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Meg and Robert Holub were surprised to receive a letter last week welcoming them to a new health insurance plan and telling them to pay $3,483 by Jan. 8. “We have received your application for individual and family coverage effective 1/1/2018,” the letter said. The only problem: They never applied for the coverage, did not want it and could not afford it. “I worried, did someone hack my account to sign me up for this?” Mr. Holub said. “And I wondered, what are the implications if I don’t pay for this plan? Will I be hounded by a credit agency?” (Pear, 12/11)

Consumer advocates reported some glitches Monday in the final days for "Obamacare" sign-ups, although the Trump administration largely seemed to be keeping its promise of a smooth enrollment experience. In Illinois, some consumers who successfully completed an application for financial assistance through HealthCare.gov got a message saying they would likely be eligible to buy a health plan, "but none are available to you in your area." (Alonso-Zaldivar, 12/11)

Former President Barack Obama on Monday urged people to sign up for ObamaCare ahead of Friday’s deadline and denounced Republican efforts to roll back the law. Obama joined a call with navigators and volunteers who help people sign up for coverage under the law, his office said, and made an appeal on Twitter and Facebook. (Sullivan, 12/11)

Since leaving the administration, [Lori] Lodes and other Democrats have come to believe that the Trump administration is actively working to sabotage the Affordable Care Act and health coverage gains made under Obama. The White House has moved to shorten ObamaCare’s enrollment period, cut its advertising budget by 90 percent and reduced by 41 percent funding for outside groups assisting with sign-ups — all while pushing Congress to repeal and replace the law. (Roubein, 12/12)

In week five of the six-week open enrollment period, about 823,180 people signed up for health insurance on healthcare.gov, according to the Centers for Medicare and Medicaid Services. More than 3.6 million people have enrolled on the federal exchange for health insurance plans in 2018 since open enrollment began on Nov. 1. (Griffin, 12/12)

Kaiser Health News: Sign-Up Deadline Is Friday, But Some People May Get Extra Time

Open enrollment on the federal health law’s marketplace ends Friday, and most people who want a plan for next year need to meet the deadline. But some consumers who miss the cutoff could be surprised to learn they have the opportunity to enroll later. “While a lot of people will be eligible … I am still worried that a lot of consumers won’t know it,” said Shelby Gonzales, a senior policy analyst at the Center on Budget and Policy Priorities. (Andrews, 12/12)

Open enrollment for plans on the Affordable Care Act’s marketplace will come to an abrupt end at midnight Friday, and the director of Virginia’s statewide navigation program is urging stragglers to sign up as soon as possible. (O'Connor, 12/11)

Nashville consumers have two carrier options for individual ACA plans in 2018 — Cigna and Oscar Health — but only Cigna offers coverage at Vanderbilt. Does every consumer need to be covered at the city’s academic medical center? Realistically, no. Some consumers may have no healthcare needs next year, or only very basic needs that do not require going to Vanderbilt. (Tolbert, 12/11)

It's a beautiful morning in Pittsburgh, but Ariel Haughton is stressed out. She's worried her young children's health insurance coverage will soon lapse. "So, we're like a low-middle-class family, right?" she says. "I'm studying. My husband's working, and our insurance right now is 12 percent of our income — just for my husband and I. And it's not very good insurance either." (Kodjak, 12/12)

Jimmy Kimmel was absent from his ABC late-night show last week while his 8-month-old son, Billy, recovered from his second heart surgery. Ever since Billy was born with a heart defect and required immediate surgery, Kimmel has become an outspoken advocate for universal health care, occasionally using his monologue to plead with (or deliver scathing criticisms of) members of Congress. “No parent should ever have to decide if they can afford to save their child’s life,” he said tearfully in May. On Monday, Kimmel returned to the stage with his son in his arms. Billy, wearing a tiny sweater vest, stayed remarkably calm on camera as Kimmel choked up once more while talking about his son. (Yahr, 12/12)

Federal funding for the Children’s Health Insurance Program (which includes PeachCare) expired Sept. 30, putting the future of the popular insurance program in limbo.  ...Through PeachCare, it covers roughly about 130,000 children in Georgia. (Miller, 12/11)

Virginia is planning to send a letter to enrollees in the Children’s Health Insurance Program (CHIP) on Tuesday that they could lose their coverage on Jan. 31 if Congress does not renew the funding. CHIP’s authorization expired on Sept. 30, and states are now nearing the point where they will run out of funds. Congress is expected to renew funds for the program either this month or next, but the uncertainty from not having acted yet is leading some states to warn enrollees about the possibility of losing coverage if Congress does not act. (Sullivan, 12/11)

It took media inquiries in late October to figure out Gov. Doug Ducey's position on whether Congress should renew funding for a children's health-insurance program. The short answer: He supports kids. But a records request by The Arizona Republic filed before talking to the governor found Ducey wasn't doing much outreach to the folks who could make a difference — at least not until reporters started asking about it. (Pitzi, 12/11)

Congress has two more weeks to fund CHIP after the House and Senate approved a spending bill Thursday that keeps the government open until Dec. 22. The stopgap legislation also gives money to several states that are running out of funds to keep CHIP going. On Friday, El Paso Rep. Beto O’Rourke and 98 other Democratic representatives sent a letter to Congressional leaders urging them to approve CHIP funding quickly. (Wang, 12/11)

Vermont and New Hampshire’s senators are urging Senate leaders to work to pass legislation funding community health centers after a major source of their federal dollars lapsed Sept. 30. Community health centers are a large source of comprehensive primary care for some of the nation’s most vulnerable, serving 27 million people. They take any patient who walks in their doors, regardless of if they have insurance, and Congress let a fund expire that represents 70 percent of their federal grant revenue. (Roubein, 12/11)

Senate Republicans are divided over whether they should use the months before the 2018 elections trying to cut spending on social programs, including Medicare. Sen. John Thune (R-S.D.), the third-ranking Republican in the Senate, said that Congress should consider reducing long-term spending on these federal programs next year. “If we’re going to do something about spending and debt, we have to get faster growth in the economy — which I hope tax reform will achieve. But we have also got to take on making our entitlement programs more sustainable,” including Medicare, Thune said on Thursday. “I think there is support, generally, here for entitlement reform.” (Stein, 12/11)

The Republican tax plan will deliver a swift adrenaline shot to the economy that will send hundreds of billions pouring into federal tax coffers, the Trump administration asserts in a new analysis. But nonpartisan analysts make a less rosy projection of new revenue from the tax legislation now before Congress. (12/12)

After five months in office, President Trump’s new director of the Centers for Disease Control and Prevention has been unable to divest financial holdings that pose potential conflicts of interest, hindering her ability to fully perform her job. Brenda Fitzgerald, 71, who served as the Georgia public health commissioner until her appointment to the CDC post in July, said she has divested from many stock holdings. But she and her husband are legally obligated to maintain other investments in cancer detection and health information technology, according to her ethics agreement, requiring Fitzgerald to pledge to avoid government business that might affect those interests. Fitzgerald provided The Post with a copy of her agreement. (Sun and Crites, 12/11)

The new director of the Centers for Disease Control and Prevention (CDC) has had to recuse herself from involvement in significant health issues because her investments might pose a conflict of interest, says Sen. Patty Murray (D-Wash.) Murray, ranking Democrat of the Senate Health Committee, wrote in a letter to CDC Director Brenda Fitzgerald that her remaining investments prevent her from engaging in matters relating to cancer and the opioid crisis. (Hellmann, 12/11)

Murray and her staff obtained copies of Fitzgerald’s government ethics agreement and financial disclosure form, which are not publicly available because the CDC director is not a Senate-confirmed position. Fitzgerald apparently is “unable to divest from certain investments,” according to a letter from Murray released Monday. “In order to ensure the CDC is led by an individual who can engage on all issues under its purview, it is imperative that you resolve the issues that are currently limiting your ability to divest from these holdings,” Murray wrote. She asked Fitzgerald to make her ethics agreement public and brief the committee on her recusals. (Siddons, 12/11)

The Food and Drug Administration plans new medical-device approval processes to speed products’ entry to the U.S. market, mirroring the desires of industry and President Donald Trump to clear barriers to new business. FDA commissioner Scott Gottlieb, who has long espoused speedier steps to promote innovation, in an interview called for “progressive,” or stepped, approvals of certain devices that would allow them to go to market with initial approvals, with further evidence to assess performance coming later. That would entail more risk to patients initially than current procedures where clinical trials or other evidence come before market launch. (Burton, 12/11)

The medical device industry is pushing the Trump administration to propose a policy soon to expedite Medicare coverage of some new devices. But the attempt to get these products covered more quickly raises some safety concerns and follows another similar effort that some observers found disappointing. A proposed rule is currently under review at the Office of Management and Budget with the title “Expedited Coverage of Innovative Technology.” The proposal has been waiting at OMB since late April, but industry groups don’t think its publication is imminent. (Siddons, 12/11)

A spate of hospital deals stands to further remake the U.S. health-care landscape, pushing up prices for consumers and insurers and changing how individuals get care. Just this month, health systems with at least 166 hospitals and $39 billion in combined annual revenue have announced merger plans. There’s likely more to come: The Wall Street Journal reported on Sunday that Ascension and Providence St. Joseph Health, a pair of nonprofits that together have 191 hospitals and nearly $45 billion in annual revenue, are in deal talks. (Tracer, 12/11)

American hospitals have a target on their backs. The latest merger talk is an attempt to rally their strength, but industry payers’ battle against high health-care costs shows no sign of letting up. Two major nonprofit hospital chains, Ascension and Providence St. Joseph Health, are in talks to combine, the Wall Street Journal reported on Sunday. A deal would create a chain of 191 hospitals in 27 states with annual revenue of about $45 billion. (Grant, 12/11)

Though the issue gets scant attention in this center of world-class medicine, segregation patterns are deeply imbedded in Boston health care. Simply put: If you are black in Boston, you are less likely to get care at several of the city’s elite hospitals than if you are white. (Kowalczyk, Wallack Dungca et. al., 12/12)

The life expectancy of Native Americans in some states is 20 years shorter than the national average. There are many reasons why. Among them, health programs for American Indians are chronically underfunded by Congress. And, about a quarter of Native Americans reported experiencing discrimination when going to a doctor or health clinic, according to findings of a poll by NPR, the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health. (Whitney, 12/12)

After a Danish study last week reported finding more breast cancer cases among women who use hormone-based birth control methods, many women were left wondering: How significant is the risk, and what are the alternatives? The answer will be different for each woman and will depend on such factors as her age and general healthand her other risks for breast cancer. But many doctors who prescribe contraceptives say there’s no cause for alarm — and no one should throw away her pills and risk an unwanted pregnancy. (Rabin, 12/11)

Within a few hours of Baylor University Medical Center announcing two weeks ago that it had successfully delivered the first baby in the U.S. to a mother who had undergone a uterine transplant, inquiries began pouring in to the facility. In just one week, Baylor logged nearly 400 calls and emails from potential donors and recipients. (Rice, 12/11)

For all that Americans spend on prescription drugs — $425 billion last year — you’d think we’d actually take our medicine. But one of the frustrating truths about American health care is that half or more of prescribed medication is never taken. It’s called medication nonadherence, and it’s a well-documented and longstanding problem, particularly for patients with chronic conditions. The drugs they’re prescribed are intended to prevent costly complications, reduce hospitalization, even keep them alive. But even when the stakes are high, many patients don’t take their meds. (Frakt, 12/11)

Sanofi Genzyme on Monday told doctors and pharmacists to return more than 12,000 syringes filled with an injectable arthritis gel because it was contaminated, as the Cambridge-based biotech elevated its “product hold” of last week to a recall. (Saltzman, 12/12)

In an unexpected development, sales of antibiotics used in food-producing livestock fell in the U.S. in 2016 although drawing any firm conclusions from the data is likely premature, since a new program designed to limit usage did not go into effect until this year. Last year, sales dropped 14 percent from 2015, the first time since data collection began in 2009 that there has been a year-over-year decrease in the sale of medically important antibiotics used in food-producing animals, according to a report from the Food and Drug Administration. “Medically important” refers to antibiotics that are also used to treat people. (Silverman, 12/11)

Kaiser Health News: An Overlooked Epidemic: Older Americans Taking Too Many Unneeded Drugs

Consider it America’s other prescription drug epidemic. For decades, experts have warned that older Americans are taking too many unnecessary drugs, often prescribed by multiple doctors, for dubious or unknown reasons. Researchers estimate that 25 percent of people ages 65 to 69 take at least five prescription drugs to treat chronic conditions, a figure that jumps to nearly 46 percent for those between 70 and 79. Doctors say it is not uncommon to encounter patients taking more than 20 drugs to treat acid reflux, heart disease, depression or insomnia or other disorders. (Boodman, 12/12)

This surge in illicit fentanyl presents a new challenge for families and medical professionals trying to keep loved ones from the harm of opioid misuse. And it’s unclear if the most validated defense for opioid misuse — medication-assisted therapies like naloxone, methadone and buprenorphine — can stem the surge of overdoses caused by fentanyl. (Akpan, 12/11)

Williamson County may join nearly 200 other counties and cities in a lawsuit against certain pharmaceutical manufacturers and distributors of prescription opioids. County commissioners authorized the mayor Monday to execute a contract with a law firm leading potential litigation against manufactures and distributors alleged to be contributing to drug addiction. The mass tort seeks compensation for cities and counties for economic harm caused by the opioid crisis, such as the costs of addiction treatment, law enforcement and health care delivery systems. (Balakit, 12/11)

Whether to establish a state-run, single-payer health-care system is shaping up to be one of the main differences among the candidates for governor in California in the run-up to the June primary election. ...Implementing a single-payer system would require tens of billions of dollars in new taxes - and thereby lead the Golden State into financial ruin. (Pipes, 12/11)

Johns Hopkins Health System, Baltimore, named Duke University Hospital President Kevin Sowers as its own president. Sowers replaces Ronald Peterson, who announced in June that he planned to retire at year-end. Sowers, who has been at Duke for 32 years and was president of the hospital for eight, also will serve as executive vice president of Johns Hopkins Medicine. He will start at the organization on Feb. 1, becoming the second president ever of the system. Prior to his current position at Duke, Sowers was chief operating officer for Duke University Hospital, and had experience in other administrative positions. (Barr, 12/11)

Johns Hopkins Health System stepped outside its ranks and tapped Kevin W. Sowers, a nurse and career executive with the Duke University Health System, as the new president and executive vice president of Johns Hopkins Medicine. He will succeed Ronald R. Peterson, who is retiring at the end of January after 44 years at the medical institution. He will be an adviser for a year to help with the transition. (McDaniels and Cohn, 12/11)

A second top leader at Fenway Community Health Center has been forced out following disclosures that Fenway mishandled complaints about a high-profile doctor who allegedly sexually harassed and bullied staff members for years. (Pfeiffer and Healy, 12/11)

The director of the city’s future sobriety center — a building where Austin police officers will be able to bring intoxicated people instead of taking them to jail or a hospital — was introduced Monday at the center’s future site. (Hall, 12/11)

The number of deaths from drugs and deaths from cardiovascular disease are among the reasons Tennessee slipped a spot in the annual health ranking from United Health Foundation. The number of drug deaths nationally increased 7 percent over the last five years, but those in Tennessee jumped 27 percent in the same time, said Dr. Rhonda Randall, chief medical officer of UnitedHealthcare Retiree Solutions. (Fletcher, 12/11)

The Million Veteran Program is collecting blood and information from veterans across the nation for research into illnesses that could lead to breakthroughs in treatment and cures. Researchers plan to use the samples to study diseases such as diabetes, cancer and military-related illnesses like post-traumatic stress disorder. (Jones, 12/11)

For years, Republicans mocked Rep. Nancy Pelosi — and other Democrats — for dismissing the need to read the text of the Affordable Care Act before passing it. This time around, Republicans have insisted that we must pass tax reform to know what’s in it, and Democrats have denounced the sausage-making. The more important similarity lies in the fact that both parties pursued long-term ideological goals in the face of public opposition. President Obama gave dozens of speeches in favor of the Affordable Care Act and yet it was never popular with voters before passage or after — at least not until Donald Trump was elected, which just shows you how policy preferences take a backseat to partisanship. (Jonah Goldberg, 12/12)

Of all the votes for the Senate GOP tax bill, those of Sens. Susan Collins (R-Maine), John McCain (R-Ariz.) and Lisa Murkowski (R-Alaska) were perhaps the most puzzling. These lawmakers killed an Obamacare repeal bill last summer because it was hastily drafted and poorly designed. Yet they each just endorsed a tax bill that contains a hastily drafted and poorly designed repeal of a key piece of Obamacare, the law’s “individual mandate” requiring all Americans to carry health-care coverage. (12/11)

American consumers aren’t the only ones struggling with higher healthcare costs. CVS Health’s proposed $69-billion purchase of health insurer Aetna is driven in part by the companies’ efforts to get control over more of the costs they face, and to make their operations more efficient. The question for regulators, though, is whether the combination results in a company that uses its clout to help consumers or squeeze more dollars out of them. (12/11)

In the face of increasing consolidation among insurers, hospitals are themselves linking up at ever-greater rates. The Wall Street Journal reported Monday that we may see one of the biggest hospital deals yet: a possible merger of non-profit giants Ascension and Providence St. Joseph Health, which would create the largest hospital group in the U.S. But while consolidation seems like a rational response to the issues facing hospitals, it isn't a surefire solution. (Max Nisen, 12/11)

One year ago this week, President Obama signed into law one of the most consequential bills passed by the 114th Congress: the landmark, bipartisan 21st Century Cures Act. ... When FDA Commissioner Scott Gottlieb and NIH Director Francis Collins testified before the Subcommittee on Health earlier this month on the implementation of this law, they told us that Cures is already having a monumental impact at these vital government agencies. We are following through to ensure that in spite of proposed budget cuts, the programs supported through our bill, with widespread support in both chambers of Congress, can continue to do their vital work. (Reps. Fred Upton (R-Mich.) and Diana DeGette (D-Colo.), 12/12)

The FDA recently approved the first prescription digital therapy, Pear’s Reset app and program, which is focused on substance abuse. Others are likely to follow. That means your next trip to the doctor could include a prescription for a mobile app in addition to, or instead of, medicine. Digital therapy represents a powerful yet provocative new idea in health care. Software brings a precision to therapy and with it an ability to personalize treatment. This gives digital therapy a big role to play as we transition to value-based care. (Stephanie Tilenius, 12/11)

Finally, Missouri Gov. Eric Greitens has taken long overdue steps to improve treatment for 1,300 military veterans in seven state-run skilled nursing care facilities. On Monday, Greitens called for the firing of Rolando Carter, the administrator of the St. Louis Veterans Home, where allegations of mistreatment of veterans surfaced last spring. Greitens also said he had found replacements for five members of the Missouri Veterans Commission whose terms have expired. He said he wants to replace Larry Kay, the commission’s executive director. (12/11)

Many veterans aren't receiving the health care they desperately need. Among them was Iraq War veteran Curtis Gearhart, who committed suicide last year. Gearhart, who had suffered from PTSD and recurring headaches from a tumor, sought out care but was told by the Veterans Affairs (VA) office that it would be five to six weeks before they could see him for medical care. (Raymond March, 12/11)

You are what you eat. It's an expression with roots in the early 1800s that has come to mean if you consume what's good for you, you will be healthy, and if you don't, well, watch out. But our latest research on what influences consumers to make unhealthy food choices has compelled us to turn that axiom on its head: You eat what you are. (Christine A. Vaughan and Tamara Dubowitz, 12/11)

You’d probably be surprised to hear someone living with cancer say they consider themselves lucky. But, that is how I feel. For one, just a few years ago, that statement, “living with cancer” wasn’t something you heard very often. But, it’s more than just luck that is keeping me and thousands of other patients’ cancer at bay; it’s science. It’s access to breakthrough medications that have changed the ways we each treat our individual diseases. I’m also lucky that I’ve had affordable access to these life-saving medications, but that’s not the case for everyone. (Karen Coulson, 12/9)

At the Cuyahoga County Board of Health, we champion women's health and access to medical care all year long. We think it is important to continue the conversation around women's health issues beyond October--and to encourage and empower all women to prioritize their own health care needs. (Sharon Verhotz, 12/10)