�Թϲ�����

Newly disclosed financial records show that President Donald Trump's nominee to become Health and Human Services secretary reaped big earnings during his tenure as a top pharmaceutical executive. As a top drug industry veteran from 2007 to 2017, former Eli Lilly and Co. executive Alex Azar built a substantial financial portfolio now worth $9.5 million to $20.6 million, and he was paid nearly $2 million in his final year at the company. (Braun, 11/20)

Alex Azar, who was previously president of the U.S. division of pharmaceutical giant Eli Lilly and Co., has a net worth of at least $8.7 million, according to documents filed with the Office of Government Ethics and analyzed by The Hill. Azar was paid nearly $2 million in his final year at Eli Lilly, according to the documents, which only date back to the previous 12 months. The company also paid him a $1.6 million severance package. (Weixel, 11/20)

Multiple Senate Democrats, and independent Vermont Sen. Bernie Sanders, have already declared their opposition to Azar's nomination because of his ties to the drug industry. The Health, Education, Labor and Pensions Committee is set to hold the first confirmation hearing on his nomination Nov. 29. After leaving Indianapolis-based Lilly, Azar leaned heavily on his industry experience to find new work. He collected $46,500 in speaking fees for four events, including ones hosted by the National Association of Specialty Pharmacy and pharma-focused tech company Veeva Systems. Azar also valued his consulting firm's worth at between $15,001 and $50,000. The firm's clientele included the National Pharmaceutical Council and drug company UCB Inc. (Cancryn, 11/20)

On the 597th day, the day he hoped everything would change, Joe Stewart woke early. He took 15 pills in a single swallow. He shaved his head. And then he got down to the business of the day, which was the business of every day, and that was waiting. He looked outside, and saw his mother there in a green sedan, engine running. So many months he had waited for this moment, and now it was here. Time for his Social Security disability hearing. Time to go. (McCoy, 11/20)

Community health centers are scrambling to make contingency plans as they anxiously wait to see if Congress will renew billions of dollars in federal funding that expired on Sept. 30. Often situated in medically underserved areas, the health centers provide care to some 26 million of the nation’s most vulnerable people. They’re required to take any patient who seeks care, regardless of whether they can pay. (Roubein, 11/21)

About two months after federal funding lapsed for the Children’s Health Insurance Program, state officials still don’t know exactly when they’ll run out of money or when Congress will renew funding — leaving families that depend on the program increasingly anxious about their benefits. At least a few states say that they could exhaust funds as soon as next month. States are growing more concerned about the program with just a few days left on the congressional calendar until December and no signs that lawmakers plan in the immediate future to renew funding. (Raman, 11/20)

Billions of dollars in cuts to a federal program that helps hospitals cover the cost of caring for the uninsured will begin to take effect in a matter of weeks if Congress does not delay them. The House recently included a postponement in cuts to what's known as disproportionate share hospital, or DSH, payments in its bill to reauthorize funding for the Children’s Health Insurance Program (HR 3922). But the Senate hasn't followed suit thus far, leaving hospitals in the dark about whether they will start to see funding slashed in the first quarter of 2018. (Williams, 11/20)

Republicans are seeking to roll back a tax credit for drugs that treat rare diseases, alarming patient groups who fear the move would slow the development of new treatments. The so-called orphan drug tax credit would be repealed in the tax-reform bill that passed the House last week. Patient groups are lobbying to preserve the credit, as are some drug companies. (Sullivan, 11/21)

Deaths linked to alcohol are significantly more common than drug overdose deaths, but lawmakers may promote more drinking through a two-year tax break for producers of beer, wine and spirits as part of the Senate’s tax code overhaul. The tax break, for 2018 and 2019, would save alcohol producers $4.2 billion, according to the Joint Committee on Taxation. The provisions in the Senate Finance Committee’s tax plan were requested by Republican Sen. Rob Portman of Ohio, but are based on a bill from Sen. Ron Wyden of Oregon, the committee’s top Democrat. (Siddons, 11/21)

Sen. Lamar Alexander (R-Tenn.) expressed optimism about a bipartisan effort to stabilize ObamaCare markets, saying his bill could be included in the upcoming funding package if it had President Trump's blessing. "I think if the president supports it, it'll be a part of the end-of-the-year package," Alexander told CNBC in an interview published Monday. (Sullivan, 11/20)

The average uninsured rate in states that use the federal HealthCare.gov exchange is nearly double that of states that set up their own public health insurance exchanges, data released by the CDC shows.In the first six months of 2017, HealthCare.gov states had an average uninsured rate of 16.1%, while states with their own exchanges—like California and Colorado—had an average uninsured rate of 8.3%. The disparity in coverage in states that use HealthCare.gov and those with state-based exchanges can be explained, at least in part, by Medicaid expansion. (Livingston, 11/20)

The percentage of Californians without health insurance reached a record low 6.8 percent during the first six months of 2017, according to new estimates from the U.S. Centers for Disease Control and Prevention. The figure, released Thursday, is down slightly from the 7.2 percent uninsured rate from a year ago, which was at the time a record low — and significantly lower than the 17 percent uninsured rate in 2013, before the Affordable Care Act took effect. (Ho, 11/20)

Michele S. Eberle was named the new executive director of the quasi-public state agency that administers the Maryland health exchange nearly three weeks into the annual open enrollment period for the insurance known as Obamacare. Eberle had been working as the chief operating officer for the Maryland Health Benefit Exchange since 2015 and was chosen by the board of directors on Monday. (Cohn, 11/20)

Governor Charlie Baker signed into law Monday a bill that will mandate many Massachusetts women receive free access to contraceptives — a direct response to President Trump’s efforts to roll back coverage. The bill, which the state House and Senate passed overwhelmingly, will require health insurance in Massachusetts to cover most contraceptive drugs, devices, and products without a copay — that is, at no direct cost to the women getting them. (Miller, 11/20)

Massachusetts Gov. Charlie Baker was expected to sign legislation on Monday that would cement in state law the Obama-era mandate for free birth control regardless of changes in federal policy or future repeal of the Affordable Care Act. The bill quickly sailed through the state legislature earlier this month, after President Trump signed an executive order in October allowing any company or nonprofit organization to opt out of providing coverage due to a religious or moral objection. (Raphelson, 11/20)

The top official at the Department of Veterans Affairs said he wants private-sector providers to play a larger role in veterans’ health care, a view likely to draw opposition for a Trump cabinet member who has enjoyed rare bipartisan support. David Shulkin said in an interview that he wants to make the VA’s hospital system compete with private-sector providers for military veteran customers, which he said would give veterans greater choice over their health care. (Kesling and Nicholas, 11/20)

A group of nonprofits is testing a new outreach program in Los Angeles County, dubbed Women Vets on Point, which aims to overcome the barriers keeping female veterans from connecting with services. Experts say there are many possible reasons women don’t avail themselves of veteran-specific resources. (Denkmann, 11/20)

Ten years ago, the average gram of meth available in the U.S. was 39% pure. Today, it is being sold in a nearly pure state, manufactured in Mexican "superlabs" and smuggled across the border to feed an epidemic of addiction. The drug is being peddled alongside fentanyl, a synthetic opioid 50 times stronger than heroin, and carfentanil, an elephant tranquilizer that can kill a human with just a speck or two. (Davis, 11/20)

Say you're a publicly-insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit. New research suggests you can do it the way most treatment-seeking addicts in the state do — by undergoing a medically-supervised "detoxification" that's difficult, expensive and highly prone to failure. (Healy, 11/20)

Roughly 8 million Americans are on long-term opioid therapy for chronic pain, and as many as a million are taking dangerously high doses, said Michael Von Korff, a senior researcher at the Kaiser Permanente Washington Health Research Institute. In the Medicare program alone, 500,000 patients were on high opioid doses in 2016, according to a 2017 report from the U.S. Department of Health and Human Services. Many health professionals, fearing sanctions or even the loss of their licenses following government cases against a handful of doctors, have been caught up in a broader crackdown sweeping the pharma industry. In 2016, the Centers for Disease Control and Prevention issued guidelines for treating chronic pain, warning doctors to avoid prescribing high opioid doses when possible. Doctors have been heeding the message. Since peaking in 2010, prescriptions for more dangerous, higher-dose opioids dropped 41 percent from 2010 to 2015, according to a CDC analysis. (Langreth, 11/21)

About a month ago, President Trump declared the opioid epidemic a public health emergency. He's spent a lot of time talking about the severity of the drug crisis. But he's spent less time outlining the specific steps he'll take to fight it. Today, a White House analysis declared that the true cost of the opioid epidemic in 2015 was more than half a trillion dollars. (Jochem, 11/20)

Kaiser Health News: Doctor’s Rx For A Stiff Knee: A Prescription For 90 Percocet Pills

I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number. When I got home and opened the package to take a pill, I discovered that there were 42 inside. (Andrews, 11/21)

A new way of genetically altering a patient’s cells to fight cancer has helped desperately ill people with leukemia when every other treatment had failed, researchers reported on Monday in the journal Nature Medicine. The new approach, still experimental, could eventually be given by itself or, more likely, be used in combination treatments — analogous to antiviral “cocktails” for H.I.V. or multidrug regimens of chemotherapy for cancer — to increase the odds of shutting down the disease. (Grady, 11/20)

John Dalman had been in the waiting room at a Loxahatchee, Fla., dermatology clinic for less than 15 minutes when he turned to his wife and told her they needed to leave. Now. “It was like a fight or flight impulse,” he said. His face numbed for skin-cancer surgery, Mr. Dalman, 69, sat surrounded by a half-dozen other patients with bandages on their faces, scalps, necks, arms and legs. (Hafner and Palmer, 11/20)

Our bodies are full of bugs. They’re everywhere, hanging out on our skin, reproducing in our gut, growing on the glistening surface of our eyes. These bacteria, it turns out, don’t just beget other bacteria. They also beget scientific paper after scientific paper, which, in turn, beget headline after headline. But for all our talk of microbiomes, we aren’t all that great at shaping them, says Dr. Timothy Lu, an associate professor of biological engineering and electrical engineering at the Massachusetts Institute of Technology. (Boodman, 11/21)

Pregnant women might increase their risk of a stillbirth if they sleep on their backs during their third trimester, a new study has found. The research, published Monday in the British Journal of Obstetrics and Gynaecology, is the largest of its kind and the clearest evidence yet that sleeping conditions during pregnancy could have significant effects on the fetus. (Wan, 11/20)

Decades after they were banned from the airwaves, Big Tobacco companies return to prime-time television this weekend — but not by choice. Under court order, the tobacco industry for the first time will be forced to advertise the deadly, addictive effects of smoking, more than 11 years after a judge ruled that the companies had misled the public about the dangers of cigarettes. (Perrone, 11/21)

Dietary supplements make lots of claims and consumers often believe them: The booming U.S. industry has grown from $9 billion in sales in 2007 to $15 billion this year, according to Euromonitor International, a market research firm. But a new study gives ammunition to critics of the supplements and their potential health risks. (Reddy, 11/20)

Finding the perfect doctor can be a feat for anyone. And a poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health finds that 18 percent of all LGBTQ Americans refrain from seeing a physician for fear of discrimination. One of those people is 20-year-old Alex Galvan. The moment right before he told his doctor earlier this year that he is gay and sexually active felt like a nightmare. (Romero, 11/21)

Research investigating a popular form of surgery aimed at easing chronic shoulder pain doesn't fix the problem, a careful, placebo-controlled study suggests. In the condition known as shoulder impingement, certain movements, such as reaching up to get something off a shelf, for example, or even scratching your own back can be painful and get worse during a night of tossing and turning. (Neighmond, 11/20)

A little spit may help predict whether a child's concussion symptoms will subside in days or persist for weeks. A test that measures fragments of genetic material in saliva was nearly 90 percent accurate in identifying children and adolescents whose symptoms persisted for at least a month, according to a study published Monday in JAMA Pediatrics. That's in contrast to a concussion survey commonly used by doctors that was right less than 70 percent of the time. (Hamilton, 11/20)

For the Black Friday faithful, the excitement begins on Thanksgiving, when eager shoppers line up outside big box and department stores for the chance to grab “doorbuster” sales and “prices slashed” merchandise when the doors open. Black Friday videos posted in recent years show shoppers shoving and shouting, with one temporary worker even trampled to death in 2008. What turns ordinary shoppers into dangerous mobs? Social scientists and psychologists are trying to find out. (Luccheshi, 11/21)

A clinical trial that involved Emory University and Grady Memorial Hospital may help produce an effective treatment for thousands of stroke victims nationally. For patients suffering a stroke, which occurs when blood flow to an area of brain is cut off, current guidelines recommend blood clot removal only within six hours of the onset of the event. (Miller, 11/20)

Mayor Bill de Blasio said on Monday that he expected a federal monitor could be appointed to supervise the city’s vast Housing Authority, as he acknowledged that the city had failed for years to do required lead-paint inspections in thousands of public-housing apartments. “There was no attempt to deceive,” the mayor said at a news conference in Queens. “We’ve been able to get a fuller picture and what happened should not have happened.” (Goodman and Neuman, 11/20)

New York City Mayor Bill de Blasio said he was increasing controls in the city’s public housing authority on Monday, nearly one week after a watchdog agency revealed that the housing authority hadn’t conducted inspections of lead paint required by federal and state rules for four years. “What happened should not have happened and will not happen again,” Mr. de Blasio said at a news conference in Queens on Monday, where he spoke publicly for the first time since a Department of Investigation report last week outlining the lapses. (Gay, 11/20)

Chemicals once used by 3M Co. for Scotchgard, fire retardants and other products have shown links to cancers and premature births, Minnesota’s State Attorney General said in a request to update a $5 billion lawsuit against the company. Minnesota, which initially sued in state court for natural-resource damages in 2010, is now seeking punitive damages as well, it said in court filings on Nov. 17. Elevated levels of cancers, leukemia, premature births and lower fertility have been found in the suburbs east of St. Paul, Minnesota where 3M dumped the chemicals for more than 40 years, the state said. 3M also concealed health risks from regulators and distorted science on the chemicals, according to the filing. (Kary, 11/20)

Minnesota Attorney General Lori Swanson says toxic chemicals dumped by 3M Co. in the east metro suburb Oakdale caused higher rates of cancer, infertility and low birthweight babies — the first time anyone has estimated the potential human health impact of groundwater contamination in the area since the problem came to light almost two decades ago. (Marcotty, 11/21)

Rochester, Minn.-based Mayo Clinic more than doubled its operating income in the third quarter to $182 million, up from $86 million in the third quarter of last year. An increase in expenses to $2.79 billion, up from $2.63 billion, related to higher labor, supplies and services costs, did not offset its revenue gains, according to its third-quarter earnings report. The highly touted health system saw its total revenue increase to $2.97 billion, up from $2.72 billion, driven by a boost in patient revenue and positive returns on investment. (Kacik, 11/20)

The CEO of Nashville General Hospital at Meharry thinks closing in-patient services would be detrimental to its mission but said that change, given the mayor's push, is necessary. A proposal by Mayor Megan Barry to transition the city-owned hospital into an ambulatory surgery center and outpatient clinic — a vision that preceded her tenure as mayor — could derail Joseph Webb's plan of strengthening the coordination of care to improve people's long-term health. (Fletcher, 11/20)

Kaiser Health News: Displaced Puerto Ricans Face Obstacles Getting Health Care

The federal government has granted people affected by the devastating hurricanes that wracked coastal states and Puerto Rico 15 extra days to sign up for health coverage under the Affordable Care Act. But Puerto Ricans who fled to the mainland after the destruction face problems well beyond timing. (Andalo, 11/21)

Universal Health Services Inc. was the big winner in New Jersey’s largest expansion of its inpatient psychiatric capacity in 20 years, securing the right to add 336 beds, 41 percent of the 811 approved by the state’s Department of Health. The King of Prussia company, which is the largest U.S. operator of behavioral health facilities and which has long been dogged by federal investigations of potential billing fraud, told the state it planned to open two new 120-bed facilities, in Passaic and Monmouth Counties. It also said it would expand hospitals in Burlington and Union Counties by 48 beds each. (Brubaker, 11/20)

About 300 employees of Duluth-based Essentia Health could lose their jobs for refusing to comply with the company's new mandatory flu shot policy. Monday is the deadline for the company's 15,000 employees to get the vaccine, or receive a medical or religious exemption. (Kraker, 11/20)

UC Davis Health and Sacramento County said Monday that they have reached a settlement agreement of a pending university lawsuit over county payments for health care administered to county indigent residents and jail inmates. (Glover, 11/20)

The consulting company that recently lost its contract to run the District’s public hospital will stay on for up to two months as the hospital’s board seeks a new management company to take over, board members decided Monday. The unanimous vote by United Medical Center’s directors means that Veritas of Washington, which has overseen since 2016 the financially troubled hospital’s operations for a monthly fee of $300,000, could remain in charge through the end of 2017. (Jamison, 11/20)

A Vermont man and his companion have been charged with manslaughter and Medicare fraud after authorities say his severely disabled son died of septic shock from infected bed sores in which his skin was “rotting away.” Fifty-one-year-old Jeffrey Kittredge and 42-year-old Jennifer Cote, of Montpelier, pleaded not guilty last week to charges in the July 2016 death of 20-year-old Jeffrey A. Kittredge II. (11/20)

New profiles of each of Cleveland's 17 wards confirms what many people would expect: the city is wrestling with a host of problems ranging from poverty and unaffordable housing to high rates for teen pregnancy and, in some cases, lack of health insurance. (Higgs, 11/20)

Millicent Graves will get a raise from Social Security next year, but her household budget will get worse, not better. The 2 percent cost-of-living adjustment (COLA) announced by Social Security for 2018 last month will boost Graves’ monthly benefit by $20.70. But in reality, that increase will be wiped out by a higher Medicare Part B premium, which will be deducted from her Social Security benefit. (Mark Miller, 11/20)

According to the Congressional Budget Office, the GOP tax bill will instantly trigger $400 billion in automatic cuts to Medicare in the next ten years, including $25 billion in the first year after enactment alone. These cuts are the result of a law known as Statutory PAYGO. That law requires an automatic cut in spending when Congress increases the deficit. ... To be clear: If the tax bill passes the Senate and is signed into law by Donald Trump, nothing more needs to be done to cut Medicare. If the House and Senate do nothing, the cuts take effect immediately after the end of the Congressional session and get bigger with every passing year. A vote for this tax bill is a vote to cut Medicare. (Nancy Altman and Linda Benesch, 11/20)

Republicans once again are trying to overturn the Affordable Care Act, this time by repealing the individual mandate as part of the Senate’s broader tax bill. In lieu of pushing for a repeal — which would do far more harm than good, given how many healthy people it would drive from the market — the GOP should implement what’s working in the states where Obamacare is successful. (Jennifer Fitzgerald, 11/20)

Healthcare industry groups and many policy experts warn that eliminating the law's mandate will cause healthier people to drop coverage, driving up premiums, unraveling the individual insurance market and leading to more uncompensated care. So why don't Republican and Democratic senators who are pushing legislation to stabilize the market add a replacement mechanism in their bill to prod consumers to buy and keep coverage? (Harris Meyer, 11/20)

These days, it seems as if mass shootings in the U.S. are occurring with increasing frequency and producing ever higher death tolls. Did we say "seems"? Actually, that impression is the truth. William P. Gardner has compiled the data in graph form, and they show a distinct increase in the frequency of mass killings — or, to put it another way, a steady decrease in the number of days between mass shootings. (Michael Hiltzik, 11/20)

The decision last week by the Arizona Supreme Court makes a bunch of current and former Republican lawmakers and their Scrooge-like lawyers at The Goldwater Institute VERY unhappy. They would have loved for the court to say that the state’s Medicaid expansion program is unconstitutional and should be dissolved. (EJ Montini, 11/20)

Often when I’m denying my kids something they want me to buy they will joke, “Can’t wait to put you in a nursing home.” To which I reply, “That’s why I’m saving for my own retirement.” But the fact is, I may need to live in a nursing home someday. And when I think of that possibility, the next question I fear: What if my stay is so long that I run out of money? The answer is I might be put out. And this is a national problem, according to AARP, which has become involved in a California case that is worth following. (Michelle Singletary, 11/20)

If California doctors won’t take Medi-Cal patients, why not let out-of-state physicians provide services? Rents and salaries are lower in some states, which is why call centers are in the Midwest. (Shirley Svorny, 11/20)