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The country’s largest nurses union will endorse Senator Bernie Sanders for president this week, a significant boost to his campaign from a major ally in the fight for his signature health care proposal. The union, National Nurses United, fervently supported Mr. Sanders’s last bid for the White House in 2016, and its members have been significant players in Democratic politics since then, showing up in red T-shirts to support Mr. Sanders’s progressive allies in intraparty battles. They have also canvassed neighborhoods in swing congressional districts, urging voters to get behind “Medicare for all,” Mr. Sanders’s plan for a nationalized health insurance system. (Epstein, 11/12)

Kaiser Health News: Warren Says Out-Of-Pocket Health Spending Will Total $11 Trillion In The Next Decade. We Checked Her Math.

Promoting her much-discussed plan to create a single-payer “Medicare for All” health system, Sen. Elizabeth Warren emphasized a striking figure. “If we make no changes over the next 10 years, Americans will reach into their pockets and pay out about $11 trillion on insurance premiums, copays, deductibles and uncovered medical expenses,” the Democratic presidential candidate said in an Instagram video posted Monday. (Luthra, 11/12)

Google is engaged with one of the U.S.’s largest health-care systems on a project to collect and crunch the detailed personal-health information of millions of people across 21 states. The initiative, code-named “Project Nightingale,” appears to be the biggest effort yet by a Silicon Valley giant to gain a toehold in the health-care industry through the handling of patients’ medical data. Amazon.com Inc. and Apple Inc. and Microsoft Corp. are also aggressively pushing into health care, though they haven’t yet struck deals of this scope. Google began Project Nightingale in secret last year with St. Louis-based Ascension, a Catholic chain of 2,600 hospitals, doctors’ offices and other facilities, with the data sharing accelerating since summer, according to internal documents. (Copeland, 11/11)

The partnership between Google and the medical system, Ascension, could have huge reach. Ascension operates 150 hospitals in 20 states and the District of Columbia. Under the arrangement, the data of all Ascension patients could eventually be uploaded to Google’s cloud computing platform. It is legal for health systems to share patients’ medical information with business partners like electronic medical record companies. Even so, many patients may not trust Google, which has paid multiple fines for violating privacy laws, with their personal medical details. (Singer and Wakabayashi, 11/11)

Google said in a blog post on Monday that patient data "cannot and will not be combined with any Google consumer data." Ascension "are the stewards of the data, and we provide services on their behalf," wrote Tariq Shaukat, president for industry products and solutions at Google Cloud. In a press release, Ascension said the partnership is in compliance with the Health Insurance Portability and Accountability Act (HIPPA) which safeguards medical information. (Dave, 11/11)

In recent years, hospitals nationwide have begun entering into contracts with large technology companies to store patient information in their clouds, where it can be analyzed using machine learning tools to help providers analyze patients’ health needs and zero in on the most effective treatments for specific conditions. Earlier this year, Mayo Clinic inked a sweeping 10-year partnership with Google to store its data in the company’s cloud and use its tools to analyze clinical information, although it emphasized any patient data shared with Google would be de-identified. (Ross, 11/11)

Google and other big tech companies have been pushing into health care in recent years. Apple Inc. asks its Apple Watch users to opt in to studies on heart rate, while Amazon.com Inc. has bought an online pharmacy and partnered with other corporations on a health venture called Haven. Google, for its part, has built a significant health-care team and is experimenting with using artificial intelligence to improve health care. (DeVynck, 11/11)

Questions have been raised about whether Google’s actions broke federal law, but privacy experts say it doesn’t. The experts reference the Health Insurance Portability and Accountability Act of 1996 that says data can be shared with business partners without consent of the patient “only to help the covered entity carry out its health-care functions,” the Journal reported. (Coleman, 11/11)

At least eight former White House, presidential transition and campaign officials for President Donald Trump were hired as outside contractors to the federal health department at the cost of hundreds of thousands of dollars per year, according to documents newly obtained by POLITICO. They were among at least 40 consultants who worked on a one-year, $2.25 million contract directed by Centers for Medicare and Medicaid Services Administrator Seema Verma. The contractors were hired to burnish Verma’s personal brand and provide “strategic communications” support. They charged up to $380 per hour for work traditionally handled by dozens of career civil servants in CMS's communications department. (Diamond and Cancryn, 11/12)

U.S. President Donald Trump said on Monday he will be meeting with vaping industry representatives as his administration considers tightening e-cigarette regulations amid a nationwide outbreak of vaping-related injuries and deaths. "Will be meeting with representatives of the Vaping industry, together with medical professionals and individual state representatives, to come up with an acceptable solution to the Vaping and E-cigarette dilemma. Children’s health & safety, together with jobs, will be a focus!" he wrote on Twitter. (11/11)

“Will be meeting with representatives of the Vaping industry, together with medical professionals and individual state representatives, to come up with an acceptable solution to the Vaping and E-cigarette dilemma,” Mr. Trump wrote in a tweet Monday morning. “Children’s health & safety, together with jobs, will be a focus!” He didn’t say when the meeting would happen, but the policy has been delayed under heavy lobbying. On Friday, Mr. Trump said he supported raising the minimum purchase age for e-cigarettes nationwide to 21 years old from 18. (Burton and Leary, 11/11)

A recent surge in underage use of e-cigarettes prompted Health and Human Services Secretary Alex Azar to say in September that the administration would put tighter restrictions on flavored nicotine vaping products. At the time, Azar suggested that most flavors except tobacco could be removed from the market pending review by the U.S. Food and Drug Administration. Since then, public-health advocates and vaping-related businesses have been awaiting guidance on the new curbs. Last week, planned meetings between White House policy officials and industry groups were canceled, a development some saw as a sign that restrictions were imminent. (Porter and Wingrove, 11/11)

But the president has faced considerable backlash from the vaping industry and advocates, who argue a ban would eliminate jobs and options for adults who use those products as an alternative to traditional cigarettes. They argue raising the tobacco purchasing age to 21 would be a better alternative. Trump said Friday the White House would release a "big paper" this week. "We're talking about the age. We're talking about the flavors," he said. (Hellmann, 11/11)

Vaping advocates feel optimistic that the Trump administration will back off its plan to ban the sale of all flavored e-cigarette products. President Trump and some of his top advisers have questioned in recent days whether the flavor ban it promised two months ago could have an adverse effect on the economy. They’ve also worried it could make it harder for adults who use the products to try to quit smoking. (Hellmann, 11/12)

On a frigid Saturday afternoon, the best-smelling place in America was Ellipse Park in Washington, D.C., where it was impossible to go one step in either direction without walking into a fragrant cloud of sweet-smelling vapor — though marketed to mimic everything from strawberries to cotton candy, it all came out smelling the same. Hundreds of members of the vaping community gathered to protest an impending vape flavors ban announced by President Donald Trump, taking hits off their elaborate hardware while clutching signs reading “Make America vape again,” or “Vape kills like Epstein killed himself.” The crowd frequently broke into chants of the catchphrase of the afternoon: “We vape, we vote.” (Dickson, 11/11)

Doctors at a Detroit hospital have performed what could be the first double lung transplant on a man whose lungs were damaged from vaping. No other details of the transplant were released Monday by Henry Ford Health System, which has scheduled a news conference Tuesday. The patient has asked his medical team to share photographs and an update to warn others about vaping. (Williams, 11/11)

Doctors at Detroit's Henry Ford Hospital have performed a double-lung transplant on a person with a vaping-related lung injury. The hospital system announced Monday that it believes it is the first in the country to perform the surgery on someone who had irreparable lung damage from vaping. It plans to host a news conference Tuesday to offer more details. (Shamus, 11/11)

[The patient] has asked the hospital to let the public know about his injuries and to see pictures, to "warn others," according to the hospital, but has also asked for privacy, so he will not attend the press conference. (Christensen, 11/11)

Former FDA Commissioner Scott Gottlieb said Monday that Juul Labs’ products should be removed from the market, citing two studies that showed the scope of teen use of its e-cigarettes and flavored pods. “It’s very clear that Juul can’t keep their products out of the hands of kids,” said Gottlieb, a physician, health advocate and Pfizer board member. He left the Food and Drug Administration in April. “What’s driving the youth use is primarily Juul.” (Bursztynsky, 11/11)

Smoking cigarettes has long been established as a major cause of heart disease deaths; now, there's growing evidence that electronic cigarettes may hurt the heart, too. In two separate studies that will presented at the upcoming meeting of the American Heart Association, e-cigarettes use was shown to impact cholesterol, as well as the body's ability to pump blood. In one study, researchers at the Boston University School of Medicine compared the cholesterol levels among four groups of adults: people who used e-cigarettes, people who smoked regular cigarettes, those who used both products, and nonsmokers. (Edwards, 11/11)

Kaiser Health News: Some Academics Quietly Take Side Jobs Helping Tobacco Companies In Court

In 1998, major tobacco companies reached a historic legal settlement with states that had sued them over the health care costs of smoking-related illnesses. But individual smokers have continued to sue, and to this day the tobacco industry remains tied up in hundreds of court fights with sickened smokers, or with family members who lost a loved one to cancer, heart disease or other smoking-related illness. These days, tobacco companies no longer try to claim that cigarettes aren’t harmful — in fact, in an ironic reversal, a favorite legal defense in current cases is the argument that nearly everyone was aware of the dangers, even back in the 1950s. (Farmer, 11/12)

The Trump administration is preparing to significantly limit the scientific and medical research that the government can use to determine public health regulations, overriding protests from scientists and physicians who say the new rule would undermine the scientific underpinnings of government policymaking. A new draft of the Environmental Protection Agency proposal, titled Strengthening Transparency in Regulatory Science, would require that scientists disclose all of their raw data, including confidential medical records, before the agency could consider an academic study’s conclusions. (Friedman, 11/11)

The move is an expansion from previous drafts of the formally titled Strengthening Transparency in Regulatory Science rule, also dubbed the “secret science” rule, which was first pitched in 2017 by former EPA Administrator Scott Pruitt. EPA Administrator Andrew Wheeler told a congressional committee in September that the agency was moving forward with the rule to "ensure that the science supporting agency decisions is transparent and available for evaluation by the public and stakeholders.” The new rule is now headed for the White House, according to the Times. (Green, 11/11)

The 3-year-old girl traveled for weeks cradled in her father's arms, as he set out to seek asylum in the United States. Now she won't even look at him. After being forcibly separated at the border by government officials, sexually abused in U.S. foster care and deported, she arrived back in Honduras withdrawn, anxious and angry, convinced her once-beloved father abandoned her. He fears their bond is forever broken. (Sherman, Mendoza and Burke, 11/12)

They are doctors and pharmacists, business owners and students who were brought to the United States as children, unaware that they had entered illegally or on visas that later expired. Without legal status, their hopes for the future were dim. Seven years ago, their lives dramatically changed when the Obama administration announced it would defer deportation and allow work permits for young people who met certain residency, educational and background requirements under a policy known as Deferred Action for Childhood Arrivals. (Carcamo, Castillo, Watanabe, Kohli, 11/12)

When Timothy Hellrung was told he had aggressive cancer this past June and had only days or weeks to live, he knew where he wanted to die. Mr. Hellrung, a 73-year-old veteran of the Vietnam War disabled by Agent Orange, spent his last 10 days in hospice care at the community living center of the V.A. Ann Arbor Healthcare System in Michigan. The staff provided him with a roomy suite. A social worker wheeled in a bed for his wife of 44 years, Brenda, and gave her pajamas so she could be comfortable spending every night with him. (Halpert, 11/11)

The large field of Democrats running for president may have differing views on the best way to provide health care to the masses or exactly how to reform the immigration system. But when it comes to helping America’s veterans they largely agree: The Department of Veterans Affairs needs some serious help, and those who have served need much better access to benefits, health care, housing, education and jobs. (Stevens, 11/11)

Sen. Elizabeth Warren (D-MA), Sen. Bernie Sanders (I-VT), South Bend, Indiana, Mayor Pete Buttigieg, and Sen. Kamala Harris (D-CA) have all released new plans that include measures to expand VA benefits to 500,000 veterans who are currently denied them because of their discharge status. Simply put, veterans with an “honorable” discharge — meaning a service member ended their service in good standing with no issues whatsoever — can use the VA for their physical and mental health care needs, as well as for readjustment into civilian life and reemployment assistance. It’s the only designation that doesn’t negatively impact a veteran’s benefits. (Ward, 11/11)

Army veteran Randy Lloyd hit rock bottom after serving during the height of the Iraq War. His job was to hunt for roadside bombs. Lloyd said he realized he had post-traumatic stress disorder when he found himself waking up, thinking he was "over there." Lloyd turned to drugs, ended up in jail for felony possession and then, he said, it got worse. "I overdosed. The paramedic looks at me and says, 'You were dead. You might want to start thinking about what you're doing,'" Lloyd said. (O'Donnell, 11/11)

About 40 volunteers, led by a handful of former military personnel, marked Veterans Day on Monday by reaching out to homeless veterans in the District. The effort — organized by Veterans on the Rise and the Union Veterans Council of the AFL-CIO — targeted shelters and other places frequented by the homeless. The volunteers gathered in the parking lot of Shiloh Baptist Church for an 8 a.m. briefing before breaking into smaller teams that handed out kits containing toiletries, gloves, socks and wool caps to anyone who needed them. They also handed out cards with information on how to obtain temporary shelter or assistance from Veterans Affairs. (Kunkle, 11/11)

After Microsoft CEO Satya Nadella crashed his car into a sand trap in the Xbox One video game Forza, he wondered aloud if it was time to give up. His competitor, Roger Brannon, thought differently. “Never give up,” Brannon said. “That’s a Marine,” Nadella replied. Brannon, a veteran who served in the armed forces for over half his life, was playing against Nadella using Microsoft’s Adaptive Controller, a video game controller designed for individuals with limited mobility. Brannon, who suffers from the neuromuscular disease ALS, demonstrated the benefits of the device to Microsoft leadership at the VA Medical Center in Washington, D.C. in early October. (Andrejev, 11/11)

Josh Milich and Brian Tjersland are both ultra-runners who have finished 100 mile marathons. Now, they are attempting to do something even more extreme on Veterans Day – a 500-mile run. They left the Massachusetts National Cemetery on Cape Cod Monday and will run all the way to the Arlington National Cemetery in Virginia, averaging about two marathons a day for 11 days in a row. Their goal is to raise awareness about veteran suicide. (Meiler, 11/11)

After more than two decades of research, the world finally has an approved Ebola vaccine. The European Commission granted marketing authorization to Merck’s vaccine, known as Ervebo, on Monday, less than a month after the European Medicines Agency recommended it be licensed. It is currently being used in the Democratic Republic of the Congo under a “compassionate use” or research protocol similar to a clinical trial. (Branswell, 11/11)

Since the middle of last year, the Congo Ebola outbreak has killed more than 2,100 people, making it the second-largest Ebola outbreak in history, after the 2013-16 epidemic in West Africa that killed more than 11,300. “The EU is supporting international efforts to combat Ebola on all fronts, from vaccine development to delivering humanitarian aid on the ground,” EU Ebola Coordinator Christos Stylianides said in a statement dated Nov. 10. (11/11)

Cannabis-based medicines were approved on Monday for use by the National Health Service in England and Wales, a milestone decision that could change the lives of thousands of patients. Three treatments using medicinal cannabis were authorized by the National Institute for Health and Care Excellence, a public body that provides guidance on health care practices. The decision comes a year after Sajid Javid, then the British home secretary, said that some doctors could legally prescribe the drug in special cases. (Magra, 11/11)

The sensations surged up from somewhere inside, like poison through a syringe: a mix of sadness, anxiety, and shame that would overwhelm anyone, especially a teenager. “I had this Popsicle stick and carved it into sharp point and scratched myself,” Joan, a high school student in New York City said recently; she asked that her last name be omitted for privacy. “I’m not even sure where the idea came from. I just knew it was something people did. I remember crying a lot and thinking, Why did I just do that? I was kind of scared of myself.” (Carey, 11/11)

It seems like lately everyone on Instagram and YouTube is feeling anxious, stressed and depressed. Images of amazing vacations, flawless bodies and beautiful homes that once dominated social-media feeds are being replaced with snapshots of real life, with all its laundry piles and stretch marks. Celebrities and influencers are sharing more of their emotional baggage. But when regular teens do the same, it can be risky. Influencers have used the word “anxiety” three times more so far this year than they did in all of 2016 and more than six million posts on Instagram reference #mentalhealthawareness, according to Captiv8 Inc., an influencer marketing firm. (Jargon, 11/12)

Kaiser Health News: More Adolescents Seek Medical Care For Mental Health Issues

Less than a decade ago, the emergency department at Rady Children’s Hospital in San Diego would see maybe one or two young psychiatric patients per day, said Dr. Benjamin Maxwell, the hospital’s interim director of child and adolescent psychiatry. Now, it’s not unusual for the emergency room to see 10 psychiatric patients in a day, and sometimes even 20, said Maxwell. “What a lot of times is happening now is kids aren’t getting the care they need, until it gets to the point where it is dangerous,” he said. (Reese, 11/12)

Mayor London Breed is pushing for a November 2020 bond measure that could help fund some of the major reforms proposed for San Francisco’s mental health care system. The plan for exactly how the city will treat and eventually house the roughly 4,000 homeless people suffering from mental illness and drug addiction is still coming together. (Fracassa, 11/11)

Some good health news: Americans' cholesterol levels are dropping, and more people at especially high risk are getting treatment. Researchers say Monday's report suggests a controversial change in recommendations for cholesterol treatment may be starting to pay off. "It is very heartening," said Dr. Pankaj Arora of the University of Alabama at Birmingham, who led the study. "But there is more to do." (Neergaard, 11/11)

Efforts to reduce deaths from breast cancer in women have long focused on early detection and post-surgical treatment with drugs, radiation or both to help keep the disease at bay. And both of these approaches, used alone or together, have resulted in a dramatic reduction in breast cancer mortality in recent decades. The average five-year survival rate is now 90 percent, and even higher — 99 percent — if the cancer is confined to the breast, or 85 percent if it has spread to regional lymph nodes. (Brody, 11/11)

New guidance on concussions shows there isn't enough solid evidence to answer some of parents' most burning questions about contact sports. That includes what age is safest to start playing them. Pediatric experts in sports medicine, neurology and related fields evaluated and rated three decades of sports concussion-related research. They say recent evidence filled in some blanks. (Tanner, 11/11)

Racial bias may affect whether black patients with heart failure are approved for heart transplants, according to a new study published in the Journal of the American Heart Association. Researchers in Arizona asked 422 doctors, nurses and other hospital decision-makers to look at a pool of hypothetical patients, both black and white, and decide which should be referred for a heart transplant. (Kilpatrick, 11/11)

Some studies, and many ads, suggest that omega-3 supplements are helpful for improving mental health. But a systematic review of research has found the supplements are probably ineffective in treating or preventing depression and anxiety. The analysis, in the British Journal of Psychiatry, included a broad range of long-term trials of omega-3 fatty acid supplementation. Omega-3s are found in fatty fish like salmon and other foods. Neither length of treatment nor size of dosage demonstrated effectiveness. (Dixon, 11/12)

Big, destructive hurricanes are hitting the U.S. three times more frequently than they did a century ago, according to a new study. Experts generally measure a hurricane's destruction by adding up how much damage it did to people and cities. That can overlook storms that are powerful, but that hit only sparsely populated areas. A Danish research team came up with a new measurement that looked at just the how big and strong the hurricane was, not how much money it cost. They call it Area of Total Destruction. (Borenstein, 11/11)

A Tennessee doctor who had five patients fatally overdose in a 10-month span intends to plead guilty to distributing a controlled substance. The Tennessean reports 64-year-old Dr. Darrel Rinehart's attorney filed a motion to have a hearing in December where Rinehart "intends to plead guilty." (11/11)

The federal indictment against Rinehart states that he “routinely” prescribed opioids and other drugs “without legitimate medical purpose” and that four patients died while in his care. In January, Rinehart was also the subject of a joint investigation by The Tennessean and The Indianapolis Star. State health records showed at least five of Rinehart’s patients suffered fatal overdoses that were partially or wholly caused by drugs he prescribed between March 2015 and January 2016. At least six more Rinehart patients had nonfatal overdoses between 2014 and 2016, and one of those patients overdosed three times, state health records showed.(Kelman, 11/11)

The federal Drug Enforcement Administration has sued the board that regulates Colorado’s pharmacies, demanding it share information from a database that tracks opioid prescriptions and setting up a clash over patient privacy amid the nation’s overdose epidemic. The requested information is part of an investigation into whether two unnamed pharmacies broke the law in dispensing opioids and other drugs, according to a DEA agent’s declaration filed in the lawsuit. (Ingold, 11/11)

Methadone and Suboxone (the brand name for buprenorphine) ease opioid cravings and withdrawal symptoms. Forty-four of the estimated 200 people incarcerated at the Frankin County facility receive addiction medications on this day. (Becker, 11/12)

Dr. Kimberly Sue is the medical director of the Harm Reduction Coalition, a national advocacy group that works to change U.S. policies and attitudes about the treatment of drug users. She's also a Harvard-trained anthropologist and a physician at the Rikers Island jail system in New York. Sue thinks it's a huge mistake to put people with drug use disorder behind bars. (Vaughn, 11/12)

Products containing the herbal supplement kratom may damage the liver in rare cases, a new review suggests. All seven patients with liver damage in the review fully recovered, but the research adds to the debate over the risks and benefits of the unregulated, little-studied derivative of a Southeast Asian tree. ...The new analysis was conducted by the federally funded Drug-Induced Liver Injury Network and presented at a meeting Monday by lead researcher Victor Navarro, a gastroenterologist with the Einstein Healthcare Network in Philadelphia. (McCullough, 11/11)

A select group of 11 executives and activists struggled to tackle the role of the corporate world in combating one of the most polarizing issues in the United States today: guns. They didn’t solve the problem. No one has yet. Which is why they were there. At the head of the table sat two fathers of students who died in the Marjory Stoneman Douglas High School massacre in Parkland, Fla., on Feb. 14, 2018. At one corner next to them sat two staunch defenders of the Second Amendment who were worried about having to relinquish their firearms. (Robbins, 11/11)

While University of Texas/Texas Tribune polls consistently show that Texans are divided about gun control — with 40% to 50% saying they want stricter gun laws — all but one of the laws passed over the past decade by the state’s Republican-controlled Legislature have expanded where guns are allowed, who can have a firearm in schools and the right to openly carry guns. The timeline below details how state lawmakers and the public have responded to mass shootings — through legislation and University of Texas/Texas Tribune polls — since the 2009 Fort Hood shooting. (Cai and Fernandez, 11/12)

The authorities have charged a Virginia obstetrician and gynecologist accused of performing unnecessary hysterectomies and removing one patient’s fallopian tubes without her knowledge. The doctor, Javaid Perwaiz, 69, was arrested on Friday and charged with one count of health care fraud and making false statements relating to health care matters, according to court documents filed in the United States District Court for the Eastern District of Virginia. (Diaz, 11/11)

At Javaid Perwaiz’s gynecology practice in Chesapeake, Va., authorities say excessive surgery has been the norm for years. Women were given hysterectomies they didn’t need or want and underwent surgical procedures to remove growths they didn’t have, according to court documents. When one woman consulted with a fertility doctor after trouble conceiving, authorities said, she learned Perwaiz had burned her fallopian tubes “down to nubs” — without her knowledge. (Mettler, 11/11)

A complaint filed in U.S. District Court details Perwaiz’s alleged proclivity for convincing Medicaid recipients to undergo operations they didn’t need, to the point some of them were having the surgery every year. Several patients didn’t even know what procedures were being performed, according to the complaint. (Ortiz, 11/11)

Perwaiz has been the subject of at least eight malpractice lawsuits, the affidavit noted. In those lawsuits, plaintiffs allege he falsified medical records to justify unnecessary procedures, performed up to 30 surgeries in one day and provided "substandard care" that caused permanent injuries in at least three patients, according to the affidavit's description of the lawsuits. Two patients suffered life-threatening injuries, the affidavit said. The disposition of the malpractice lawsuits is not clear. (Silverman, 11/11)

California Gov. Gavin Newsom has accused his state’s largest utility company of mismanaging funds he said it should have used to upgrade an aging electrical grid prone to deadly wildfires. But over the past two decades, Newsom (D) and his wife have accepted more than $700,000 from the Pacific Gas & Electric Co., its foundation and its employees as the utility has supported his political campaigns, his ballot initiatives, his inauguration festivities and his wife’s foundation, including her film projects, according to records reviewed by The Washington Post. (MacMillan and Satija, 11/11)

On one hand, North Carolina is slated to drastically alter the health care landscape of the state with a scheduled February handoff for most of its massive Medicaid system to managed care companies. The hope is that these companies, which will be paid a capitated, per-person rate, will improve health outcomes and maybe even save money. But, a now months-long state budget standoff between Gov. Roy Cooper, a Democrat, and Republican legislative leaders is threatening to get in the way of that start date as the opposing sides battle over the separate, but related, issue of expanding Medicaid. (Ovaska-Few, 11/12)

When Armando Gutierrez learned he was HIV-positive last December, he struggled to share the information with his employer. The 31-year-old believed he was well-liked at the Kansas chain restaurant where he had worked as a server for a year, but he still worried his co-workers would stigmatize him if they learned of his condition. In a lawsuit filed last week in U.S. District Court in Kansas, Gutierrez claims his fears were well founded, because shortly after sharing his status with a manager, he says he was fired. (Epstein, 11/11)

Sweet victory has quickly soured for Trillium Community Health Plan as the state continues to reorganize its Medicaid health plans. State regulators late last week notified Eugene-based Trillium that they had rescinded their decision to allow the company to expand from its Lane County base into the Portland area. The company has been unable to assemble a viable group of hospitals and health care providers, regulators said. (Manning, 11/11)

University of Georgia researchers are receiving millions of federal dollars to help create a “universal” flu vaccine.But what does that term mean? And will a breakthrough vaccine persuade more Americans to get flu shots? Right now, fewer than 40 percent of adults get a flu shot. And that’s bad. (Laguaite, 11/11)

Chicago's not-for-profit hospitals face new pressure to justify property tax exemptions worth hundreds of millions of dollars. Not-for-profits in Illinois are exempt from property taxes, in return for providing free or discounted services to poor and underinsured people. But activists are alleging the hospitals don't provide enough free care to warrant the break. (Goldberg, 11/11)

Seattle Children’s has closed three of its operating rooms because of the same fungus that forced the shutdown of all the hospital’s operating rooms earlier this year. The hospital is also looking into two new infections caused by the Aspergillus mold. The mold was discovered during a routine air test conducted Sunday, according to a Children’s news release Monday, which said, “We are deeply sorry for the impact the air quality issues in our operating rooms continue to have on our patients and families. Seattle Children’s remains committed to doing what’s right to keep our patients safe.” (Blethen, 11/11)

To improve Ohio’s foster care system, Gov. Mike DeWine assembled an advisory council, which has scheduled seven meetings across the state to listen to kids, parents, advocates and others. The problem, advocates say, is no meetings have been scheduled in or near Cleveland or Cuyahoga County – which in October, accounted for over 17% of the state’s 16,186 children in foster care. (Hancock, 11/11)

A new Texas Medical Center national survey challenges the often-repeated prediction that the United States will face a dire physician shortage in coming years. The fifth annual survey by the medical center’s Health Policy Institute not only asked doctors in all 50 states about future shortages, but also polled thousands of consumers about what they were experiencing now. Both answers seem to contradict conventional wisdom. (Deam, 11/12)

Portland Street Medicine has been around less than two years, but already it’s attracted a small army of medical volunteers who hit the Portland streets at least twice a week. Groups that usually consist of at least one nurse, doctor and one social worker spend hours on Mondays, Wednesdays and Fridays either going directly to shelters or looking for specific people who need help. ...Portland Street Medicine’s 2019 budget is about $207,000, of which $114,000 consists of donations of staff time, equipment and medical supplies. Most of the cash donations come through the group’s website. The organization has 42 volunteer medical professionals and eight volunteer community members and administrators. (Zarkhin, 11/11)

Missouri has already approved more than 17,000 patients for its yet-to-be-launched medical marijuana program — a stark contrast to neighboring Illinois, which had less than 3,000 patients in the first 10 months. Licenses for Missouri’s dispensaries are expected to be awarded by January, and cannabis should be available for medical card holders by spring. (Driscoll, 11/12)

The figure is mind-boggling: $20.5 trillion over 10 years. That’s how much presidential candidate Elizabeth Warren says her plan will cost above what the federal government currently spends for health care. Cue the attacks.So here we go again. Another election in which the question of how best to reform the U.S. health care system will be front and center. Sadly, relying on the media to understand the features of various proposals is like reading a newspaper in a lightning storm—mostly opaque with occasional flashes of illumination. (Drew A. Harris, 11/11)

The U.S. health-care system is a paradox. While most Americans are satisfied with their care, international studies consistently show that — but for cancer — U.S. health outcomes are generally worse than in other large industrial democracies. That’s despite the fact the U.S. spends more per capita on government-funded health care than any such nation, including those with single-payer systems like Canada and Great Britain — a little-appreciated fact that lays bare Republican grousing against “socialist medicine” as insincere or uninformed. This backdrop is what makes a proposal from Rep. Ro Khanna, D-Fremont, so intriguing. He wants to allow states to receive a bulk payment from Washington equivalent to all federal health care funds that would otherwise be spent on state residents through Medicare, Medicaid, the Affordable Care Act and other programs. States could use this money to launch a single-payer system. (11/11)

The promise of curing deadly diseases by administering a one-time therapy that rewrites a patient’s genetic code is no longer the stuff of science fiction. Yet this innovation comes with a steep price tag.Zolgensma, approved for spinal muscular atrophy (SMA), has a list price of approximately $2.1 million. Other gene- and cell-based therapies coming to the market have launched at prices in the hundreds of thousands of dollars.With dozens of gene therapy products in the pipeline, employers and health plans are rightfully concerned about how the evolution of gene therapy will affect their ability to keep health benefits affordable. Enter Express Scripts and Cigna: The companies have announced Embarc, a program that aims to provide employers and health plans with a predictable cost for gene therapy. (Jeremy Schafer, 11/12)

The Register’s Nov. 3 editorial, "Iowa should learn a lesson from Arkansas, reject Medicaid work requirements," which denounced requiring able-bodied Medicaid recipients to work in return for receiving Medicaid, was misguided, short-sighted and disrespectful toward taxpayers. This policy isn’t unfair to elderly or physically disabled recipients, and won’t require children to work in exchange for benefits. In most cases, it won’t impact recipients who already work full-time. Nonetheless, most Democrats in both houses of Iowa’s Legislature oppose this Trump administration-inspired proposal. Why do leftists ignore the reality that taxpayers have a right to set the conditions and terms for those who want such benefits? (Todd Blodgett, 11/10)

The controversial TennCare proposal has drawn overwhelming opposition because it removes federal patient safeguards and restructures the program’s federal funding. The nation’s most respected patient advocacy organizations have explicitly warned that Medicaid block grants threaten the health of people with serious illnesses and undermine the health care infrastructure on which all Tennesseans rely. (Tom Jedlowski,11/12)

Seventy-five years ago, President Franklin Delano Roosevelt penned a letter to his director of the Office of Scientific Research and Development, Dr. Vannevar Bush. Basking in the recent glory of the D-Day invasion, exhibiting an innovative mix of confidence and curiosity, the ailing president asked Bush to explore an idea. On the president’s mind was whether the formula, that worked so well in bringing industry, academia, and the government together to produce unprecedented military success during World War II could be applied to life sciences research in order to accelerate the development of cures for deadly diseases. A different war with a different enemy, one fought on the endless battlefield of human biology; but a war nonetheless, with millions of American casualties and counting. (Douglas Eby, 11/12)

How can ordinary Americans move the debate about guns and gun violence forward, when it seems our legislators cannot? We thought a conversation might be the right way to start. We paired readers with differing perspectives about guns and American society and asked them to discuss gun violence and legislation. Specifically, we asked them to reach across the aisle and see what areas of agreement they could find, if any. (Rachel L. Harris and Lisa Tarchak, 11/11)

In August 2015, I attended multiple funerals in just one week. I said goodbye to close friends, and trusted teammates I had relied on during extremely intense combat in Iraq and Afghanistan. We’ve lost over 100 guys in my peer group, some of them in battle, but too many here at home to the ravages of substance use and suicide. The statistics are alarming and heartbreaking. According to the Department of Veterans Affairs, 20 veterans and active-duty personnel die by suicide every day. One in 15 veterans are dealing with a substance use disorder — which is often a precursor to either intentional or “unintentional” suicide, those who drink so much they don’t wake up. (Dan Cerrillo, 11/12)

One winter afternoon, as we stood at the corner waiting to cross the street, my friend turned to me and said he wished he'd get run over by a car. It would make everything he worried about go away. It was 2017, less than a month into the new Trump administration, yet it had already signed executive orders to increase border security, empower ruthless Immigration and Customs Enforcement agents, and ban millions of people in Muslim-majority countries from traveling to the United States. (Josue De Luna Navarro, 11/12)

As the National Coalition Against Domestic Violence notes, with most of the domestic violence awareness movement focused on heterosexual relationships, the LGBT community has largely been left out of the movement, with significant consequences. According to a National Intimate Partner and Sexual Violence Survey, conducted by the National Centers for Disease Control and Prevention (CDC), nearly half of lesbians and 61% of bisexual women experience rape, physical violence or stalking by an intimate partner, compared to 35% of heterosexual women. (Anthony Williams, 11/10)

I do not have the answers on how to stop gun violence. But as executive director of Uplift Center for Grieving Children, I do oversee a grief center for children and families that often provides the crisis and postcrisis support groups offered at city schools and other community venues. Our team is out there working with other agencies and members of the community helping to lessen the harm perpetrated by violence.Last year, Uplift served 1,700 children in groups, and approximately 30% of those children were grieving a loved one who died by homicide. As our officials work on solutions to this crisis, we need to stand up for our city’s youth and give them the support they need. (Darcy Krause, 11/12)