�Թϲ�����

Michigan Consumers for Health Care, a nonprofit group, has enrolled thousands of people in health insurance under the Affordable Care Act and was honored last year as one of the nation’s top performers — a “super navigator” that would serve as a mentor to enrollment counselors in other states. So the group was stunned to learn from the Trump administration that its funds for assisting consumers ahead of the open enrollment period that begins Nov. 1 would be cut by 89 percent, to $129,900, from $1.2 million. (Pear, 10/9)

President Trump's planned executive order on ObamaCare is worrying supporters of the law and insurers, who fear it could undermine the stability of ObamaCare. Trump’s order, expected as soon as this week, would allow small businesses or other groups of people to band together to buy health insurance. Some fear that these Association Health Plans (AHPs) would not be subject to the same rules as ObamaCare plans, including those that protect people with pre-existing conditions. (Sullivan, 10/10)

For the time being at least, Congress is not going to repeal Obamacare. But President Trump knows there's a lot he can do on his own. There are reports that he’s going to issue an executive order this week, making it easier for insurers to sidestep ACA regulations and sell more bare bones, cheaper plans to healthier consumers. (Gorenstein, 10/9)

On Tuesday afternoon, Senate Republicans said they would not bring the latest attempt to repeal Obamacare to a vote, citing a lack of support among GOP senators. Here’s a look at all the other times the party’s attempts came to a standstill under President Trump. (Reiss, 10/10)

For the first time, rank-and-file Republicans are acknowledging Obamacare may never be repealed. After multiple failures to repeal the law, the White House and many GOP lawmakers are publicly promising to try again in early 2018. But privately, both House and Senate Republicans acknowledge they may never be able to deliver on their seven-year vow to scrap the law. (Haberkorn, 10/9)

Washington state sued President Donald Trump on Monday over his decision to let more employers claiming religious or moral objections opt out of providing no-cost birth control to women. State Attorney General Bob Ferguson, who successfully sued to block Trump's initial travel ban early this year, announced his latest lawsuit on Monday, three days after the new rules were issued. (Johnson, 10/9)

Charging the president with discrimination against women, the 30-page complaint claims the new rules violate equal-protection clauses and constitutional guarantees of religious freedom by allowing companies to use religious beliefs as a right to deny woman a federally entitled health benefit. (Lee, 10/9)

“President Trump’s contraception rules are unfair, unlawful, and unconstitutional,” Attorney General Bob Ferguson (D) said in a statement. “I refuse to let President Trump disregard our laws and our constitution in an effort to deny women access to contraception.” Ferguson alleges that the new rules, announced last week by Trump administration officials, violate the First Amendment by “requiring individuals to bear the burdens of religions to which they do not belong,” as well as the equal protection clause of the Fifth Amendment. (Carter, 10/9)

On Friday, the Trump administration issued new rules that allow a wide range of employers and insurers to be exempt from the Affordable Care Act's provision that grants women contraceptives without additional payments. The move may appeal to social conservatives who object to contraception, but is it a good idea from a medical perspective? Birth control pills, shots and other devices — especially the still-ubiquitous little pink or blue pills — are about much more than preventing pregnancy. Many women suffer from major hormonal fluctuations in their monthly cycle. (Cha, 10/9)

It is one of the few instances — maybe the only one, experts say — in which a drug maker agreed to pay individual patients who alleged that it had underplayed the addiction risk of its medications. A decade later, the smooth, stylish [Paul] Hanly has again set his sights on opioid manufacturers, this time on behalf of cities and counties in five states. The drug companies, those plaintiffs allege, sought to create a false perception around opioids, seeding a public health and safety crisis that has cost Hanly’s clients hundreds of millions of dollars. (Joseph, 10/10)

Pain and pleasure rank among nature’s strongest motivators, but when mixed, the two can become irresistible. This is how opioids brew a potent and deadly addiction in the brain. (Akpan and Griffin, 10/9)

With addictions and overdoses surging over the past two decades, recent CDC guidelines urge doctors to avoid or dramatically limit the use of legal painkillers. In Southern California, a group of Kaiser Permanente doctors has been helping chronic pain patients "step down" from high-dose opioids with the help of alternative therapies that work well for many. (Wise, 10/9)

First lady Melania Trump will visit a drug treatment center in West Virginia Tuesday amid the nation's ongoing opioid epidemic, CNN reported Monday. Trump will reportedly visit Lily's Place, a recovery center in Huntington, that provides medical care to infants exposed to drugs while in the womb. (Hellmann, 10/9)

Gov. Jerry Brown vetoed a measure on Monday that sought to curb escalating opioid addiction rates by creating a new state working group tasked with determining best practices in prescribing addictive drugs. The measure, Assembly Bill 715 by Assemblyman Jim Wood (D-Healdsburg), would have directed the state Department of Public Health to convene doctors, opioid addiction specialists and other experts to examine how painkillers are being prescribed to treat acute, short-term pain. (Mason, 10/9)

Wyoming’s county commissioners recently attended a discussion on opioid addiction with a representative from Kentucky, the state with the fifth highest rate of opioid overdoses in the country. Such rates haven't hit Wyoming yet. (Edwards, 10/9)

The hurricane that wreaked havoc on Puerto Rico last month has disrupted production of widely used intravenous solutions. Several prominent hospitals across the country are scrambling to find alternative supplies, change the way they administer drugs and devise backup plans to make the fluids themselves. The products affected are smaller-volume bags of sodium chloride, known as saline, and dextrose. These normally ubiquitous solutions are used to rehydrate patients and to dilute medications from antibiotics to painkillers to cancer drugs. Their manufacturer, Baxter International, has said that “multiple production days” were lost in the wake of Hurricane Maria, and it has set up an allocation system for hospitals based on past purchases. (McGinley, 10/9)

Anticipating a wave of hurricane migrants from Puerto Rico and the U.S. Virgin Islands, Florida health officials are advising doctors and others caring for evacuees to look out for health risks associated with the aftermath of storms, including bacterial infections, puncture wounds and diseases spread by mosquitoes and animal bites. (Chang, 10/9)

When the police arrived at the nursing home during Hurricane Harvey, more than a foot of water filled the one-story building — along with the stench of urine and feces. Volunteers with boats stood ready to remove the 70 frail residents, many of them in wheelchairs. But the man in charge of Lake Arthur Place nursing home in Port Arthur refused to allow the evacuation, according to a police affidavit detailing the incident. He had to be handcuffed before police and volunteers could begin taking the elderly to shelters and hospitals. (Langford and Hacker, 10/9)

Overall, suicide death rates for rural counties nationally (17.32 per 100,000 people) were higher than medium/small metropolitan counties (14.86) and large metropolitan counties (11.92), the CDC reported late last week. Dr. W. Vaughn McCall of the Medical College of Georgia (MCG) at Augusta University said Monday that there’s a growing disparity in the economic status of rural vs. urban residents. (Miller, 10/9)

Had Matthew Goodwin’s blood pressure been checked at age 3, when it should have been, he most likely would have been spared a medical emergency a year later. He spent two weeks in the pediatric intensive care unit while doctors tried to determine why his blood pressure had spiked off the charts following minor surgery. (Brody, 10/9)

While surgeons can remove tumors without removing a whole breast, spare nipples and skin, and begin reconstruction immediately after surgery using an implant or fat from a women’s own belly, the scars remain. They are often big, jagged lines women can see every time they look in the mirror. ...Most of the more than 230,000 women diagnosed with the cancer each year require surgery. It’s unclear how many surgeons are working to hide scars, which remains a relatively new approach, [Dr. Dona] Hobart said. (Cohn, 10/10)

On the website of the company Neurocore, an illustration of an anthropomorphized human brain, complete with hopeful eyes and a wide smile, is pumping iron. “A stronger brain makes anything possible,” says the tagline next to the cheery brain. This concept — body-building for the brain — is the premise behind the Michigan-based company’s popular therapy. Known as neurofeedback, the therapy is based on the idea that by monitoring and adjusting electromagnetic signals, or waves, emanating from the brain, people can improve their mood, for example, or alleviate a headache. (Furfaro, 10/9)

Aside from the flames themselves, smoke exposure is one of the biggest health hazards from wildfires. The problems can range from mild (stinging eyes and sore throat) to severe (an uptick in asthma attacks, heart attacks and even premature death). (Feibel, 10/10)

California lawmakers have passed legislation to reduce the penalty for those who knowingly or intentionally expose others to HIV without their knowledge, rolling back a law that mostly affected sex workers. The bill, SB 239, which was approved by the Democrat-controlled state legislature in September and signed into law by Governor Jerry Brown (D) on Friday, will lower the charges for these acts from a felony to a misdemeanor when the law goes into effect in 2018. The act of knowingly donating HIV-infected blood, also a felony now, will be decriminalized. (Rosenberg, 10/9)

These so-called “microhospitals” typically have eight to 10 inpatient beds and such core services as emergency care, outpatient services, labs, imaging and pharmacies, said John Palmer, spokesman for the Ohio Hospital Association. They target communities that might not need a full-blown facility. (Viviano, 10/10)

In Arapahoe County, there is plexiglass paneling on bunk beds. Jefferson County’s strategy involves flexible pens. And in Denver, it is tear-resistant sheets and blankets. Across the state, jails and prisons are employing an array of strategies to push back against rising inmate deaths and suicide attempts, a problem complicated by the state’s burgeoning mental health and opioid abuse crises. (Aguilar, 10/9)

The health insurance giant Anthem Blue Cross and Blue Shield is planning to change its guidelines for reimbursing imaging services like MRIs and CT scans, favoring freestanding outpatient clinics or imaging centers over hospitals. In a statement, the company said a subsidiary, AIM Specialty Health, will help “identify when hospital outpatient services for certain imaging tests, such as MRIs and CT scans, are medically unnecessary,” in which cases members can receive those services — frequently used to help in the diagnosis process — at free-standing centers instead. (O'Connor, 10/9)

A 46-year-old Bend woman who filed an $8.75 million lawsuit against her doctors -- claiming that for months they misread telltale signs that she was about to suffer cardiac arrest -- has dropped her 2016 lawsuit. Attorney Gordon Welborn said cardiac arrest victim Shelley Harding decided to withdraw her lawsuit against doctors Dana Rhode and Jeffrey Scott after it became clear she didn't have the evidence to prove her case. Welborn, who represented the doctors, said they both testified in pretrial depositions that they never heard Harding tell them, "I feel like I'm having a heart attack." (Green, 10/9)

Kaiser Health News: In Oregon, End-Of-Life Wishes Are Just A Click Away

Just four hours earlier, Sallie Cutler had been sharing Mother’s Day lunch with her mom, Alyce Cheatham. Then, that same evening, Cheatham, 96, landed in a Portland, Ore., emergency room, lethargic, unable to speak and paralyzed on her right side by a massive stroke. Cutler now admits her first impulse was to demand action. (Aleccia, 10/10)

The family of a stillborn baby discarded in Regions Hospital’s dirty laundry after staff promised to cremate the remains is suing the medical institution. The mother of the child, Esmeralda Hernandez, filed a lawsuit against the St. Paul hospital in Ramsey County District Court earlier this month along with several of her family members. The civil suit accuses Regions of reckless interference with a dead body. The family is seeking damages “far in excess of $50,000” for their ongoing pain related to the incident, according to legal documents. (Horner, 10/9)

Five months ago, a New Jersey health panel voted in favor of dramatically expanding the list of conditions that may be treated with cannabis. Chronic pain, Alzheimer’s, autism, anxiety, migraines, and other maladies should be added to the list of 13 ailments, said the panel of doctors and other health professionals. Before the panel reached this decision, it reviewed petitions submitted by 68 patients a year ago, and then held three hearings. At these hearings, patients pleaded for the right to use cannabis to alleviate various ailments. Many confided that they had tried cannabis and wanted to be able to use it legally because it had helped. (Hefler, 10/10)

The San Antonio Metropolitan Health District is holding a daylong forum Wednesday with community leaders and people living with HIV to discuss strategies to stop the spread of HIV infection in Bexar County. The number of people newly diagnosed with HIV has increased by more than 50 percent in the last decade, from 234 in 2006 to 360 last year. (Ravani, 10/9)

In 2015 and the years preceding, Halifax County came in almost dead last North Carolina’s county health rankings at 99 out of 100. The local medical community was alarmed by this rating, and by the number of people suffering complications from hypertension, cancer and heart disease. ...In response, Hardy said, the medical community formed the Roanoke Valley Community Health Initiative. The group talked about changing the healthcare landscape from caring for people who are already sick to preventing disease. An additional motivation was cost: Practicing “sick care” and treating chronic diseases is costly and patients didn’t always have the best insurance. (Knopf, 10/9)

Overdoses on synthetic cannabis sent people to the hospital in Minneapolis at least 60 times last week, causing hallucinations and violent behavior in some users, while leaving others nearly “comatose,” health officials said. The number of emergency calls involving suspected overdoses in the city was double that number, from midnight Sept. 29 through Sunday afternoon, officials said. (Jany, 10/9)

California marijuana growers north of San Francisco faced mandatory evacuation orders as well as potentially tens of millions of dollars in crop damage and loss amid widespread wildfires in Wine Country and surrounding areas. There might be anywhere from 3,000 to 9,000 cannabis gardens in Sonoma County, according to county surveys. (Downs, 10/9)

Still smarting from congressional Republicans’ abject failure to repeal the Affordable Care Act by legislative means, President Trump now reportedly is plotting a backdoor attack aimed at gutting the act’s most important consumer protections. An executive order expected to be issued sometime this week would expand the ability of small businesses to band together and create “association health plans.” On the surface, the idea looks like a means of offering employees of those businesses more options for health coverage; in reality, according to health reform experts, it would strip the ACA’s consumer safeguards from those plans. (Michael Hiltzik, 10/9)

President Donald Trump has already done a lot to sabotage the Affordable Care Act, whether it’s slashing the program’s advertising budget or threatening to cut off some payments that insurers need to cover their costs. Now Trump is thinking about using his executive authority to do something that could be even more damaging to the law ― and, arguably, more threatening to people who depend on it for coverage. Sometime in the next few days, according to a report in The Wall Street Journal, Trump is likely to instruct three key agencies to rewrite a series of regulations that affect health insurance. (Jonathan Cohn, 10/9)

President Trump has strongly hinted that new rules may be forthcoming imminently that would let many more people purchase "Short Term Health Insurance" and "Association Health Plans" instead of being largely confined to higher-priced plans that conform to all the requirements of the Affordable Care Act. Critics of this proposal argue that it would result in healthy people exiting the Exchanges established by the ACA, resulting in major insurer losses for 2018 and higher premiums or, frankly, collapse of many markets by 2019. Supporters of the proposal note that Obamacare has left individual health insurance unaffordable for large segments of the American public and that some alternative needs to be provided. ... There actually is a middle ground, though. ... Make the insurance alternatives (short term plans, association plans) more widely available, but do so only to persons for whom the Obamacare market has indeed become unaffordable. (Seth Chandler, 10/9)

Promising efforts to get a grip on medical costs have lately run into resistance from the Trump administration. The federal agency in charge of Medicare is moving to curtail new requirements that hospitals "bundle" medical charges for hip and knee replacements, rather than assess separate fees for each appointment. Efforts to arrange similar lump-sum payments for other procedures are to be stopped altogether. These changes are misguided on two counts. (10/9)

In a new rule about coverage of contraception, the Trump administration argues against the positives of birth control and highlights potential harms. But those claims don’t stand up to scrutiny. The new rule weakens the mandate for health coverage of contraception under the Affordable Care Act, giving more leeway to employers with religious or moral objections. (Aaron E. Carroll, 10/10)

Large majorities of Americans believe first-trimester abortions should be legal. But once pregnancy moves into the second trimester — that is, at 12 to 24 weeks — only 27% of Americans have a pro-choice position. These Gallup poll results mirror policy in most European nations, where abortion is legally restricted early in the second trimester. For years now, anti-abortion activists in the United States have been trying to establish similar restrictions at 20 weeks’ gestation. (Charles C. Camosy, 10/9)

Primary fights to the death over single payer will accomplish nothing good — including for those who want to pass single-payer. Parties do not expand through purges. (Richard North Patterson, 10/10)

The United States health care system has many problems, but it also promotes more innovation than its counterparts in other nations. That’s why discussions of remaking American health care often raise concerns about threats to innovation. But this fear is frequently misapplied and misunderstood. (Aaron E. Carroll and Austin Frakt, 10/9)

Who ultimately should be in charge of care at our nation’s hospitals — physicians or businesspeople? In January 2016, the board of directors at Tulare Regional Medical Center, a small community hospital in central California, voted to terminate the elected leaders of its medical staff office. Medical staff offices help ensure that patient needs are kept separate from business imperatives, such as increasing hospital profits. They have historically operated independently of hospital administrators. (Sandeep Jauhar, 10/10)

Generally speaking, according to World Health Organization statistics for 2015, the American rate of mortality from interpersonal violence is four times higher than the British. Americans are also 10 times more likely to die from cocaine use, and between two and three times more likely to die from drug abuse, poisonings, and intentional injuries. ... In any case, the Brits have their own idiosyncrasies when it comes to death. In 2015 they were five times more likely than Americans to die of the lung cancer known as mesothelioma, nearly three times more likely to die of oesophageal cancer, twice as likely to die of stomach cancer, and nearly twice as likely to die of prostate and bladder cancer. These figures are in line with a variety of studies showing that Britain is not the best place in the developed world to be diagnosed with cancer. (Niall Ferguson, 10/10)

Unfortunately, the doctor shortage will get worse quickly if the Deferred Action for Childhood Arrivals (DACA) program is ended .... the move could also be debilitating for our health-care system. DACA recipients are nurses, physician assistants, medical technicians, respiratory therapists and yes, doctors. In fact, more than 25 percent of America’s doctors are immigrants, and if DACA continues, the program will add roughly 5,400 physicians who would otherwise be ineligible to work in the United States over the next few decades. (Anirudh Rao, 10/10)

California doesn’t have enough doctors. By 2025, the state will be short about 4,700 primary-care physicians, according to a recent report from the UC San Francisco Healthforce Center. This will result in more people turning to costly emergency-room visits for routine care, it predicts. One solution is to expand the role of well-trained nurse practitioners, who can meet the basic healthcare needs of our growing population at a fraction of the cost of doctor visits. That’s what many other states are doing. (David Lazarus, 10/10)

While our medical system can usually fix the physical trauma, it is largely unprepared to address the emotional trauma that follows being a victim of an assault. Young patients are often discharged back into the same environment in which the injury occurred, with an ongoing risk for retaliation, re-injury, and sometimes even death. Boys and young men of color experience a disproportionate burden of assaults. (Rachel Myers, 10/9)

Another overdose issue is playing outside their shadow: the misuse of over-the-counter pain medicines like acetaminophen, aspirin, ibuprofen, naproxen, and others. These widely used “safe” medications can cause serious gastrointestinal bleeding; create stomach ulcers; damage the esophagus, intestine, and liver; and even kill. In the United States, misuse of these medications sends nearly 200,000 people to the hospital each year. (Charles Melbern Wilcox, 10/9)