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A record number of people signed up for ObamaCare in the first few days of open enrollment this year compared to the same period in previous years, several sources close to the process told The Hill. The surge in sign-ups, which was confirmed by an administration official, comes despite fears from Democrats that enrollment would fall off due to the Trump administration's cutbacks in outreach and advertising. (Sullivan, 11/6)

More than 200,000 Americans chose a plan on Nov. 1, the day open enrollment began, according to one administration official. That’s more than double the number of consumers who signed up on the first day of enrollment last year. More than 1 million people visited HeathCare.gov, the official federal website, the official said, which amounts to roughly a 33 percent increase in traffic compared with 2016. These figures capture only a portion of the nation’s overall ACA enrollment, because they encompass states that either use the federal health-care marketplace or rely on its website for their consumers to sign up for coverage. More than a dozen states and the District of Columbia run their own programs and do not use HealthCare.gov. (Eilperin, 11/6)

It's open enrollment for Americans buying health insurance through the exchanges under the Affordable Care Act. This year's enrollment period has been cut in half, and some consumers may face higher premiums because the Trump administration has discontinued cost-sharing payments that used to subsidize insurance providers for covering low-income customers. (Chakrabarti, 11/6)

President Donald Trump's 90 percent cut to Obamacare advertising has U.S. health insurers in many states digging deeper into their pockets to get the word out about 2018 enrollment, which opened last week. Independence Blue Cross, a health insurer in Pennsylvania, has commissioned a tractor trailer truck to bring insurance consultants out to shopping centers and other neighborhood spots around Philadelphia. (Humer, 11/6)

Holly Monger seems like an unlikely candidate for short-term health insurance, the type of just-in-case policy known for being cheap and skimpy. She's self-employed, helping clients wade through mountains of medical bills to appeal on their behalf or to educate them about health insurance options. When it came to buying her own plan, the Obamacare public health insurance exchange was too expensive, Monger says. So last year she bought a short-term policy with a roughly $400 monthly premium, less than half the cost of a private plan she looked at. She'll pay the $695 federal tax penalty, too, since her plan doesn't meet the requirements of the Affordable Care Act; it doesn't cover preventive care, for example. (Schorsch, 11/6)

If you get health insurance from your employer, you have to make decision every year about which coverage to choose. So here is a warning: If you are simply sticking with an old plan with a low deductible, that may well be a wrong and costly choice. ... Because of human quirks, lack of understanding and overly complicated plans, many people are paying more without getting anything extra in return. (Thaler, 11/4)

Doing a thorough comparison of health care plans is difficult. But there is an imperfect, yet fairly, simple way to check whether a high-deductible plan might qualify for “no-brainer” status, meaning, it enables you to save on health care no matter how often you go to the doctor. Here’s how to do it. (Thaler, 11/4)

The House is unlikely to repeal the mandate to buy insurance under ObamaCare as part of its tax-reform bill, GOP sources say, though the issue could return down the road. President Trump and conservative lawmakers are pushing for the individual mandate to be repealed in the bill, but House Ways and Means Committee Chairman Kevin Brady (R-Texas) has expressed worry that the controversial measure would jeopardize the broader tax-reform bill, given the Senate’s failure on health care earlier this year. (Wong and Sullivan, 11/6)

Ways and Means Committee Chairman Kevin Brady told reporters Monday night that an emerging bipartisan agreement to delay some medical care taxes could include changes to health savings accounts. “We are working with our Democrats on a bipartisan agreement on the medical device tax and health insurance tax, and perhaps HSAs as well,” the Texas Republican said Monday night. “And we expect that to be part of the discussion on CHIP and teaching health centers and all that." (McIntire, 11/6)

White House officials have prepared an executive order that would weaken the Affordable Care Act’s requirement that taxpayers demonstrate proof of insurance, according to people briefed on the matter, suggesting they will issue it if congressional Republicans cannot achieve the same goal through the tax reform process. President Trump supports abolishing the insurance requirement, called the individual mandate, but he cannot eliminate it unilaterally because it is enshrined in law. Given that several Republican bills aimed at unraveling the ACA have failed, Trump and his deputies are now seeking other ways to scale back the requirement for health-care coverage. (Eilperin and Sullivan, 11/6)

The White House is reportedly preparing an executive order to weaken ObamaCare’s individual mandate in the event congressional Republicans don’t include the measure in the tax-reform bill. According to the Washington Examiner and The Washington Post, the draft executive order would seek to broaden the “hardship exemptions” to the requirement that taxpayers must demonstrate proof of insurance or pay a fine. (Weixel, 11/6)

President Donald Trump called the Texas church shootings gunman “deranged,” the New York bike path attacker “a very sick and deranged person,” and the Las Vegas massacre shooter “a sick, demented man.” It’s a common reaction to mass violence — who in their right mind would commit these senseless crimes? The truth is more nuanced. (Tanner, 11/6)

President Trump on Monday attributed the slaughter of 26 people in a Texas church — the nation’s third mass killing in five weeks — to “a mental health problem,” saying it wasn’t a “guns situation.” ...Critics say blaming mass killings on “mental health problems” is not only medically inaccurate, it is politically disingenuous — a “fig leaf,” to make it appear that Trump is doing something about gun violence. (Garofoli, 11/6)

In the wake of the massacre at a small-town Texas church on Sunday, many people are asking why. We know that a large portion of the mass shootings in the U.S. in recent years have roots in domestic violence against partners and family members. Depending on how you count, it could be upwards of 50 percent. (Fulton, 11/7)

If the purpose of a gun is to inflict serious damage to a body, then these weapons have become increasingly effective, new research shows. An analysis of U.S. hospital records shows that gun injuries bad enough to land a victim in the hospital grew more severe over the course of two decades. Wounds involving "serious open fractures" — trauma that pairs a break in the skin with a broken bone — increased by 0.61% per year between 1993 and 2013. Meanwhile, gun injuries classified as "minor" fell by 0.74% per year during the study period. (Kaplan, 11/6)

Ricky Hurst’s doctors told him last year that there was nothing more they could do. His heart was failing and he should get his affairs in order. The end was coming. His family gathered. He spoke to his pastor and resigned himself to death. “If it was meant to be, it was meant to be,” he said. (Kolata, 11/6)

A bipartisan group of four senators on Monday introduced a bill they say would better align Alzheimer’s treatment and prevention strategies with public health approaches for other chronic health conditions, allowing the Centers for Disease Control and Prevention to “create a modern infrastructure for the prevention, treatment, and care of Alzheimer’s and related dementias.” The legislation, authored by Sens. Susan Collins (R-Maine), Catherine Cortez Masto (D-Nev.), Shelley Moore Capito (R-W.Va.), and Tim Kaine (D-Va.), focuses on improving early detection mechanisms, local health program coordination, and data-gathering operations. (Facher, 11/6)

Scientists in California think they may have found a way to transplant insulin-producing cells into diabetic patients who lack those cells — and protect the little insulin-producers from immune rejection. Their system, one of several promising approaches under development, hasn't yet been tested in people. But if it works, it could make living with diabetes much less of a burden. For now, patients with Type-1 diabetes have to regularly test their blood sugar levels, and inject themselves with insulin when it's needed. (Palca, 11/6)

When people don't get enough sleep, certain brain cells literally slow down. A study that recorded directly from neurons in the brains of 12 people found that sleep deprivation causes the bursts of electrical activity that brain cells use to communicate to become slower and weaker, a team reports online Monday in Nature Medicine. (Hamilton, 11/6)

Being able to connect with doctors online during pregnancy about vaccine concerns may encourage new mothers to make sure their babies get all the recommended shots, according to a new study in Colorado. Researchers at the Kaiser Permanente Colorado Institute for Health Research found that, when moms-to-be were able to ask questions of doctors and other experts through a specially made website, their children were significantly more likely to be fully vaccinated after six months than if the moms weren’t given the option of online interaction. (Ingold, 11/6)

The floodgates for direct-to-consumer genetic tests are swinging wide open. The Food and Drug Administration plans on loosening many of the regulations surrounding genetic health risk tests, or GHRs, according to a statement Monday from Commissioner Scott Gottlieb. It’s a change of course for the agency, which in 2013 put a freeze on direct-to-consumer marketing of genetic tests for health conditions. Since then, the FDA has generally been approving tests one by one before they hit the market. (Keshavan, 11/6)

Minuscule blobs of human brain tissue have come a long way in the four years since scientists in Vienna discovered how to create them from stem cells. The most advanced of these human brain organoids — no bigger than a lentil and, until now, existing only in test tubes — pulse with the kind of electrical activity that animates actual brains. They give birth to new neurons, much like full-blown brains. And they develop the six layers of the human cortex, the region responsible for thought, speech, judgment, and other advanced cognitive functions. (Begley, 11/6)

Kaiser Health News: Beyond Stigma And Bias, Many Transgender People Struggle With Mental Health

Diana Feliz Oliva, a 45-year-old transgender woman who grew up outside Fresno, Calif., remembers being bullied when she was younger and feeling confused about her gender identity. She was depressed and fearful about being found out, and she prayed every night for God to take her while she slept. “I was living in turmoil,” said Oliva, who now works as health program manager in a clinic for transgender people at St. John’s Well Child & Family Center in Los Angeles. “Every morning, I would wake up and I knew I would have to endure another day.” (Gorman, 11/7)

Tenet Healthcare Corp., Dallas, reported a net loss from continuing operations in the third quarter of $366 million, up from a loss of $9 million a year earlier. Same-hospital patient revenue fell 2.3% to $3.777 billion from $3.867 in the same respective periods, according to the company. (Barr, 11/6)

Shares of Dallas-based hospital operator Tenet Healthcare continued to dip in after hours trading on Monday as the company reported a third quarter loss of $367 million. That’s about 45 times higher than the loss reported at the same time last year. The company slashed its annual earnings outlook by about $50 million. At $12.65 per share, the ailing health care company’s stock is at a five-year low. (Rice, 11/6)

A year ago, California officials appeared to be coming down hard on doctors and parents who were reluctant to vaccinate children. The state had just implemented one of the strictest vaccination laws in the nation. The medical board was threatening to pull the license of Dr. Robert Sears, a celebrity in the anti-vaccine community. One vaccine skeptic called the case against Sears “a shot across all the doctors’ bows.” (Karlamangla, 11/6)

More than a month after Hurricane Irma tore through the Florida Keys, Lower Keys Medical Center is still grappling with its aftermath. About 5% of the facility's employees still haven't returned after the storm devastated the Keys and flattened their homes. Another 28 employees lost everything. The majority of those employees are shuffling from one hotel to the next, while Lower Keys Medical does what it can to find them shelter. (Livingston, 11/4)

Two more high-ranking former employees of the District’s only public hospital stepped forward Monday to criticize the firm running the facility, even as the company’s owner fought back on the eve of a high-stakes D.C. Council vote on whether it should continue to manage United Medical Center. Pamela Lee, the hospital’s former chief operating officer, and Stanley Pierre, its former quality director, said the consulting firm, Veritas of Washington, had taken steps to remove critical safeguards for patients — particularly by understaffing the department that ensures quality of care and compliance with state and federal laws. (Jamison, 11/6)

Kaiser Health News: Ohio’s Drug-Pricing Ballot Question Triggers Voter Confusion

Lawmakers in the nation’s capital have yet to grapple with rising drug costs, but Ohio voters are being asked — in a single ballot-box question next week — to figure out how best to lower the tab the state pays for prescriptions. The Drug Price Relief Act, better known as Ohio Issue 2, has been promoted and pilloried in a dizzying crush of robocalls, TV and radio ads, and direct mailings. (Luthra, 11/7)

Georgia employers’ health care costs are lower than the national average, a recent survey has found. And the survey — done by New York-based Mercer, the world’s largest human resources consulting company — finds that employers in the Peach State offer what are called “consumer-driven health plans’’ at a greater rate than their national counterparts. (Miller, 11/6)

Though the case count in San Diego's ongoing hepatitis A outbreak increased again Monday, officials said that the number of new infections continues to slow. In a presentation to the San Diego County Board of Supervisors, Dr. Wilma Wooten, the county's public health officer, showed a chart that indicated there were 31 cases in October, significantly fewer than the 81 reported in September and 94 in August — the largest total of the outbreak so far. (Sisson, 11/6)

An urgent care clinic owned by local emergency room physicians is on track to open in West Nashville later this month. Physicians Urgent Care will be open seven days a week for people who need treatment for minor issues for which an emergency room trip is not necessary, said Dr. Ty Babcock, managing partner and one of seven physician co-owners. (Fletcher, 11/6)

Minnesota's multi-drug resistant tuberculosis outbreak spread innocently enough, in part through hours of card games played by Hmong elders at a senior center in Ramsey County. Now, the outbreak is the largest of its kind in the nation, infecting 17 people across the state. (Yuen, 11/6)

As the deadliest fires in California history swept through leafy neighborhoods here, Kathleen Sarmento fled her home in the dark, drove to an evacuation center and began setting up a medical triage unit. Patients with burns and other severe injuries were dispatched to hospitals. She set about treating many people whose symptoms resulted from exposure to polluted air and heavy smoke. (Upton and Feder Ostrov, 11/7)

Two Cincinnati area hospital systems plan new facilities that could change how local residents get screened, diagnosed and treated for cancer. Here are some reasons for the evolving landscape, and what it means to you. (Saker, 11/6)

Many people suffer from brain injuries from falls, collisions or accidents — and finding a cure for those injuries has doctors stumped. The Brain Injury Research Lab at Hennepin County Medical Center is studying better ways to detect and treat brain injuries. (Weber, 11/6)

Two inmates died within four days of each other after each was transported to the hospital from an Orleans Parish jail facility, according to the Orleans Parish Sheriff's Office. The deaths do not appear to be related. The sheriff's office earlier on Monday issued a statement saying 27-year-old Evan Sullivan died Sunday (Nov. 5) at a hospital "of apparent natural causes," after he was taken there from the jail. Hours later, The New Orleans Advocate reported a second inmate had died in recent days. The agency then issued a second news release with information about that death. (Lane, 11/6)

As of this academic year, students in high-school health classes across Ohio are being exposed to information about organ donation, thanks to a new state law that requires the education. While such lessons have been available in some schools for years, this is the first time they’re required by the state, said Jenny Hudak, who heads up community education outreach for Lifeline of Ohio. (Viviano, 11/6)

A Grapevine-based medical real estate company is building a $25 million medical complex in Garland. The North Garland Medical Center will be constructed by New Era Partners at 7217 Telecom Parkway. The 3-story 95,000 square foot of healthcare development space will be built near Bush Turnpike at Lookout Drive and Telecom Parkway. (Brown, 11/6)

An environmental response team responded to the Cincinnati VA Medical Center last week after mercury leaked out of an old pipe that was moved during construction. ...The mercury spill is the latest minor building failures at the Corryville hospital, which serves more than 44,000 veterans in Greater Cincinnati. (Brookbank, 11/6)

Buda voters on Tuesday will decide whether the Central Texas city should again add fluoride to its water supply. The widespread and decades-old practice of fluoridation — roughly two-thirds of Americans live in communities with fluoridated water supplies — is a federally recognized public health policy meant to curb tooth decay. (Riordan, 11/7)

Despite recent alarming revelations that children in 10 San Francisco and Oakland schools had been exposed to lead contamination well above federal safety standards, data from household water quality tests performed this year by the Bay Area’s two major utilities indicate that lead levels remain well below dangerous thresholds in the vast majority of the region’s homes. (Fracassa, 11/6)

There is an agonizing predictability to the mass shootings that regularly horrify the nation. The latest, in which 26 churchgoers were shot to death at Sunday worship in Texas, offered all the most cruel and terrifying characteristics. It was carried out by a disturbed individual with easy access to assault weapons adapted from military warfare and marketed in the spurious name of sportsmanship. (11/6)

President Trump’s suggestion that the tragedy in Texas is a mental health issue rather than a gun issue deserves more than an arrogant dismissal by gun control proponents. There are roughly 90 million gun owners in the U.S. who responsibly own firearms of all kinds. They didn’t harm anybody on Sunday, and indeed one of those citizens courageously grabbed his own rifle and opened fire on the killer, causing him to drop his rifle and flee the scene. We have tried numerous restrictive gun control measures, and none has lived up to sales pitches about preventing violence. (Alan M. Gottlieb, 11/6)

Americans may someday look back in shame at a time when their country was awash in guns, when every few weeks people were slaughtered en masse and when society repeatedly mourned its dead, even as it facilitated their murder with easy access to powerful weapons. ... As shocking as the killings are, equally shocking is that the nation’s political leaders do nothing to stop them. Now, these leaders even want to deny that gun violence has anything to do with … guns. (11/6)

"You never expect something like this,” said one official about Sunday’s mass shooting in the small Texas community of Sutherland Springs. “Unimaginable,” said a man whose parents were among the 26 people killed, along with a pregnant woman, an 18-month-old baby and a 14-year-old girl. Among the awful truths of what happened Sunday morning in a place where no one locks their doors is that gun violence is not unimaginable anywhere in this country. Mass shootings have become commonplace, and shootings far more so: Guns kill more than 30,000 people every year and injure roughly 80,000 more. Just as there was a last time (an outdoor musical festival a little more than a month ago in Las Vegas) and a this time (a rural Texas church), there will surely be a next time unless national lawmakers come to grips with the problem and take meaningful steps to stem the obscene and unfettered access to weapons of war. (11/6)

Standard advance directives are often not helpful for patients who develop dementia. Dementia is a unique disease from the standpoint of advance directives. ... Clinicians, perhaps unsure of the goals of care for such patients, often may continue to provide the same care they would have in the absence of dementia, without addressing whether plans should be adjusted. Clinicians and family members often find it easier to continue current treatment paths rather than having conversations about whether such care is what a person with dementia would have wanted. (Barak Gaster, Eric B. Larson and J. Randall Curtis, 11/6)

In 2015, one of us published a peer-reviewed study, together with colleagues at the University of California, San Francisco, replicating prior research from the US Food and Drug Administration (FDA) detecting a designer stimulant, β-methylphenylethylamine, in sports, weight loss, and “cognitive function” supplements sold in the United States. The confirmatory study prompted the FDA to take enforcement action against companies selling the stimulant as a dietary ingredient. One of the companies that received an FDA warning letter sued the study’s authors for $200 million in damages for libel, claiming, without supporting scientific evidence, that multiple statements in the article were false. ... The case is just a recent example of using litigation to target scientists. ... When lawsuits target scientists, it does not matter that plaintiffs almost never win. It does not even matter if the case goes to trial. The goal is to intimidate. (Nicolas Bagley, Aaron E. Carroll and Pieter A. Cohen, 11/6)

When I was 14 years old, my older brother Zach overdosed on heroin. It was, not surprisingly, the defining moment of my life; a moment when I came to appreciate the tremendous strength of my family, the vital importance of friends and the overwhelming compassion of my community. Eleven years later, the opioid crisis still feels visceral and raw; I watched my mentor and friend suffer through addiction, I cried endless tears after my time with him was forced into memory, and I’m reminded of him every time I meet new families suffering through the same. I know too well Zach’s struggle and the heartbreak of my family is not unique. In 2006, the year he died, 34,424 others died from an overdose as well. Last year, that agonizing statistic grew to over 64,000. (Connor Goddard, 11/5)

Along with West Virginia, New Hampshire, Kentucky and Rhode Island, Ohio is in the top-five list of states that have the highest rates of drug-overdose deaths. ...Repealing the Affordable Care Act and making deep cuts to Medicaid in the federal budget would take health care away from the more than 1 million Ohioans who got coverage under the ACA. (Phillip Krauss, 11/6)

At the end of the 20th century, Americans were worried about the dangers posed by crack cocaine. They didn’t realize that another drug menace would soon eclipse it. Prescription opioids were gaining favor as a tool against undertreated pain. No one foresaw where this would lead: to an epidemic of opioid overdoses that the nation is only starting to confront with the urgency it warrants. (11/4)

We can say two things for sure about the American workforce and its health insurance. First, more Americans are working past the traditional retirement age of 65. Second, more are taking advantage of employer insurance plans that include tax-exempt Health Savings Accounts. Add these two facts together, and you end up with a pitfall that could cost unwary American workers as much as $2,700 a year in tax exemptions if they exercise their right to enroll in Medicare at 65. That pitfall exists because of the confusing way HSAs interact with Medicare, and because many big employers fail to help their older employees deal with the potential complexities—or even to know about them. (Michael Hiltzik, 11/6)

Whenever I talk to physicians about outcomes that are worse than you’d expect, they are quick to point out that noncompliance — when a patient does not follow a course of treatment — is a major problem. Sometimes prescriptions aren’t filled. Other times they are, but patients don’t take the drugs as prescribed. All of this can lead to more than 100,000 deaths a year. (Aaron E. Carroll, 11/6)