�Թϲ�����

New actions from the Trump administration are complicating efforts of vulnerable Republicans to show their support for pre-existing condition protections heading into Tuesday's midterm elections. The Trump administration moved last week to allow states to waive certain ObamaCare requirements and pursue conservative health policies that were previously not allowed under the Obama administration. (Weixel, 11/3)

Republicans are entering the final days of the campaign with a message they hope will win over wavering suburban voters — the economy is booming, don’t let Democrats ruin it — while echoing President Trump in stoking fears about undocumented immigrants to try to rile the GOP base. Democrats are focused on female and independent voters angry with Trump, minorities and young people, hoping that coalition will turn out for the midterms and propel them to victory. The party has been especially focused on health care, warning that Republicans threaten a core provision of the Affordable Care Act — the protection for Americans with preexisting medical conditions. (DeBonis, 11/4)

Republicans have tried to contain the damage of their “repeal and replace” push as they defend their majorities in the midterm elections. In order to pull that off, the campaigns have had to find ways to discredit the sympathetic voices of people with complex medical needs who opposed their votes. These health care advocates include people who got engaged in advocacy for the first time because of Republicans’ attempts to dismantle the law. They are patients with serious health conditions who are covered through the law’s marketplaces and patients who rely on Medicaid. They worry that without the law they could go into bankruptcy or go without care. (Kopp, 11/2)

A few short years ago, Kim Adams couldn’t have told you the name of her representative in Congress. That changed last year, when Republican Rep. Mimi Walters voted to repeal the Affordable Care Act as Adams watched live on C-Span from her home in Tustin. News cameras showed a smiling Walters taking a celebratory selfie in the White House rose garden after the vote on the Obama-era healthcare law. That, Adams said, made things personal. After she was diagnosed with multiple sclerosis in 1999, Adams lost her small business as her health deteriorated and she eventually got to a point where she could no longer afford her health insurance premiums. For three years, the single mother was uninsured and unable to get treated for her MS — until the Affordable Care Act kicked in. And her congresswoman had voted to take it away. (Kim, 11/4)

Sen. Thom Tillis (R-N.C.) on Sunday accused Democrats of spreading a "false narrative" that Republicans want to take away health-care protections for individuals with pre-existing conditions, even though the GOP has repeatedly voted to repeal the Affordable Care Act. "It’s a false narrative for Democrats to come in and say if you elect Republicans we’re going to take that away. We’re doing everything we can … to make sure we protect pre-existing conditions," Tillis, the vice chairman of the National Republican Senatorial Committee, said on "Fox News Sunday." (Samuels, 11/4)

In Arizona's 9th Congressional District, a Republican doctor is running against the Democratic former mayor of Phoenix in a race has been dominated by their disagreements over the future of health care. Steve Ferrara, a doctor who works at the Phoenix VA and the county hospital, wants to adjust the Affordable Care Act by letting states direct Medicaid and moving people with pre-existing conditions into high-risk pools. Greg Stanton, the former Phoenix mayor, wants to protect the Affordable Care Act and work on lowering prescription drug prices. (Leingang, 11/3)

The Democrats thought they had the most devastating weapon: a political video showing the Republican incumbent [in New York] hugging a young mother with a brain tumor and a spinal condition, and promising to protect her coverage of pre-existing conditions — only to vote for the Republican bill to repeal Obamacare weeks later. The Republicans, in turn, believed they had the most devastating piece of political tape: the Democratic challenger rapping a decade ago, using expletives and a racial epithet common among black rap artists, as he veered into controversial topics. The question: Which clip will prove more politically potent in America in 2018? (Goldmacher, 11/4)

Democrats hope Kara Eastman will unseat first-term Republican Rep. Don Bacon Tuesday in Nebraska’s most competitive U.S. congressional race, a district centering on the Omaha area where the GOP has reigned for 22 of the last 24 years. Democratic groups and politicians across the country are attacking Republican candidates for their health care record. It’s become a central issue in the campaign, with Republicans saying Eastman’s support for “Medicare for all” is too extreme and costly for taxpayers while Democrats argue Bacon has voted to strip benefits from the Affordable Care Act. (Seitz, 11/2)

Members of Congress from Massachusetts are getting some big money from Big Pharma. The state's House delegation ranks among the nation’s leaders in donations received from pharmaceutical companies over the last two years, according to data from Kaiser Health News. (Thompson, 11/2)

Voters in four red states will decide Tuesday whether to expand Medicaid to thousands of low-income adults, potentially circumventing GOP legislators who for years have blocked one of ObamaCare's key provisions. Ballot initiatives in Idaho, Montana, Nebraska and Utah aim to bring those states in line with the 32 that have already embraced Medicaid expansion. (Hellmann, 11/4)

Last year’s failed attempt by Trump and congressional Republicans to unravel Obamacare revealed the popularity of the ACA with voters. Health policy experts said it also helped educate the public about the benefits of Medicaid, prompting activists in the four states to circumvent their Republican-led legislatures and take the matter directly to the voters. Activists also were encouraged by the example of Maine, where nearly 60 percent of voters last year approved Medicaid expansion after the state’s Republican governor vetoed expansion bills five times. (Ollove, 11/5)

Kaiser Health News: Tobacco Tax Battle Could Torch Montana Medicaid Expansion

Montana legislators expanded Medicaid by a very close vote in 2015. They passed the measure with an expiration date: It would sunset in 2019, and all who went onto the rolls would lose coverage unless lawmakers voted to reapprove it. Fearing legislators might not renew funding for Medicaid’s expanded rolls, Montana’s hospitals and health advocacy groups came up with a ballot measure to keep it going — and to pay for it with a tobacco tax hike. (Whitney, 11/5)

In the run-up to Election Day, residents of Washington and Oregon have been bombarded with similar messages from groups with names like Yes! To Affordable Groceries. The organizations have spent more than $25 million on commercials that feature plain-spoken farmers and penny-pinching moms urging support of ballot measures that would prohibit municipalities from taxing food sales. But what most voters don’t know is that Coca-Cola, PepsiCo and other American beverage companies are largely financing the initiatives — not to block taxes on staples like milk and vegetables but to choke off a growing movement to tax sugary drinks. (Jacobs, 11/2)

Opposition to Proposition 8, a California ballot measure that would cap revenue at the state’s dialysis clinics, has broken a record for the most money raised to support or oppose a single ballot measure in recent state history. The opposition is being bankrolled by two of the nation’s largest dialysis companies, DaVita and Fresenius Medical Care, which have financed a vast majority of the record-high $111.4 million raised to defeat the initiative. (Ho, 11/3)

Both sides of a contentious ballot question to regulate nurse staffing levels in Massachusetts are stoking fears of a doomsday scenario, either if the measure passes or if it fails. But in California, where a more lenient version of the law has been in effect for almost 15 years, the results seem to undercut the panic on both sides, proving to be neither a panacea for improving patient care nor a fatal blow to hospitals’ finances. (Dayal McCluskey, 11/2)

Ohio's controversial Issue 1 has driven debate on criminal justice reform for months – and led to some heated exchanges in the governor's race, too. With less than a week until Election Day, supporters and opponents of the constitutional amendment are making their final pitches to voters. ... Issue 1, the sole statewide ballot initiative, would [reduce] penalties for some drug offenses. Fourth- and fifth-degree drug possession charges would become misdemeanors, punishable with county jail time instead of prison time. Issue 1 also would prohibit jail time for these offenses until the third conviction within 24 months. (Balmert, 11/4)

Gov. Scott Walker and Democrat Tony Evers doubled down Sunday on new policy stances as they traded charges over health care and taxes during a final sprint in their close and dramatic race. Speaking to supporters in Glendale, Walker hit back at claims that he was not a longtime backer of covering those with pre-existing health conditions, even though he authorized Wisconsin to join a federal lawsuit against the Affordable Care Act. (Marley, Glauber and Hauer, 11/4)

Republican treasurer Walker Stapleton has attacked his opponent in the race for Colorado governor, Democratic U.S. Rep. Jared Polis, as too radical and extreme for the rapidly growing state as the GOP tries to prevent a complete Democratic takeover of the Statehouse. ... Polis and his supporters largely view the race as a referendum on President Donald Trump, whom [Republican treasurer Walker] Stapleton has embraced. Trump’s efforts to dismantle former President Barack Obama’s health care law top the list of issues. “Health care is on the ballot. Social Security and Medicare are on the ballot,” Tom Perez, chairman of the Democratic National Committee, told activists while campaigning with Polis at Servicios de la Raza, a Denver community center. “You need guardrails here in Colorado.” (Anderson, 11/3)

We’re left wondering what issues have an enduring impact. Health care does, it turns out. We’ll get to other issues in a moment, but after Google provided us with search data for more than a hundred politics-related issues, there was one obvious pattern. In almost every county in almost every month for the past year, health care topped the charts. Medicare and Medicaid were perennially popular, as was mental health. (Van Dam, 11/3)

Republicans who just endured months of withering attacks over health care will face an immediate high-stakes decision if, against all odds, they keep control of the House and Senate: whether to mount one more bid to kill Obamacare that's almost certain to fail. The GOP believes it can't just walk away from an eight-year pledge to repeal the law, a promise the party's base still wants Republicans to keep despite Obamacare's relative new popularity. If an election-night shocker keeps Republicans in power — rebuking the conventional wisdom that voters will punish them for their Obamacare attacks — they might be emboldened to mount another repeal push without risking reprisals at the polls next time around. (Cancryn, 11/5)

In the final days before pivotal midterm elections, President Donald Trump is painting a distorted picture of immigration while exaggerating his record of achieving economic gains for non-whites and improving health care for veterans. ... Meanwhile, on health care, Trump falsely suggests that Democrats would seek to destroy Medicare if they take control of Congress and overstates improvements he made to the Department of Veterans Affairs. (Woodward and Yen, 11/5)

Kaiser Health News: Quick: What’s The Difference Between Medicare-For-All And Single-Payer?

Across the country, catchphrases such as “Medicare-for-all,” “single-payer,” “public option” and “universal health care” are sweeping state and federal political races as Democrats tap into voter anger about GOP efforts to kill the Affordable Care Act and erode protections for people with preexisting conditions. Republicans, including President Donald Trump, describe such proposals as “socialist” schemes that will cost taxpayers too much. ... Voters have become casualties as candidates toss around these catchphrases — sometimes vaguely and inaccurately. (Young, 11/5)

Democratic National Committee (DNC) Chairman Tom Perez on Sunday said that "health care is under attack" from President Trump and the GOP, calling it the top issue ahead of this week's midterm elections. Appearing on CNN's "State of the Union," Perez made a closing pitch to voters two days ahead of the midterms, saying that health care will be "on the ballot" on Tuesday. (Burke, 11/4)

Investors this year have poured almost $9 billion into exchange-traded funds focused on health care, one of the main sectors that could feel an impact from the U.S. midterm elections on Nov. 6, according to ETF analysts. “Year-to-date, health-care ETFs have gathered shy of $9 billion across the globe, compared with less than $1.5 billion of inflows in 2017,” says Antoine Lesne, head of SPDR ETF research and strategy, Europe, Middle East and Africa, at State Street Global Advisors. “Within the sector, biotech has attracted the greatest investor attention, with inflows north of $2 billion,” he says. (Akhtar, 11/4)

An investigation by APM Reports and KCUR found that between 2008 and 2016, Missouri purged more than double the number of voters for mental incompetence than any other state, followed by Kentucky (4,907) and Virginia (3,905). Proponents of these laws say they help protect the integrity of the election and prevent voter fraud, but critics say the one-size-fits-all nature of these laws discriminates against people with mentally illness by preventing them from exercising their constitutional rights. (Lowe, 11/5)

[Daniel] Harnsberger is the Progressive Liberal, a professional wrestler whose renewable energy politics and preening arrogance have riled supporters of President Trump across the Appalachian Mountains. He praises Hillary Clinton and invokes the Affordable Care Act. Worst of all he’s an outsider, a real estate agent from Richmond, Va., who drives south on weekends and slips on “blue wave” tights and a conceit that he’s better than out-of-work coal miners and Baptists with rifle racks in their pickups. (Fleishman, 11/4)

The FDA also said it had signed a memorandum of understanding with the Defense Department to expedite availability of medical products, particularly those used to treat injuries in battlefield settings. Others weren’t convinced that the drug’s benefits outweighed potential risks. “It is certain that Dsuvia will worsen the opioid epidemic and kill people needlessly,” Dr. Sidney Wolfe, founder and senior adviser of Public Citizen’s Health Research Group, said in a statement. (Burton and Armental, 11/2)

In a highly controversial move, the Food and Drug Administration approved an especially powerful opioid painkiller despite criticism that the medicine could be a “danger” to public health. And in doing so, the agency addressed wider regulatory thinking for endorsing such a medicine amid nationwide angst about overdoses and deaths attributed to opioids. The drug is called Dsuvia, which is a tablet version of an opioid marketed for intravenous delivery, but is administered under the tongue using a specially developed, single-dose applicator. These “unique features” make the medicine well-suited for the military and therefore was a priority for the Pentagon, a point that factored heavily into the decision, according to FDA Commissioner Scott Gottlieb. (Silverman, 11/2)

The Food and Drug Administration on Friday approved a new form of an extremely potent opioid to manage acute pain in adults, weeks after the chairman of the advisory committee that reviewed it asked the agency to reject it on grounds that it would likely be abused. The drug, Dsuvia, is a tablet form of sufentanil, a synthetic opioid that has been used intravenously and in epidurals since the 1980s. It is 10 times stronger than fentanyl, a parent drug that is often used in hospitals but is also produced illegally in forms that have caused tens of thousands of overdose deaths in recent years. (Goodnough, 11/2)

FDA Commissioner Scott Gottlieb issued an unusual statement saying he would seek more authority for the agency to consider whether there are too many similar drugs on the market, which might allow the agency to turn down future applications for new opioid approvals. “We need to address the question that I believe underlies the criticism raised in advance of this approval,” Gottlieb wrote. “To what extent should we evaluate each opioid solely on its own merits, and to what extent should we also consider . . . the epidemic of opioid misuse and abuse that’s gripping our nation?” (Bernstein, 11/2)

The tiny pill was developed as an option for patients who pose difficulties for the use of IVs, including soldiers on the battlefield. The pill from AcelRx Pharmaceuticals contains the same decades-old painkiller often given in IV form or injection to surgical patients and women in labor. (Johnson, 11/2)

In approving the drug, the agency skirted its normal vetting process, these critics say. Dsuvia is an unnecessary opioid, they say, and its size and potency will appeal to people looking to sell or misuse it. (Harper, 11/2)

But this wasn’t an FBI sting or DEA operation. The lead agent in that hotel room was Spencer Morrison, of the Food and Drug Administration’s Office of Criminal Investigations. The OCI, it turns out, is staffed by 300 gun-toting officers, all of them employees of the same bureaucracy that issues food recall notices and verifies that medicines are safe and effective. But it is little-known in Washington or beyond. (Florko, 11/5)

Drug overdose deaths hit the highest level ever recorded in the United States last year, with an estimated 200 people dying per day, according to a report by the U.S. Drug Enforcement Administration. Most of that was the result of a record number of opioid-related deaths. Preliminary figures show more than 72,000 people died in 2017 from drug overdoses across the country. About a week ago, U.S. Health and Human Services Secretary Alex Azar said overdose deaths, while still slowly rising, were beginning to level off, citing figures from late last year and early this year. (Balsamo, 11/2)

Kaiser Health News: Like Clockwork: How Daylight Saving Time Stumps Hospital Record Keeping

Modern technology has helped medical professionals do robot-assisted surgeries and sequence whole genomes, but hospital software still can’t handle daylight saving time. One of the most popular electronic health records software systems used by hospitals, Epic Systems, can delete records or require cumbersome workarounds when clocks are set back for an hour, prompting many hospitals to opt for paper records for part of the night shift. And it happens every year. (Lupkin, 11/3)

Daylight Saving Time ends and clocks will "fall back" an hour this weekend, giving Americans the feeling of an extra hour in the morning, which could negatively affect their health. "Ever since the institution of Daylight Saving Time, there has been controversy regarding whether it accomplishes its goals or not, and if so — at what cost," Timothy Morgenthaler, Mayo Clinic's co-director of the Center for Sleep Medicine, said in an email. Morgenthaler has reviewed about 100 medical papers related to how the time change could affect health. (May, 11/2)

When it comes to turning back the clocks on our devices, technology has us covered. Our smartphones automatically adjust. But our internal clocks aren't as easy to re-program. And this means that the time shift in the fall and again in the spring can influence our health in unexpected ways. "You might not think that a one hour change is a lot," says Fred Turek, who directs the Center for Sleep & Circadian Biology at Northwestern University. "But it turns out that the master clock in our brain is pretty hard-wired, " Turek explains. It's synchronized to the 24 hour light/dark cycle. (Aubrey, 11/3)

Is the key to Alzheimer’s disease lurking, overlooked, in the 100,000-plus scientific papers that have been published on this disease over the last century? A Texas businessman who lost family members to dementia thinks so, and on Monday he announced that there’s $4 million waiting for the people who find it: Prizes of up to $2 million will be awarded to those who comb the scientific literature, extract the key findings, and synthesize them into one simple explanation of the disease, said James Truchard, 75, an electrical engineer who recently retired as CEO of National Instruments, which he co-founded in 1976. (Begley, 11/5)

L.A. Found, which launched in this sprawling county in September, equips potential wanderers with trackable bracelets that, when activated by search crews, transmit a radio signal to handheld receivers placed in several Sheriff’s Department cruisers and helicopters. The battery-operated bracelets are available to anyone with Alzheimer’s disease, dementia or autism. The bracelets are nothing new. They are distributed by Project Lifesaver, a nearly 20-year-old nonprofit group based in Florida that has issued the white, watch-sized wristbands — each equipped with a radio transmitter — to hundreds of municipal public-safety agencies around the country. (Kuznia, 11/3)

During the 2017-18 season, the flu virus and its complications claimed an estimated 80,000 American lives — the highest number in at least four decades. Health-care providers are stressing the importance of getting vaccinated as a new flu season takes off. Certain people are more at risk of catching the flu bug and suffering serious complications, so it behooves all of us to get vaccinated to protect ourselves and the most vulnerable among us, doctors say. (Viviano, 11/4)

So [British entomologist Steve Lindsay] set out to create the ultimate disease watchdogs — canines that can smell parasites living inside people. Then, as people hop off international flights, these watchdogs could take a few sniffs at each person's skin and paw at the people who might be carrying a parasite. "The person can be taken aside and possibly tested for the disease with a blood test," Lindsay explains. Sound far-fetched? Well, it might not be as far from reality as you would think. (Doucleff, 11/2)

The Juul e-cigarette was created to help adult smokers quit, according to the company that makes it. Its developers wanted to make the experience of getting a stimulating hit of nicotine dramatically better than sucking on a stinky, smoking stick of burning tobacco. Their success made Juul the top-selling e-cigarette in the U.S. in two years, but it achieved that position in part by attracting a huge following among kids younger than 18, who aren’t legally allowed to purchase such products. Concerns about the hazards of vaping for the young have provoked the U.S. Food and Drug Administration to warn that it will tighten regulations on e-cigarettes unless their makers convince the agency they will combat use by minors. (Edney, Alexander and Zaleski, 11/5)

One in 3 adults in the United States, about 100 million people, are living with diabetes or prediabetes, according to the CDC. Another case is diagnosed every 21 seconds. The American Diabetes Association estimates the total cost of diagnosed diabetes, including lost productivity, reached $327 billion in 2017, a big jump from $245 billion just five years earlier. That’s roughly one-tenth of the astronomical $3.5 trillion in annual U.S. health expenditures. People with diabetes are at risk for other chronic conditions such as heart disease, as well as dangerous conditions including stroke, amputation, kidney failure and blindness. The challenge is finding ways of preventing diabetes when possible and managing it optimally when prevention fails. (11/2)

“Exercise isn’t really important for weight loss” has become a popular sentiment in the weight-loss community. “It’s all about diet,” many say. “Don’t worry about exercise so much.” This idea crept out amid infinite theories about dieting and weight loss, and it quickly gained popularity, with one article alone citing 60 studies to support and spread this notion like wildfire. The truth is that you absolutely can — and should — exercise your way to weight loss. So why is anyone saying otherwise? (Prologo, 11/4)

The group is part of Dr. Green and her colleagues’ treatment program for perinatal anxiety at St. Joseph’s Healthcare Hamilton. It is one of a small but growing number of psychological therapy programs that are specifically designed for pregnant and postpartum women who struggle with anxiety and depression. They address a critical need. While scientific studies have generally found that antidepressant medications are safe to use during pregnancy and breast-feeding, there are still some concerns about their impact on babies. Some doctors encourage women to avoid the drugs during the perinatal period, especially those patients with mild illness. And many women, even some with severe depression and anxiety disorders, simply refuse to take them while pregnant or breast-feeding. (Petersen, 11/3)

A new study examining how long black or white people survive after a heart attack concludes that it’s socioeconomic status, far more than race, that explains who fares better. Previous studies have focused on black patients being less likely than white patients to receive the standard of care both before and after having a heart attack, placing them at higher risk for another heart attack, another hospitalization, and death. Some of those disparities in care and outcomes have narrowed, but inequalities persist between how ill black and white patients are after a heart attack and how many die. (Cooney, 11/2)

In a paper published Saturday, a team from the Boston University School of Medicine identifies a new clue in understanding an illness that has raised worrisome questions about the long-term risks of playing contact sports. Genes had been suspected of playing a role in CTE, and the study is the first to suggest a specific culprit: a common variant of a gene known at TMEM106B. (Freyer, 11/4)

State leaders hope a new program will encourage more medical providers and facilities to offer free care to some of Wyoming’s poorer residents. Wyoming’s Volunteer Health Services Program was created earlier this year by the state Legislature. The gist of the program is this: If a licensed healthcare provider or medical facility agrees to provide voluntary, free services to low-income Wyoming residents, the state government will effectively shield them from legal liability (i.e. medical malpractice suits) for that care. (Powell, 11/4)

Foreign-born physicians help fill the gaps, especially in primary care. There are not enough American-born doctors to supply that need, says Dr. William Salazar of Augusta University’s Medical College of Georgia, who came to the U.S. from Colombia. Rural Georgia has a higher percentage of immigrant doctors than urban areas, says Jimmy Lewis of HomeTown Health, an association of rural hospitals in Georgia.(Miller, 11/4)

This year, more new medical students are starting their careers in Spokane than in Seattle. Why does it matter? Here in Washington and elsewhere across the nation, there’s a shortage of physicians in rural areas and small cities, a problem that’s expected to worsen as a generation of baby-boom doctors retires. The hope is that getting students to train in Eastern Washington will sway more of them to stay east of the mountains, or to make their homes in smaller communities and rural areas, and to focus on primary care instead of specialty medicine — known for being more lucrative. (Long, 11/4)

Ohio State’s medical college has a program focused on teaching students to address not only individual but community health as well. Students work in neighborhoods to improve the health of a specific, underserved population. (Viviano, 11/5)

A Senate inquiry faulted state and federal oversight for fatal heat strokes and chaotic evacuations at nursing homes after last year’s hurricanes, calling for tougher disaster preparedness standards on Friday. Officials with the Centers for Medicare and Medicaid Services, a federal agency that was a subject of the inquiry, have said they would clarify expectations for how nursing homes must maintain safe temperatures in emergencies. Officials added in an interview this week that they were actively seeking lessons from recent disasters. But they defended the agency’s new preparedness requirements for health care providers, which did not come under enforcement until just after last year’s hurricane season. (Fink, 11/2)

Fending off creditors and repeated fines for patient deaths and injuries, a New Jersey nursing home company plans to close two of its 10 Massachusetts facilities as a court-ordered receiver works to sell its other properties. Synergy Health Centers’ facilities in Sunderland and Newton are set to close in February, according to state records. (Lazar, 11/2)

North Carolina wants to reshape how it pays for its workers’ health care—and save hundreds of millions of dollars—by scrapping the secret negotiations typically used to set rates with doctors and hospitals. The fate of the plan, from the state’s treasurer, is expected to be watched closely by other employers eager to stem rising health costs. But hospitals are already fighting back. At issue is the system that employers’ health plans have long used to determine how much they will pay doctors and hospitals. The payments are typically set through negotiations, conducted in secret, between health insurers and the hospital systems and physician groups. (Wilde Mathews, 11/4)

A substantial number of mothers with opioid addictions are giving birth in rural hospitals that are presumably less equipped to address their challenges and to manage the withdrawal symptoms that their babies suffer in their first days. The University of Minnesota’s Katy Kozhimannil examined births involving rural mothers with opioid-use disorders in the U.S. from 2007 through 2014 and found that 60 percent occurred in local, smaller-town hospitals. (Olson, 11/3)

Advocate South Suburban Hospital has received approval from state regulators for a nearly $98 million expansion and modernization of the Hazel Crest hospital. The Illinois Health Facilities and Services Review Board approved the project Oct. 30, and work will include adding nearly 91,000 square feet and modernizing another 37,000 square feet, according to Advocate Aurora Health. (Nolan, 11/2)

Maureen Pacheco had expected to have a spinal procedure. It was April 2016, and she was told a surgeon would fuse together a couple of vertebrae in her lower back to help relieve pain believed to be from an injury she sustained in a car accident the previous year. However, when she woke up from surgery at Wellington Regional Medical Center in Wellington, Fla., she learned that the surgeon had done something else, according to court records. (Bever, 11/2)

Beaumont Health is to announce details Monday about its plan to build a new mental health hospital in Dearborn in conjunction with Pennsylvania-based Universal Health Services. Construction on the $40 million free-standing hospital is to begin in early 2019 on eight acres of vacant land on Oakwood Boulevard near the Southfield Freeway. When it opens, the hospital — Beaumont's ninth — will have space for 150 beds and will be operated and managed by UHS, which also will be the majority owner. (Shamus, 11/5)

Virginia is facing a huge bill for unexpected Medicaid costs that hamper proposed new spending on things like school improvements or tax breaks for the poor. State officials said Friday that Virginia has about $460 million in unforeseen Medicaid costs. The new costs, first reported by the Richmond Times-Dispatch, are unrelated to Virginia’s recent decision to expand Medicaid eligibility to low-income adults under the Affordable Care Act. (Suderman, 11/2)

A class-action lawsuit that could cost CalPERS $1 billion is headed to trial in June, and many of the 122,000 retirees who bought an insurance plan at the center of the case are receiving small checks from an agreement that settled a portion of the claims. ...Michael Bidart, the attorney representing CalPERS members who allege the pension fund carried out a contract-breaking rate hike on their long-term health care plans five years ago, anticipates that the trial will go forward as scheduled. (Ashton, 11/5)

The state of Nevada will likely appeal a jury verdict that it must pay $250,000 to scores of people it put on Greyhound buses after discharging them from a mental health hospital, officials said Friday.A Sacramento Bee investigation in 2013 found that Rawson-Neal Psychiatric Hospital purchased bus tickets for roughly 1,500 patients after discharge over a five-year period, sending them to California and other states across the country. (Reese and Hubert, 11/2)

Tenants who find mold in their homes have no safety net in metro Atlanta and elsewhere in Georgia, placing them and their children at risk of chronic breathing problems, infections and lost school days. Local and state government agencies lack the legal authority and funding to test the air in Gray’s apartment, much less make it healthy to breathe, an Atlanta Journal-Constitution investigation found. (Mariano, 11/2)

A California mother who cares for her disabled daughter sued a union representing home health care workers, claiming the group won’t let her cancel her membership. Delores Polk said in the lawsuit filed Thursday in Sacramento federal court that a telemarketer with the Service Employees International Union pressured her to join and failed to properly inform her that she could decline membership. The suit is the latest in a string of cases nationwide filed since the U.S. Supreme Court ruled that government workers can’t be forced to contribute to labor unions that represent them in collective bargaining. (Melley, 11/2)

After years as one of the worst states when it comes to using dangerous medications to sedate people, Kansas showed marked improvement in the latest federal data released last month by the National Partnership to Improve Dementia Care in Nursing Homes. In the first quarter of 2018, the percentage of long-term nursing home residents on anti-psychotics in Kansas was 17.4 percent — the state’s lowest rate since the partnership started tracking it in 2011 and down from a high of 26 percent. (Marso, 11/5)

Kansas authorities said that they have recaptured a sexual predator 12 days after he absconded from a mental health facility in Miami County. The Miami County Sheriff’s Office said that Jason Michael Hale had fled on Oct. 21 and was taken back into custody early Friday. (Rizzo, 11/2)

A former employee of Centria Healthcare, believed to be the nation's largest provider of autism therapy, has been charged with two felony counts of Medicaid Fraud False Claims, after investigators say she forged billing records for care she didn't provide. The charges are punishable by up to four years in prison. The criminal charges brought by the Michigan Attorney General's Office are the first sanctions to result from the ongoing probe of the Novi-based company, although the accused is being prosecuted as an individual, not as an employee of the company where she used to work. (Wisely, 11/2)

The state’s child welfare agency Friday agreed to stop sending children in its care to a Chicago psychiatric hospital where children have reported being sexually abused and assaulted, but said it would not seek the full independent investigation advocates had requested, setting up a possible court fight. The decision by the Illinois Department of Children and Family Services came one day after state lawmakers and the American Civil Liberties Union of Illinois demanded the agency allow an outside expert to conduct a comprehensive investigation of Aurora Chicago Lakeshore Hospital on the city’s North Side. (Eldeib, 11/2)

This is the most important election of our lifetime. Voters face a choice between a Republican Party marching in lockstep behind President Donald Trump and a Democratic Party that will fight for affordable health care; protect Medicare, Medicaid and Social Security; stand up for working families, hold Trump accountable; and restore sanity to our politics. (Tom Perez, 11/2)

Americans say health care is a leading concern in Tuesday’s election, and voters say they trust Democrats over Republicans by double-digit margins. Yet the Trump Administration has put together an impressive suite of reforms that allow consumers more freedom and personal choice, not that you’ll read about it anywhere else. Last month the Trump Administration rolled out a rule on health-reimbursement arrangements that would allow employers to offer workers tax-exempt dollars to buy insurance in the individual market. The Obama Administration banned this via regulation as part of the Affordable Care Act. (11/4)

President Donald Trump and his allies would like the midterms to be a vote you cast based upon dread and anxiety. All his energy and much of the Republican Party's message have centered on playing to what GOP consultants see as your worst fears: A caravan of lepers coming to invade. Innocent men branded as sexual harassers. The government taking away your health care. (Andy Slavitt, 11/5)

The Democrats' emphasis on health care may give them a modest, but not a decisive, advantage with seniors in Tuesday's elections.Why it matters: Older voters are the one group that always turns out to vote in midterm elections. They vote at higher rates than younger adults in all elections, but especially in midterms. In 2014, for example, turnout was 55% among the 60-plus population compared to about 16% among 18-29 year-olds. (Drew Altman, 11/5)

The results are in! No, not the outcome of tomorrow’s midterm elections. I’m talking about the winner of 2018 when it comes to political advertising, stump speeches and social media campaigns. On every platform for political messaging, the number one issue driving voters is healthcare. Talk about a comeback. In 2010, Tea Party opposition to ObamaCare led the GOP to pick up 63 seats in the House and expand their Senate majority by six seats. At that time, polls showed the Affordable Care Act was viewed unfavorably by a plurality of Americans. (Juan Williams, 11/5)

What a difference eight years make. On the eve of the midterm elections of 2010, career-ending defeat loomed over dozens of Democratic congressman who’d voted for the Affordable Care Act, derisively branded “Obamacare” at the time. In 2018, Republicans, the current target of voter rage, are scrambling to reassure constituents that they’ll save — even extend — key features of the ACA. For example, last week Idaho’s right-wing Republican Gov. Butch Otter endorsed a ballot measure that would extend Medicaid coverage to more than 60,000 of his state’s low-income residents. The federally funded expansion of Medicaid, let us recall, was one of the ACA’s most contentious components. And, in the end, every single Republican congressman and senator voted against the final bill. Now a Republican governor in Idaho is all for it. (Harold Meyerson, 11/5)

Over the past several months, Democratic candidates have vowed to defend ObamaCare regulations on pre-existing conditions if they regain control of Congress. They argue these rules protect patients suffering from costly illnesses like cancer, diabetes and multiple sclerosis. They say Republicans and other supporters of consumer-driven health care want to heartlessly rip these protections away. However, contrary to these Democratic talking points, ObamaCare caused far more problems than it solved for many vulnerable people. (Charlie Katebi, 11/2)

On Halloween, the Trump administration’s administrator of Centers for Medicare & Medicaid Services, Seema Verma, made a joke on Twitter that the scariest Halloween costume would be “Medicare for All.” As a Miami resident and a former longtime Republican, I’m not laughing. I’m voting, and I’m voting only for those who make solving our health care crisis a priority. (Montel Williams, 11/4)

November is here, and in most U.S. states that means the start of open enrollment, the sign-up period for obtaining insurance via the U.S. Affordable Care Act’s exchanges. It also means we’re a few days away from an election where health care has taken center stage. One thing that’s likely to be strengthened, rather than put in existential peril for once, is this key part of President Obama’s signature law. Enrollment is likely to decline modestly for the third year in a row after a GOP tax bill zeroed out the individual mandate, eliminating the financial penalty for those who didn’t sign up for insurance. But if you look beyond the headline numbers, the individual market is increasingly stable, and, depending on how the midterm elections go, may only become more so under a friendlier Congress. (Max Nisen, 11/4)

House Republicans proposed a budget in June with cuts to entitlement programs, including Medicaid, to balance spending. Our daughter is kept alive and flourishing because of a Medicaid waiver program for medically complex children. The president fired his entire HIV advisory council in December. One of my children has HIV. People with U.S. birth certificates — citizens — have been denied passports in Texas; people across the country may have their legal status in jeopardy if they use government benefits. We’ve used public assistance in the form of reduced lunch and early intervention services, and four of my children are immigrants. (Shannon Dingle, 11/5)

Trump administration lawyers told a Texas court in June that they will no longer defend protections for preexisting conditions; that judge is expected to rule soon on whether the Affordable Care Act and its protections are constitutional. Thus far, all the substitute GOP health care plans and proposals have fallen short of what Obamacare offers to people who’ve had health issues. That includes the American Health Care Act, which would have allowed for people with preexisting conditions to be charged thousands or tens of thousands of more dollars per year. That also includes a bill sponsored by NC Sen. Thom Tillis that Republicans have touted this fall, called Ensuring Coverage for Patients with Preexisting Conditions, which experts say has loopholes that could allow insurers to deny some coverage, as well as charge higher premiums to people in less healthy communities and occupations. Republicans, as they did last May, believe that’s still enough to claim they are protecting Americans with preexisting conditions. It’s not. Voters should remember that Tuesday. (11/2)

On Tuesday, California will choose a new governor, but one issue that has not received nearly enough attention during the campaign is our state’s aging population and its associated challenges, such as health care, long-term care, supportive services and housing. The Public Policy Institute of California estimates that by the year 2030 the over 65 population will increase by 4 million. (Eric Dowdy, 11/2)

In the American mind, drug addiction happens only to people “born under a bad sign.” That’s just not true. Worse, it implies that success in life protects individuals from addiction. Throughout my 50-year career working on drug abuse prevention and treatment, I’ve often seen drug addiction befall every kind of person. That’s one reason I have been urging people to see “Beautiful Boy,” a new film about the relationship between a good father and his good son as the teenager dives into addiction. The film is based on a pair of best-selling books: “Beautiful Boy,” which tells the story from the father’s perspective, and “Tweak,” which tells it from the son’s. (Robert L. DuPont, 11/5)

Justice Sandra Day O’Connor set a high bar. As the first woman on the Supreme Court, she remade our image of a powerful judge. Justice O’Connor was ahead of the curve again last week when she announced her diagnosis of early Alzheimer’s. She sets another example by taking this brave step and bringing this difficult disease out of the shadows. (Barak Gaster, 11/4)

Citizens in four states vote Tuesday on ballot initiatives to legalize some form of cannabis. Residents of Missouri and Utah will decide on its medical availability, Michigan and North Dakota on recreational consumption for adults. If all four measures pass, the tally of states that allow some sort of cannabis use will jump to 32, nearly two-thirds of the U.S. The trend could not be clearer: Cannabis prohibition is coming to an end. A Gallup poll last month found 66% of Americans favor legal marijuana. I am now one of those Americans. (Former speaker of the U.S. House of Representatives John Boehner, 11/4)

Miss? Miss? Are you kidding me? You’ve got to be kidding me. You demanded to speak to a doctor, your mother’s doctor, now, right now, and I came and answered your questions politely and with patience — and yet I’m still not the doctor? That “Miss” just sucks the air right out of me. I don’t know what to do with that. Suddenly I feel small. (Caitlin Bass, 11/4)

Most cystic fibrosis studies, including Phase 1, 2, and 3 trials, require participants to have an FEV1 of at least 40 percent. Mine is 25 percent which, for more than 10 years of my life, has made me ineligible for clinical trials. I’m not alone. That requirement overlooks the fact that cystic fibrosis affects different people in different ways. Some who need supplemental oxygen, have a hard time completing daily tasks, are unable to work, and are on disability have FEV1s above 40 percent and so would qualify for trials. Others, like me, who work, travel, have good quality of life, and use oxygen only when sleeping or during laborious physical activity, yet have FEV1s of 30 percent, are excluded from taking part in trials. (Ella Balasa, 11/5)

In the left-of-center universes where I have mostly lived, worked and been politically active, it is now awkward to introduce oneself as a Democrat who supports the choice for life over that of abortion. The reaction is often polite but perplexed. I have regularly had people greet this news with a shocked silence — as though supporting universal health care, economic redistribution, minority rights, strong unions, environmental regulation, gun controls, criminal justice reform and freedom of expression but balking at abortion is so illogical that it can be explained only by some psychological deficit or religious dogmatism beyond rational discussion. A few outraged interlocutors have suggested that to be both a liberal and an abortion opponent is a form of insidious false advertising, just short of claiming to sell oneself as a benign Nazi. (Peter Steinfels, 11/5)

Personal care attendants, or PCAs, in Minnesota are collecting cards for the largest decertification in labor law history. They have less than 30 days to prove that they want a new election on union representation. This petition for an election comes after the discovery that at least eight states have a scheme in which unions deduct dues from Medicaid reimbursements to PCAs, who are usually family members taking care of individuals with disabilities. (Olivia Grady, 11/3)

After months of stalling and whining, officials in Orange County have finally developed plans to provide shelter for hundreds of homeless people, many of whom were removed from encampments along the Santa Ana River Trail earlier this year. That’s a meaningful step forward; at the time the rousting began, officials had no plan for where people should go. There were not enough emergency shelters available, and the largest of them was a converted bus terminal that looked and felt more like a refugee camp. (11/5)

Opioid addiction has become such a serious problem that it can only be remedied through effective and coordinated measures. That’s why we are pleased to see the joint efforts at both the state and federal level in recent weeks to combat this crisis.President Donald Trump signed the “Support for Patients and Communities Act” on Oct. 24, which promises $8.5 billion this year for opioid-related programs. The next day, a Michigan executive directive signed by Lt. Gov. Brian Calley established new rules that require health professionals and facilities to report overdoses and deaths within five days of a Michigan Department of Health and Human Services request. (11/3)

Decriminalization of addiction is long overdue and I am glad to see Issue 1 on our ballot in Ohio. For years I have watched my patients with addiction get arrested over and over again as a direct result of their addictions. My patients are frequently arrested and charged with felonies when they are caught in possession of drugs that they have obtained for their personal use. I have watched them cycle in and out of jail, and I have seen many of my patients go to prison. What I have learned through my experiences with my patients is that neither jail, nor prison, nor a constant fear of being locked up cures addiction. (Megan Testa, 11/4)

Tuesday, we have a once-in-a-generation opportunity to leave a legacy and positively affect generations of children for years to come. We have the chance to take a simple action that can make children’s lives better now, as well as change the arc of their future children’s lives. (Tracy Cook, 11/4)

Voting yes on Question 3 ensures that both of us have laws in place that protect us in public places and makes us feel safe. Voting no only protects only one of us. (Robson Govine, 11/5)