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The rate of Americans without health insurance remained flat in 2017 at 8.8 percent, according to data released Wednesday by the Census Bureau. The 8.8 percent uninsured rate in 2017, which translates to 28.5 million people, was the same as the rate from 2016. The data show that in the first year of the Trump administration, the uninsured rate remained the same as in the last year under President Obama. That is a contrast to data released in January from Gallup, which showed three million additional people without health insurance in President Trump’s first year and drew condemnation from Democrats. (Sullivan, 9/12)

Kaiser Health News: In Trump’s First Year, Nation’s Uninsured Rate Unchanged

However, the uninsured rate did rise in 14 states. It was not immediately clear why, because the states varied dramatically by location, politics and whether they had expanded Medicaid under the federal health law. Those states included Texas, Florida, Vermont, Minnesota and Oregon. (Galewitz, 9/12)

The finding suggests America's recent success in lowering its uninsured population has plateaued, with potential implications for policymaking and the fate of the U.S. health care system. "There has been a stall in the progress of reducing the number of uninsured Americans,” said Laura Skopec, a health care expert at the Urban Institute, a centrist think-tank. (Stein, 9/12)

Health care experts said that Trump administration policies enacted since last fall, after the repeal effort failed, could push up the uninsured rate this year. This includes the gutting of Obamacare's individual mandate and the approval of Medicaid work requirements, which could result in tens of thousands of low-income people losing coverage in some states. "Increases in the number of people uninsured could come this year and next, as changes to the [Affordable Care Act] from the Trump administration and Congress take hold,” tweeted Larry Levitt, a senior vice president with the Kaiser Family Foundation. (Roubein, 9/12)

The number of Minnesotans without health insurance climbed by 17,563 last year, driving up the uninsured rate to 4.4 percent, but the state continues to have one of the best rates of overall medical coverage in the nation. Altogether, 242,509 Minnesotans lacked health insurance in 2017, with black and Hispanic residents having the largest uninsured rates at 17 percent, according to the latest data from the U.S. Census Bureau. (Magan, 9/12)

More than 2.6 million people in Florida lacked health insurance at some point in 2017, according to data released Wednesday by the U.S. Census Bureau. That means about 12.9 percent of the state’s population last year was uninsured --- up from 12.5 percent in 2016 --- as Florida continued to be higher than the national average of 8.8 percent. (Hokrein, 9/13)

The Trump administration is making it easier for individuals to opt out of ObamaCare’s individual mandate. The Centers for Medicare and Medicaid Services (CMS) says it is streamlining the way taxpayers can claim “hardship exemptions” from the mandate, which requires everyone have health insurance or pay a fine. (Weixel, 9/12)

Premiums for Washington state’s health-insurance exchange will likely increase by nearly 14 percent next year, according to state insurance officials. The Washington Health Benefit Exchange Board will vote Thursday on the proposal from Insurance Commissioner Mike Kreidler to raise premiums 13.8 percent for 2019. If passed, it will be the fourth year in a row premiums have risen. In 2015 the increase was only 1 percent; it bumped up to 4 percent in 2016 and 11 percent in 2017. The increase this past year has been almost 24 percent. (Blethen, 9/12)

A program meant to help underserved populations enroll in and navigate the federal health insurance marketplace has slashed millions in funds for grassroots Texas groups, according to the agency that manages the program. ...For Texas, that means just two community organizations statewide received a total of $1.3 million for the navigator program, documents released Wednesday show. (Armus, 9/12)

A small DeKalb County nonprofit has been given a statewide grant to provide navigators for people seeking to enroll in the Affordable Care Act insurance exchanges. Navigators are people specially trained to advise and assist consumers who use the exchanges to buy health coverage. (Miller, 9/12)

Planned Parenthood, under fire from conservatives in Washington and state capitols, chose Leana Wen, an emergency room doctor whose family fled China when she was a child, as its next president Wednesday, picking a woman who won praise for her steadying hand as Baltimore’s health commissioner during the city’s convulsive protests in 2015. Dr. Wen, 35, grew up poor in Compton, Calif., after her family left China following the Tiananmen Square massacre just before her eighth birthday. She relied on Medicaid as a child, and in nearly four years in Baltimore has drawn acclaim for working with corporations and churches to close racial disparities in health care and sharply reducing infant mortality. (Zernike, 9/12)

She said she is leaving a job she loves in Baltimore because of growing attacks by the Trump administration and other conservatives on Planned Parenthood and women’s reproductive health rights. "I see how the single, biggest health catastrophe of our times is the threat to women’s health,” Wen said. “I am deeply troubled by how women’s health issues are singled out, stigmatized and attacked.” Wen’s departure leaves the administration of Mayor Catherine Pugh with another critical vacancy. Pugh accepted Wen’s resignation Tuesday and Wen told health department staff in a conference call Wednesday. (McDaniels, 9/12)

“As a patient, I depended on Planned Parenthood for medical care at various times in my own life, and as a public health leader, I have seen firsthand the lifesaving work it does for our most vulnerable communities," Wen said in a statement. "As a doctor, I will ensure we continue to provide high-quality health care, including the full range of reproductive care, and will fight with everything I have to protect the access of millions of patients who rely on Planned Parenthood.” (Hellmann, 9/12)

Earlier this year, Wen and the Baltimore City Health Department successfully sued the Trump administration over federal funding cuts to teen pregnancy prevention programs. She also has spoken out against the administration's changes to Title X family planning grants and the proposed domestic gag rule that would limit information about abortion that providers receiving federal money could share with patients. Just this summer, Wen joined with other cities in another lawsuit against the Trump administration's cuts to open enrollment outreach and other changes the advocates say have sabotaged the Affordable Care Act's marketplaces. (Ollstein, 9/12)

Wen, 35, immigrated from China with her family as a child. Her family relied on Medicaid, food stamps and Planned Parenthood for health care as she grew up in California, she said. She succeeds Cecile Richards, who ran the organization for the past 12 years and whose background is more political. Richards was deputy chief of staff to House Minority Leader Nancy Pelosi (D-Calif.) and is the daughter of former Texas governor Ann Richards. (Bernstein, 9/12)

Wen graduated summa cum laude from California State University, Los Angeles and earned her medical degree from Washington University School of Medicine before becoming a Rhodes Scholar. Early in her tenure as Baltimore's health commissioner, she provided strong leadership as the city was wracked by violent protests related to disputed police actions. She expanded trauma and mental health services, and secured funding for a program designed to treat gun violence as a contagious disease. (Crary, 9/12)

With less than 48 hours before Hurricane Florence was forecast to reach shore, officials in the Carolinas were still pleading for residents to evacuate communities in the storm’s path. But at the Eagle Crest senior living community near the shore here Wednesday, the windows had long been boarded up and a sign was already hung on the front door announcing that nobody was there. Preparations to evacuate the facility’s residents had begun late last week, days before South Carolina Gov. Henry McMaster (R) issued mandatory evacuation orders. (Phillips and Sullivan, 9/12)

Kaiser Health News: Trying To Protect Seniors, The Most Vulnerable, From Formidable Foe Florence

Perhaps no other population is as vulnerable during a hurricane as frail, older adults, especially those who are homebound or living in nursing homes. With Hurricane Florence predicted to slam the North Carolina coast Friday, health officials are already scrambling to keep older residents safe. Seniors “are not only the most likely to die in hurricanes, but in wildfires and other disasters,” said Dr. Karen DeSalvo, a New Orleans native who served as health commissioner in that city after Hurricane Katrina and went on to be named acting assistant secretary for health at the Department of Health and Human Services for the Obama administration. “The seniors always seem to bear a big brunt of the storms.” (Szabo, Aleccia and Pardue, 9/12)

Puerto Ricans sharply rebuke President Trump, along with the federal and local governments, for last year’s response to Hurricane Maria, a devastating storm that created an enduring humanitarian crisis affecting nearly all aspects of life on the island territory, according to a new Washington Post-Kaiser Family Foundation poll. (Clement, Zezima and Guskin, 9/12)

Facing renewed criticism of his administration’s response to Hurricane Maria, President Donald Trump lashed out again on Wednesday, grousing about his administration’s “unappreciated great job” on the Puerto Rico recovery – despite the remoteness of the island, poor access to electricity and the “totally incompetent Mayor of San Juan.” “We are ready for the big one that is coming!” an exuberant Trump concluded, as a new storm spun toward the East Coast. (Cadelago and Restuccia, 9/12)

President Trump on Thursday appeared to cast doubt on studies that found roughly 3,000 people died in Puerto Rico as a result of Hurricane Maria. "3000 people did not die in the two hurricanes that hit Puerto Rico. When I left the Island, AFTER the storm had hit, they had anywhere from 6 to 18 deaths," Trump tweeted. (Samuels, 9/18)

A campaign urging Republican Sen. Susan Collins to vote against Supreme Court nominee Brett Kavanaugh has generated more than $1 million in pledges, money that would go to her opponent in 2020 if she decides to support the judge. The senator and her Republican colleagues are decrying the effort in Maine as attempted bribery, as attention shifts from Kavanaugh's confirmation hearings to the question of how lawmakers will vote on his nomination. (Freking, 9/12)

Supreme Court nominee Brett Kavanaugh told senators that he was summarizing the plaintiffs' views in an ObamaCare case when he referred to birth control as "abortion-inducing drugs." Kavanaugh's use of the phrase during his confirmation hearing sparked days of backlash from Democrats and progressive groups, who argued the Supreme Court pick was trying to signal his own views. (Carney, 9/12)

Apple is trying to turn its smartwatch from a niche gadget into a lifeline to better health by slowly evolving it into a medical device. In its fourth incarnation, called the Series 4 and due out later this month, the Apple Watch will add features that allow it to take high-quality heart readings and detect falls. It's part of Apple's long-in-the-making strategy to give people a distinct reason to buy a wrist gadget that largely does things smartphones already do. (Liedtke, 9/13)

“The FDA worked closely with the company as they developed and tested these software products, which may help millions of users identify health concerns more quickly,” FDA Commissioner Scott Gottlieb said in a statement. Healthcare products on ubiquitous devices, such as smartwatches, may help users seek treatment earlier and empower them with more information about their health, he said. (Gurman, 9/12)

Theirs is the first electrocardiogram ever to be available over the counter, Apple’s COO Jeff Williams said. The Apple Watch Series 4 will cost at least $399. Apple wasn’t the only one bragging about the move Wednesday. FDA Commissioner Scott Gottlieb also jumped in to tout his agency’s role in the clearance. (Sheridan, 9/12)

It is positioning the new watch as a more comprehensive health device, able to take an electrocardiogram to detect an irregular heartbeat and start an emergency call automatically if it detects a user falling down, potentially appealing to older customers. The U.S. Food and Drug Administration said it worked with Apple to develop apps for the Apple Watch and has been taking steps to ease the regulatory pathway for companies seeking to create digital healthcare products. (Nellis and Randewich, 9/13)

The device’s new health features are sure to increase Apple’s dominance of the smart watch category — and they underscore the company’s focus. When the watch was first released, critics and consumers were confused about its utility. Over time, Apple has refined the device to focus on its health and fitness capabilities. Now the narrative is clear: Get this watch, if you want to live. (Chen, Nicas, Manjoo and Abelson, 9/12)

The Apple Watch ECG “could be beneficial to lots of patients” by picking up intermittent rhythm problems, said C. Michael Valentine, president of the American College of Cardiology and a cardiologist with Centra Medical Group in Lynchburg, Va. Yet doctors also raised concerns about potential risks from relying on the app. Dr. John Mandrola, a cardiac electrophysiologist in Louisville, Ky., said the ECG feature could misdiagnose patients because of inaccurate readings, or lead to overtreatment of patients. The watch may also detect cases of low-risk atrial fibrillation that don’t need to be treated, said Eric Topol, a cardiologist and director of the Scripps Translational Science Institute. This could lead to unnecessary prescriptions for blood thinners that carry bleeding risks, he said. (Loftus and Mickle, 9/12)

Apple assured the audience at Wednesday's event that the data captured by the watch are encrypted, both on the device itself and in the cloud. But the ECG capability nevertheless brings up new questions about privacy, said Angela Radcliffe, general manager of clinical trial solutions for PulsePoint. For instance, consumers may one day be able to monetize their health data, she said. "Healthcare consumer data might be the next part of the gig economy." (Arndt, 9/12)

Hadeel Ayoub slips a black glove onto her hand before beginning the swish of sign language that is meaningless to the untrained observer. Then she pushes a button on her wrist, and a small speaker relays the message drawn in the air: “Let’s Dance!” “My dream is to give a voice to those who can’t speak,” says the 36-year-old inventor who is developing her BrightSign glove while working toward a Ph.D. in assistive technology at Goldsmiths, University of London. (Kirka, 9/13)

The Food and Drug Administration on Wednesday declared that teenage use of electronic cigarettes has reached “an epidemic proportion,” and it put makers of the most popular devices on notice that they have just 60 days to prove they can keep their devices away from minors. The order was part of a sweeping government action that targeted both makers and sellers of e-cigarettes. If Juul Labs and four other major manufacturers fail to halt sales to minors, the agency said, it could remove their flavored products from the market. It also raised the possibility of civil or criminal charges if companies are allowing bulk sales through their websites. (Kaplan and Hoffman, 9/12)

The warning from the Food and Drug Administration on Wednesday cited recent data pointing to a sharp rise in underage use of the devices, including Juul, Vuse and others. It marks a shift in the agency's tone on e-cigarettes. Since 2017, FDA commissioner Scott Gottlieb has discussed e-cigarettes as a potential tool to ween adult smokers off cigarettes, although that benefit hasn't been proven. (Perrone, 9/12)

The latest data, not yet published, show a 75 percent increase in e-cigarette use among high school students this year, compared with 2017. The FDA declined to publicly release the numbers, but people familiar with them said they were preliminary data from the National Youth Tobacco Survey, on which the agency and the Centers for Disease Control and Prevention collaborate. (McGinley, 9/12)

Dr. Gottlieb said he believes that certain flavors make the products appealing to teens. “The availability of e-cigarettes cannot come at the expense of addicting a new generation of youth onto nicotine, and it won’t,” he said in an interview. The announcement marks an about-face for the agency, which in 2016 granted a grace period for e-cigarettes already on the market until the manufacturers submitted products for FDA review. Last year, Dr. Gottlieb extended that grace period to 2022, allowing Juul Labs Inc. and others to continue to sell their existing products. (Maloney, 9/12)

The announcement was immediately hailed by anti-tobacco advocates. "This is potentially the most important step FDA has taken to curtail youth use of e-cigarettes," said an emailed statement from Matthew Myers, president of the Campaign for Tobacco-Free Kids. "Today's announcement will represent a fundamental turning point, if but only if, FDA formally requires all manufactures to comply with these requirements and FDA reverses its policy and requires that all of these products undergo premarket review now, not four years from now." (Stein, 9/12)

The actions were greeted with defiance and derision from the vaping industry. “Thousands of small-business vape shops across America do not engage in irresponsible marketing practices and don't even sell the products being targeted by the FDA with threatening letters,” said Gregory Conley, president of the American Vaping Assn., a nonprofit organization that advocates for what it calls sensible regulation. (Healy, 9/12)

Massachusetts Attorney General Maura Healey raised similar concerns about e-cigarettes in July, when she said her office was investigating one of the biggest makers, San Francisco-based JUUL Labs Inc., for alleged sales to minors. While teen cigarette use has hit a record low, she said, “ ‘juuling’ and vaping have become an epidemic in our schools, with products that seem targeted to get young people hooked on nicotine.” (Saltzman and Freyer, 9/13)

As a major hurricane menaces the East Coast, Congress is moving to avert a legislative disaster that could lead to a partial government shutdown just weeks before the November midterm elections. Senators approved a $147 billion package Wednesday night to fund the Energy Department, veterans' programs and the legislative branch. The bill is the first of three spending packages Congress hopes to approve this month to avoid a government shutdown when the new budget year begins Oct. 1. (Daly, 9/12)

Lawmakers hope to pass another spending package, containing bills to fund the Pentagon and the Health and Human Services Department, ahead of the Sept. 30 end of the fiscal year. If they succeed in sending those bills to Trump, they will have provided for most of the government’s budget for next year. And they hope Trump will be willing to declare victory over a big boost in Pentagon funding and delay the border wall fight. (Werner, 9/12)

Even though hundreds of children separated from their families after crossing the border have been released under court order, the overall number of detained migrant children has exploded to the highest ever recorded — a significant counternarrative to the Trump administration’s efforts to reduce the number of undocumented families coming to the United States. (Dickerson, 9/12)

U.S. border authorities arrested dramatically more immigrant families at the Mexico border in August compared to previous months in a spike that a Trump administration official said Wednesday was the result of "legal loopholes" allowing children to avoid immediate deportation to their homelands in Central America. (Spagat, 9/12)

Total family apprehensions since October, the beginning of the federal fiscal year, is already higher than for any complete prior fiscal year for which data is available. The total number of people arrested at the border in August rose about 20% from the prior month, to more than 37,500. (Caldwell, 9/12)

Cancer will claim the lives of 9.6 million people in 2018, accounting for one in eight of all deaths among men and one in 11 among women, the World Health Organization's cancer research agency said on Wednesday. In its GLOBOCAN report detailing prevalence and death rates from many different types of cancer, the WHO's International Agency for Research on Cancer (IARC) said the global cancer burden would rise to an estimated 18.1 million new cases this year. This was up from 14.1 million - and 8.2 million deaths - in 2012, when the last GLOBACAN survey was published. (9/12)

Lawsuits didn’t do it, public shaming didn’t do it, patients and doctors banding together to “free the data” couldn’t do it: For 22 years Myriad Genetics, one of the oldest genetic testing companies, has refused to make public its proprietary database of BRCA1 variants, which lists more than 17,000 known misspellings in that major “cancer risk” gene, along with the medical significance of each. The database lists which mutations increase the risk of breast and ovarian cancer, which do not, and which have an unknown health effect. (Begley, 9/12)

Seven U.S. states now have adult obesity rates of 35 percent or higher, up from zero states just five years ago, according to federal data released Wednesday. The 2017 data, from the Centers for Disease Control and Prevention, highlight continuing discrepancies in adult obesity rates across geographic areas, race, and education levels. (Joseph, 9/12)

Minnesota again has the lowest rate of obesity in the Upper Midwest, according to 2017 figures released Wednesday by the U.S. Centers for Disease Control and Prevention. For the first time, it also has the lowest rate among 12 Midwestern states.The CDC survey found 28.4 percent of Minnesota adults self-reported they were obese, which makes Minnesota the only Midwestern state below 30 percent. (Tarala, 9/12)

When the next dead­ly pan­dem­ic flu hits, the first chal­lenge will be to de­vel­op a vac­cine. But loom­ing behind that ob­sta­cle is another: How to get an in­oc­u­la­tion to millions of people with­out in­ad­vert­ent­ly ex­ac­er­bat­ing the cri­sis. Af­ter all, droves of people — some who might already be sick­ened — who flock to health centers for a shot could be a po­tent way for the in­fec­tion to spread. (Johnson, 9/12)

U.S. and Cuban officials will meet later today in an effort to determine the method and motive behind mystery incidents in Havana that have injured American diplomats. The meeting comes amid widespread frustration among national security agencies and in Congress at the lack of answers about what the U.S. describes as “health attacks” that began nearly two years ago and affected some two dozen people, including some diagnosed with brain damage. It also comes amid a flurry of reports suggesting investigators have narrowed their suspicions as to the cause and culprit. (Lee, 9/13)

Kianni Arroyo clasps 8-year-old Sophia’s hands tightly as they spin around, giggling like mad. It’s late afternoon, and there are hot dogs on the grill, bubble wands on the lawn, balls flying through the air. The midsummer reunion in a suburb west of the city looks like any other, but these family ties can’t be described with standard labels. Instead, Arroyo, a 21-year-old waitress from Orlando, is here to meet “DNA-in-laws,” various “sister-moms” and especially people like Sophia, a cherished “donor-sibling.” (Cha, 9/12)

Scientists say they've found a new way to help determine whether specific genetic abnormalities are likely to make people sick, a step toward avoiding a vexing uncertainty that can surround DNA test results. Researchers used genetic engineering to create thousands of tiny variations in a gene linked to breast cancer, and tested each one in a lab to predict whether it would promote the disease if it appeared in a person. (9/12)

A kissing cousin to pot is showing up in your coffee, candy and chocolate bars. Companies are selling a growing number of products that contain cannabidiol, or CBD, a chemical found in hemp. It’s being added to everything from gumdrops to beverages, as marketers claim benefits such as pain relief and stress reduction. (Chaker, 9/12)

After viewing “Blackfish,” a documentary about the mistreatment of animals at SeaWorld, Jeffrey Miller’s daughter, Hannah, became concerned that eating meat was murder. Last year, she decided to become a vegetarian. “Our 14-year-old has completely bailed on meat of her own accord, so we’ve had to do some maneuvering,” Mr. Miller said of his daughter, who is the lone vegetarian in a household where both parents and her 16-year-old sister, Emma, happily consume chicken, pork and turkey. He noted that in their town of Sioux Falls, S.D., the middle of the pork and beef belt, many of her friends view her vegetarian status as “weird.” (Halpert, 9/13)

Overseas doctors are cheaper. Artificial intelligence could eventually be smarter. Patient safety concerns have multiplied. Are American radiologists' days numbered? These radiologists say no — and take listeners inside their work. (9/12)

Although more than half of Americans misuse prescription drugs, the percentage that did so has held steady for four consecutive years, according to a new analysis. Meanwhile, though, there has also been a surge in the use of illicit drugs and medicines obtained without a prescription among patients being treated for substance use disorders. The overall rate at which drugs were misused was 52 percent last year, according to an analysis of approximately 3.9 million laboratory test results that were stripped of identifying patient information. (Silverman, 9/12)

Kaiser Health News: Insurers Are Starting To Deny Coverage Of Opioid OxyContin

The largest insurer in Tennessee has announced it will no longer cover prescriptions for what was once a blockbuster pain reliever. It's the latest insurance company to turn against OxyContin, whose maker, Purdue Pharma, faces dozens of lawsuits related to its high-pressure sales tactics around the country and contribution to the opioid crisis. Last fall, Cigna and Blue Cross Blue Shield of Florida both dropped coverage of the drug. (Farmer, 9/12)

A southwest Virginia school district plans to start stocking the opioid overdose antidote naloxone. The Roanoke Times reports Roanoke’s school board voted 6-0 this week in favor of providing the drug, often referred to by the brand name Narcan, in each school. (9/13)

Ohio - University Hospitals in Cleveland is one of a dozen recipients of a state grant to develop technology aimed at combating Ohio's opioid addiction epidemic, a state commission announced Wednesday. Eric Beck and a University Hospitals team received $200,000 to work on a real-time opioid surveillance and tracking tool. (Hancock, 9/12)

New data from Navigant Consulting challenge the common perception that scale will improve healthcare providers' operations, researchers said. The report, which covered 104 highly rated health systems comprising about half of nation's hospitals, showed that there was no correlation between higher revenues and better operating margins from 2015 to 2017. The largest for-profit systems had steeper declines in operating income than their smaller peers, granted they started with much higher revenues. The data opposes some of the rationale that drives the speeding train of mergers and acquisitions, said Jeff Goldsmith, national adviser for Navigant. (Kacik, 9/12)

Proposed efforts to keep smaller providers out of the Merit-based Incentive Payment System poses a blow to large health systems that have spent millions to implement the CMS' pay program. For the second year in a row, the CMS proposed that physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year would be exempt from MIPS. (Dickson, 9/11)

Cigna Corp. is launching a venture fund to invest in health-care startups, committing $250 million of its own capital. Health insurers have been starting venture-capital arms to find new ideas to improve their businesses and generate financial returns. UnitedHealth Group Inc., the biggest health insurer, said in November that its Optum unit was creating a venture arm with $250 million in funds. Humana Inc., Kaiser Permanente, and a group of Blue Cross and Blue Shield insurers all have venture units. (Dodge, 9/12)

What is clear is that D.C. has among the worst maternal mortality rates in the country. What is clear is that if you’re a black mother in D.C. you’re twice as likely to have a preterm birth than a white mother. What is less clear is how to change these outcomes. On Wednesday, medical providers, policy makers and community organizations gathered to tackle that goal at the district’s first-ever Maternal and Infant Health Summit at the Walter E. Washington Center. (Schmidt, 9/12)

Total health spending in Massachusetts increased 1.6 percent in 2017 — the lowest level of growth in five years — even as costs remain a burden for many consumers. Spending on health care totaled $61.1 billion, or $8,907 per person, according to the report from the Center for Health Information and Analysis, a state agency. That was within a state-mandated target for controlling costs. (Dayal McCluskey, 9/12)

A Louisiana abortion clinic asked a state judge Wednesday to throw out a 2015 state rewrite of clinic regulations, saying the health department ignored the rules for making such changes. Hope Medical Group for Women in Shreveport argues that the Louisiana Department of Health disregarded reams of public comments about the regulations when they were being proposed. (9/12)

Jill Pelovitz depends on an army of in-home nurses to keep her teenage daughter alive. Fourteen-year-old Nadiya suffers from a rare genetic disorder that causes life-threatening seizures, breathing problems and other complications. The teenager, who needs help with basic life skills such as dressing and walking, requires constant monitoring in case she has a seizure, especially at night when she is sleeping in their Severn home. (McDaniels, 9/13)

RAI Services Company, the makers of Newport and Camel cigarettes, didn't disclose their financial involvement in a campaign to defeat a Montana ballot initiative that would tax cigarettes more to pay for healthcare programs, the state's top campaign official determined. A Sept. 5 decision found "sufficient evidence" to show RAI and another tobacco company, Altria (formerly Philip Morris), helped fund the campaign against the ballot initiative and didn't report it within five days as required by Montana law. (Contorno, 9/12)

Louisiana is in quiet crisis.­ The state’s mental health system has been gradually broken under the weight of financial cuts and psychiatric hospital closures. State leaders took what critics call a short-term view, gutting mental health to fix budget gaps, leaving emergency rooms, jails and nursing homes filled with the seriously mentally ill – at often-ignored taxpayer and human expense. Much of those health care cuts over the last decade took place under the leadership of then-Gov. Bobby Jindal. His administration closed New Orleans Adolescent Hospital in 2009 with promises those inpatient services would continue at Southeast Louisiana State Hospital in Mandeville. Then the Jindal administration closed that hospital in 2012. State funding cuts to other mental care services and losses in federal money added to the problems.  (Sayre, 9/12)

Iowa is critically short of mental health treatment for children, and there is little coordination of the few services that are available, health care leaders say. Parents like Clogg are left to flounder, trying to use Google or the telephone to figure out where their kids should go for help, how long they would have to wait for it and whether their insurance would pay. A new state children’s mental health committee, appointed by Gov. Kim Reynolds, started work last month. It is the fourth such committee since 2011. The previous panels disbanded after releasing reports on what should be done. Little changed. (Leys, 9/12)

Xavier Cunningham and his buddies were climbing into a treehouse when a wasp landed on his hand. The children had stumbled into a massive yellow jacket nest Saturday afternoon in a neighbor’s treehouse in western Missouri, and Xavier, who was at the top of the ladder, tried to swat one of them away. But in the process, Xavier’s stepfather said, the 10-year-old lost his balance and fell face-first to the ground — right where he and his friends had stuck a long metal meat skewer they had found. (Bever, 9/12)

People born in New York City who don't identify as male or female will have the option of changing their birth certificates to "X'' under legislation passed Wednesday by the City Council. The bill adopted by a 41-6 vote will also allow parents to choose the "X'' designation for their newborns, and it will permit adults to change the gender on their birth certificates without an affidavit from a doctor or mental health professional. (9/12)

Delaware health official say they have confirmed another human case of West Nile virus, marking the state’s fifth case this year. The News Journal of Wilmington reports this case involving a 57-year-old New Castle County man makes this Delaware’s highest number of confirmed cases since 2015. Officials says the man’s case still is awaiting confirmation from the Centers for Disease Control and Prevention. Officials confirmed this year’s first Delawarean case of the virus in early August. (9/13)

A volunteer who rocks babies in a neonatal intensive care unit has donated more than $1 million to an Alabama hospital. The University of South Alabama said in a news release last week that Louis and Melinda Mapp donated more than $1 million to USA Health Children's & Women's Hospital's Hollis J. Wiseman Neonatal Intensive Care Unit. The gift will establish an endowment that will enable staff to identify and offset unforeseen needs within the unit. (9/12)

The Miami-based contractor that provides medical services at the Milwaukee County Jail has decided not to resolve criminal charges that it falsified inmates' records. Milwaukee County District Attorney John Chisholm charged the company in February with seven misdemeanor counts, some related to the dehydration death of Terrill Thomas, several months after an inquest jury found probable cause that seven jail employees responsible for Thomas broke the law. (Vielmetti, 9/13)

Members of the Massachusetts medical marijuana industry are warning that a state crackdown on their use of pesticides — including natural compounds used widely on organic food — would cripple growing operations and threaten the supply of cannabis to patients who rely on the drug. Regulators at the state Department of Public Health ordered Colorado-based medical marijuana company Good Chemistry to close its growing and processing operation in Bellingham and its dispensary in Worcester after a routine inspection earlier this month. (Adams, 9/13)

Earlier this summer, Robert Runcie, the superintendent of schools in Broward County, Florida, sent a back-to-school message to the “families and community” of Marjory Stoneman Douglas High School.His missive mentioned nothing about teachers or books or curriculum. Instead it went on for four pages about security measures the school has taken since a gunman committed mass murder there last February, killing 17 and injuring 17 more. (9/12)

Exceptional dangers require exceptional and sometimes unusual responses. This was the spirit animating the volunteers at a phone bank here Tuesday night. ...They were asking citizens to urge their state’s popular Republican senator, Susan Collins, to oppose the confirmation of Judge Brett M. Kavanaugh to the Supreme Court. The organizers were unapologetic. “The idea of Susan Collins attacking an effort by 35,000 small-dollar donors as bribery is politics at its worst,” Marie Follayttar Smith, the Accountable Leadership group’s co-director, said in a statement. “We absolutely have the right to prepare to unseat her given everything Judge Kavanaugh would do on the Supreme Court to make life worse for Maine women.” (E.J. Dionne Jr., 9/12)

(President) Trump’s response to the tragedy in Puerto Rico has been to congratulate himself for his amazingly fantastic relief efforts. On Tuesday, he celebrated his “incredibly successful” response to Maria, which killed about as many Americans as the 9/11 attacks. On Wednesday, he said his team “did an unappreciated great job in Puerto Rico,” again blaming the island territory’s infrastructure and San Juan’s “incompetent” mayor for any troubles. And the Republican majority in Congress has assisted Trump’s fiction by suppressing an investigation. (Dana Millbank, 9/12)

Kaiser Health News: Are We Being Misled About Precision Medicine?

Facing incurable breast cancer at age 55, MaryAnne DiCanto put her faith in “precision medicine” — in which doctors try to match patients with drugs that target the genetic mutations in their tumors. She underwent repeated biopsies to identify therapies that might help. “She believed in it wholeheartedly,” said her husband, Scott Primiano of Amityville, N.Y., a flood-insurance broker. “You live on hope for so long, it’s hard to let go.” (Liz Szabo, 9/13)

As we send our kids back to school, we do our best to prepare them for the new academic year. We buy their school supplies, make their lunches, sort out secure routes to and from campus and attempt to curb bullying. But there is a truly lethal threat that we scarcely discuss: asbestos poisoning. Roughly one-third of American schools contain asbestos, the dangerous mineral once heralded for its fire-resistant properties, but which we now know causes cancer and a host of other diseases, even at very low levels of exposure. (Linda Reinsteins, 9/13)

The 1998 Master Settlement Agreement (MSA) between the tobacco industry and 46 state attorneys general (AGs), five U.S. territories, and Washington, D.C., remains the largest legal settlement ever executed in the United States. The MSA achieved important public health objectives, including substantially reduced smoking rates and lives saved. Given its success, the agreement has enormous promise as a model for similar litigation or settlements that could hold industries accountable when they knowingly deceive and injure consumers with their products. Several of the most serious public health problems in the United States could be targets for AGs, including the opioid epidemic, firearm violence, excessive consumption of fast food and sugar-sweetened beverages, alcohol use, and climate change. Collectively, obesity, the misuse of alcohol and opioids, and firearm violence cause approximately 374,000 deaths each year in the United States. Data on U.S. deaths related to climate change are not systematically collected. (Cheryl Healton, 9/13)

As an infectious diseases specialist, those outpatient evaluation and management encounters are essential to the care I provide, and take about 90 percent of my time. Last month, however, the Centers for Medicare and Medicaid Services released a proposal that would add to the challenges of providing that cognitive (nonprocedural) care, by significantly reducing reimbursement for evaluation and management of complex cases such as the patient I’ve just described. (Daniel McQuillen, 9/12)

The National Academies of Science, Engineering, and Medicine (NASEM) recently released a report on sexual harassment of women working in academic sciences, engineering, and medicine. Its findings are deeply disturbing: sexual harassment is common across scientific fields, has not abated, and remains a particular problem in medicine, where potential sources of harassment include not just colleagues and supervisors, but also patients and their families. To highlight one statistic, as many as 50% of female medical students report experiencing sexual harassment. Imagine a medical-school dean addressing the incoming class with this demoralizing prediction: “Look at the woman to your left and then at the woman to your right. On average, one of them will be sexually harassed during the next 4 years, before she has even begun her career as a physician.” (Esther K. Choo, Jane van Dis, and Dara Kass, 9/13)

From the moment of conception onward, genes control our development and health. But they don’t do it alone. The exposome — all the internal and external chemical exposures we experience during the course our lives — influences, for better or worse, the genes and proteins they code for. A better understanding of the exposome, a concept still in its infancy, will help identify how nongenetic factors influence biological reactions and possibly the development of chronic diseases. There’s a canonical equation in genetics: P = G + E. In English, it means that an individual’s Phenotype (observable health and physical traits) is the sum of his or her Genetics and Environment.I think the E should stand for exposome, a term coined in 2005 by Christopher Wild, now the director of the International Agency for Research on Cancer. (Anthony Macherone, 9/13)

A smart new mental-health survey and intervention program at a number of middle schools in King County promises to help detect and prevent teen substance abuse as well as tease out feelings of anxiety or suicidal thoughts. The program, funded by the voter-approved initiative Best Starts for Kids and the Mental Illness and Drug Dependency Levy, is expected to reach as many as 35,000 students across the county in a dozen school districts over the next three years. It is a demonstration of good teen mental-health services as well as a stark example of how extra tax money can help school districts do more than the basics for their students. (9/12)

Proposition 8, which would limit revenues at nearly 600 outpatient dialysis clinics, is another power play by SEIU-United Healthcare Workers West, which is trying to organize clinic workers and force more hiring. ...While Proposition 8 is backed by labor, Proposition 11 is on the Nov. 6 ballot due to a pro-worker court decision. (9/12)