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Under Federal Travel Regulations, officials are advised to take the “most expeditious” means of transportation and “by no means should include personal use,” Chairman Trey Gowdy and ranking member Elijah Cummings write in a sample letter addressed to Price, who served more than a decade in the House before joining Trump's administration. Similar letters were sent to 23 other agencies and the White House. (Diamond, 9/27)

Politico has revealed that Price has flown 26 times on private aircraft since last May at a cost of hundreds of thousands of dollars, a break with the practice of his predecessors, who generally took commercial flights. Some Trump advisers are urging Trump to get rid of Price, according to three people familiar with the conversations. “His conduct is pretty much indefensible,” one senior administration official said. “I don’t know how you defend it.” (Dawsey, Restuccia and Nelson, 9/27)

President Donald Trump says he’s “not happy” with his top health official, putting Tom Price’s job in jeopardy after his costly charter flights triggered a congressional investigation of administration travel. Asked whether he’s planning on firing Price, Trump responded Wednesday: “We’ll see.” (Alonso-Zaldivar and Lucey, 9/28)

President Trump on Wednesday said he is "not happy" about revelations that Health and Human Services Secretary Tom Price took numerous flights on government-funded private jets for work and personal trips. But the former congressman from Georgia is likely to keep his job, according to two people familiar with Trump's thinking. Responding to questions from reporters at the White House, Trump said he is “looking into” the situation and that “personally, I'm not happy about it, and I let him know it.” Trump spoke by phone with Price in recent days, said the sources, who spoke on condition of anonymity to discuss the personnel issue. (Nakamura and Gearan, 9/27)

According to a senior administration official familiar with Mr. Trump’s thinking, the president’s willingness to ferret out financial wrongdoing is not good news for Mr. Price, a physician and a former Georgia congressman who has been a vocal proponent of cost-cutting within his own agency. Mr. Trump, who is known to dislike appearances of financial waste, is said to be increasingly frustrated with a series of reports published by Politico about Mr. Price’s spending habits. (Rogers, 9/27)

The inspector general of the Health and Human Services Department is probing the flights, and the House Oversight Committee has asked the White House and various agencies to turn over information about any private flights. (Decker, 9/27)

On Capitol Hill, House Oversight Committee Chairman Trey Gowdy, R-S.C., and ranking Democrat Elijah Cummings, D-Md., sent letters instructing administration officials to supply details and documents from all trips on government-owned or chartered aircraft by nonelected political appointees. Letters went to the heads of 24 executive departments and independent agencies and to White House chief of staff John Kelly. (Overby, 9/27)

Democratic lawmakers began calling for Health and Human Services Secretary Tom Price to resign on Wednesday following a series of reports about his use of private jets at taxpayers’ expense. Five House Democrats joined together to demand Price’s resignation, hours after President Trump said he’s “not happy” with his health secretary’s pattern of costing taxpayers hundreds of thousands of dollars to ride on private planes. (Marcos, 9/27)

As a Republican effort to repeal the Affordable Care Act collapsed for the second time in three months this week, the man tapped to  lead the charge found himself at the center of another controversy. Health and Human Services Secretary Tom Price, according to a series of reports from Politico, has racked up a tab of more than $400,000 in private jet travel, despite his predecessors’ longstanding practice of traveling on commercial airlines. (Facher, 9/27)

On Wednesday, the the House Committee on Oversight and Government Reform released a letter asking Price for details on his use of “government-owned aircraft for personal travel or private non-commercial aircraft for official travel.” The letter, signed by the committee’s top Republican and Democrat, gives Price two weeks to provide the records. It also drags the former congressman into an inquiry by fellow Republicans, a relative rarity in Washington politics. HHS’s Office of Inspector General is also investigating the trips. (Edney, 9/27)

The House Oversight Committee will investigate the use of private jet travel by Cabinet officials. The committee on Wednesday sent letters to the White House and 24 federal agencies requesting information related to senior officials’ use of government-owned aircraft or private non-commercial aircraft for official and personal travel. (Weixel, 9/27)

A majority of voters thinks it's inappropriate for Health and Human Services Secretary Tom Price to use private jets for official business, a new poll released Wednesday shows.  Price has used a charter flight at least 26 times since May, totaling about $400,000, according to a series of Politico reports.  (Hellmann, 9/27)

President Trump said Wednesday that he could take executive action next week to allow insurers to sell health plans across state lines and make it easier for individual consumers to buy coverage as a group, a policy approach long championed by conservatives. Trump’s comments, which came on the same day that insurers in about three dozen states had to finalize their federal contracts to offer 2018 coverage under the Affordable Care Act, did little to allay their concerns or those of state officials. (Eilperin and Winfield Cunningham, 9/27)

A day after Congress' last-ditch attempt to repeal Obamacare failed, Trump said he may soon sign an executive order on health care that would affect millions of people. "I'll probably be signing a very major executive order where people can go out, cross state lines, do lots of things and buy their own health care, and that will be probably signed next week," he told reporters Wednesday. "It's being finished now. It's going to cover a lot of territory and a lot of people. Millions of people." (Luhby, 9/27)

Trump said the order is “being finished now. It's going to cover a lot of territory and a lot of people — millions of people.” Selling insurance across state lines is an idea Republicans have long backed. They say competition will help drive down prices. Experts said it’s not clear what an executive order on selling insurance plans across state lines would do. (Weixel, 9/27)

The push to ease interstate health-insurance sales has long been a goal of Republicans. Insurers that operate nationally already can sell plans to consumers in any state as long as they are licensed in that state and follow its rules. Republicans have sought to give insurers leeway to sell policies to consumers in a state where they aren’t licensed; such policies would only need to meet the insurer’s home-state regulations. Groups such as the National Association of Insurance Commissioners have argued that insurers under such a system might flock to states with the most-limited requirements for the industry. That could result in some plans carrying bare-bones coverage, even if offering cheaper premiums. In recent years, a handful of states passed legislation setting up special agreements that allow insurers in one state to sell coverage to individuals in another state, but participation has been sparse. (Peterson and Hackman, 9/27)

Trump didn't elaborate on how he would allow insurance to be sold across state lines. But most insurance experts find it hard to imagine how an executive order could supplant existing state regulations, and believe such a move would likely spark a legal challenge. “Health insurers already have the ability to sell insurance in multiple states as long as they comply with state consumer protection and licensing laws, which many already do,” said Mike Consedine, CEO of the National Association of Insurance Commissioners, in a statement to POLITICO. “The NAIC has long been opposed to any attempt to reduce or preempt state authority or weaken consumer protections.” (Demko and McCaskill, 9/27)

Health insurers appeared likely to offer Affordable Care Act plans in all U.S. counties next year, despite months of drama and worries among some state officials about last-minute exits, ahead of a late-Wednesday deadline. Some major insurers that had signaled that they might pull back, including Cigna Corp., Health Care Service Corp., Molina Healthcare Inc., Highmark Health and Independence Blue Cross, this week said they would stick to the states and regions where they had filed to offer ACA coverage. (Wilde Mathews, 9/27)

In less than six weeks, despite months of Republican attempts to dismantle Obamacare, millions of people will return to HealthCare.gov to buy insurance. Or at least, they should.You might not know it from the political rhetoric, but the Affordable Care Act is still the law. Every American is still legally required to carry health insurance or face a tax penalty of at least $695. There will still be plans available on the exchanges in every county, and the federal government will still provide the subsidies that help more than 9 million people afford their premiums. (Mershon, 9/28)

A group of Senate Democrats on Wednesday called for an investigation into the Trump administration’s decision to periodically shut down the federal ObamaCare exchange website in the middle of the next open enrollment period. Sens. Brian Schatz (Hawaii), Elizabeth Warren (Mass.), Cory Booker (N.J.) and Chris Murphy (Conn.) asked the Department of Health and Human Services's inspector general to investigate plans for hours-long maintenance shutdowns of the HealthCare.gov website. (Weixel, 9/27)

The Trump administration quietly has slashed grants this month to dozens of grass-roots groups that help enroll people in Affordable Care Act health plans, potentially crippling upcoming sign-up efforts for 2018. Some of these "navigator groups" in Texas have had their grants cut severely enough to force them to shrink outreach to the state's high number of uninsured and drastically reduce the staff who help people sign up or re-enroll for coverage. (Deam, 9/27)

A day after Republicans failed yet again to repeal Obamacare, confusion sowed by President Donald Trump’s opposition to the law is roiling the health-insurance market. In many states, insurers face a deadline of Wednesday to lock in their rates for next year under the Affordable Care Act, and some are announcing double-digit increases. Florida said Tuesday that most of its 45 percent average increase in premiums stems from the risk that the Trump administration will skip cost-sharing payments that reimburse insurers for lowering rates. Anthem Inc. said it would exit Maine, the latest state withdrawal for the one-time Obamacare stalwart. (Tracer, Edney and Tozzi, 9/27)

State insurance officials Wednesday gave approval to premium increases of more than 50 percent for the four insurers participating in next year’s insurance exchange in Georgia. The officials said that the huge rate hikes assume that subsidies for insurers to lower consumers’ out-of-pocket costs will not be paid next year by the federal government. (Miller, 9/27)

Republicans have a new promise on health care: It’s not over. As the GOP trumpeted the framework of a new tax overhaul plan at the Capitol on Wednesday, lawmakers wrestled with their message to voters after promises to roll back the Affordable Care Act officially came up short Tuesday, when party leaders scrapped a final vote after nine months of failed attempts. Now, Republicans are promising that repeal will still happen before the current session of Congress ends in January 2019. (Peterson and Armour, 9/27)

President Trump in a new interview scheduled to air Thursday insisted that Republicans have the votes to repeal ObamaCare and will pass health care reform in “a few months.” “So we'll bring it into a few months from now. We'll vote it - it's block grants. It's going to be great health care,’ Trump told “Fox & Friends.” (Shelbourne, 9/27)

Leaders decided Tuesday that the Senate won’t vote before Saturday’s deadline to use a fast-track procedure to keep Democrats from blocking a GOP-only bill and they said they would turn instead to overhauling the U.S. tax system. “We don’t have the votes” for the health-care bill, co-sponsor Bill Cassidy of Louisiana told reporters in Washington. “We’ve made the decision, since we don’t have the votes, we’ll postpone that vote.” (Litvan and Dennis, 9/27)

Guess what? Turns out Republicans have the votes to push health care legislation through the Senate, but they’ve been flummoxed because one supportive senator is in the hospital. That was President Donald Trump’s view of where things stand Wednesday on Capitol Hill. And it’s not true. Trump made the remarks a day after Senate GOP leaders discarded their drive to repeal President Barack Obama’s health care overhaul. They lacked the votes to succeed, a not-so-minor snag that hadn’t changed. The three GOP senators whose opposition sunk the Republican measure all remained against it, aides confirmed. (Fram, 9/27)

To the Republicans vowing to keep their Obamacare repeal drive alive for as long as it takes, Democrats say: Please, and thank you. While Senate Republicans abandoned their last-gasp attempt to topple Obamacare before a Saturday deadline, they’re already suggesting they might try again next year. That timing — President Donald Trump said Wednesday that Congress would take up repeal again in the first quarter of next year — could keep the threat of upending the health care system front of mind in the thick of the 2018 campaign season. (Schor and Caygle, 9/28)

Senate Republicans are reckoning with an insurgent’s win in Alabama that poses clear threats to their own grip on power and the leadership of Majority Leader Mitch McConnell. Nearly $10 million spent by a McConnell-backed super PAC couldn’t save incumbent GOP Sen. Luther Strange, who had been endorsed by President Donald Trump as well. It came the same day that McConnell, short of votes, pulled the plug on the latest and possibly final GOP effort to repeal and replace “Obamacare.” (Werner, 9/28)

Now, a majority leader celebrated for years as a brilliant tactician looks vulnerable — to dissent within his Senate conference and to insurgents from President Trump’s populist wing of the party, who are looking to storm the Senate in 2018. And if Republicans fail to fulfill their next promise — overhauling the tax code — the consequences will be dire. (Stolberg, 9/27)

A Republican senator who co-sponsored failed legislation to repeal most of the Affordable Care Act is looking at whether some states may have been getting federal money under the law’s Medicaid expansion that they aren’t entitled to. The probe by Sen. Ron Johnson of Wisconsin suggests that some Republicans, fresh off their congressional effort to repeal the health law and its expansion, will now zero in on other potential ways to rein in the program and its costs. (Armour, 9/27)

Sen. Ron Johnson (R-Wis.) is investigating whether certain states are receiving more federal Medicaid dollars than they should, leading to burgeoning costs. Johnson, the chairman of the Senate Homeland Security and Governmental Affairs Committee, is making the push one day after the ObamaCare repeal-and-replace bill that he cosponsored failed. (Sullivan, 9/27)

Questioning costs incurred under the Medicaid expansion program authorized under the Affordable Care Act, U.S. Sen. Ron Johnson, R-Wis., said, “Federal expenditures under this expansion are soaring” in the Healthy Michigan program, which offers Medicaid coverage to people making between 100% and 138% of the federal poverty limit at reduced costs in exchange for them taking on healthy behaviors. Snyder's office didn't immediately respond to the letter from Johnson. (Spangler, 9/27)

The letter to [Gov. Bruce] Rauner says the costs of Medicaid expansion in Illinois exceed initial estimates by 90 percent. ... Johnson asked Rauner to provide information about new Medicaid enrollees in Illinois in 2016 and 2017, an explanation for why enrollment is increasing significantly faster than expected, why the per-enrollee costs increased significantly, and what the state's eligibility thresholds are.(9/27)

The chairman of the U.S. Senate Committee on Homeland Security and Governmental Affairs wants Gov. David Ige to explain what caused a rapid escalation in spending in Hawaii on Medicaid .... The letter also asks for information on why the costs for new enrollees have been increasing so rapidly, and whether the state has conducted or commissioned audits of those costs or the enrollees’ eligibility. The letter also seeks “all documents and communications between and among employees or contractors of Hawaii” regarding determination of eligibility. (Dayton, 9/27)

Federal expenditures on Medicaid are "soaring in New Hampshire and per-enrollee spending is rising exponentially," according to the chairman of the U.S. Senate Committee on Homeland Security and Governmental Affairs, who wants some answers from Gov. Chris Sununu. In a three-page letter delivered Wednesday morning, Sen. Ron Johnson, R-Wis., submitted a list of questions designed to determine why the cost for new Medicaid beneficiaries in the state is rising so dramatically, up 253 percent from 2014 to 2015. (Solomon, 9/27)

Sen. Lisa Murkowski (R-Alaska) said Wednesday that ObamaCare-related legislation "needs to be bipartisan" following the collapse of GOP efforts to repeal the health-care law this week. "You know what, I think it needs to be bipartisan and that's why I'm working with Sen. Alexander and Sen. Murray," Murkowski said when asked whether a Republican-only ObamaCare bill could pass next year. (Sullivan, 9/27)

Republican senators are signaling an openness to stabilizing the individual insurance market in the short term after giving up on a last-ditch effort to replace President Barack Obama’s health care law. The negotiations are restarting just as insurers finalize contracts for the exchanges that will use HealthCare.gov next year on Wednesday. (Clason, 9/27)

The House Problem Solvers Caucus is urging congressional leaders to consider bipartisan health-care policies aimed at stabilizing the insurance markets. “When we work across the aisle and govern together, Democrats and Republicans alike can find consensus on real solutions for the American people,” the group wrote to Democratic and Republican leaders in both chambers. (Roubein, 9/27)

Sen. Ron Johnson (R-Wis.) and 10 Senate Republicans introduced a bill Tuesday to delay an ObamaCare insurer tax before it goes into effect next year. The health insurance tax, a fee on insurance companies to help pay for health care subsidies, is slated to return in 2018 after a one-year hiatus. (Hellmann, 9/27)

Congress is at risk of missing two deadlines for health programs impacting millions of people, as funding is set to expire on Saturday. The House has yet to release a bill to fund the Children’s Health Insurance Program (CHIP) just days before the deadline. The Senate has released a bipartisan five-year bill to reauthorize the program, but a vote hasn’t been scheduled. Separately, billions of dollars to fund community health centers — a safety net for 26 million people — are also up in the air. (Roubein, 9/27)

Minnesota health advocates are closely watching for signs of progress in Washington on programs that underwrite care for the uninsured and for low-income children. Unless reauthorized and funded, both are set to end on Saturday when the federal fiscal year ends. (Howatt, 9/28)

The Senate on Tuesday night unanimously passed a bill aimed at making Medicare more efficient and saving it money. The passage of the under-the-radar bipartisan health-care reforms came on the same day that Senate Republicans abandoned a vote on a bill to repeal and replace ObamaCare. (Sulivan, 9/27)

Democrats on Wednesday excoriated the GOP's proposed tax framework, saying it would blow an enormous hole in the deficit — warning that popular social programs are next. “Make no mistake: After [the] Republicans’ tax plan blows a multitrillion-dollar hole in the deficit, they will sharpen their knives for Social Security, Medicare, Medicaid and vital job-creating investments for middle-class families across America,” said House Minority Leader Nancy Pelosi (D-Calif.). (Elis, 9/27)

Weeks after a veterans’ health initiative received $2.1 billion in emergency funding, the Trump administration says the private-sector Veterans Choice health care program may need additional money as early as December to avoid a disruption of care for hundreds of thousands of veterans. The Department of Veterans Affairs said in a statement that it hoped to move quickly on a proposed long-term legislative fix that would give veterans even wider access to private doctors. The proposal, under review by the White House Office of Management and Budget, would seek money to keep Choice running for much of next year as VA implements wider changes. (Yen, 9/27)

Sen. John McCain is demanding a full accounting from the Department of Veterans Affairs on the financial status of its private-sector health care program. The Associated Press reported this week that the Veterans Choice program could run out of money by year’s end, despite receiving $2.1 billion in emergency funding last month. (Yen, 9/28)

Veterans Affairs Secretary David Shulkin implored senators Wednesday to change hiring laws so he can more quickly staff up the agency’s mental health department, as veteran suicide rates remain high. "We are going to need legislative changes,” Shulkin said at a Senate Veterans' Affairs Committee hearing. (Mejdrich, 9/27)

Amid criticism of what’s been called a slow federal response to Hurricane Maria destruction in Puerto Rico, the Pentagon said Wednesday that it will switch its efforts to land-based, long-term support. (Steele, 9/27)

The pharmaceutical industry now supports limiting prescriptions of opioid painkillers to a seven-day supply for acute pain management, PhRMA CEO Stephen J. Ubl announced Wednesday at a meeting of the White House’s opioid abuse commission. “Too often, individuals receive a 30-day supply of opioid medicines for minor treatments for short term pain,” Ubl said. “Overprescribing and dispensing can lead to patients taking longer than necessary and excess pills falling into the wrong hands.” (Joseph, 9/27)

A powerful drug industry trade group announced its support for limiting a patient’s supply of opioids to seven days for first-time acute pain treatment, as a way to curb the opioid epidemic plaguing the country. “Too often individuals receive a 30-day supply of opioid medicines for minor treatments or short-term pain,” Stephen Ubl, president and CEO of Pharmaceutical Research and Manufacturers of America, said. (Roubein, 9/27)

The on-the-ground groups targeting the opioids crisis almost universally support Washington’s efforts to direct more resources and flexibility toward their work. But a new coalition is cautioning that one proposed federal change — supported both by lawmakers and the Trump administration’s opioid commission — could actually hurt the people they’re all trying to help. At the center of the controversy: an effort to relax federal privacy rules for substance abuse treatments. (Mershon, 9/27)

A prescription drug monitoring program in Kansas will receive a federal grant worth more than $178,000 to help fight the opioid crisis. The Kansas Board of Pharmacy oversees K-TRACS, a system for monitoring prescriptions for controlled substances. Board Executive Secretary Alexandra Blasi says doctors, dentists and pharmacists who participate in the program report their prescription activity to the state to verify a patient’s history. (Shaar, 9/27)

While the number of people who have overdosed on opioids in Richmond and Chesterfield, Hanover and Henrico counties rose about 40 percent year-over-year as of mid-September, deaths from the drugs are down 19 percent from the 95 local authorities had tracked by this point in 2016. (Burnell Evans, 9/27)

City commissioners on Thursday are poised to hire a private law firm to pursue a complaint against prescription opioid manufacturers and distributors that would seek compensation for the resources Miami has been forced to dedicate to reviving overdose victims, policing drug-related crimes and healthcare. (Smiley, 9/27)

A new blood test can cheaply and quickly distinguish between the mosquito-borne Zika and dengue viruses, researchers reported Wednesday, giving public health officials a valuable tool to track the spread of outbreaks and prepare for the possible consequences of the different infections. The test, which was described in the journal Science Translational Medicine, relies on a simple paper strip, and researchers hope it can eventually be purchased for less than $1. The scientists who developed the test are at work to commercialize it and production would need to be scaled up before it could be deployed widely. (Joseph, 9/27)

A new paper in the journal Science Translational Medicine offers a potential step forward for Zika testing: a fast-acting "dipstick"-type test much like a pregnancy test that costs as little as $5 per strip and can distinguish between Zika and dengue fever — a difficult challenge because the viruses are similar. It could be ready for broad use within a couple of years, says co-author Kimberly Hamad-Schifferli, associate professor of engineering at University of Massachusetts Boston. (Goldberg, 9/27)

The Food Safety Modernization Act, which was signed into law in 2011, aims to ensure a prevention-oriented approach to food safety. ... But the new report concludes that the FDA has rarely taken advantage of these new tools. (Aubrey, 9/27)

For most of us, temptations are everywhere, from the dessert buffet to the online shoe boutique. But a new study suggests that exercise might be a simple if unexpected way to increase our willpower and perhaps help us to avoid making impulsive choices that we will later regret. (Reynolds, 9/27)

Amusement parks, lakes, neighbors’ pools — they are dangers that families of children with autism have long known anecdotally to beware of. ... An authoritative study earlier this year put some numbers to the fear. Drowning is the most common fatal injury among children with autism, researchers found. Children with autism age 14 and younger are 160 times as likely to die from drowning as the general pediatric population, with drowning risk peaking from age 5 to 7. (Samuel, 9/27)

Dinnertime is nearing, and the kitchen in this tidy home is buzzing. Lamyaa Manty, a 29-year-old Iraqi refugee, wears a neon-pink T-shirt and stirs a big pot of eggplant, onion, potatoes and tomatoes on the stove, a staple of Iraqi cooking called tepsi. Spinning around with a butterfly net in her hand and dancing to Arabic music is Fatima Abdullah, an exuberant 9-year-old. At the center of the activity is Fatima’s aunt, Salima Abdullah Khalifa, a burgundy-haired matriarch from Baghdad, who pours Pepsi into small glasses on the table. (Varney, 9/28)

It’s never been easier to have a safe abortion. With improvements in drugs designed to end a pregnancy and the spread of telemedicine, women all over the world are gaining access to low-risk, noninvasive abortions. But does this really mean that dangerous procedures are becoming a thing of the past? To find out, a team led by researchers at the World Health Organization in Geneva and the Guttmacher Institute in New York scoured abortion data from 61 countries and determined the level of safety for each procedure. The results were published Wednesday in the journal Lancet. (Kaplan, 9/27)

A federal appeals court cleared the way Wednesday for Arkansas to impose new restrictions on the way the abortion pill is administered in the state, saying it won’t reconsider a panel’s decision in favor of the 2015 law. The 8th U.S. Circuit Court of Appeals said it won’t reconsider a three-judge panel’s ruling lifting a federal judge’s preliminary injunction against the law. The measure requires doctors providing the abortion pill to maintain a contract with another physician with admitting privileges at a hospital who agrees to handle any complications. (DeMillo, 9/27)

A federal court struck down a law in Kentucky on Wednesday that requires women seeking an abortion to first undergo an ultrasound and hear a description of the embryo or fetus. The U.S. District Court Western District of Kentucky ruled that the state law is unconstitutional because it violates the free-speech rights of the patient and doctor, court documents showed. (9/28)

The ACLU said in a statement that the court recognized that the law “appears to inflict psychological harm on abortion patients,” and causes them to “experience distress as a result.” Attorney Alexa Kolbi-Molinas with the ACLU’s Reproductive Freedom Project said in the statement that, “We are pleased that Kentuckians will no longer be subjected to this demeaning and degrading invasion into their personal health care decisions.” (9/27)

Essure, a device that represents the only permanent, non-surgical form of contraception, will no longer be available for purchase anywhere in the world except for America, though the U.S. Food and Drug Administration continues to monitor the device’s safety and efficacy. (Craven, 9/27)

Rural hospitals are in danger across the country, their closures both a symptom of economic trouble in small-town America and a catalyst for further decline. Since 2010, 82 rural hospitals have closed nationwide. As many as 700 more are at risk of closing within the next 10 years, according to Alan Morgan, the CEO of the National Rural Health Association, a nonprofit professional organization that lobbies on rural health issues. The reasons are complex, woven into the fabric of a changing economy and an evolving health care system. But these rural hospital closures are hitting the southern United States the hardest. (Weber and Miller, 9/22)

The struggle to adopt a new state budget hit another stumbling block Wednesday centered on a hospital industry lawsuit. At issue is a new taxing arrangement that the administration and the Connecticut Hospital Association negotiated that would help both sides by leveraging $365 million in new federal aid for them to share. (Phaneuf, 9/27)

The heart of the Brigham’s austerity plan was a buyout offered this past June to more than 1,000 senior employees, including more than 400 veteran nurses. Some 800 workers decided to retire, including 7 percent of the nursing staff — a remarkably high acceptance rate. Many of them are leaving this week. While hundreds of new nurses are being hired at substantially lower entry-level pay, the large exodus underscores a critical challenge for the Brigham’s leadership: how to cut costs without harming patient care. (Winslow, 9/28)

[Barbara] Cuene is just one member of a team at Children’s Hospital taking a new approach to drastically reduce the risk of child victims of sexual assault contracting HIV. That innovative work, in partnership with Walgreens, puts an entire 28-day supply of the medication, known as post-exposure prophylaxis, into the hands of victims and their families before they leave the emergency room. (Lutheran, 9/27)

Health insurer Molina Healthcare is getting out of the primary care business to focus on insurance, and it's quietly shutting down medical clinics in underserved areas across the country, according to its former CEO. Dr. J. Mario Molina, who was unexpectedly ousted earlier this year from the company his father created, is in the process of buying 17 of those clinics in California that would have closed otherwise. The California clinics serve about 120,000 patients annually. (Livingston, 9/27)

Pointing to “impossible” timeframes, an industry group has filed a legal challenge to new requirements by Gov. Rick Scott’s administration that nursing homes and assisted-living facilities quickly install generators to power air-conditioning systems. (Saunders, 9/27)

Federal prosecutors say a Massachusetts pharmacy owner who was sentenced to prison after a nationwide meningitis outbreak that killed 76 people and sickened hundreds more should pay nearly $74 million in restitution. In a filing on Tuesday, prosecutors said the money would compensate about half of the victims of the 2012 outbreak for their expenses and lost income. The outbreak was traced to contaminated injections of medical steroids made by the now-defunct New England Compounding Center in Framingham. (9/28)

Federal prosecutors are asking a judge to approve a $73.7 million restitution order against the former president of a drug compounding firm, who already is serving a nine year prison sentence following his conviction on racketeering and fraud charges. The motion seeks to have the $73.7 million distributed to 349 of the victims of the 2012 fungal meningitis outbreak who filed claims with the U.S. Attorney. It includes $1.9 million requested by insurance companies and medical facilities as reimbursement for drugs purchased from NECC. (Roche, 9/27)

The Environmental Protection Agency (EPA) says that levels of nitrate in drinking water at or above 10 parts per million are unsafe, particularly for infants, who could develop a potentially fatal blood disorder called "blue-baby" syndrome. The Interim Director for the Center for Health Effects of Environmental Contamination at the University of Iowa, Pete Weyer, says that the latest research shows negative health impacts—particularly cancer—for infants and even adults at a much lower limit. (Woodbury and Kieffer, 9/27)

The death toll in San Diego’s hepatitis A outbreak increased Tuesday, and the region’s top public health official said she hasn’t seen any signs of a slowdown in the public health emergency that has now killed 17 people. Dr. Wilma Wooten said there are 49 suspected hepatitis cases and one death still under investigation. A week ago, there were 44 cases, and the number of investigations has bounced from roughly 30 to 50 at any given time for several months, public health officials said. (Sisson, 9/27)

St. Cloud could become the third Minnesota city to make it illegal to sell tobacco to anyone under age 21. The St. Cloud City Council set a public hearing for Nov. 6 on the proposed ordinance, following a study session in October. (Marohn, 9/27)

A Texas woman died earlier this month after contracting a flesh-eating infection from floodwaters brought by Hurricane Harvey, according to health officials in Houston. The Houston Chronicle reported that Nancy Reed, 77, of Houston, contracted a dangerous bacterial skin infection after she fell into dirty floodwater in her son’s home, breaking and cutting open her arm. (Bever, 9/27)

From the moment the waters began rising in Texas last month, disease was on health officials’ minds. Floodwaters, after all, are filthy. When Hurricane Harvey finally moved north and the feet of flooding drained, hospitals saw a spike in skin and gastrointestinal infections, but Texans were spared some of the most serious illnesses that contaminated water can spread: cholera, for instance, and typhoid. On Tuesday, however, the Harris County medical examiner’s office announced that the death of a 77-year-old woman 11 days earlier had been caused by necrotizing fasciitis: a gruesome and often deadly infection commonly known as flesh-eating bacteria. (Astor, 9/28)

An online chorus voicing anti-vaccine views linking some immunizations to autism has gained momentum via Twitter, a five-year University of Colorado study shows, with most of the negative comments coming from California and several northeastern states — particularly in areas of high affluence and concentrations of new moms. The study used an algorithm to analyze more than a half-million tweets between 2009 and 2015 that mentioned both autism spectrum disorder and vaccines. Although anti-vaccine comments nationally became more common over time, the study notes that this does not measure prevailing attitudes on the subject — though it does suggest that the debate rages on. (Simpson, 9/27)

Medical marijuana dispensaries would be allowed to stay open while the state decides who will get a license for the lucrative cannabis business under a pair of bills to be introduced in the state Legislature. Sen. David Knezek, D-Dearborn Heights, and Rep. Yousef Rabhi, D-Ann Arbor, will introduce the bills in the Senate and House this week to counteract an advisory by the state to dispensaries that they should close before Dec. 15 or risk their chances at getting a license. (Gray, 9/27)

First: Voters have feared every attempt by politicians to change their health-care arrangements. That sentiment helped defeat President Bill Clinton’s proposed overhaul in 1994. It forced President Barack Obama to devote half his sales job on his health-care law to reassuring people they could keep their doctors and insurance plans. This year, public wariness of change worked against the Republicans. (Ramesh Ponnuru, 9/27)

The secret to Obamacare’s persistence is that the American people want the health care system made better — by which they mean they want more people to have affordable health insurance — and Obamacare achieves that goal. By contrast, the GOP, at every single turn, has offered plans to make the system worse. (Ezra Klein, 9/27)

Shares of insurance companies with Obamacare exposure rallied Tuesday on news the Senate will not vote on the Graham-Cassidy bill, the GOP's latest effort to repeal the Affordable Care Act (ACA). But the rally has been small, likely reflecting the fact that the measure's chances of passage were always fairly slim -- and the GOP may not give up on this effort even after another bruising defeat. (Max Nisen, 9/27)

There are other, even better reasons for McConnell to reach across the aisle and engage in — gasp! — bipartisanship: Americans are sick of a Congress that seems incapable of accomplishing anything. McConnell vows to repeal the Affordable Care Act someday but first wants tax reform. There are, however, urgent health-care matters that require bipartisan cooperation. At risk are 27 million Americans — including about 175,000 Kentuckians — who buy their insurance on the individual market or are covered by the Children’s Health Insurance Program, plus many more who are partially covered by CHIP. Happily, before everything was stopped to make way for the latest doomed ACA-repeal, Republicans and Democrats were working together to stabilize the individual market and fund CHIP which expires Sept. 30. They were working through committees — the “regular order” that McConnell once promised to restore. Sen. John McCain cited the flouting of Senate order — no hearings, debates or amendments — for his opposition which helped kill his party’s health-care bill. (9/27)

John McCain is clearly on a mission to redeem the U.S. Senate, to save it from what McCain regards as its wayward ways. But in his announcement of his opposition to Graham-Cassidy, McCain depicts a Senate that is a fantasy. (Robert Robb, 9/27)

Gov. Doug Ducey appears determined to turn a win-win situation for himself into a lose-lose. He’s sticking with his support of the now-failed Graham-Cassidy bill that would have repealed the Affordable Care Act and been a total disaster for Arizona. (EJ Montini, 9/27)

It’s hard to think of someone in Washington these days who might rival Mr. Price for brazen hypocrisy, though, admittedly, the bar is high. This is the very same Mr. Price, remember, who, as a congressman from Georgia for the past 12 years, piously condemned the federal government’s “reckless spending.” (9/27)

For Tom Price, the price is right. The fake-news media is attacking our hard-working secretary of health and human services. First, those losers at Politico reported that Price took $60,000 in charter flights, including a $25,000 flight to Philadelphia, apparently at taxpayer expense. Politico pointed out that a train to and from Philly cost $72. (Dana Milbank, 9/27)

Memo to Price: Several airlines fly to Philadelphia, Nashville and Atlanta. If you really want to keep in touch with Americans, you'll meet more of them on commercial flights. ... The underlying principle is simple: Don't waste taxpayer money. “Taxpayers generally should pay no more than necessary for transportation,” and non-commercial planes should be used when they are “the most cost-effective mode of travel,” say government rules and guidance. (9/27)

Critics of Health and Human Services Secretary Tom Price have called for the Office of the Inspector General to review his travel arrangements. It’s often the case that the allegation makes headlines, but when the issue is investigated, the report indicates proper procedures were followed. Opinion might be more credibly offered after a review is completed. Decisions to use a non-commercial aircraft for government officials cannot be made casually. For each trip, a full analysis is required by law. Before a trip is authorized, multiple government executives must attest to the trip’s government purpose and economic justification. (Mike Leavitt, 9/27)

During the past five months, as congressional Republicans were making five separate efforts to gut health care for low-income Americans, the man in charge of administering Obamacare was flying around the country on private jets at a cost to taxpayers of more than $400,000. The “optics in some of this don’t look good,” Health and Human Services Secretary Tom Price conceded to Fox News on Saturday. Indeed, the optics are so bad that the House Oversight Committee has begun an investigation. President Donald Trump, who said Wednesday that he’s “not happy” about the private jet use, is putting distance between himself and Price. (9/28)

Not long ago, I attended a lecture given by a highly regarded emergency physician. His talk, “The Future of Emergency Medicine,” focused on how advances in telemedicine will transform emergency care. The following week, as I walked down a corridor at the back of my hospital, I passed seven telemedicine robots, each with a hastily scrawled “Out of Order” note taped to its screen. That captured my uneasy feelings about how interacting with a patient via internet video link would work in the poor neighborhoods served by my emergency department. (Harrison Alter, 9/27)

In a recent study published in PLOS One, researchers surveyed physicians across the United States to ask about their perspectives on unnecessary medical care. These physicians reported that more than 20% of overall medical care was not needed. This included about a quarter of tests, more than a fifth of prescriptions, and more than a 10th of procedures. (Aaron Carroll, 9/27)

Medical devices have historically been viewed as having faster and lower-cost paths to market than their pharmacological counterparts: the average cost to develop high-risk, novel medical devices is estimated to be $94 million. After all, device engineers can leverage lower-cost animal models further into development than their pharmaceutical colleagues, the human clinical trials necessary for FDA approval are often smaller in scale, and, in some cases, expenses can be defrayed by revenue generated outside the United States in markets with faster regulatory pathways. Yet, despite these advantages, the FDA approved only 39 novel devices last year through its premarket approval process. Why is it so hard to bring a medical device to market in the U.S.? (Shantanu Gaur, 9/27)

One of the most important decisions that a physician makes is whether to admit a patient to the intensive care unit (ICU). ... ICU care is also one of the most expensive, intensive, and intrusive endeavors in health care. Although patients admitted to the ICU account for approximately one-quarter of hospitalized patients, they account for half of total hospital expenditures in the United States .... Furthermore, ICU care can be unnecessary, harmful, or futile. Importantly, the provision of ICU services is increasing. ... An important question is whether this growth in ICU services and beds is necessary to meet the demands of an expanding population of critically ill patients or whether ICU beds are being oversupplied and subsequently are being filled with patients who might be cared for in less-intense settings at lower cost with similar or better outcome. (Derek C. Angus, 9/27)

In all, more than 2 million Americans were diagnosed last year with a sexually transmitted disease – including chlamydia, the most common. And while the hardest hit states were mostly in the Deep South, where stigmas around sex education and sexual health in general are strongest, some of the biggest statistical surprises were in tolerant, health-conscious California. (9/27)