suspected he would face felony charges when he called 911 last August. He had agreed to take in a friend’s son who was struggling with addiction, on the condition that no drugs be brought into his house. When Mr. Weil discovered a packet of white powder in the guest bedroom, he called 911. “Somebody’s messed up in my house,” he recalled saying. “He’s on drugs. I don’t know what he’s on. Can we get somebody here?” (Smith, 12/17)

A Kentucky appeals court on Friday upheld a judge’s ruling ordering the release of secret records about Purdue Pharma’s marketing of the powerful prescription opioid OxyContin, which has been blamed for helping to seed today’s opioid addiction epidemic. The records under seal include a deposition of Richard Sackler, a former president of Purdue and a member of the family that founded and controls the privately held Connecticut company. Other records include marketing strategies and internal emails about them; documents concerning internal analyses of clinical trials; settlement communications from an earlier criminal case regarding the marketing of OxyContin; and information regarding how sales representatives marketed the drug. (Armstrong and Joseph, 12/14)

In September 2016, the town of East Liverpool, Ohio, captured national attention when a photo of a local couple's overdose went viral. It showed a woman and her boyfriend sprawled comatose in the front seats of a car, while the woman's 4-year-old grandson sat in the back. The image was originally posted by the local police department. Overnight, East Liverpool, a town of just over 11,000 people, became the face of the opioid crisis enveloping parts of the country. (Brown, 12/15)

David Braithwaite was standing next to his pickup truck Thursday in a parking lot outside the Cumberland County health center in Carlisle, Pa. He's a chaplain for Carlisle Truck Stop Ministry. His hat even says it. Braithwaite said he and another chaplain minister to truck drivers, homeless people and anyone else who needs help at the truck stop seven days a week. (Sholtis, 12/14)

It was a typical, single-family house with a landscaped yard and Christmas decorations in a quiet neighborhood in eastern Pennsylvania. But this week investigators, acting on a tip, uncovered a secret in the basement — a drug operation worth an estimated $8 million a week. On Wednesday, prosecutors announced that 11 people were charged with felony drug offenses in the bust, which was believed to be one of the largest in the county. (Hauser, 12/14)

Medical knowledge is evolving at warp speed, spinning out reams of new information into sound bites, articles and more and more new health books to overload your sagging shelves. But if you’re tempted to toss out all the old stuff, better think twice — despite the changes in medical science, some constants endure. The human body still sickens and recovers much the way it always has; our dogged, heartfelt efforts to prevent and relieve pain and suffering are no different than they ever were. Even books published decades or in some cases centuries in the past may still speak clearly to today’s medical issues. (Zuger, 12/17)

Even as Virginia expects a slight dip in fatal opioid-related drug overdoses in 2018, deaths caused by cocaine and methamphetamine as well as babies born addicted to drugs are on the rise, indicating a “disease of despair,” according to a report by the state health commissioner. (Balch, 12/14)

Last year, 1,481 certified peer specialists were employed in Pennsylvania, according to data the counties report to the Department of Human Services. Across the United States, there are an estimated 25,000 certified mental-health peer support specialists. Though the U.S. Bureau of Labor Statistics doesn't track the position, it estimates job growth for community health workers in general will increase 16 percent in the coming decade — nearly double the average job growth. (Pattani, 12/17)

Historically, supported housing was meant as a finish line for those who had demonstrated, under decreasing levels of supervision, that they could live alone. But the court order ushered a wave of adult home residents directly into a system in which people like [Nestor] Bunch were expected, overnight, to be able to care for themselves. Last week, ProPublica and the PBS series Frontline published an investigation, in collaboration with The New York Times, showing how the sudden shift has proven perilous, even deadly, for those who were not ready to live with minimal support. (Sapien and Etheredge, 12/14)

Kaiser Health News: Assisted Living’s Breakneck Growth Leaves Patient Safety Behind

They found Bonnie Walker’s body floating in a pond behind her assisted living facility in South Carolina. There were puncture wounds on her ear, her temple, her jaw and her cheeks. Her right forearm and her pacemaker were inside one of the alligators that lived in the pond. Like 4 in 10 residents in assisted living facilities, Walker, 90, had dementia. Shortly after midnight one day in July 2016, she slipped out of her facility, Brookdale Charleston, as she had done a few days before. This time, no one noticed her missing for seven hours. (Rau, 12/17)

The friendly touches at a luxury hotel aren’t normally expected at a busy Bronx hospital. But that is exactly what Marcello Khattar of Montefiore Health System is trying to do—put a little of the hotel experience into the health-care setting. Mr. Khattar, 36 years old, is a director of patient experience and customer service at Montefiore, a new role. His charge is to make the hospital experience feel a little warmer, easier and more personal. It is not enough for a patient or family member just to have medical needs met, he says. (West, 12/16)

Twice as many high school students used nicotine-tinged electronic cigarettes this year compared with last year, an unprecedented jump in a large annual survey of teen smoking, drinking and drug use. It was the largest single-year increase in the survey's 44-year history, far surpassing a mid-1970s surge in marijuana smoking. (12/17)

The proportion of U.S. high school seniors who are vaping tobacco products nearly doubled in the past year, with more than 1 in 5 now saying they have vaped to get a hit of nicotine in the past 30 days, according to a new study. The prevalence of nicotine vaping nearly doubled among 10th-graders as well, with nearly 1 in 6 using the electronic devices, researchers reported Monday in the New England Journal of Medicine. (Kaplan, 12/17)

"It is very worrisome," says Nora Volkow, director of the National Institute on Drug Abuse, which funds the survey. "We are very concerned about the increase in vaping." The proportion of high school seniors who reported vaping nicotine in the last month rose to 20.9 percent in 2018, a nearly 10-percentage-point increase from 11 percent in 2017, according to results released Monday. (Stein, 12/17)

Last winter’s dreadful flu season may have had a silver lining: Flu vaccine uptake rose sharply this fall in both children and adults, according to newly released data. The Centers for Disease Control and Prevention reported Friday that the number of children and teens vaccinated as of mid-November was up nearly 7 percentage points over last year at that time and coverage among adults was up 6.4 percentage points. (Branswell, 12 /14)

My kids and I tried something different for our flu shots this year. Instead of making separate visits to my doctor and their pediatrician, we all went to the same place: our local Target, where the in-store clinic offered us each a $5 gift card for getting vaccinated. The visit was convenient: We walked right in without an appointment on a Saturday morning. For the first time, my ­5-year old didn’t scream as the needle went in. And the boys were thrilled to shop for new toys after their shots. (Sohn, 12/15)

At an NIH meeting Thursday, Director Francis Collins said that research into alternatives is “scientifically, highly justified,” but also defended the value of fetal tissue research, saying, “There is strong evidence that scientific benefits can come from fetal tissue research, which can be done with an ethical framework.” As part of the Trump administration audit, NIH in September froze the acquisition of new fetal tissue purchases. That has already upset research at an HIV lab in Montana and may soon hamper work in groups studying cancer and eye disease. (Swetlitz, 12/17)

In the three weeks since the remarkable announcement about Nana and Lulu, STAT has pieced together the story of the years leading up to that fateful Monday. With details reported for the first time, it describes the many times He [Jiankui] met with and spoke before some of the world’s leading genome-editing experts, the low opinion they had of his research, and the hints he dropped about his grandiose aspirations. It is based on interviews in Hong Kong and with experts on four continents, with scientists and others who have crossed paths with He, as well as on documents and published accounts. He did not reply to requests for an interview. (Begley and Joseph, 12/17)

Homelessness nudged higher in 2018 for the second consecutive year, as cities struggled to get people off the streets even as many ramped up building and poured millions of dollars into potential solutions. The increase was slight—just 0.3%, according to an annual report to Congress by the Department of Housing and Urban Development to be released Monday. But after seven years of declines, the small rises over the past two years are a troubling reversal at a time when unemployment is at a near 50-year-low and wages are rising. (Kusisto and Malas, 12/17)

Despite a number of studies questioning the usefulness of very low-salt diets in the last few years, most major medical organizations continue to recommend them. We would assume that they do so from a strong base of evidence. But with respect to heart failure, there is a shockingly small amount of evidence. (Carroll, 12/17)

Gordon Surber and Mark Hailey have the same terminal lung disease. Brothers-in-law, they live next door to one another on the Hoopa Valley Indian Reservation in rural Northern California. But they live in different worlds when it comes to health care. Not so long ago, Surber, 57, was a robust man who loved fishing on the Trinity River, racing motocross and feeling his strength return each season when he went back to work in the woods as a logger. Now he can’t lift his baby granddaughter or walk more than a few steps without his oxygen tank. (Underwood, 12/15)

Infants and toddlers in low-income communities may be even more at risk from second- and third-hand smoke exposure than has been believed, according to new federally supported research. In testing that included over 1,200 children, researchers found that up to 15 percent of them had levels of cotinine, a byproduct of the body’s breakdown of nicotine, comparable to what would be found in an adult smoker. (Giordano, 12/14)

By day, some of the most dangerous animals in the world lurk deep inside this cave. Come night, the tiny fruit bats whoosh out, tens of thousands of them at a time, filling the air with their high-pitched chirping before disappearing into the black sky. The bats carry the deadly Marburg virus, as fearsome and mysterious as its cousin Ebola. Scientists know that the virus starts in these animals, and they know that when it spreads to humans it is lethal — Marburg kills up to 9 in 10 of its victims, sometimes within a week. But they don’t know much about what happens in between. (Sun, 12/13)

Congo’s Health Ministry says a newborn baby called Benedicte is the youngest survivor of what is now the world’s second-deadliest Ebola outbreak. The ministry posted a photograph of the infant on Twitter this past week showing her surrounded by caregivers who had watched over her 24 hours a day for weeks. (12/16)

There seems no straight line between that pressure and these suicides; no easy way to understand or to respond. Loss by suicide is like no other, and the succession of deaths has left a void at the heart of the two towns, as if they were struck by a meteor. The aftershocks of numbing sadness, pulsing outward in every direction, have spared almost no one. (Arsenault, 12/16)

A human heart left on a commercial airliner provides a glimpse into the nation’s transplant system, which relies on an obscure network of nonprofit organizations to collect and transport human organs and tissue. The heart traveled in the cargo compartment of a Southwest Airlines flight from Sacramento to Seattle on Sunday. It was supposed to be picked up in Seattle but remained on the plane when the aircraft left for Dallas. There are conflicting accounts of what went wrong, and an investigation is underway. (Kindy and Bernstein, 12/14)

Barry Goldsmith went to great lengths to stay out of the doctor’s office. His belief in the power of exercise — particularly running — to keep him fit and healthy had long been an article of faith. If he wasn’t feeling well Goldsmith would lace up his shoes and “run it off.” The Maryland patent lawyer routinely racked up about 30 miles per week — more when he was training for a marathon or triathlon — interspersed with swimming, cycling and weight training. (Boodman, 12/15)

Some universities are installing vending machines where students can purchase emergency contraception, an effort to remove barriers to and anxiety surrounding products like Plan B. Barnard College in New York said it would soon install a vending machine, months after Columbia University did. Stanford University, Dartmouth College and a few University of California campuses have added vending machines with Plan B or its generic alternative in recent years. Yale University students have pushed for one, and the student council at Miami University in Ohio voted last month in support of selling emergency contraception in campus markets as well. (Korn and West, 12/16)

Arkansas' predominantly Republican Legislature is preparing to take up new abortion restrictions when lawmakers convene next month, even as the state's past efforts to restrict the procedure remain caught up in legal fights. Two abortion measures have already been filed ahead of the session, while anti-abortion groups say they're talking with legislators about several other new restrictions. (12/14)

Proposed legislation in Kentucky this week would reportedly make abortion punishable by up to five years in prison. State Rep. Robert Goforth (R) prefiled a bill on Thursday that would ban abortion after a fetal heartbeat is detected, according to WAVE, an NBC affiliate. (Folley, 12/14)

Anti-abortion family planning clinics are increasingly vying for the same federal funds that go to Planned Parenthood, signaling a major change in federal policy being pushed by the Trump administration. This new front in the abortion wars comes as conservatives have largely given up on completely defunding Planned Parenthood, so they’re trying to use the rules to their advantage, pushing for faith-driven women’s clinics to apply for those same federal funds to push an anti-abortion agenda. (Colliver, 12/14)

After six years of the state-run insurance marketplace MNsure, are Minnesotans ready for more or less government involvement in their health care? MNsure just passed its first enrollment deadline on Saturday and for the second year in a row, rates are declining, access has been largely maintained and enrollments remain steady. ...The stability keeping consumers in the market didn’t happen on its own. It took widespread government intervention and the commitment of hundreds of millions of dollars of taxpayer money to stabilize Minnesota’s individual insurance market. (Magan, 12/14)

Nine years into a robust economic expansion, with Minnesota’s unemployment rate at historic lows, the number of people on public health insurance for the poor is still at historic highs. Back in 2013, when Minnesota’s unemployment rate was 5 percent, the state had 740,000 people on Medical Assistance, also known as Medicaid. Since then, unemployment has fallen to 2.8 percent, while Medicaid rolls have grown every year, reaching 1.1 million. The result is that, despite the strongest economy in a generation, roughly 1 in 5 Minnesotans qualify for subsidized health coverage. (Howatt, 12/16)

At the end of the year, most people are thinking about holidays, not health insurance. But this is actually a key time to make sure you are getting the most value out of your health plan. Why? Most insurance plans reset on Jan. 1, including all those sold through the Affordable Care Act, or Obamacare, marketplaces. Many employer-sponsored health plans also renew on Jan. 1, which means you may want to review the following health care checklist before your plan renews. (Tolbert, 12/16)

California's health care marketplace has extended the deadline for people to sign up for insurance that will start on Jan. 1, 2019, in response to a federal court ruling handed down on Friday that invalidated the Affordable Care Act. (Levi, 12/15)

In the complaint, filed late last month in Harris County District Court, Judy Kveton alleges that her 64-year-old husband died as a result of mistakes by Baylor College of Medicine doctors and St. Luke’s nurses during and after his transplant in January 2017. It asserts that hospital leaders should not have allowed the surgeon to continue operating after receiving complaints about his performance. And it accuses the hospital of fraudulently marketing its heart transplant program, exaggerating the quality of its outcomes and “luring” patients “into a deadly situation.” (Hixenbaug and Ornstein, 12/14)

When a wildfire burned across Big Sur two years ago and threatened hundreds of homes scattered on the scenic hills, thousands of firefighters responded with overwhelming force, attacking flames from the air and ground. In the first week, the blaze destroyed 57 homes and killed a bulldozer operator, then moved into remote wilderness in the Los Padres National Forest. Yet for nearly three more months the attack barely let up. (12/15)

The remaining residents who fled from the deadliest wildfire in California history were allowed to return to their home Saturday and assess the damage. All evacuation orders were lifted in Paradise more than a month after the fire broke out Nov. 8, killing at least 86 people and destroying 14,000 homes in the town and nearby communities in the Sierra Nevada foothills. (12/15)

A state panel is considering a proposal to publish statistics online that would detail the number of deaths at Florida children’s heart surgery programs each year and be updated as often as every six months. The move would make the centers subject to an unprecedented level of transparency, letting prospective patients and their families know whether programs are struggling far more quickly than is currently possible. (Bedi and McGrory, 12/17)

An Arlington mental health hospital, indicted last month on charges of illegally holding patients, was indicted on 11 new counts Thursday by a Tarrant County grand jury. Sundance Behavioral Healthcare System now faces 20 counts of violating state mental health codes, nearly all of them related to holding patients illegally. Lawyers representing Sundance said their position on the charges is unchanged, repeating their belief that the case is an instance of "unprecedented overreach" that will have major consequences. (Sarder, 12/15)

The California medical board has begun monitoring warning letters sent by the U.S. Food and Drug Administration to doctors engaged in potentially harmful practices following a Milwaukee Journal Sentinel/MedPage Today investigation about the failure of states to act on allegations raised in the letters. The investigation found that 73 doctors around the country with active medical licenses had been the subject of FDA warning letters alleging serious problems over a five-year period, but only one had been disciplined. (Fauber, 12/14)

The Minnesota Department of Human Services does a decent job overseeing who gets public medical assistance, but improving that work could mean big savings for the state. That’s the finding of the Office of the Legislative Auditor, a government watchdog, which released an examination of the department’s compliance in its medical assistance for adults without children program. In 2017, Minnesota spent about $1.8 billion on medical assistance for 297,000 adults without children, the report found. (Magan, 12/14)

An investigation into Maryland’s only prison for women following the 2017 suicide of an inmate found the facility violated the constitutional rights of individuals with disabilities who are placed in segregation and did not take sufficient steps to “prevent future harm.” The investigation, released Friday by Disability Rights Maryland, reviewed the Maryland Correctional Institution for Women and its role in the death of inmate Emily Butler, who was found dead in her cell from an apparent suicide by hanging on Nov. 12, 2017. At the time of her death, Butler, who had a history of mental health issues, was serving a 14-year sentence for a charge related to arson and would have been eligible for parole this past April. (Reed, 12/14)

Insured patients in Florida shouldn’t have to pay large bills if they require emergency medical transportation services. They also should have access to copies of their medical records free of charge, a state advisory board agreed Thursday. (Sexton, 12/14)

Aurora Health Care has agreed to pay $12 million to the federal and state governments to settle allegations that it violated the federal anti-kickback law by paying excessive compensation to two cardiologists. The settlement hinges on the Stark Law, which prohibits physicians from having a financial relationship with hospitals and other health care providers to whom they refer patients. (Boulton, 12/14)

Jailers began falsifying the record of Richard Degraffenreid’s short stay at the Jackson County Detention Center even before paramedics arrived to try reviving him from what turned out to be a fatal drug overdose. As the ambulance neared, former jail guard Charles Obasi said he began working to make it appear that everything had been done by the book during the 2 1/2 hours Degraffenreid was strapped into a restraint chair. (Hendricks, 12/16)

A Travis County man was sentenced Friday to nearly three years in federal prison as part of a $36 million fraud scheme involving the collection of unnecessary lab tests of saliva and urine that were billed to the U.S. military's health care system. Jody Sheffield pleaded guilty last year to conspiracy to commit health care fraud. Prosecutors say that soldiers in Killeen, where Fort Hood is located, were given $50 Walmart gift cards in exchange for taking part in the drug toxicology and DNA cancer screening tests that were not needed and were "the product of kickbacks" to physicians. (Krause, 12/15)

A pediatric rheumatologist who once worked at Children’s Mercy Hospital was sentenced to 10 years in prison Thursday after he pleaded guilty to coercion and enticement of a minor. In his guilty plea agreement in September, Mark Franklin Hoeltzel admitted that he created a fake Facebook persona under the name “Ryan Gardner” to contact minor girls, including an 8th grader from whom he requested sexually explicit photographs. (Margolies, 12/14)

The state Department of Public Health (DPH) on Thursday ordered Triple M to immediately stop selling medical marijuana products and quarantine its inventory, after inspectors determined that marijuana cultivated by the company “could pose an immediate or serious threat to the public’s health, safety, or welfare.” (Adams, 12/15)

In the coming year, police in Massachusetts will likely have to deploy a litany of tests before arresting drivers for being high on marijuana, state officials said Friday. Because there’s no accurate breathalyzer for cannabis use, officers will probably need to use a combination of their observations, roadside assessments, saliva tests, and a 12-step expert evaluation at the police station, said Walpole police Chief John Carmichael, a member of the state’s commission on operating under the influence. (Martin, 12/15)

A higher percentage of California marijuana products are passing strict safety tests, but the sudden closing of a lab that state authorities found wasn’t correctly checking for pesticides has raised new questions about the system intended to protect the purity and potency of legal cannabis. California broadly legalized marijuana at the start of the year, and mandatory testing began in July 1. During the first two months the failure rate was about 20 percent, but state data collected through November showed improvement — about 14 percent of nearly 24,000 products were blocked from store shelves by tests. (Blood, 12/16)

No one opposes ObamaCare more than we do, and Democrats are now confirming that it was designed as a way-station to government-run health care. But a federal judge’s ruling Friday that the law is unconstitutional is likely to be overturned on appeal and may boomerang politically on Republicans. (12/16)

Coverage for pre-existing conditions is critical for the millions of Americans living with chronic diseases, and it’s a matter of decency and existing law. Until the Affordable Care Act, people with pre-existing conditions were denied insurance coverage, charged higher premiums and offered limited benefits. Friday’s decision by a federal judge in Texas that threatens coverage of pre-existing conditions leaves millions in jeopardy a month after the topic dominated the midterm elections. (Derek Rapp, 12/15)

For the moment, nothing will change. The ACA will stand while appeals are filed, probably until the case reaches the Supreme Court. The new ruling may well be overthrown, but those who depend on the ACA are left stranded in uncertainty. The timing could hardly be worse. Enrollment in individual insurance is already down this year, and the population of uninsured Americans stands to rise.It’s maddening that the ACA’s legal troubles could be easily resolved. Congress needs only to restore the individual mandate’s tax penalties. Keep in mind, the mandate still exists: Americans are still required to have health insurance. All Congress did last year was set the penalty for failing to comply at zero. (12/16)

In a shocking legal ruling, a federal judge in Texas wiped Obamacare off the books Friday night. The decision, issued after business hours on the eve of the deadline to enroll for health insurance for 2019, focuses on the so-called individual mandate. Yet it purports to declare the entire law unconstitutional — everything from the Medicaid expansion, the ban on pre-existing conditions, Medicare and pharmaceutical reforms to much, much more. (Jonathan H. Adler and Abbe R. Gluck, 12/15)

Late Friday night, a district court in Texas declared the entire Affordable Care Act unconstitutional — lock, stock and barrel. That includes not only the individual mandate and the protections for people with preexisting conditions, but also the entire Medicaid expansion as well as a host of other ACA rules without any connection at all to health insurance. The logic of the ruling is as difficult to follow as it is to defend, and it sets the stage for yet another round of high-stakes constitutional litigation over the future of health care in the United States. (Nicholas Bagley, 12/15)

After sitting on a ruling for months, a federal judge in Texas has given the Trump administration and a group of Republican-led states exactly what they asked for, and then some: the invalidation of the entire Affordable Care Act. Don't panic. The ruling, issued late on Friday and only one day before the end of the law’s annual open enrollment period, is not a model of constitutional or statutory analysis. It’s instead a predictable exercise in motivated reasoning — drafted by a jurist with a history of ruling against policies and laws advanced by President Barack Obama. (Cristian Farias, 12/15)

President Donald Trump apparently hasn't had enough of the health care fueled butt-kicking handed to him and his party in the midterm elections. He heralded as "Great news for America!" a ruling from a Texas judge Friday that found the entire Affordable Care Act unconstitutional. Once again, Trump and Republicans have put taking away health care at the top of the agenda, this time for the 2020 presidential election. (Andy Slavitt, 12/16)

What is the strongest political force driving America toward national health care? No, it’s not Sen. Bernie Sanders and his “Democratic Socialist” minions. It’s the Republican Party. Hang on, don’t Republicans stand foursquare against a government takeover of the entire U.S. health care system? So they say. But the GOP’s pig-headed opposition to less drastic ways to make sure everyone has coverage is stimulating Americans’ appetite for a bigger government role in health care — and it will only be fueled by a federal judge's ruling Friday night that the Affordable Care Act is unconstitutional. (Will Marshall, 12/16)

Seven years after Congress passed the 2011 Food Safety Modernization Act (FSMA), the FDA still hasn’t implemented a number of key reforms required by that law. Among other things, the law required the FDA to issue new industry record-keeping rules that mandate traceability, so the agency can quickly trace the source of food-borne illness outbreaks and strong standards to ensure that the water used to irrigate crops is safe and sanitary. (Jean Halloran, 12/14)

In a highly unusual move, the federal Bureau of Industry and Security is asking U.S. industry to help identify emerging technologies that are essential to national security but currently escape the tangle of laws and regulations that govern — and in some cases restrict or prohibit — the sale or transfer of commodities, technology, and technical data to foreign businesses, research institutions, government and private organizations, and individuals who are neither U.S. citizens nor lawful permanent residents. The bureau’s advance notice of proposed rulemaking specifically mentions categories of emerging technology that ought to deeply interest STAT readers: nanobiology, synthetic biology, genomic and genetic engineering, neurotechnology, molecular robotics, neural networks and deep learning, evolution and genetic computation, direct neural interfaces, brain-machine interfaces, and biomaterials. (Zack Hadzismajlovic, 12/17)

Pre-existing conditions are in the news again, now that a federal judge's ruling could wipe out the Affordable Care Act. But there's been a similar issue all along that's drawn less attention: seniors with pre-existing conditions can be denied coverage in many cases when they apply for Medicare supplemental insurance policies, or Medigap. (Drew Altman, 12/17)

Sometimes, dramatic shifts in American politics go unnoticed. They are buried under other news or dismissed because they represent such a sharp break from long-standing assumptions and expectations. So please open your mind to this: Taken together, the events of 2016 and the results of the 2018 election will be remembered as the beginning of the end of the gun lobby’s power. Supporters of reasonable gun regulation have been so cowed by National Rifle Association propaganda over the past quarter-century that we are reluctant even to imagine such a thing. No matter how many innocents are slaughtered, no matter how many Americans organize, demonstrate and protest, we assume the NRA and its allies will eventually overpower us. (E.J. Dionne, 12/16)

Legal issues are a constant of corporate life, especially in health care. That is especially true for Johnson & Johnson, one of the largest and most sprawling health-care companies, with products ranging from baby shampoo to cancer drugs and surgical staples. J&J faces major liability risk from lawsuits over a possible link between asbestos in its talc products and cancer. A Reuters investigation released Friday alleged the company was both aware of and worried about the presence of small amounts of asbestos in its baby powder for decades, but didn’t disclose it. (Max Nisen, 12/14)

America has an alarming shortage of primary care physicians, and the problem is worse in rural areas. As the Houston Chronicle noted, new medical schools won’t solve the problem. Here in Texas, 54 counties have 27 doctors to care for more than 255,000 people, who are scattered over more than 60,000 square miles.Advanced practice registered nurses (APRNs) can help. (Deane Waldman, 12/15)

The toxicity that can emerge in outbreak culture isn’t limited to the response to Ebola. We’ve documented the same dysfunctions — and sometimes worse — during other large-scale epidemics. Outbreak culture fueled the stigmatization of groups of people susceptible to AIDS in the 1980s, led to the underreporting of initial cases of severe acute respiratory syndrome (SARS) in China in 2002, and delayed research into the 2006 avian flu outbreak in Indonesia. Outbreak culture also inhibited an adequate response to Zika. (Lara Salahi and Pardis Sabeti, 12/17)

Paul Allen continues to give gifts benefiting Seattle and the rest of the world.Last week, two months after the Microsoft co-founder’s death from cancer, the Allen Institute for Immunology was launched in Seattle’s South Lake Union neighborhood. This expands what’s already a strong cluster of biomedical research expertise in Seattle.The institute’s mission is to increase understanding of how healthy immune systems work and of system failures that enable disease to occur. (12/16)

Despite the booming economy and low unemployment in Silicon Valley, Second Harvest and our partner agencies are serving a record number of people – an average of 260,000 kids, families and seniors every month. That’s because the cost of housing has skyrocketed, while wages have remained relatively flat for many, leaving little left over for food. Unfortunately, hunger will take a seat at too many tables this holiday season. (Bruno Pillet, 12/16)

One of the largest existing and potential funders of children’s programs in Ohio is the Medicaid program. So it will be critical for the new administration to quickly get a handle on these programs and their performance so they can be focused on providing an opportunity to every Ohio child -- despite their circumstances, health or disability. (John Corlett, 12/16)