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After cutting funds for nonprofit groups that help people obtain health insurance under the Affordable Care Act, the Trump administration is encouraging the use of insurance agents and brokers who are often paid by insurers when they help people sign up. The administration said in a recent bulletin that it was “increasing partnerships” with insurance agents and viewed them as “important stakeholders” in the federal marketplace, where consumers are now shopping for insurance. But some health policy experts warned that a shift from nonprofit groups, which are supposed to provide impartial information, to brokers and agents, who may receive commissions for the plans they recommend, carries risks for consumers. (Pear, 11/11)

Kaiser Health News: Brokers Are Reluctant Players In A Most Challenging ACA Open-Enrollment Season

Lee Nathans, like insurance brokers in many states, expects to be crazy busy for the next several weeks, fielding calls from “people who are not going to be happy.” Open enrollment for Affordable Care Act coverage started Nov. 1, and the approximately 10 million people who buy their own health insurance are only now getting a look at what’s being offered. It’s daunting. “There will be a lot of people who will need to use a broker,” said Nathans, of Columbus, Ohio. (Appleby, 11/13)

Insurer competition in the ObamaCare marketplaces is declining, but three-quarters of enrollees still have a choice of two or more insurers, according to a new analysis. The analysis from the Kaiser Family Foundation finds that the average number of insurers per state declined to 3.5 for 2018, down from 4.3 this year and 5.6 the year before. (Sullivan, 11/10)

ObamaCare is emerging as a top issue for Democrats as they seek to gain control of Congress in next year's midterm elections. Just a year after worries about ObamaCare premiums were seen as a contributing factor in Hillary Clinton's loss, voter concerns about GOP attacks on the health-care law seem to be bolstering Democratic candidates. (Sullivan, 11/10)

Five states are asking a federal judge to halt the implementation of the Trump administration's recent rollback of ObamaCare's birth-control mandate. The attorneys general in California, New York, Maryland, Delaware and Virginia filed the motion for a preliminary injunction Thursday night with the U.S. District Court for the Northern District of California. (Hellmann, 11/10)

ObamaCare is entering its third week of open enrollment and supporters are watching to see if the fast pace of sign ups will continue. About 600,000 people signed up for ObamaCare plans in the first four days of enrollment, the Trump administration announced Thursday. About twice as many people signed up on the first day, Nov. 1, this year compared to last year. (Hellmann, 11/13)

People around the Philadelphia region, like consumers around the country, are rushing to sign up for health insurance under the Affordable Care Act, also known as Obamacare, advocacy groups reported Friday. More than 600,000 people nationally selected insurance plans in the first week of the annual open enrollment period — a pace that could be double last year’s signups early on. Given that President Trump and congressional Republicans have spent the past year attacking and trying to dismantle President Barack Obama’s signature law, that is stunning many observers. (Sapatkin, 11/10)

Kaiser Health News: Podcast: ‘What The Health?’ We Have Numbers!

Democrats won some unexpectedly large victories in Tuesday’s off-off-year elections, putting health care squarely back on the political map. Meanwhile, enrollment was unexpectedly high in the insurance exchanges’ opening days, according to the Department of Health and Human Services. (11/10)

For several decades, a consensus has grown that reining in the United States’ $3.2 trillion annual medical bill begins with changing the way doctors are paid: Instead of compensating them for every appointment, service and procedure, they should be paid based on the quality of their care. The Obama administration used the authority of the Affordable Care Act to aggressively advance this idea, but many doctors chafed at the scope and speed of its experiments to change the way Medicare pays for everything from primary care to cancer treatment. Now, the Trump administration is siding with doctors — making a series of regulatory changes that slow or shrink some of these initiatives and let many doctors delay adopting the new system. (Goodnough and Zernike, 11/12)

The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group. The researchers said the study results, being published in JAMA Cardiology, can’t show cause and effect, but “support the possibility that the [penalty] has had the unintended consequence of increased mortality in patients hospitalized with heart failure.” (Evans, 11/12)

The clinics are flanked by an atrium, a cafe and a library with an outdoor deck. Their main concourses are dotted with furnished alcoves. One thing they don't have: designated waiting rooms. That's because patients at the clinics in the Health Transformation Building at Dell Medical School, part of UT Health Austin, can either go straight to their rooms, if available, or if they arrive early, to any of those decidedly non-institutional spaces, where in the future they'll be buzzed via a smartphone app. (Arndt, 11/11)

Tom Price left his job as Health and Human Services secretary in September, but the investigation into his use of private jets for official travel now threatens to enmesh others in the department. The department’s inspector-general’s probe will review who approved — or should have been approving — Price’s use of private jets on at least 26 trips from May to September, some of them quick jaunts on routes heavily traveled by commercial aircraft, according to three people with knowledge of the probe. (Pradhan and Diamond, 11/13)

President Donald Trump speaks with pride about the progress of his overhaul of health care for veterans, declaring that the Department of Veterans Affairs already "is a whole new place." Old problems persist, though, and some of his steps are not as advanced as he advertises. For Veterans Day, the White House came out with a two-page statement to support the contention that "tremendous progress has been made in a short period of time." (Yen, 11/10)

Patient advocates fear that the Republican tax plans' proposed changes to a tax credit for drug companies that develop rare-disease treatments will chill research. Proponents of the GOP plans say they could save tens of billions of dollars over a decade and curb abuses by companies that exploit the credit. The House tax bill (HR 1), which the Ways and Means Committee approved Thursday and which will likely get a floor vote next week, would completely eliminate the Orphan Drug Tax Credit, which effectively reimburses drug developers for half of their research costs on treatments meant for diseases with patient populations fewer than 200,000 people. The Senate tax plan released Thursday would not go as far as the House in rolling back the incentive, but would still cut down the size of the multibillion-dollar subsidy for drug research. (Siddons, 11/10)

STAT and The Boston Globe interviewed 10 people treated at the institute over the last five years — teachers, mostly from New Jersey, as well as school custodians and social workers or their relatives. Most said they were allowed only limited contact with family. They complained about inadequate and cookie-cutter treatment, consisting mostly of group counseling and 12-step meetings, massages at a local chiropractor’s office, and plenty of free time. Several said the staff warned that their jobs would be at risk when they tried to leave before the treatment center deemed it appropriate. Although the patients were there voluntarily, many needed letters indicating they were fit to return to work. (Armstrong and Allen, 11/10)

The goal is simple: a drug that can relieve chronic pain without causing addiction. But achieving that goal has proved difficult, says Edward Bilsky, a pharmacologist who serves as the provost and chief academic officer at Pacific Northwest University of Health Sciences in Yakima, Wash. "We know a lot more about pain and addiction than we used to," says Bilsky, "But it's been hard to get a practical drug." (Hamilton, 11/13)

Jon McHann, 56, got started on prescription opioids the way a lot of adults in the U.S. did: he was in pain following an accident. In his case, it was a fall. "I hit my tailbone just right, and created a severe bulging disc" that required surgery, McHann says. McHann, who lives in Smithville, Tenn., expected to make a full recovery and go back to work as a heavy haul truck driver. But 10 years after his accident, he's still at home. (Aubrey, 11/13)

The New York state Senate is planning another meeting to hear from local law enforcement, mental health experts and the loved ones of those lost to heroin and opioids. Tuesday's meeting in Newburgh in the Hudson Valley will be hosted by Republican Sens. George Amedore, Fred Akshar and William Larkin. 11/11)

During his confirmation hearings to lead the Food and Drug Administration, Scott Gottlieb promised to make the opioid crisis his top priority, calling it “a public health emergency on the order of Ebola and Zika.” His comparison of the opioid crisis to those attention-grabbing international outbreaks was a reflection of its growing magnitude. Abuse of prescription painkillers, heroin and other opioids in the United States caused 33,000 deaths in 2015, a number likely to exceed 53,000 when 2016 data is finalized. It was also a course correction for Gottlieb. When he was an FDA official in 2005, he warned against FDA actions that could limit patients from getting pain pills, calling chronic pain an “undertreated medical problem.” (Siddons, 11/13)

Across the country, rates of opioid addiction and abuse have been skyrocketing in recent years — killing more than 30,000 Americans each year, according to Centers for Disease Control and Prevention data analyzed by Blue Cross Blue Shield, one of the largest health insurers in the country. Blue Cross Blue Shield reports that, among those it insures, diagnoses of opioid use disorder have spiked nearly 500 percent in just the last seven years. (Gilmour, 11/10)

Wartime medicine is an incredibly challenging setting for the doctors, nurses, and paramedics who practice it: Not only are the injuries frequently serious ones, but the tools at hand are often more limited than in a traditional hospital. Over the centuries, that has meant that battlefield medical personnel have had to innovate. Those wartime practices, in turn, often served to refine medical practice beyond the military. (Samuel, 11/10)

One of the biggest health threats facing Americans age 65 and older is also one many of them don’t like to talk about: falling. At least half of senior Americans who fall don’t tell anyone, according to a report from the Centers for Disease Control and Prevention. Whether it’s a spouse declining to tell a partner, or an elderly parent hiding it from the children, many seniors keep quiet because they are embarrassed and fear losing their independence. (Sadick, 11/12)

For the 5 million Americans living with Alzheimer’s disease, help can seem far away. Scientists don’t fully understand the disease. The progressive dementia it brings can be scary and disorienting. And social isolation and loneliness are often part of the equation, further affecting brain function. Starting Nov. 30, a new stamp will lend a helping hand. (Blakemore, 11/11)

Ankle replacements, a new kid on the block compared with knee and hip replacements, used to be deemed a risky bet for patients under 65. But as doctors steadily gain confidence that the replacements will last, Carrie Kvitko, 60, from Columbus, Ohio, is one of a growing group of younger patients to sport a new ankle, made of metal and plastic and bending nearly as well as the original. In September, a year after her surgery, Mrs. Kvitko went on vacation to Magic Kingdom Park in Orlando and climbed 116 steps to the top of the Swiss Family Tree House. (Johannes, 11/12)

The day Dr. Roberto Montenegro finished his Ph.D. was memorable. But not for the right reasons. "I still cringe when I think about it," says Montenegro. It had started well. His colleagues at UCLA had taken him and his girlfriend (now wife) out to a fancy restaurant to celebrate. "I was dressed up in the fanciest suit I had at the time and my wife looked beautiful, like always," he says. "We laughed and we ate and we were excited we didn't have to pay for this." (Bichell, 11/11)

Del.-elect Danica Roem, the transgender woman who is perhaps the best known of the flood of Democrats who won seats this week in the Virginia state house, said Friday that she wants to make it easier for people to get health insurance coverage for treatment related to gender transitions. Roem (Prince William), who plans to focus mostly on easing traffic congestion in her district, said she also wants to work with the Democratic caucus in the House of Delegates to develop a bill that would require insurance companies to cover the costs of hormone medication, surgery and other treatments. (Olivo, 11/10)

It’s usually one of the first items you’ll see after you enter a hospital room: a small, clear plastic bag filled with a saline or sugar-water solution, hanging above a loved one’s bed. But a serious shortage of the bags used to inject drugs intravenously is now alarming many Bay Area hospitals after Hurricane Maria in September slammed into Puerto Rico and shut down production at three plants owned by Baxter International, which makes a large percentage of the IV bags used in the United States. (Seipel, 11/10)

In an attempt to ensure fair treatment for kids taken from their parents, Arizona lawmakers decades ago mandated that Foster Care Review Boards — which help decide the fates of children in foster care — mirror the races, ethnicities and income levels of the communities they serve. They don't. (Polletta, 11/12)

To protect the elderly and disabled residents of Florida’s 683 nursing homes from the ravages of an Irma-like storm or other disaster, state law requires that administrators submit detailed emergency plans to regulators every year. ...Two counties, Broward and Palm Beach, refused to release emergency plans when the Miami Herald filed public records requests, citing a state law designed to protect public spaces from terrorists. (Marbin Miller and Ostroff, 11/11)

The family of a mentally ill woman who killed herself inside a Pennsylvania detention center in 2015 will receive $7 million after a lawsuit against the private company running the prison was settled, according to a lawyer handling the case. The recent settlement capped a case that began with a descent into depression and paranoia in Janene Wallace’s late twenties and eventually resulted in imprisonment, a nearly three-month stint in solitary confinement and finally, a death by hanging, family attorney David Inscho said. (Izaguirre, 11/11)

Mayor Megan Barry's proposal to close the inpatient services at Nashville General Hospital reignited the debate over the future of the city's safety net hospital. Barry revealed her plan the same day Meharry Medical College unveiled a landmark agreement with HCA Healthcare to train students at TriStar Southern Hills Medical Center. Barry wants to make Nashville General an ambulatory surgery center and outpatient clinic, while creating a fund to pay for indigent care at Nashville's other hospitals for the city's poorest residents. (Fletcher, 11/10)

The lawsuit claims the facility, among other things, failed to properly evaluate Olivia’s condition and improperly discharged her instead of immediately transferring her to a hospital. An autopsy report from the Tarrant County medical examiner, done on Aug. 8, the day after the incident, found Olivia’s primary cause of death was bacterial meningitis, a brain infection that can turn deadly in a matter of hours. (Rice, 11/11)

An arbitrator ruled that Prospect Medical Holdings Inc., a private-equity backed California company that acquired Crozer-Keystone Health System Inc. in a deal valued at $300 million, still owes Crozer-Keystone Community Foundation $23.7 million. The foundation, based in Media and established to use the proceeds from the sale to improve the health and quality of life of Delaware County residents, and the for-profit Prospect were in a dispute over how much money Prospect had to pay at closing to settle working-capital accounts. (Brubaker, 11/10)

Designed to give cities a legal route to manage what they consider problem properties or residents, the nuisance laws disproportionately affect renters, people of color, survivors of domestic violence and those experiencing mental health crises, a new study by Cleveland State University students and researchers finds. (Christ, 11/10)

Sixteen months after transplant surgery gave Sandness the face that had belonged to Calen “Rudy” Ross, he met the woman who had agreed to donate her high school sweetheart’s visage to a man who lived nearly a decade without one. The two came together last month in a meeting arranged by the Mayo Clinic, the same place where Sandness underwent a 56-hour surgery that was the clinic’s first such transplant. (Potter, 11/11)

The William Brady Charitable Organization has worked for years to grow its housing program, eventually operating 11 homes that have served more than 3,000 people whose addiction, mental illness or other chronic problems make it all but impossible for them to rent on their own. ...Columbus code inspectors discovered the lapses after a former resident complained about conditions at one of the Brady houses, which also were cited for not having rooming house licenses. (Price and Ferenchik, 11/12)

Disneyland has shut down two bacteria-contaminated cooling towers after Orange County health officials discovered several cases of Legionnaires’ disease in people who had visited the Anaheim theme park, authorities said. Twelve cases of the bacteria-caused illness were discovered about three weeks ago among people who had spent time in Anaheim and included nine people who had visited Disneyland in September before developing the illness, according to the Orange County Health Care Agency. (Barboza, 11/11)

Republicans in Congress are plowing ahead on tax reform, and one obstacle is the complexity of Senate budget rules that limit how much taxes can be cut. The good news is that for once Washington’s fiscal fictions could be deployed to improve policy by repealing ObamaCare’s individual mandate as part of tax reform. The Senate Finance Committee on Thursday released the details of its tax proposal, which includes a permanent 20% corporate rate and more. Senators Pat Toomey and Bob Corker cut a budget deal to allow for $1.5 trillion in net tax cuts over 10 years without accounting for faster economic growth (and more revenues) as a result of reform. (11/12)

If you were deliberately trying to design the most arbitrary, painful and pointless tax possible, how would you go about it? First, you would structure it to inflate the cost of an essential product. Then, you’d create exemptions so vast that only 5% of taxpayers were subject to it. You might even ensure that it hit people only when they were particularly vulnerable—like when they’d lost a job. Finally, you would use it to drive enrollment in entitlements, so that it increased the federal deficit by $338 billion. (Chris Pope, 11/12)

The pharmaceutical industry was listed as one of the “Contributors to the Current Crisis” in the final report of President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis. The report cites decades of aggressive marketing and industry-sponsored physician “conferences” aimed at expanding opioid use by minimizing the dangers of addiction. Lawsuits by state attorneys general, counties and local jurisdictions allege that the industry fostered the epidemic by overpromoting its products, while raking in billions as Americans became addicted and overdosed. “To this day,” the commission says, “the opioid pharmaceutical industry influences the nation’s response to the crisis.” (11/10)

Over the past decade, Medicaid spending has grown at an annual rate of 8.9 percent — far faster than the budget as a whole (although that has grown plenty, too). ...Officials hope a new approach will keep it from hitting one-fourth of the budget. They intend to shift thousands of beneficiaries from the traditional fee-for-service model to a managed-care system conducted through private insurance companies. (11/11)

Will “virtual medicine” transform the American health-care system? Will the latest computer-based technologies—apps, wearables, remote monitors and other high-tech devices—make Americans healthier? That’s the promise made by tech gurus, who see a future in which doctors and patients alike track health problems in real time, monitor changing conditions and ensure both healthy habits and compliance with drug and therapy regimens. (Ezekiel J. Emanuel, 11/10)

Most doctors are not geniuses, but even geniuses make mistakes. As a diagnostician myself, I’d like to believe I’ve made some good, even great, diagnoses in my day. But patients need to spend more time focusing on a more important issue — physician error. (Vinita Parkash, 11/13)

Where “DFCS” was once a four-letter word, the Division now actively seeks to become a regular part of community conversations—even the difficult ones—because families are less likely to fall through the cracks when communities are actively engaged in their success. (Bobby Cagle, 11/11)