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The Trump administration on Friday moved to expand the rights of employers to deny women insurance coverage for contraception and issued sweeping guidance on religious freedom that critics said could also erode civil rights protections for lesbian, gay, bisexual and transgender people. The twin actions, by the Department of Health and Human Services and the Justice Department, were meant to carry out a promise issued by President Trump five months ago, when he declared in the Rose Garden that “we will not allow people of faith to be targeted, bullied or silenced anymore.” (Pear, Ruiz and Goodstein, 10/6)

The rules significantly widen the range of employers and insurers that can invoke religious or moral beliefs to avoid the ACA requirement that birth control pills and other contraceptives be covered by insurance as part of preventive care. Administration officials and their allies on the right downplayed the impact of the change on American women, while women’s rights and civil liberties groups portrayed it as a massive, discriminatory act. (Goldstein, Eilperin and Wan, 10/6)

The new policy was a long-anticipated revision to Affordable Care Act requirements that most companies cover birth control as preventive care for women, at no additional cost. That Obama-era requirement applies to all FDA-approved methods, including the morning-after pill, which some religious conservatives call an abortion drug, though scientists say it has no effect on women who are already pregnant. (10/6)

The new policies, which take effect immediately, reignite a fierce battle over one of the health care law's most controversial provisions and quickly drew legal challenges. The requirement to provide FDA-approved contraception at no cost was long opposed by religious groups that heavily favored Trump, and has been wrapped up in litigation for more than five years. (Ehley, 10/6)

"This provides an exemption, and it's a limited one," said Roger Severino, director of the HHS Office of Civil Rights. "We should have space for organizations to live out their religious identity and not face discrimination." He said he expects that most companies will continue to provide coverage for birth control and that the changes will only affect a tiny percentage of U.S. women. The new rules are being published Friday in the Federal Register and go into effect immediately. But some health policy analysts say the new rule creates a huge opening that lets any employer claim an exemption, leaving their female workers to pay the full cost of any birth control out of pocket. (Kodjak, 10/6)

Women’s health advocates said millions of women who had gained access to birth control at no cost would be at risk of losing that coverage. They also said some employers not associated with religious movements will use the move to justify declining to cover birth control because of unspecified moral objections. (Facher, 10/6)

The American College of Physicians said the rule change will “create substantial barriers to patients receiving appropriate medical care as recommended by their physicians.” The American Congress of Obstetricians and Gynecologists said the rules would hurt patients. “Contraception is a medical necessity for women during approximately 30 years of their lives,” the group said. “It improves the health of women, children and families as well as communities overall; reduces maternal mortality; and enhances economic stability for women and their families.” (Tracer, Edney and Larson, 10/6)

Kaiser Health News: 4 Takeaways As HHS Relaxes Rules On Contraception Coverage At Work

Here are some frequently asked questions and answers about the new rules. (Carey and Verdon, 10/6)

California Attorney General Xavier Becerra (D) on Friday filed a lawsuit challenging the Trump administration's rollback of an Obama-era policy that required employers include birth control coverage in their health insurance plans. “Donald Trump wants businesses and corporations to control family planning decisions rather than a woman in consultation with her doctor. These anti-women's health regulations prove once again that the Trump administration is willing to trample on people’s rights,” Becerra said in a statement. (Manchester, 10/6)

In a complaint filed Friday afternoon in federal district court in San Francisco, Becerra argued that the directive issued by President Donald Trump, through the U.S. Department of Health and Human Services, is unconstitutional. (Hart, 10/6)

The lawsuit claims the rule change is unconstitutional because it specifically targets and harms women — thus denying their Fifth Amendment rights to equal protection under the law — and allows employers to use their religious beliefs to discriminate against employees. The suit also accuses the Trump administration of violating a federal law that requires regulatory changes to go through a public comment period before taking effect. It seeks an injunction to stop the policy change from taking effect. (Ho, 10/6)

Massachusetts dove headfirst into another legal confrontation with the Trump administration Friday, as Attorney General Maura Healey sued the federal government over newly issued rules giving employers the right to deny women birth control coverage by claiming religious or moral objections. (Ebbert, 10/6)

To Connecticut’s Democratic lawmakers, President Donald Trump’s decision to roll back the Affordable Care Act’s mandate that businesses include birth control benefits in health care policies covering their workers amounted to fighting words. (Radelat, 10/6)

For Oregon women, the change comes just months after House Bill 3391 went into effect. That bill, also called the Reproductive Health Equity Act, requires all insurance plans to cover no-cost birth control beginning Jan. 1, 2019. Will that mean possible a year gap in coverage for Oregon women in 2018? Jake Sunderland, spokesperson Oregon Department of Consumer and Business Services, Oregon's largest consumer protection and business regulatory agency, said they are still trying to figure that out. (Acker, 10/6)

Experts don’t anticipate a plethora of North Texas companies will drop contraceptive coverage from their offerings in the short or long term, however. “There’s a real business reason to offering coverage for abortion and contraceptives,” said Marianne Fazen, executive director of the Dallas-Fort Worth Business Group on Health. For one, few companies would take the route Hobby Lobby chose, publicly taking a controversial position that draws unwanted attention to their organizations. But more important, large employers benefit from coming up with the most competitive packages they can offer. (Rice and Kelly, 10/7)

The Trump administration put in place a new rule Friday that allows employers to deny insurance coverage of birth control under the Affordable Care Act if that employer has a religious or moral objection to providing that coverage. The new U.S. Department of Health and Human Services rule, which takes effect immediately, lifts a requirement under ACA that employers provide free birth control coverage, and pits employers' religious freedom and morality against women's reproductive rights for a second time in three years. (Shamus, 10/7)

The White House is finalizing an executive order that would expand health plans offered by associations to allow individuals to pool together and buy insurance outside their states, a unilateral move that follows failed efforts by Congress to overhaul the health care system. President Donald Trump has long asserted that selling insurance across state lines would trigger competition that brings down premiums for people buying their own policies. Experts say that's not guaranteed, partly because health insurance reflects local medical costs, which vary widely around the country. (Thomas and Alonso-Zaldivar, 10/9)

Mr. Trump will order three agencies, the departments of Health and Human Services, Labor and Treasury, to take steps to make it easier for people to band together and buy insurance through “association health plans,” the official said. Such plans would in some ways be like large employer’s health plans, subject to some restrictions set by the Affordable Care Act, including a ban on lifetime limits. But they would be free of other regulations, including the requirement that insurance plans cover a set package of benefits. These plans are popular with conservatives; some insurers fear that associations would peel off healthier and younger individuals and leave traditional insurance plans to cover sicker and older customers. (Radnofsky, Armour and Mathews, 10/7)

Together, if executed in an expansive way, Mr. Trump’s changes could “cause a bifurcation of the market,” said Cori Uccello, senior health fellow at the American Academy of Actuaries. Insurers that offer plans under the ACA could face new difficulties, but companies also might find opportunities in offering new types of insurance. Mr. Trump’s order, described by a senior administration official, will include broad instructions for federal agencies to loosen rules on health plans that the administration says have driven up premiums and reduced insurance offerings available to people who buy coverage on their own or who work for a small employer. (Radnofsky, Mathews and Armour, 10/8)

President Trump reached out to the Senate Democratic leader, Chuck Schumer, on Friday to propose yet another effort to repeal and replace the Affordable Care Act, but Mr. Schumer later said he had quickly shot down the offer. Mr. Trump’s phone call, which he announced in a tweet on Saturday morning, was his latest overture to Democrats, after reaching a bipartisan spending deal and forging an unexpected, if tentative, alliance on immigration with Mr. Schumer and the House Democratic leader, Nancy Pelosi. (Landler, 10/7)

Trying to revive health care talks, President Donald Trump said Saturday that he had spoken to the Senate's Democratic leader to gauge whether the minority party was interested in helping pass "great" health legislation. The answer back: Democrats are willing to hear his ideas, but scrapping the Obama health law is a nonstarter. (Thomas, 10/7)

“I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill,” the president wrote on Twitter Saturday morning. “ObamaCare is badly broken, big premiums. Who knows!" (Wallbank, 10/7)

Trump, appearing at the Greensboro home of Republican Party donor Louis DeJoy, did not pinpoint any lawmakers for criticism, as he has done previously with Arizona Sen. John McCain and Kentucky Sen. Rand Paul, both of whom have balked at getting behind the specific repeal efforts. Trump also chose not to attack Senate Majority Leader Mitch McConnell, another past target of his frustration, the two attendees said. (Isenstadt, 10/8)

"The president wanted to make another run at repeal and replace and I told the president that's off the table," Schumer said in a statement. "If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs." (Rucker, 10/7)

A Democratic aide told The Hill in an email Saturday, "Particularly after the birth control decision yesterday, the administration has to stop sabotaging the law before anything real can happen." (Byrnes, 10/7)

Obamacare's first open enrollment season under the Trump administration is expected to be a flop — and even the law's most ardent supporters are worried there's little they can do to change that. With less than a month before sign-up begins, the federal government has gutted outreach and marketing, slashed funding to outside enrollment groups and left state officials in the dark on key details. (Demko and Cancryn, 10/6)

The administration has cut funding for advertising and outreach by 90 percent, raising the odds that fewer people will join the health-care exchanges during the fall enrollment period. It has slashed funds by 41 percent for outside groups that help reach and enroll likely ObamaCare consumers. (Sullivan and Roubein, 10/7)

Sen. Ron Johnson (R-Wis.) on Sunday pushed back on the thinking that the GOP's effort to repeal and replace ObamaCare collapsed. "Just ran out of time," Johnson said on CNN's "State of the Union." "I wouldn't say collapsed, I think it's still alive and well ... We need more time." Republicans have long been pushing to repeal and replace ObamaCare, but multiple efforts stalled in the Senate due to a lack of GOP support. (Savransky, 10/8)

As it works to roll back the Affordable Care Act, the Trump administration is letting crucial state health initiatives languish, frustrating a growing number of state leaders, including several from solidly Republican states. Last week, Oklahoma’s health secretary sent a blistering letter to senior administration officials, taking them to task for failing to approve a plan state officials drew up to protect their consumers from large rate hikes. (Levey, 10/6)

For 66-year-old Richard Boston, an Army veteran who has been disabled for more than 20 years, Oklahoma's Advantage program is a lifeline that allows him to continue living in his modest home in southwest Oklahoma City. The state-funded program provides volunteers who do light housework and run errands. It also gives out medical equipment like a lift chair that allows him to get in and out of the bathtub despite his bad knees and back, the result of a disabling fall he suffered during his career as a truck driver. (10/5)

In a strongly worded letter to the Trump administration, Oklahoma's health commissioner recently expressed frustration that a state waiver to lower costs for Obamacare customers had not been approved as quickly as federal officials had promised. The proposal called for a reinsurance program in which government funding pays for costly medical claims while keeping prices down for other customers. (Leonard, 10/9)

Consider this your official notice – open enrollment is less than one month away. Beginning Nov. 1, individual health insurance consumers will be able to compare and select 2018 health coverage. That might seem far away now, but don’t procrastinate this year. Open enrollment will be shorter this year than ever before. You have just 45 days to sign up for 2018 coverage. The final deadline is Dec. 15. In years past, open enrollment has extended through January, so be aware that this will not be the case this year. You will have just six weeks to sign up once open enrollment begins, and Healthcare.gov will also be down for maintenance every Sunday morning, with the exception of Dec. 10. (Tolbert, 10/8)

Kaiser Health News: Overlooked By ACA: Many People Paying Full Price For Insurance ‘Getting Slammed'

Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care. ”Teri Goodrich, of Raleigh, N.C., has the same complaint. “We’re getting slammed. We didn’t budget for this,” she said. Millions of people have gained health insurance because of the federal health law. Millions more have seen their existing coverage improved. (Rovner, 10/9)

There are 59 countries that allow abortion “without restriction as to reason,” or “elective,” or “abortion on demand.” These are countries where the letter of the federal law does not impose specific eligibility requirements for women. The other 139 countries “require some reason to obtain an abortion, ranging from most restrictive (to save the life of the mother or completely prohibited) to least restrictive (socioeconomic grounds) with various reasons in between (e.g., physical health, mental health),” the report says. Only seven of the 59 countries allow elective abortions after 20 weeks, the group found: Canada, China, Netherlands, North Korea, Singapore, the United States and Vietnam. (Lee, 10/9)

An Oklahoma judge has again overturned a state law restricting women's access to drug-induced abortions, according to attorneys for the state and for the groups challenging the law. Oklahoma County District Judge Patricia Parrish on Friday overturned a 2014 state law that banned "off-label" use of medication used for abortions. (10/7)

Planned Parenthood of Wisconsin is opening a new clinic in Milwaukee that will provide abortion services, the first such center the group has opened in the state in more than a decade. The move comes despite state Republican leaders' efforts to limit access to the procedure. (Spicuzza, 10/6)

As he raced to triage victims of the Las Vegas shooting on the night of Oct. 1, Brandon Snook encountered many familiar wounds. He had seen them in the bodies of U.S. soldiers evacuated from battle in Fallujah, Iraq. Dr. Snook, a surgeon and colonel in the Air Force, is one of several military personnel who pitched in to treat shooting victims at University Medical Center of Southern Nevada. The nearby Nellis Air Force Base supplies the hospital with doctors and nurses aiming to maintain their battlefield skills when they are stateside, where gun violence in some cities provides a steady supply of horrific wounds. (Whalen, 10/9)

As the number of mass shootings continues to climb across the United States, emergency medical workers in central Ohio are among those nationwide seeking to arm bystanders with the knowledge, equipment and confidence needed to save lives during bleeding emergencies. (Viviano, 10/8)

Sticking to the facts—mass public shootings in the U.S. are still quite rare—and answering kids’ questions in words they can understand is a good strategy for caregivers to help children cope with news of tragedies and avoid becoming unnecessarily fearful, according to psychologists. (Romero, 10/6)

Commute. Work. Commute. Sleep. Commute. Work. Commute. Sleep. If you think your daily grind’s killing you, you may be right, according to an article by Leslie Kaufman in the September/­October issue of Popular Science. Kaufman examines the work of chronobiologists — scientists who add the element of time to their research on topics such as the neurons that help awaken the human brain and the metabolic processes that occur after a midnight snack. (Blakemore, 10/8)

Breast cancer is the most common cancer in American women except for skin cancers. Researchers at the American Cancer Society estimate that there will be 252,710 new cases of invasive breast cancer in women in the United States in 2017. Some 40,610 women will die from the disease. In addition, there will be 63,410 cases this year of carcinoma in situ, abnormal cells that may be an early form of cancer. (Bakalar, 10/6)

Lori Wallace is sitting on a couch with her 11-year-old son and his new pet snake. It's burrowing under his armpit, as if it were afraid. But Wallace says it's not. "If he was terrified, he would be balled up," Wallace says. "See, that is why they are called ball pythons. When they are scared, they turn into a little ball. "Wallace is dying of breast cancer, but a stranger couldn't tell. (Harnett, 10/8)

Health officials urge all Americans 6 months and older to get an annual flu shot — except for those who have ever had a severe or life-threatening allergic reaction to an influenza vaccine or vaccine component. Individuals who have had severe allergic reactions to a flu vaccine “should not get the vaccine again,” said Dr. Lisa Grohskopf, a medical officer with the Centers for Disease Control and Prevention. (Rabin, 10/6)

Jason Lathrop was training for a solo backpacking trip in 2015 when he started to feel a creaking sensation in his knees during morning runs near his home in Portland, Ore. Expecting to learn that he’d torn his meniscus or strained a ligament, he went to his doctor, who told him his knees were just fine. Instead, he learned, he had a heart murmur. Six weeks later, the 43-year-old father of two was undergoing open-heart surgery to repair a faulty mitral valve. (Sohn, 10/7)

This week's grand opening of the One Brave Idea research center showcased a splashy, $75 million science project that brings together the American Heart Association, the Google life sciences spinoff Verily and the drug company AstraZeneca to fight heart disease. (Goldberg, 10/6)

Two weeks after Maria struck Puerto Rico, hospitals are still struggling, and many like the one in Jayuya are without electricity and communications, reliant on generators and running short of vital medications. (Hennessy-Fiske, 10/6)

More than 1 in 5 older adults who commit suicide disclose their intention to kill themselves before taking their own lives, a study suggests. Overall, 23 percent of suicide victims age 50 or older shared suicidal thoughts with another person in the month before their death, the study found. Disclosure rates were higher among the elderly and more common when people had chronic health problems or suffered from depression. (Rapaport, 10/7)

On Twitter, hundreds of thousands of people are #TalkingAboutIt. The popular hashtag is all over the social media platform, denoting tweets on experiences and concerns about mental health conditions. Its goal is to demystify mental illness, promote open conversation and encourage people to seek support. But for many, it can be hard to have those same conversations offline. People often find it tough to communicate what they’re going through or to get the help they need. Similarly,  it can be difficult for people to figure out the best way to support loved ones. (Salazar, 10/7)

Opioid overdoses killed so many people in the past year that Connecticut’s forensic examiners ran out of cooler space for the bodies. And yet professionals at the front lines of the crisis reported on a few reasons for hope: Doctors are prescribing fewer painkillers, while local law enforcement possesses more tools to reverse overdoses and lock up drug dealers who enabled them. (Peak, 10/8)

The first time county jail in Middlesex, Massachusetts tried providing opioid-addicted inmates with medication to help stave off relapse it was in Sheriff Peter Koutoujian's words an "abject failure." (Dissell, 10/9)

When Anne Arundel County announced a program to open police and fire stations to people seeking treatment for drug addiction, expectations were low that many people would actually come. ...To date, more than 200 people have come to fire and police stations in the county seeking heroin treatment. About 60 percent have entered 28-day inpatient treatment programs in then county. Five percent went to outpatient treatment and 9 percent went to mental health treatment. Even those who have come from outside Anne Arundel have found help: Crisis counselors placed about half of out-of-county cases into treatment facilities as well. (Wood, 10/9)

Top elected and appointed leaders from Richmond and its surrounding counties banded together Friday to pledge regional cooperation in the fight against a killer that has taken more than 80 area lives so far in 2017. (Burnell Evans, 10/6)

A federal jury has found a Cincinnati area doctor guilty of prescribing oxycodone in Kentucky for illegitimate purposes. Court records show he prescribed a half-million doses in under one year. (Brookbank, 10/6)

As Ohio struggles to contain the fallout from a still-raging epidemic of drug addiction, some experts worry that too many of the state’s opioid-treatment clinics follow a business practice like that of the “pill mills” that fueled the crisis: They deal in cash. (Schladen and Price, 10/8)

Experts say San Diego took all the right steps in addressing what is now one of the largest hepatitis A outbreaks the country has seen in decades, but variables unique to the city’s situation contributed to the outbreak. At least 481 people have been infected and 17 have died of the infection since November in San Diego. Another 88 cases have been identified in Santa Cruz and Los Angeles counties, where hepatitis A outbreaks have been declared. (Schroeder, 10/8)

The Florida nursing home where 12 elderly residents died in the aftermath of Hurricane Irma has shut down and laid off its staff. The Rehabilitation Center at Hollywood Hills, Fla. laid off 245 employees and notified the state of the layoffs on Sept. 20, the Sun Sentinel reported Friday. (Thomsen, 10/7)

His mother and the Bakers oppose immunization on religious and health grounds. But now that the boy is in temporary state custody, the Kansas Department for Children and Families intends to vaccinate him despite the family’s wishes. (Rizzo, 10/8)

Several Maryland health department officials will appeal a Baltimore judge’s decision to hold them in contempt of court in a lawsuit over a shortage of hospital beds for mentally ill defendants. A spokeswoman for the Maryland Attorney General’s Office told The Baltimore Sun on Friday that the decision was made this week but the appeal hasn’t been filed. (10/7)

MassHealth, which covers the state’s poor and elderly residents, proposed new rules several weeks ago in an effort to tighten oversight and ensure “program integrity.” But the proposal caused a backlash in the adult day health industry, where executives said the rewritten rules would have eliminated nursing care and supervision for people who had nowhere else to turn. (Dayal McCluskey, 10/8)

Supporters of the incentives promised to Foxconn can only hope that the billions of dollars have the same effect on the state’s economy as Epic Systems in Verona has had. The company, which writes software for electronic health records, has hired about 3,200 people in the past three years alone. (Boulton, 10/6)

The first thing Dave Asprey will tell you about his newly opened Bulletproof Labs in Santa Monica is that it’s not a gym. Rather, he says, it’s the world’s first “human upgrade” facility dedicated exclusively to biohacking, or tweaking your biology for better performance. At first glance, the light-filled space adjacent to his Bulletproof Coffee café on Main Street certainly looks like a gym, with personal trainers standing by and gleaming equipment lined up. (Fulmer, 10/6)

The 120,000 Independence Blue Cross members in the Philadelphia area who faced potential loss of access to several community hospitals — Brandywine, Chestnut Hill, Jennersville Regional, Phoenixville, and Pottstown Memorial — can rest easy. Independence and Tower Health have reached a three-year deal to keep the five hospitals “in-network” for Independence members, the two organizations said Friday. Reading Hospital also will remain in-network; it could have fallen out in November. (Fernandez, 10/6)

More than 39,000 Floridians have signed up through the Florida Department of Health to receive medical marijuana as a form of treatment for a list of qualifying illnesses since the registry opened in 2016. (Griffin, 10/6)

The Trump Administration on Friday eased Obama Care’s contraception mandate, the now infamous regulation that coerced Americans (even Catholic nuns) to pay for forms of birth control that violate their religious beliefs. This is welcome news for American tolerance and pluralism, not a scene from “The Handmaid’s Tale.” (10/8)

Under the guise of protecting religious freedom and moral sensibilities, the Trump administration is making it harder for women to get access to birth control. On Friday, it rolled back an Obama-era rule requiring most employers to provide their employees with birth control coverage without co-payments. The mandate, established under the Affordable Care Act, has helped millions of women avoid unwanted pregnancy by eliminating out-of-pockets costs for contraception. (10/6)

The Trump administration on Friday tore a big hole in an important public-health law, eroding the federal requirement that health insurance plans cover contraception. ... the Trump administration decided that the federal government’s interest in ensuring women access to birth control is not very important, and therefore surrendered to the objectors. Universities, charities and small businesses will now be able to ignore the contraception mandate without doing anything but informing their employees that they will get no birth control coverage. They could allow the government to independently arrange contraception coverage for their employees — or forbid such a workaround. (10/7)

The average American woman spends just three years pregnant or trying to become pregnant, and a full 30 years trying not to be pregnant. So it’s no surprise that birth control is a standard part of most women’s lives. In fact, roughly nine out of 10 women will use birth control during their lifetime. On Friday, the Trump administration revealed its disdain for women when it removed the guarantee that health insurance will cover their birth control. (Raegan McDonald-Mosley, 10/6)

This week in the world of Washington and sex: The House of Representatives passed a bill banning late-term abortions. One of the co-sponsors announced he was resigning from office after word came out that he had urged his lover to have an abortion. The anti-abortion Trump administration announced it was going to let employers off the hook if they didn’t want to cover contraception in their employee health programs. Is anything wrong with this picture? (Gail Collins, 10/6)

Better access to contraception under Obamacare has measurably improved women's health, finances and lives. The Trump administration's move to reverse these gains is wrong. ... One more thing. This abrupt and destructive new policy is not what Americans want. More than two-thirds -- including a majority of Republicans -- say they favor the requirement that employers cover the full cost of birth control. (10/7)

Over the past few weeks, the evidence has been mounting that the administration is engaged in a concerted effort to undermine Obamacare and in the process deny Americans health insurance coverage. (Michael Cohen, 10/6)

The Obamacare debate has been out of whack from the start. Republicans have criticized the wrong things, allowing Democrats to ignore the Affordable Care Act’s biggest flaws. Now, this off-kilter debate may lead to the quiet loss of one of the law’s most important provisions, currently on Congress’s chopping block. ... A bipartisan bill ending the [Independent Payment Advisory Board] passed the House Ways and Means Committee last Wednesday. Republicans, who claim they want to reduce wasteful government spending, should stop trying to repeal this important piece of Obamacare. So should Democrats. (10/8)

Despite years of Republican efforts in Washington to repeal the Affordable Care Act, support in Virginia for Medicaid expansion remains as strong as ever. A new University of Mary Washington survey of 1,000 adult Virginians found that 70 percent favor increasing access to Medicaid, an important but optional part of the Affordable Care Act, with only 25 percent opposed. A year ago, 68 percent said they wanted Virginia to expand this public health-insurance program for low-income, uninsured state residents. (Stephen J. Farnsworth, 10/6)

As a numbers guy, Gov. Rick Snyder can surely see the rising costs of the state’s Medicaid expansion. The governor has defended the Healthy Michigan program as a model for other states, but now the program expansion across the country has prompted questions from a Republican U.S. senator. ... In his letter to Snyder, [Sen. Ron] Johnson wrote: “I am seeking to better understand these rising costs and higher-than-expected enrollment, especially in states where costs are increasing especially quickly. Has Michigan taken any steps to control these costs and, if so, what are those steps?” Johnson is right to ask these questions, and we join him in awaiting the state’s response. (10/7)

After the collapse of Republican efforts at one-party health care reform, many Democrats have embraced Senator Bernie Sanders’s Medicare for All proposal. Few liberals would object to this “single payer” plan if it could be enacted with a magic wand, but the political realities of getting it through Congress are daunting. (Ed Dolan, 10/9)

For decades, millions of Americans have received insurance through a patchwork quilt of employer-based insurance and government programs to cover vulnerable populations. With the rise of the gig-economy, the quilt is unravelling, presenting an opportunity to fix our country’s flawed healthcare system. ... If we were to shift to a system where the government was the primary insurer, we could help employees and businesses more freely make decisions about what is best for their careers, families, and growth. People would be able to move jobs easily, innovate and build their own business, or work in the growing class of gig-economy jobs without the fear of bankruptcy from medical costs. (Charlie Simmons, 10/7)

I don't know how the federal corruption trial of U.S. Sen. Bob Menendez will turn out, but after following the case for almost four years I do know this: Medicare is guilty. Guilty of not having a "gate-keeper" that is. In health-care parlance, a gate-keeper is an administrator who decides whether a certain drug or treatment should be funded. ... But without such monitoring we see the sort of thing that was exposed last week at the trial in Newark of Menendez and his co-defendant, Florida eye doctor Salomon Melgen. (Paul Mulshine, 10/8)

I should be 100 percent supportive of establishing California’s own single-payer health system, which means the government, not insurance, pays health care costs for all people.  ...So why do doubts keep springing to my diseased mind? (Joe Mathews, 10/8)

These all-too-frequent outbursts of individual insanity-for some reason these attacks with automatic rifles are never called an act of terror-continue to be our No. 1 public health crisis. Tens of thousands of innocent people-the wounded, family members, neighbors, friends-will suffer a lifetime of physical and emotional scars because of these senseless acts of slaughter. Yet our elected leaders can't summon up the courage to do something about it. The National Rifle Association's chokehold on American politics appears resistant to even the most repugnant reality. (Merrill Goozner, 10/7)

One of our country's longest-running and most inadequately addressed health challenges reared its ugly head last week in Las Vegas. The gun violence epidemic that kills over 33,000 people each year produced the largest outbreak in modern history in last week's mass slaughter, leaving 58 dead and nearly 500 injured. This epidemic is growing. In the past 477 days, there have been 521 mass shootings. But those numbers are just the tip of the iceberg. On an average day, 91 people are killed with a firearm, seven of them children, with another 200 injured. Many of these tragedies are preventable. The most important question now: When are we going to act to stop this epidemic? (Georges Benjamin, 10/7)

In the wake of the deadliest mass shooting in modern American history, Las Vegas continues to mourn and the wounded continue to heal as our community demonstrates an unparalleled level of unity in the face of an unspeakable tragedy. As our team at University Medical Center continues to treat victims of this horrific shooting, we find strength in the tremendous outpouring of local and national support for our patients and their families. (Mason VanHouweling, 10/5)

Life for patients extends beyond the sterile corridors of the hospital, and careful consideration of these factors and potential solutions — including consolidating treatments, coordinating appointments with other providers, and providing resources for patients and families, both medical and financial — can make all the difference in the world. It’s time to look beyond the conventional understanding of what it means to treat, be treated, and establish patient-centered policies. (Jacquelyn Corley, 10/6)

It’s vital that the state manage these millions of Medicaid claims in a timely and efficient manner so that needed services are rendered and providers are compensated. Nebraska has about 228,000 Medicaid recipients. At the start of the year, Nebraska launched a new system, called Heritage Health, for handling most Medicaid accounts. ... The arrangement so far has brought important positives, with better coordinated care and additional services, but also troubling negatives in some cases. At public hearings, some providers and clients have vented their frustration, describing failure to be paid, long lag times and other problems. (10/9)