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Hundreds of thousands of Americans who rely on the federal food stamp program will lose their benefits under a new Trump administration rule that will tighten work requirements for recipients. The move by the administration is the latest in its attempt to scale back the social safety net for low-income Americans. It is the first of three proposed rules targeting the Supplemental Nutrition Program, known as SNAP, to be finalized. The program feeds more than 36 million people. (Linderman, 12/4)

The rule, which was proposed by the Agriculture Department in February, would press states to carry out work requirements for able-bodied adults without children that governors have routinely been allowed to waive, especially for areas in economic distress. The economy has improved under the Trump administration, the department argued, and assistance to unemployed, able-bodied adults was no longer necessary in a strong job market. The change is expected to shave nearly $5.5 billion from food stamp spending over five years. “Government can be a powerful force for good, but government dependency has never been the American dream,” said Sonny Perdue, the agriculture secretary. “We need to encourage people by giving them a helping hand but not allowing it to become an indefinitely giving hand.” (Fadulu, 12/4)

SNAP statutes already limit adults to three months of benefits in a three-year period unless they meet the 20 hours per week requirement, but many states currently waive that requirement in high unemployment areas. This change would make those waivers harder to get. "The rule restores the system to what Congress intended: assistance through difficult times, not a way of life," Perdue said. As NPR reported last year, though, Congress passed the farm bill without changes like these to SNAP. (Fessler and Treisman, 12/4)

Critics say the moves will hurt poor Americans. “This is an unacceptable escalation of the administration’s war on working families, and it comes during a time when too many are forced to stretch already-thin budgets to make ends meet,” said U.S. Representative Marcia Fudge, an Ohio Democrat. (Polansek, 12/4)

Sen. Debbie Stabenow, D-Mich., the ranking member of the Senate Committee on Agriculture, Nutrition and Forestry, said this rule would do little to help anyone find work. All the rule change does is strip people from accessing the benefit, she said. "This Administration is out of touch with families who are struggling to make ends meet by working seasonal jobs or part time jobs with unreliable hours," Stabenow said. "Seasonal holiday workers, workers in Northern Michigan’s tourism industry, and workers with unreliable hours like waiters and waitresses are the kinds of workers hurt by this proposal." The senator also noted that an attempt to add work requirements to SNAP had failed in Congress when they had considered the Farm Bill last year. The House rejected it in a bipartisan vote of 330-83, and the Senate voted down a similar amendment 68-30. (McCausland, 12/4)

Americans who live in cold-weather states like Vermont, New York and South Dakota could be the next to feel the impact of the Trump administration’s efforts to tighten food-stamp eligibility. (Picchi, 12/5)

About 200,000 people in California could lose benefits once the new rule is implemented because it would limit states ability to obtain such waivers. "That's important in a state like California which has had pretty variable unemployment rates across the state," she said. The change would affect adults with no dependents 18-49. "Many of these are among our most vulnerable adults," said Waxman. (Munoz, 12/5)

Feeding Kentucky says this could cause havoc for food pantries across the nation. Feeding Kentucky acts as the middle man for hundreds of food pantries across Kentucky. They work to find resources and send them to pantries ultimately to be passed out in communities. Kentucky remains as a top state for hunger to be a living issue. Feeding Kentucky says the change will cause more people to take advantage of pantries, which in theory is what they are for. However, the organization says many pantries are already unable to provide for the need at hand. (12/4)

An estimate of the number of Ohioans among the 688,000 people ages 18 to 49 nationwide who would be disqualified from receiving Supplemental Nutrition Assistance Program benefits effective April 1 was not available from state officials. “It’s going to be catastrophic. This is a systematic attempt to destroy a federal nutrition safety net for our most vulnerable citizens,” said Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks. (Ludlow, 12/4)

There are about 54,000 childless Georgia adults who receive SNAP and are not subjected to the federal time limits, according to state data. But they would be in April under the new rules. “Americans are generous people who believe it is their responsibility to help their fellow citizens when they encounter a difficult stretch,” Perdue told reporters on the call. “We want to encourage people by giving them a helping hand, but not an infinitely giving hand.” (Prabhu, 12/4)

Rural Georgians are more likely to need the help of food stamps to pay for their groceries, but that public help probably doesn’t stretch as far as it does in places such as Atlanta because of higher food prices in small-town stores. Poor, rural Georgians pay more for fresh lettuce, macaroni and cheese, and other foods in part because there is so little competition for their business, according to an Atlanta Journal-Constitution review. (Prabhu, 11/27)

Changes to the food stamp program will impact hundreds of thousands of people across the country and thousands of families in Alabama. It will bring around $5 billion in savings to taxpayers. The premise is that there are currently more job openings than people to fill them. With the new rules in Alabama, it's estimated some 5,800 people will lose access to food stamps. (Gordon, 12/4)

Nearly 50,000 Louisianans could be affected by new work rules for food stamp benefits. The Department of Children and Family Services (DCFS) says of the 810,000 Louisiana residents who get Supplemental Nutrition Assistance Program (SNAP) benefits, around 49,000 meet the definition of an able-bodied adult without dependents. (12/4)

About 200,000 Florida students could become ineligible for automatic free school lunches under a Trump administration proposal expected to reduce the number of food stamps enrollees, according to state education officials. Children automatically qualify for free lunches if their families receive food stamps, but in July the Trump administration proposed tightening eligibility for what was formerly called the Supplemental Nutrition Assistance Program. A finalized rule could come as soon as the end of the month. (12/4)

With proposed changes to the federal food stamp program looming, some food pantries in Aurora, DuPage County and across the suburbs are bracing for a spike in clients. (12/4)

The nation’s hospital groups sued the Trump administration on Wednesday over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures. The hospitals, including the American Hospital Association, argued in a lawsuit filed in United States District Court in Washington that the new rule “is unlawful, several times over.” They argued that the administration exceeded its legal authority in issuing the rule last month as part of its efforts to make the health care system much more transparent to patients. (Abelson, 12/4)

The lawsuit filed Wednesday says the rule compelling the hospitals to publish their negotiated rates with insurers violates the First Amendment and goes beyond the statutory intent of the Affordable Care Act. “The burden of compliance with the rule is enormous, and way out of line with any projected benefits associated with the rule,” according to the suit, which was filed by the American Hospital Association and other industry groups in U.S. District Court in Washington. (Armour, 12/4)

The hospitals argue that the efforts and cost required to follow the rule are overreaching as they would be required to release massive spreadsheets with data on negotiated drugs, supplies, facility and physician care prices. The estimated cost to hospitals to follow the rule is between $38.7 million to $39.4 million. (Coleman, 12/4)

“The rule ... does not provide the information patients need. Mandating the public disclosure of negotiated charges would create confusion about patients’ out-of-pocket costs, not prevent it,” the plaintiffs said. The rule, seen as a violation of the First Amendment by the hospital groups, also demands confidential information on individually negotiated contract terms with all third-party payers, including private commercial health insurers. (12/4)

When he announced the regulation last month, Health and Human Services Secretary Alex Azar said he believes it will survive any legal challenges from hospitals. "Hospitals should be ashamed that they aren't willing to provide American patients the cost of a service before they purchase it," Caitlin Oakley, an HHS spokeswoman, said Wednesday. (Luhby, 12/4)

Between the lines: The industry has a lot to lose; even non-for-profit systems, as my colleague Bob Herman put it, "swimming in cash." The Trump administration's transparency measure could lead to either more pricing competition or further regulation, if it exposes egregious pricing practices. (Owens, 12/4)

Hospitals sued HHS on Wednesday over a new rule that would force them to disclose the rates they negotiate with insurers. The complaint alleges HHS doesn't have the legal authority to require hospitals to publicly disclose the prices that commercial health insurers and hospitals negotiate with each other. The lawsuit also claims that the mandate violates the First Amendment rights of hospitals and health insurers. (Brady, 12/4)

Attorney General William P. Barr warned that communities and critics of policing must display more deference or risk losing protection, a stark admonition that underscored the Trump administration’s support for law enforcement amid an ongoing national conversation about police brutality against minorities. “They have to start showing, more than they do, the respect and support that law enforcement deserves,” Mr. Barr said on Tuesday afternoon in comments at an awards ceremony for policing. “And if communities don’t give that support and respect, they may find themselves without the police protection they need.” (Benner, 12/4)

Research published Wednesday in Science Advances finds that black mothers who were exposed to police shootings of unarmed black Americans during pregnancy were more likely to give birth to infants who were born prematurely or with low birth weight. Living within 1 kilometer of such incidents tended to have a greater effect on these indicators of infant health. The effect was also more pronounced among infants born to mothers who had previously had children without exposure to such events. (Chakradhar, 12/4)

A consultant known for urging cities to stop “enabling” homeless people, in part by blocking charities from handing out food, has been tapped to lead the agency that coordinates the federal government’s response to homelessness. Robert Marbut, who has worked with several cities, including Fresno and several other California cities and counties, would succeed Matthew Doherty as executive director of the U.S. Interagency Council on Homelessness. (Oreskes, 12/4)

The latest of President Trump’s confirmed federal judges has been assailed by fellow lawyers for her lack of trial experience and has been lambasted by reproductive rights advocates for her vigorous opposition to abortion, surrogacy and in vitro fertilization. And in a near-party-line vote Tuesday, the Senate approved the nomination of Sarah Pitlyk, making the conservative lawyer the newest federal judge for the U.S. District Court in St. Louis. Sen. Susan Collins (R-Maine) joined the Democrats to oppose Pitlyk. Every other Republican present voted for her. (Thebault, 12/4)

Former vice president Joe Biden released a plan Wednesday to raise $3.2 trillion in taxes over 10 years to pay for his domestic spending proposals, including on health care and climate, as he seeks to cast himself as the fiscal moderate in the Democratic presidential primary amid pressure from his liberal rivals. (Stein, 12/4)

Until now, Mr. Biden has largely confined his ideas to rolling back parts of the 2017 Republican tax cut and pursuing policies that the Democratic Obama administration, in which he served as vice president, couldn’t get through Congress. The new proposals come atop Mr. Biden’s previous calls for tax increases, which would push the corporate tax rate to 28% from 21%, tax unrealized capital gains at death and push the top rate on individuals to 39.6% from 37%. (Rubin, 12/4)

Biden’s camp said he was leveling with voters about how he would pay for new policies aimed at combating climate change, and expanding access to higher education and health care, after he accused rivals of falling short in that area. “He believes that being forthright with voters about how plans would be financed is critical to building the public support necessary to beat Donald Trump, help more Democrats win up and down the ballot, and then pass legislation through Congress,” said Stef Feldman, Biden’s policy director. (Becker, 12/4)

A few weeks ago, Elizabeth Warren made huge news with her plan to finance "Medicare for All." But as part of it, the Massachusetts senator made a big change to one of her other major policy goals: she boosted the size of the wealth tax she wants to impose on the very rich: The top rate went from 3% to 6%, giving her trillions more dollars in theoretical revenue to fund the sweeping program. (Kurtzleben, 12/5)

Kamala Harris was hosting a town hall in her hometown of Oakland, Calif., two years ago when she made an announcement that set off a mad scramble in the U.S. Senate. “Here, I’ll break some news,” Harris told hundreds of people packed into the sanctuary at Beebe Memorial Church on Aug. 30. “I intend to co-sponsor the ‘Medicaid for All’ bill because it’s just the right thing to do,” she said, flubbing the name of the proposal. (Thompson, Otterbein and Ollstein, 12/5)

One lesson of the past few weeks is that the Medicare-for-all debate has become a minefield for Democrats — and it’s not clear that any candidate has a safe path through it. Sen. Elizabeth Warren has dropped 14 points since October 8, when she briefly led the Democratic field in the RealClearPolitics polling average. Most attribute her decline to her handling of Medicare-for-all — the financing plan she released made her the target of attacks from the moderates, and then the transition plan she released, which envisions a robust public option in the first year of her presidency and only moving to Medicare-for-all in year three, left single-payer advocates unnerved about her commitment to the cause. (Klein, 12/4)

Republicans in Congress have tried to discredit the Democratic-led impeachment inquiry by arguing that it distracts Congress from its real duties. One Republican-aligned group recently released a poll of 1,600 voters in four congressional districts that suggested Americans “prioritize issues over impeachment.” But when we look at data on revealed priorities from people all over the country, we see something different. In reality, there are few things facing the nation that anyone, regardless of party, believes are a higher priority right now. Most people would give up their preferred outcomes on health care, the environment or taxes if it meant getting what they want on impeachment. (Vavreck, Sides and Tausanovitch, 12/5)

Virginia is moving toward dropping work requirements for Medicaid enrollees after Democrats won full control of the state legislature for the first time in a generation. Democratic Gov. Ralph Northam said Wednesday that his administration is hitting “pause” on its request for federal approval to requires some Medicaid recipients to have a job or participate in some form of approved community engagement and pay part of the premiums. (Sunderman, 12/4)

A work requirement was just one of several strings attached by conservatives before Virginia’s Republican-controlled General Assembly would agree to expand the program in May 2018. Another would make certain recipients responsible for co-payments, deductibles and monthly premiums. The state has been seeking the federal government’s permission — a “waiver” from the Center for Medicaid and CHIP Services — to impose those conditions. But in a letter Tuesday to Washington, the Northam administration said it wanted to hold off “in light of recent changes in our state legislature, which have generated dynamic policy conversations with regard to the . . . waiver.” (Vozzella, 12/4)

“Virginians made it clear they want more access to health care, not less," [Gov. Northam] said in the statement. "Given the changed make-up of the General Assembly and based on conversations with new leadership, it is unlikely Virginia will move forward with funding a program that could cause tens of thousands of Virginians to lose health care coverage." (Weixel, 12/4)

Northam’s reversal drew a swift rebuke from House Speaker Kirk Cox, R-Colonial Heights, who had worked closely with the Democratic governor on a compromise that would allow Republicans to drop opposition to expanding Medicaid under the Affordable Care Act after a bitter, five-year political battle. “I’m disappointed to say the least,” Cox said in a statement. “The governor and I made personal commitments to each other on this long-term public policy agreement.” (Martz, 12/4)

Gov. Chris Sununu on Wednesday signed an executive order that will speed up the licensing of officials who process Medicaid funds for schools, averting the potential loss of millions in grants to local districts because of stringent federal regulations. Sununu said the initiative brings the state’s Medicaid to Schools program into compliance with federal guidance while maximizing how much schools can be reimbursed for health care services. (Landrigan, 12/4)

For four years, the Department of Health and Human Services, physical and mental health service providers, the managed care organizations that will run the new system, and North Carolina’s entire health care system has been gearing up for the change. Under transformation, the Medicaid program will go from one that pays for each individual visit, shot and test, to one that pays providers a lump sum in exchange for better health outcomes for beneficiaries. (Hoban, 12/5)

Three members of the House Education & Labor Committee are shifting gears to explore a tweaked version of a provider-friendly solution to surprise medical billing. Reps. Joe Morelle, (D-N.Y.), Donna Shalala (D-Fla.) and Van Taylor (R-Texas) are circulating a letter obtained by Modern Healthcare asking their House colleagues to support surprise billing legislation founded on an independent dispute resolution process, an approach supported by providers. (Cohrs, 12/4)

More than two years after California’s surprise-billing law took effect, there’s one thing on which consumer advocates, doctors and insurers all agree: The law has been effective at protecting many people from bills they might have been saddled with from doctors who aren’t in their insurance network. But the consensus stops there. (Andrews, 12/4)

Kaiser Health News: ‘An Arm And A Leg’: How Much For Stitches In The ER? Hard To Gauge Upfront

Sarah Macsalka had heard the stories about how expensive an emergency room visit can be, even for a minor complaint. So when her 7-year-old son, Cameron, tripped and gashed his knee in the backyard, the ER was not where her family headed first. In fact, Macsalka did just about everything she could to avoid paying a big, fat bill to get Cameron’s knee stitched up.Ultimately, she failed. (Weissmann, 12/5)

Despite progress in the movement to pay hospitals and doctors for the value of healthcare services they provide, the payment models implemented are not moving the needle on the cost and quality of healthcare, a new report suggests. More than half of commercial payments to providers are tied to the value of those services in some way. Still, most of those value-based payments are built on a fee-for-service foundation and few pose any sort of downside risk to providers, the Catalyst for Payment Reform found in its latest national scorecard on payment reform. (Livingston, 12/4)

If every primary care physician in Wisconsin provided the same quality of care and was as prudent in their use of health care dollars as those in the top half for performance, the cost of treating key medical conditions would be 30% lower.That would work out to hundreds of millions of dollars in savings a year while providing better care to patients. That’s the finding of a study that analyzed millions of medical claims to gauge the performance of primary care physicians — those who specialize in family medicine, internal medicine or pediatrics — in Wisconsin. (Boulton, 12/4)

Mayo Clinic is closing its hospital and emergency department in the southwest Minnesota town of Springfield, citing troubles with recruiting patients and physicians to the medical center. The hospital and ER, as well as clinics in the towns of Springfield and Lamberton, will close effective March 1, the clinic announced this week. (Snowbeck and Olson, 12/4)

The latest announcement involves a clinic in Lamberton and a hospital and clinic in Springfield. Mayo officials say the closures, slated for March 2020, will affect 60 people working in these southern Minnesota facilities. “The reasoning behind this very difficult decision … stems from what is happening in the rural health care crisis that we’re seeing not only in Minnesota, but across the U.S.,” said Dr. James Hebl, regional vice president for Mayo Clinic's health system in the southwestern part of the state. “Mayo Clinic is certainly not immune to the challenges of rural health care.” (Richert, 12/4)

The three largest healthcare systems in Northeast Ohio increased their spending on education, charity care and other community benefits in 2018, upping contributions 12% to $1.6 billion. In 2018, MetroHealth directed the largest share of its operating revenues to community benefit, contributing 18% ($219 million). The Cleveland Clinic, meanwhile, directed 12% ($1.04 billion) of its operating revenues to community benefit, the highest dollar amount ever provided for that purpose by the Clinic. (Christ, 12/4)

For most everyday citizens, robocalls are an unwelcome annoyance. For hospitals, the stakes are much higher. Robocallers have clogged hospital phone lines reserved for patients, wasted staff time, preyed on unsuspecting patients by imitating hospital phone numbers, impersonated law enforcement to threaten doctors and disturbed sick patients in their hospital beds. Congress heard hospitals' complaints, and the U.S. House of Representatives is set to vote Wednesday on first steps to protect medical centers from robocalls. (Cohrs, 12/4)

DexCom Inc. said Wednesday a data-sharing feature for its diabetes devices is now operating at “full service levels” after a technology problem caused the service to crash over the weekend. The lapse, which began early Saturday, blocked many parents’ and caregivers’ smartphones from remotely receiving blood-sugar readings of diabetes patients who wear DexCom’s glucose monitors. (Loftus, 12/4)

Minnesota Attorney General Keith Ellison sued Juul Labs on Wednesday, accusing the e-cigarette maker of unlawfully targeting young people with its products to get a new generation addicted to nicotine. The lawsuit filed in Hennepin County District Court in Minneapolis seeks to force Juul to stop marketing to young people; fund a corrective public education campaign in Minnesota on the dangers of youth vaping; fund vaping cessation programs; disclose all its research on vaping and health; and surrender all profits from its allegedly unlawful conduct. (Karnowski, 12/4)

“It is clear that JUUL has turned a generation of youth into addicts,” Minnesota Attorney General Keith Ellison said in a lawsuit filed in Hennepin County District Court Wednesday. (Klar, 12/4)

The lawsuit seeks to declare that Juul created a public health nuisance with its vaping products. Ellison wants the court to order the company to stop its marketing to kids and fund corrective public education to help people stop vaping. Juul contends that its vaping products are a healthier alternative to smokers trying to quit combustible cigarettes. (Pugmire, 12/4)

A teen from Southeast Alaska is the state's first case of vaping-related lung injury, according to the Alaska Department of Health and Social Services. There have now been cases of e-cigarette, or vaping, product use associated lung injury reported in all 50 states. The department announced on Tuesday that the teen is hospitalized but improving. The patient reported regularly vaping nicotine and products containing tetrahydrocannabinol or THC, the main psychoactive substance in cannabis. (Howard, 12/4)

“Our thoughts are with the patient and family members and we are thankful the patient is steadily recovering,” Dr. Anne Zink, Alaska’s chief medical officer, said in a statement. “We are fortunate that we haven’t identified a case ... in Alaska until now, but it’s not surprising that we have joined the rest of the nation in this outbreak,” she added. (Klar, 12/4)

Vaping, already under scrutiny for health risks and deaths, was linked to a rare type of lung damage in a new case report. Doctors investigating a patient’s breathing difficulties found damage that appears similar to an occupational health hazard, called hard-metal pneumoconiosis. The condition typically strikes workers involved in sharpening or polishing metal tools, physicians from the University of California, San Francisco wrote in a case history published in the European Respiratory Journal. (Fourcade, 12/4)

The cars with Massachusetts license plates pull into gas stations and vape shops here steadily every day, the people inside them ready to stock up on electronic cigarettes they can’t buy at home. Along the border in New Hampshire and Maine, sales of nicotine and cannabis vaping products have boomed since Sept. 24, when Massachusetts Governor Charlie Baker banned both amid an outbreak of vaping-related lung injuries. (Martin, 12/4)

For decades, scientists have debated whether hair dyes frequently used by women might contribute to cancer. The research has been mixed and inconclusive, but now government investigators have turned up a disturbing new possibility. Black women who regularly used permanent dyes to color their hair were 60 percent more likely to develop breast cancer, compared to black women who did not report using dye, according to an analysis published this week in the International Journal of Cancer. (Rabin, 12/4)

Researchers don't know which ingredients in the products might be of concern. The study did not look at the specific ingredients in the products women were using, only at whether they had used the product and whether they developed breast cancer. All women in the Sister Study were already at high risk for breast cancer since they had a sister who had breast cancer. (Neighmond, 12/4)

"Researchers have been studying the possible link between hair dye and cancer for a long time, but results have been inconsistent," said corresponding author Alexandra White, head of the NIEHS Environment and Cancer Epidemiology Group. "In our study, we see a higher breast cancer risk associated with hair dye use, and the effect is stronger in African American women, particularly those who are frequent users." (Clanton, 12/4)

The brains arrive at all hours in white cardboard boxes stamped “RUSH!” Inside each package is an inch-and-a-half-thick foam liner and a red bag protecting an ordinary white plastic bucket. When a courier service delivered Kevin Ellison’s brain to the Bedford VA Medical Center near Boston just after 2 p.m. on Jan. 22, Dr. Victor Alvarez performed the routine he has done so many times that he’s stopped counting. (Fenno, 12/3)

Children who moved out of high-poverty neighborhoods visited the hospital significantly less, according to a new study. Children whose families received a housing voucher to move to low-poverty neighborhoods were admitted to the hospital nearly 16% less than families who remained in impoverished areas, curbing annual inpatient spending by 24%, according to a new analysis of 4,604 families tracked across an average of 11 years. The results for adults were insignificant, researchers found. (Kacik, 12/4)

Birth control pills work great if women remember to take them every day but missing doses can mean a surprise pregnancy. Now scientists have figured out how to pack a month’s supply into one capsule. The trick: A tiny star-shaped gadget that unfolds in the stomach and gradually releases the drug. (12/4)

The star-shaped capsule could help reduce unintended pregnancies that arise from users forgetting to take their daily dose of the pill, according to a news release from the Massachusetts Institute of Technology (MIT). The capsule is coated with gelatin that can remain in the stomach for weeks after being swallowed, the researchers said. From there, it slowly releases hormones to prevent pregnancy. (Cheung, 12/5)

Kaiser Health News: As His Wife’s Caregiver, A Doctor Discovers What’s Missing At Health Care’s Core

Caring for someone with a serious illness stretches people spiritually and emotionally, often beyond what they might have thought possible. Dr. Arthur Kleinman, a professor of psychiatry and anthropology at Harvard University, calls this “enduring the unendurable” in his recently published book, “The Soul of Care: The Moral Education of a Husband and a Doctor.” (Graham, 12/5)

At certain levels, just five minutes of carbon monoxide exposure is enough to be fatal. The colorless, odorless gas is produced wherever fuel is burned, and can build to deadly levels especially quickly in enclosed spaces. Portable generators, whose engines each emit as much carbon monoxide as approximately 450 cars, are especially common culprits. (Treisman, 12/4)

A bankruptcy judge approved millions of dollars in bonus and incentive payments for a group of employees of OxyContin maker Purdue Pharma LP. But Judge Robert Drain put off a decision to approve a $1.3 million bonus for Purdue Chief Executive Officer Craig Landau at a hearing Wednesday in U.S. Bankruptcy Court in White Plains, N.Y. (Biswas, 12/4)

Purdue said maintaining its bonus program is essential to keep key employees on the job and performing while the company goes through the bankruptcy settlement process. If the company falls apart while still under bankruptcy protection, it would mean less money left over to address the opioid crisis for the states, local governments, Native American tribes, medical providers and others that have sued it. (12/4)

As the U.S. opioid addiction epidemic grinds on, startups offering treatment services are gaining popularity with health-care providers and investors. One company making headway in the crisis is Groups, which recently raised $27 million in new financing from major health organizations. Groups, which is based near Boston and officially called Recover Together Inc., said its backers were impressed by its above-average patient success rates. (Mack, 12/4)

Defunct opioid maker Insys Therapeutics Inc. faced tough questioning from a bankruptcy judge Wednesday over its plan to bar shareholders from suing anyone involved in the company’s demise. (Brickley, 12/4)

The Freer Gallery of Art and the Arthur M. Sackler Gallery have long described themselves as the Smithsonian’s Asian art museums. Now the two institutions want to be known as the National Museum of Asian Art. Don’t call it a name change, though. Museum officials say it is a rebranding that clarifies the missions of the joint institutions. And, they say, it has absolutely nothing to do with international protests over the Sackler family’s connection to the opioid crisis. (McGlone, 12/4)

We must address stigma and lack of understanding about addiction that persists even within the medical community. Stigma keeps individuals from seeking treatment but also keeps medical practitioners from offering care. (Lori Trahan and James Baker, 12/5)

Cuyahoga County and the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County are funneling $60,000 into the Fentanyl Test Strip grassroots distribution program to continue its operation through 2020. Each will provide $30,000, according to a news release. (Christ, 12/3)

It’s no secret that the many side effects caused by medicines do not get reported to the Food and Drug Administration, but a new report suggests the magnitude of underreporting is far greater than imagined. After examining side effects that were conveyed to the regulator for five widely used medicines — two different types of arthritis treatments, an antipsychotic, and a blood thinner — just 1% of an estimated 276,000 serious adverse events had been reported in 2017. (Silverman, 12/4)

Nearly 150 CEOs of emerging biotech companies are sending a unified, stark message to Capitol Hill: Abandon the Democrats’ signature drug pricing policy. In a new letter, signed by buzzy biotech startups like Global Blood Therapeutics (GBT) and Alnylam Pharmaceuticals (ALNY), the executives lob a blistering critique of the signature drug pricing bill unveiled this fall by House Speaker Nancy Pelosi. The legislation would allow Medicare to negotiate the price of certain high cost drugs and wage huge fines for companies that don’t comply. (Florko, 12/5)

Kaiser Health News: Pharma’s Take On The Pelosi Drug-Pricing Bill: Fair Warning Or Fearmongering?

House Speaker Nancy Pelosi’s flagship proposal to curb prescription drug prices, the “Lower Drug Costs Now Act” ― H.R. 3 ― could come up for a vote in the chamber this month. The measure would allow Medicare to negotiate prices for a limited number of drugs, cap what seniors pay out-of-pocket at $2,000 and force companies that have raised prices beyond inflation since 2016 to either reverse the price or rebate the amount of the increase to the federal government. And drug manufacturers are in full attack mode. (Luthra, 12/5)

Asmall drug maker called Rising Pharmaceuticals agreed to pay more than $3 million to resolve criminal and civil charges related to a price-fixing scheme involving a high blood pressure pill, the second time a company has reached such a deal with federal authorities who are conducting a probe into the generic industry. From April 2015 until at least September 2015, Rising conspired with another unnamed generic drug maker and its executives to fix prices and allocate customers for Benazepril HCTZ, according to court documents. Effectively, the companies “engaged in a conspiracy to suppress and eliminate competition,” the Department of Justice wrote in a document outlining the charges. (Silverman, 12/4)

A drug that curbs delusions in Parkinson's patients did the same for people with Alzheimer's disease and other forms of dementia in a study that was stopped early because the benefit seemed clear. If regulators agree, the drug could become the first treatment specifically for dementia-related psychosis and the first new medicine for Alzheimer's in nearly two decades. It targets some of the most troubling symptoms that patients and caregivers face — hallucinations that often lead to anxiety, aggression, and physical and verbal abuse. (Marchione, 12/4)

Global health regulators are looking into whether widely used diabetes drugs may contain unsafe levels of a carcinogen that has previously been found in heart and gastric medications. The U.S. Food and Drug Administration said in a statement Wednesday that the agency is testing samples of metformin sold in the U.S. for NDMA, and that it will recommend recalls of the medication as appropriate. Metformin is widely prescribed to patients when they are initially treated for type 2 diabetes. (Lauerman, 12/4)

A key pharmaceutical provision of the U.S.-Mexico-Canada trade agreement that the Trump administration has hailed as a major improvement over the North American Free Trade Agreement is being modified to make it less onerous for Mexico, a top Mexican official said Wednesday. (Palmer, 12/4)

A U.S. Navy sailor shot three people, then killed himself at Pearl Harbor on Wednesday, military officials said, three days before the anniversary of the attack that prompted the United States to enter World War II.  Two victims are dead and one is hospitalized in stable condition, officials at Joint Base Pearl Harbor-Hickam said. The shooting at the naval shipyard happened at about 2:30 p.m. local time. Military forces responded to the scene and put the roughly 66,000 people who live at the base on lockdown for about an hour. (Lam, 12/4)

The guards brought the 18-year-old detainee with a gashed lip into a special holding cell on Friday night. He had been injured after a fight with seven other inmates and was being transferred to an urgent care facility on Rikers Island. What happened over the next six hours would plunge the jail and the city’s correction department into a crisis on Wednesday over the supervision of inmates, especially those at risk of suicide, at a time when the city is seeking to close Rikers. (Ransom, 12/4)

Mayor Bill de Blasio tweeted the allegations that officers failed to immediately intervene in Feliciano’s suicide attempt are “deeply troubling.” “The people in our jails are human beings,” de Blasio wrote. “Their well-being is our responsibility.” Correction Commissioner Cynthia Brann said in a statement the allegations were “extremely troubling and we are taking them seriously.” (12/4)

New York could bar doctors from performing so-called virginity tests under legislation prompted by the rapper T.I.'s controversial claim that he has a gynecologist check his daughter's hymen annually. Assemblywoman Michaelle Solages said Tuesday the bill she submitted last month would prohibit medical professionals from performing or supervising such examinations, though it's unclear how common they are in the U.S. New York would also consider it sexual assault when such tests are performed outside of a medical setting. (12/4)

The union representing roughly 4,000 Kaiser Permanente mental health clinicians announced Wednesday that they have rescheduled their five-day strike for the week of December 16, after postponing it in November after the death of the company’s chief executive officer, Bernard Tyson. The National Union of Healthcare Workers said the strike would affect patients at more than 100 Kaiser facilities in California from Sacramento to San Diego. (Anderson, 12/4)

The push to lower Ohio’s infant mortality rate will likely carry on for years to come, but local leaders say a recently awarded $4.5 million grant will help make a dent in longstanding racial disparities. A coalition of 13 organizations, led by CelebrateOne, will use the grant awarded Monday by the Ohio Department of Medicaid to expand programs addressing the issue. About 52% of births in the state are covered by Ohio’s Medicaid system, state Medicaid Director Maureen Corcoran said in a statement. (Fixby, 12/4)

A flesh-eating bacteria linked to the use of black tar heroin has killed at least seven San Diego County residents who injected the drug since early October, county health officials said Wednesday. Between Oct. 2 and Nov. 24, nine people who injected black tar heroin were hospitalized with severe myonecrosis, a soft-tissue infection that destroys muscle, health officials said. The patients ranged from 19 to 57 years old; of the seven who died, five were men. (Riggins, 12/4)

One-quarter of Colorado's mental health-related emergency department visits were for children in 2018, a new report has found. The share of children's emergency department visits where mental health was the primary diagnosis grew from 21% in 2016 to 25% in 2018, according to an analysis performed by the Center for Improving Value in Health Care using claims data for commercially insured, Medicaid and Medicare Advantage patients. Those visits for adults dropped from 79% to 75% in that time. (Bannow, 12/4)

According to the FBI, there were more than 16,000 law enforcement agencies participating in the Hate Crime Statistics Program in 2018, but only about 12% reported incidents. The other 87% reported that no hate crimes occurred in their jurisdictions. Agencies participate on a voluntary basis and provide one to 12 months of data. (Driscoll, 12/4)

Amending emergency rules put in place two weeks ago, the Illinois State Board of Education says it will again allow schoolchildren to be physically restrained in positions it had banned, though only in crisis situations. The change comes after several schools said they could no longer serve some students with behavior issues because of the new restrictions, put in place after publication of a Chicago Tribune/ProPublica Illinois investigation that found overuse and misuse of “isolated timeouts” in public schools across the state. (Richards, Cohen and Chavis, 12/4)

Next summer, a health care provider for seniors will open three new locations here. ChenMed, which serves low-to-moderate-income seniors through Medicare, announced Tuesday that it would expand into five new cities: Cincinnati, Cleveland, Memphis, Orlando and St. Louis. ChenMed advertises a more personal care model, where doctors provide patients with their cellphone numbers, and primary care doctors each serve 400 patients on average. (Merrilees, 12/4)

The number of medical students coming from rural areas has fallen by almost 30% since 2002, according to a new report. Researchers say the trend is partly to blame for healthcare workforce shortages in rural states like New Hampshire. The research, which appears in Health Affairs, was led by Dartmouth professor Scott Shipman. It examined medical school enrollment across the country from 2002 to 2017. (Moon, 12/4)

Quorum Health could be the latest healthcare provider to be gobbled up by private equity investors, if the beleagured chain accepts a buy-out proposal from KKR. The 24-hospital, publicly traded company has struggled since it was formed in 2016, posting more than $300 million in net losses in 2017 and 2018 combined. Quorum said it's considering private equity firm KKR's offer to buy out its public shares held by minority owners for $1 per share. That would value the company at about $33 million, based on the number of outstanding shares as of Nov. 6. (Bannow, 12/4)

According to the recent influenza-like illness regional report by the U.S. Centers for Disease Control and Prevention, seasonal influenza activity in Tennessee is considered "high." With widespread cases of flu being reported across the state, Williamson County Schools encouraged parents to review the district's illness guidelines when deciding whether a student should go to school or stay home. (Bartlett, 12/4)

Tallahassee’s City Commission will hear a presentation on conversion therapy during its December 4th meeting. The move comes as state lawmakers prepare to weigh a statewide ban of the practice. Conversion therapy is the practice of trying to change someone's sexuality from gay to straight. Studies have shown the practice is harmful for people and has led to depression, substance abuse and suicide. (Gaffney, 12/4)

Public-health officials are investigating a norovirus outbreak associated with Brave Horse Tavern in South Lake Union that has sickened 43 people. Of those who fell ill, 30 were customers who ate at the restaurant on Nov. 23 and Nov. 24, while 11 were employees who experienced symptoms dating back to Nov. 24, according to a statement from Public Health — Seattle & King County. Two of the employees lived with people who had experienced symptoms since Nov. 20, according to Public Heath. (Fields, 12/4)

From the outside, the University of South Florida’s new Morsani College of Medicine building looks complete. The sleek skyscraper in downtown Tampa is about to become the among the first completed pieces of the Water Street project backed by Tampa Bay Lightning owner Jeff Vinik. About 1,800 students, faculty and staff will fill the 13-story tower when the next semester begins Jan. 13. With 395,000 square feet of space, it has been billed as a state-of-the-art teaching and research facility connecting the medical school with nearby Tampa General Hospital and other downtown destinations. (Griffin, 12/5)

San Francisco cleared a Civic Center alley of tents Wednesday, one of its largest homeless sweeps of the year, causing dozens of people to fold up their makeshift homes, throw out their belongings and scatter elsewhere. City officials say outreach workers spent the past six weeks visiting Willow Street and tried connecting as many people as possible to services. (Thadani, 12/4)

Efforts to loosen New Hampshire's marijuana laws appear to be losing momentum at the State House, as separate Senate committees took action this week against bills that would make marijuana more accessible. New Hampshire decriminalized up to three-quarters of an ounce of marijuana in 2017, but if the Senate committee votes stand, full legalization will be off the table in 2020. So will allowing doctors to prescribe medical marijuana for "any condition." (Rogers, 12/4)

Fetal alcohol spectrum disorders (FASD) comprise the continuum of disabilities associated with prenatal alcohol exposure. Although infancy remains the most effective time for initiation of intervention services, current diagnostic schemes demonstrate the greatest confidence, accuracy, and reliability in school-aged children. Our aims for the current study were to identify growth, dysmorphology, and neurodevelopmental features in infants that were most predictive of FASD at age 5, thereby improving the timeliness of diagnoses. (Kalberg et al, 12/1)

Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among US rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county’s majority racial/ethnic group. Premature death rates were significantly higher in rural counties with a majority of non-Hispanic black or American Indian/Alaska Native (AI/AN) residents than in rural counties with a majority of non-Hispanic white residents. (Henning-Smith et al, 12/1)

Growing up in a rural setting is a strong predictor of future rural practice for physicians. This study reports on the fifteen-year decline in the number of rural medical students, culminating in rural students’ representing less than 5 percent of all incoming medical students in 2017. Furthermore, students from underrepresented racial/ethnic minority groups in medicine (URM) with rural backgrounds made up less than 0.5 percent of new medical students in 2017. Both URM and non-URM students with rural backgrounds are substantially and increasingly underrepresented in medical school. (Shipman, 12/1)

ach year, Medicare beneficiaries in private Medicare Advantage plans and Part D stand-alone prescription drug plans (PDPs) have the opportunity to change plans during the annual open enrollment period (October 15 to December 7). Medicare’s private plans vary significantly from each other and can change from one year to the next, which can have a significant impact on enrollees’ coverage and costs. The Centers for Medicaid & Medicare Services (CMS) encourages beneficiaries to shop for Medicare Advantage and prescription drug plans to potentially save money on prescriptions or get new benefits. (Koma et al, 12/2)

Medicare is prohibited by US law from directly negotiating drug prices with manufacturers. The Department of Veterans Affairs (VA) Health System, in contrast, relies on direct negotiation and closed formularies to reduce costs. A 2018 US congressional report found that Medicare would have saved $2.8 billion in 2015 if it had paid VA-negotiated prices for the 20 most commonly prescribed drugs to beneficiaries of Medicare Part D. A 2019 study estimated that, for the 50 costliest oral drugs, Medicare Part D would have saved $14.4 billion in 2016 with VA-negotiated prices. However, neither study assessed the influence of formularies in conjunction with price negotiations, and the 2019 study excluded products with nonoral routes of administration. (Feldman et al, 12/2)

The children of mothers with diabetes may be at increased risk for early heart disease. Researchers used Danish national health registries that included 2.4 million children who were born without heart disease. During 40 years of follow-up, 1,153 of the children whose mothers had diabetes — either Type 1 or Type 2 disease, or diabetes of pregnancy (gestational diabetes) — were given diagnoses of cardiovascular disease. Cardiovascular disease developed in 91,311 children whose mothers who did not have diabetes. (Bakalar, 12/4)

Results from the National Intimate Partner and Sexual Violence Survey indicate that 18.3% of US women and 1.4% of men have experienced rape. Trauma from sexual assault can lead to severe, long-standing negative sequelae, particularly when left untreated. Further complicating matters, only 23% of sexual assault crimes are reported to the police, in part because of a lack of awareness of how to obtain help. (Torgerson et al, 12/2)

There is a horrible irony in taking food from the tables of hungry Americans during the holidays, but that’s the latest act of cartoonish villainy by the Trump administration. It could be, perhaps, that their shoes were too tight or that their heads weren’t screwed on just right, but this week, the Agriculture Department played the part of the Grinch, finalizing a rule to cut billions of dollars from the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. (Rep. Marcia L. Fudge, 12/4)

Judging by the rhetoric, you’d think President Trump was shutting down Great Depression bread lines. “The Trump administration,” Senate Minority Leader Chuck Schumer said, “is driving the vulnerable into hunger just as the Christmas season approaches.” Humbug. Two incongruous facts: With the U.S. unemployment rate now at 50-year lows, there are seven million job openings for only six million job seekers. Yet as of last year 2.1 million potential hires—specifically, adults age 18 to 49, able-bodied, without dependents—were receiving food stamps despite not working. (12/4)

Won’t you spare a thought for America’s medical debt collectors? And while you’re at it, will you say a prayer for the nation’s health care billing managers? Let’s also consider the kindly, economically productive citizens in swing states whose job it is to jail pregnant women and the parents of cancer patients for failing to pay their radiology bills. Put yourself in the entrepreneurial shoes of the friendly hospital administrator who has found a lucrative new revenue stream: filing thousands of lawsuits to garnish sick people’s wages. (Farhad Manjoo, 12/4)

Iowans have an extraordinary opportunity to shape our nation’s history through the caucuses that launch the presidential nomination season on Feb. 3. The rest of America is counting on the seriousness with which they have always approached the responsibility that comes with their pivotal role in presidential selection.For Democrats, it is critical to focus on our core health care principles. Universal access to affordable health care must be a core principle. No one should be denied life-saving care because of the size of their paycheck. Justice demands an effective and achievable way to get it done soon. (Chuck Hassebrook, 12/4)

It’s the guarantee — provided for the first time to all Americans by the Affordable Care Act — that people with pre-existing health conditions will have access to affordable private health insurance. The coverage of 54 million Americans with health problems would be at risk if the protections currently contained in the Affordable Care Act (ACA) are declared unconstitutional in a pending court case, or if opponents of the law succeed in renewed efforts to repeal it. (David Blumenthal, 12/4)

It is said endlessly that disagreement in politics is a good thing. Except when one side of the argument is occupied by America’s political left, which in its modern incarnation allows little dissent. That was made clear as the Democratic presidential contest began an eon ago, with Ms. Harris in tow. The defining moment of the campaign back then was when the party somehow took two of its core policy issues—health care and climate change—and reimagined them into the Fractured Fairy Tales of the Green New Deal and Medicare for All. (Daniel Henninger, 12/4)

One of the greatest threats to public health today, in the United States and around the world, isn’t a new exotic hazard. It’s antibiotic resistance: the potential failure of one of our most important and well-known disease-fighting tools. The latest Antibiotic Resistance Threats Report, recently published by the Centers for Disease Control and Prevention, shows that antibiotic-resistant (AR) infections — when germs defeat the drugs designed to kill them — cause more than 35,000 deaths each year in the United States. (HHS Secretary Alex M. Azar and CDC Director Robert Redfield, 12/4)

I discovered vaping in 2008 after smoking cigarettes for 30 years. It was life changing. I had wanted to quit but nothing I tried helped me — not the patch, pills, nicotine gum or the cold turkey route. The first couple of times I tried vaping, I was skeptical it could replace or even wean me off cigarettes. But I found that it helped me accomplish something I never thought was doable — quit smoking entirely. (Nick Orlando, 12/5)

The number of shootings in which four or more victims are killed has spiked to 32 thus far this year, according to the Associated Press/USA TODAY/Northeastern University Mass Killing Database. This alarming figure already surpasses the yearly total for any point in time since the 1970s. This past weekend saw a pair of shooting sprees in New Orleans. Although the shootings fortunately did not meet the definition of mass killings in terms of fatalities, they certainly made residents of the Big Easy (and elsewhere) quite a bit uneasy. (James Alan Fox, 12/3)

When a 13-year-old boy found out earlier this year that a bullet lodged in his spine was going to leave him paralyzed from his belly button down, he didn’t scream. He didn’t cry. He didn’t even sulk in the way other children his age do when they lose their video games or cellphones for a day. “Am I going to live?” he asked. (Theresa Vargas, 12/4)

We tend to tell two basic stories about measles: first, that we had more or less eliminated the disease, and second, that it has resurfaced — more than 440,000 cases were reported worldwide between January and November — because of mindless anti-vaxxers who ignore science and celebrate libertarianism from the comfort of their Internet echo chambers. Both of these narratives, however, are, at best, partial truths. While anti-vaxxers are certainly part of the problem, increasing the numbers of people susceptible to the virus, they are best understood as harmful scapegoats or dangerous distractions for public health experts. (Laurence Monnais, 12/4)

As gastroenterologists, we treat patients in Portland, Ore., and Des Moines, Iowa, with challenging disorders like Crohn’s disease and ulcerative colitis who sometimes need infusions of medications. Legislation before Congress could make it difficult — and potentially impossible — for us to provide this important care in our medical practices. That could force our patients to go to hospitals or large medical centers for their infusions, which is less convenient for them and more expensive for the health care system. (Rajalakshmi Iyer and James Regan, 12/3)

Pennsylvania’s legislature has pushed a bill mandating death certificates and the offering of funerals for fertilized ova. How inequitable! In Ohio, lawmakers have suggested a bill to rescue fertilized ova that have wound up outside the womb, even when this is literally medically impossible. But all right-minded citizens must ask the question: Why such concern for these fertilizing spermatozoa, more than others? (Alexandra Petri, 12/4)