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The Trump administration announced a new policy on Monday making it easier for states to circumvent coverage requirements and consumer protections in the Affordable Care Act. States could, for example, use federal funds to subsidize short-term insurance plans with skimpy benefits and fewer protections for people with pre-existing conditions. Coming two weeks before Election Day, the new policy appeared to be a political gift to Democrats, who are making health care a potent campaign theme. (Pear, 10/22)

Under guidance issued Monday by the Centers for Medicare and Medicaid Services (CMS), states seeking federal waivers to run their insurance marketplaces will be given much more leeway. That includes the ability to apply ACA subsidies to short-term and association health plans — two types of coverage the administration has expanded as a way of making cheaper plans available to those who want them. These plans don’t include coverage of certain “essential” benefits like mental-health services and prenatal care and they can refuse to cover people with preexisting conditions. (Winfield Cunningham, 10/22)

The new proposal from the Department of Health and Human Services and the Treasury Department would not explicitly scrap the law’s protections, which bar health plans from denying coverage to people with preexisting medical conditions. But the administration plan would dramatically reshape rules established by the 2010 law that were designed to prevent states from weakening these protections. (Levey, 10/22)

Health advocates say the new policy is the latest example of the Trump administration allowing states to wiggle around ObamaCare requirements. While Congress was unable to repeal the law, the waivers will allow states to enact policies that advocates say counter the law’s intentions. During a call with reporters, Verma said she has received “numerous” requests from states for a more flexible waiver policy. The new guidance will take effect immediately, Verma said, but will only impact health plans in 2020 and later. Open enrollment for 2019 begins Nov. 1. (Weixel, 10/22)

Red states have expressed interest in skirting Obamacare requirements. Iowa, facing an exodus of insurers, last year proposed a waiver that would have reduced financial support to lower-income health insurance shoppers and created new aid for middle-income individuals. Iowa Gov. Kim Reynolds withdrew the plan last October, complaining that the waiver rules were "inflexible." Verma declined to comment on whether specific states would seek waivers under the new policy. Conservative health policy experts hailed the administration's announcement. (Goldberg, 10/22)

Waivers that lead some residents to drop insurance coverage will no longer be a deal-breaker, according to the notice. States must ensure that a comparable number of people remain covered. But the flexibility and potential shifting of exchange members to association health plans could make it seem like more people have adequate healthcare coverage even though access is worse. "The Trump administration's new guidance on state ACA waivers opens the door to states creating parallel insurance markets attractive to healthier people, with lower premiums but fewer protections," Larry Levitt, senior vice president at the Kaiser Family Foundation tweeted. (Dickson, 10/22)

Democrats said the move contradicted Republicans’ claims that they want to protect people with pre-existing medical conditions from high premiums. “The American people should look at what Republicans are doing, rather than what they’re saying, when it comes to health care,” said Senate Minority Leader Chuck Schumer (D., N.Y.). “Just weeks before the election, Republicans are once again undermining protections for people with pre-existing conditions and sabotaging our health-care system.” (Hackman, 10/22)

Vulnerable Republicans across the country have been scrambling to say that they support pre-existing condition protections to try to fend off a potent line of Democratic attack, but Schumer and other Democrats argued Monday that the new rules undermined those claims. “The American people should look at what Republicans are doing, rather than what they’re saying, when it comes to health care,” Schumer said. The Democratic Senatorial Campaign Committee added that every Republican Senate candidate “should be forced to answer for this.” (Sullivan, 10/22)

Kaiser Health News: Marketplace Subsidies May Be Option In 2020 For Plans That Skirt Obamacare

Earlier in the year, the administration also approved a rule allowing businesses to band together in “associations” to buy health insurance to offer insurance to members. Critics fear that rule could expose consumers to coverage gaps or higher out-of-pocket costs because these plans would be classified as “large-group plans” and not have to meet some ACA requirements. The changes unveiled on Monday do not affect people who get their coverage through their jobs. (Galewitz and Appleby, 10/22)

While the guidance takes effect immediately, it won’t affect insurance until the 2020 plan year. Open enrollment for 2019 begins Nov. 1, so plans and prices are already set. (McIntire, 10/22)

The Trump administration is rolling out new options for small employers to use tax-free accounts for providing health coverage to workers, officials said Monday. The idea is to expand so-called "health reimbursement arrangements" to allow employees to buy their own individual health insurance policies. Employers could also pair the accounts with workplace health plans, allowing workers to use the money for additional benefits such as dental care. (10/22)

HRAs allow workers to purchase coverage using tax-free dollars. Currently, an HRA can only be used to reimburse an employee or dependents for certain qualified medical expenses. The Obama administration prohibited HRAs for large- and mid-sized companies, and the IRS previously said HRAs did not comply with ObamaCare coverage requirements. HRA contributions can only be tax-free if they are coupled with a health plan that meets ObamaCare’s coverage protections. (Weixel, 10/22)

Administration officials say they expect the proposed rule would offer more choices to employees, particularly those who work at small businesses who may only have one insurance plan option or who don't currently receive insurance through their employer. A senior administration official told reporters Monday evening that the proposed rule “dramatically increases choices for workers whose employers offer an HRA" by giving employers more options for providing health care to workers. Initial estimates suggest that 10 million employees could be affected by the HRA rule, including 1 million who could be newly insured, said Dan Kowalski, a counselor to the Treasury secretary. Offering these plans would count toward the requirement for most large employers to offer their workers health insurance under the 2010 health care law. (McIntire, 10/22)

L.G.B.T. activists mobilized a fast and fierce campaign that included a protest outside the White House on Monday to say transgender people cannot be expunged from society, in response to an unreleased Trump administration memo that proposes a strict definition of gender based on a person’s genitalia at birth. The existence of the draft memo, the administration’s latest effort to roll back the recognition and protection of transgender people under federal civil rights law, was reported by The New York Times on Sunday morning. (Mervosh and Hauser, 10/22)

"I feel very threatened, but I am absolutely resolute," Mara Keisling, executive director of the National Center for Transgender Rights, said at a news conference convened by more than a dozen activist leaders. "We will stand up and be resilient, and we will be here long after this administration is in the trash heap." The activist leaders, speaking amid posters reading "#Won'tBeErased", later addressed a protest rally outside the White House. (Crary and Alonso-Zaldivar, 10/22)

“I am livid, but clear-headed,” said Mara Keisling, executive director of the National Center for Transgender Equality, who spoke during a press conference at the headquarters for the Human Rights Campaign in Washington, D.C., before the march. “We will be here long after this administration is in the trash heap.” (Emma, 10/22)

L.A.’s LGBTQ leaders see the potential policy change as an effort to systematically undermine a national recognition of transgender people ushered in by the Obama White House. And while they aren’t surprised by the Trump administration’s effort to establish a strict legal definition of sex, they say they are still alarmed. Advocates fear the sweeping change would breed an increase in hate and violence toward transgender people, lead to new barriers in obtaining adequate healthcare and education, and induce a greater sense of hopelessness and isolation in a community that already exists on the farthest margins of society. (Newberry, 10/22)

Trump confirmed Monday that a policy change toward transgender people was under consideration but said that there is more than one way to approach the issue. He was not specific about the potential alternatives. “We’re looking at it. We have a lot of different concepts right now. They have a lot of different things happening with respect to transgender right now,” Trump said. “And we’re looking at it very seriously.” Asked about his promise to protect LGBT people, he replied: “You know what I’m doing? I’m protecting everybody.” (Meckler, Schmidt and Sun, 10/22)

Anatomy at birth may prompt a check in the "male" or "female" box on the birth certificate — but to doctors and scientists, sex and gender aren't always the same thing. The Trump administration purportedly is considering defining gender as determined by sex organs at birth, which if adopted could deny certain civil rights protections to an estimated 1.4 million transgender Americans. (Neergaard, 10/23)

A new report that the Trump administration hopes to legally define a person’s sex at birth — an unchangeable condition determined by genitalia — has prompted an outcry among the transgender community. But beyond the political implications — and fears that any such change could ultimately mean the end of civil rights protections for transgender people — the proposal raises fundamental questions about something else: biology. The proposal is “highly inaccurate and just an insult to science. Basic science,” said Rachel Levin, a Pomona College neuroscientist who studies the development of sex. (Thielking, 10/22)

Researchers who have studied gender issues and provided health care to people who do not fit the typical M/F pigeonholes said that the Trump administration’s latest plan to define gender goes beyond the limits of scientific knowledge. “The idea that a person’s sex is determined by their anatomy at birth is not true, and we’ve known that it’s not true for decades,” said Dr. Joshua D. Safer, an endocrinologist and executive director of the Center for Transgender Medicine and Surgery at Mount Sinai Health System in New York. He is also president of the United States Professional Association of Transgender Health. (Grady, 10/22)

For years, elected leaders in conservative states have resisted expanding Medicaid, the government health program for low-income Americans. Now voters in four of those states will decide the question directly. Ballot initiatives in Idaho, Utah, Nebraska, and Montana will test whether there’s a disconnect between politicians and voters over a program that insures 1 in 5 Americans at an annual cost of more than half a trillion dollars to federal and state governments. Advocates behind the measures in states carried by President Donald Trump in 2016 aim to distance Medicaid expansion from the law that makes it possible: the Affordable Care Act. (Tozzi, 10/22)

The midterm elections could bring sweeping changes to Medicaid, from possible eligibility expansions to new rules requiring low-income people to work, depending on voters’ choices for governors’ offices and state legislatures across the country. Medicaid covers more people than any other federally funded health program. (Williams, 10/22)

Democrats have seized on recent comments by Senate Majority Leader Mitch McConnell (R-Ky.) in a round of media interviews after the Treasury Department reported that the federal budget deficit increased 17 percent year over year, to $779 billion in fiscal 2018. “It’s disappointing, but it’s not a Republican problem,” McConnell told Bloomberg News on Oct. 16 when asked about the deficit announcement. “It’s a bipartisan problem: unwillingness to address the real drivers of the debt by doing anything to adjust those programs to the demographics of America in the future.” He added that by “entitlement reform,” he was “talking about Medicare, Social Security and Medicaid.” Cue the immediate outrage from the left. (Glenn Kessler, 10/23)

[U.S. Rep. David] Young is also being hit on health care issues, which are top of mind for Iowa voters. He’s voted to repeal the 2010 Affordable Care Act, including a 2017 bill that would have replaced it with a program with fewer health protections for people who buy insurance outside of their employer. The measure ultimately failed. The issue is central for [Democratic candidate Cindy] Axne and Democratic groups flooding the district’s television airwaves. Young has countered that he co-sponsored an amendment that he said would have offered safeguards for people with pre-existing conditions. Nonpartisan health care groups said at the time that the overall bill still would have hurt access to quality health insurance for people, including those with pre-existing conditions. (Rodriguez, 10/22)

Kris Kobach says his proposal to reform Kansas Medicaid could save the state $2 billion. At campaign events, the Republican nominee for governor touts the benefits of combining Medicaid with direct primary care, an unconventional payment system that avoids the bureaucracy of health insurance. But the people who gave Kobach the idea say they haven’t calculated that direct primary care would save $2 billion for Kansas Medicaid.  And Kobach’s campaign hasn’t provided an alternative source for that number. (Ujiyediin, 10/22)

When San Francisco’s homelessness problem swelled in the early 2000s, Gavin Newsom endorsed a radical plan for the famously liberal city. Then a San Francisco supervisor on the rise, Newsom proposed slashing the amount of welfare for single homeless adults and instead using the funds on shelters, housing and services. Called Care Not Cash, the program sought to stop welfare recipients from spending their monthly checks on heroin or alcohol. (Smith, 10/23)

Twenty minutes before the only scheduled 2018 California’s gubernatorial debate, Lt. Gov. Gavin Newsom rolled into the San Francisco parking garage in a black SUV. Through the tinted windows, a soft overhead light slightly illuminated the front-runner’s chiseled features and slicked-back hair. In a well-tailored blue suit and matching tie, Newsom strode to the elevator and casually leaned his tall frame against the corner, emerging on KQED radio’s third floor to banter with waiting reporters — the picture of a polished and confident front-runner. (Rinker, 10/22)

The Trump administration is eyeing a shake-up of its refugee operation — and scrutinizing its controversial director — as President Donald Trump steps up his call for another crackdown along the U.S.-Mexico border. A top official at the Department of Health and Human Services, which runs the refugee resettlement program, is conducting what she called a “top to bottom” review of the program, three months after the migrant crisis paralyzed the agency last summer. (Diamond, 10/23)

U.S. authorities have held some immigrant children who entered the country illegally and without a parent in a temporary "tent city" in Texas for months, violating a 20-year-old court order on how long minors can be detained, according to court filings by civil rights lawyers and immigration advocates. More than 500 children have been housed in tents near Tornillo, Texas since August, and 46 have been held there since June, according to a Friday court filing in Los Angeles federal court by civil rights organizations and advocacy groups representing migrant children. (Hals and Cooke, 10/22)

A Trump administration proposal aimed at immigrants who rely on government programs could lead to as many as 1.7 million children who need medical care leaving Medicaid and the Children’s Health Insurance Program, a new analysis shows. Health care experts warn that immigrant parents may remove their children from health programs because of fear and confusion over a recent proposed rule that would change so-called federal “public charge” policies, which affect people’s ability to obtain legal permanent residency. Even children who were born in the United States but whose parents are not citizens could be harmed. (Williams, 10/23)

The number of fatal drug overdoses nationwide has fallen for six consecutive months, fueling hopes that the downturn marks not just a reprieve but a long-lasting shift in the tide of the addiction crisis. Annual U.S. drug overdoses have been tracking upward for nearly four decades, and the rate of growth increased sharply in the last few years with the onset of the opioid epidemic. (Joseph, 10/23)

When she was in her early 20s, Nicole Veum says she made a lot of mistakes. “I was really sad and I didn’t want to feel my feelings,” she said. “I turned to the most natural way I could find to cover that all up, and I started using drugs: prescription pills, heroin for a little bit of time.” (Dembosky, 10/23)

An analysis by The Associated Press shows New Hampshire was slower than most other states in spending its first wave of emergency money from Congress to target the opioid crisis. But state officials said Monday the numbers don't accurately reflect the state's payment system, and that contracts are in place accounting for nearly all of the funds. (Ramer, 10/22)

Boston should consider banning marijuana and liquor stores from opening near addiction treatment centers, City Councilor Lydia Edwards said, prompting objections from industry groups that believe such “buffer zones” could be illegal. Edwards has called for a hearing on whether the city should impose buffer zones around treatment centers that would prevent new alcohol and marijuana stores from opening nearby. (Adams, 10/22)

A new and expanded Friendship House, the North Country’s only residential substance abuse treatment center, has officially opened. A ribbon-cutting ceremony for the facility was held Oct. 19, The center has 32 treatment rooms - 14 more than before - as well as a four-bed medical detoxification unit. (Koziol, 10/22)

New research found no benefit from two antipsychotic drugs used by hospitals to treat delirium in critically ill patients, the latest study to call into question a common but unproven medical practice. Delirious intensive-care patients who were treated with the drugs haloperidol and ziprasidone didn’t emerge from their confusion any sooner than those given a placebo, according to the study published online Monday in the New England Journal of Medicine. (Evans, 10/22)

"In some surveys up to 70 percent of patients [in the ICU] get these antipsychotics," says Dr. E. Wesley "Wes" Ely, an intensive care specialist at Vanderbilt University Medical Center. They're prescribed by "very good doctors at extremely good medical centers," he says. "Millions of people worldwide are getting these drugs to treat their delirium. "But the drugs can have serious side effects. And Ely says there is no solid research showing that they are effective at treating delirium. (Harris, 10/22)

A generation ago, depression was viewed as an unwanted guest: a gloomy presence that might appear in the wake of a loss or a grave disappointment and was slow to find the door. The people it haunted could acknowledge the poor company — I’ve been a little depressed since my father died — without worrying that they had become chronically ill. (Carey, 10/22)

The Ebola response teams in the Democratic Republic of the Congo are having increasing trouble keeping track of where the virus is spreading, a problem that threatens containment efforts and undermines the effectiveness of the vaccination program there. Public health officials had been hopeful that an experimental vaccine could help curb the spread of the outbreak. But, for that to happen, response teams must be able to identify people who have been in contact with Ebola patients. Persistent violence in the outbreak zone has made that hard to do. (Branswell, 10/23)

In the next 60 seconds, people around the world will purchase one million plastic bottles and two million plastic bags. By the end of the year, we will produce enough bubble wrap to encircle the Equator 10 times. Though it will take more than 1,000 years for most of these items to degrade, many will soon break apart into tiny shards known as microplastics, trillions of which have been showing up in the oceans, fish, tap water and even table salt. Now, we can add one more microplastic repository to the list: the human gut. (Quenqua, 10/22)

To reduce your risk of cancer, you know you should quit smoking, exercise regularly, wear sunscreen, and take advantage of screening tests. New research suggests another item might be added to this list: Choose organic foods over conventional ones. A study of nearly 70,000 French adults who were tracked for an average of 4.5 years found that those who ate the most organic foods were less likely to develop certain kinds of cancer than the people who ate the least. (Kaplan, 10/22)

Lavender bath bombs; lavender candles; deodorizing lavender sachets for your shoes, car or underwear drawer; lavender diffusers; lavender essential oils; even lavender chill pills for humans and dogs. And from Pinterest: 370 recipes for lavender desserts. Take a deep breath. Release. (Klein, 10/23)

Some hospital patients are heading home with a sheaf of prescriptions—and a bag of spinach and spaghetti squash. Invoking the mantra that food is medicine, hospitals across the country are taking measures to prevent and treat illness through diet. To nudge patients into eating well at home, they have opened food pantries that offer nutrition counseling and healthful fare. They are growing their own produce, adding farmers to the payroll and hosting greenmarkets. A few are even tiptoeing into the grocery business. (Lagnado, 10/22)

Flu season is coming and flu shot season is here. I teach in a journalism institute, and when I was doing my stint as director, welcoming the new graduate students in the fall, I always used to urge they get flu shots: You’ll be wandering all over the city, I would tell them, you’ll be interviewing people, you’ll be using communal keyboards — whatever else you do, get a flu shot. (Klass, 10/22)

Crème brûlée, mango, pumpkin spice. Those aren’t ice cream options, but flavors commonly added to a combination of liquidized nicotine, flavor additives and solvents that e-cigarette users pull into their lungs through devices that heat and vaporize the mixture. (Ovaska-Few, 10/22)

A U.S. judge on Monday affirmed a verdict against Bayer AG unit Monsanto that found its glyphosate-based weed-killers responsible for a man’s terminal cancer, sending the German company's shares down 8 percent. In a ruling by San Francisco's Superior Court of California, Judge Suzanne Bolanos said she would slash the punitive damages award to $39 million from $250 million if lawyers for school groundskeeper Dewayne Johnson agreed. (10/23)

Monsanto spokesman Daniel Childs said that the company was pleased with the reduced reward but still planned to appeal the verdict. Childs said there’s no scientific proof linking Roundup to cancer. The jury awarded punitive damages after it found that the St. Louis-based agribusiness had purposely ignored warnings and evidence that its popular Roundup product causes cancer, including Johnson’s lymphoma. Punitive damages are designed to punish companies that juries determine have purposely misbehaved and to deter others from operating similarly. (Elias, 10/22)

Bayer inherited thousands of Roundup-related lawsuits in its recently closed acquisition of Monsanto Co. and has worked to assuage investor concerns about potential liability from the litigation. The decision is the latest turn in the first Roundup case to go to trial, which resulted in an August verdict in favor of a groundskeeper who said prolonged use of glyphosate-based herbicides caused his non-Hodgkin lymphoma. (Randazzo and Bunge, 10/23)

Over the past three decades, the world has seen a steady decline in the number of women dying from childbirth. There’s been a notable outlier: the United States. Here the maternal mortality rate has been climbing, putting the United States in the unenviable company of Afghanistan, Lesotho and Swaziland as countries with rising rates. But that trend has been reversed in dramatic fashion in one state: California. The state Department of Public Health calculates that between 2006 and 2013, California lowered its maternal mortality rate by 55 percent from 16.9 to 7.3 deaths for every 100,000 live births, which translates to saving about one life in every 10,000 live births. (Ollove, 10/23)

The Department of Health and Human Services says it will receive a $1.85 million federal grant aimed at improving dental health. The funds, from the Centers for Disease Control and Prevention, will allow the state's oral health program to continue its school-based approach.That means bringing dental hygienists directly to kids at their school, says Oral Health Program director Hope Saltmarsh. (Garrova, 10/22)

Thousands of University of California medical workers began a three-day strike Tuesday against hospitals, clinics and campuses that prompted the rescheduling of thousands of surgeries and outpatient appointments. Picket lines were called for the five UC medical centers in Los Angeles, San Francisco, San Diego, Irvine and Davis. (10/23)

With lawyers for state inmates insisting that a secret report prepared by California’s top prison psychiatrist must be made public, attorneys in the case say more whistleblowers are beginning to come forward. The revelation came during a hearing in federal court in Sacramento on Monday, where U.S. District Judge Kimberly J. Mueller is wrestling with how to deal with a 160-page report compiled by Dr. Michael Golding, the top psychiatrist in the California Department of Corrections and Rehabilitation. (Stanton, 10/22)

For several years, UConn Health has been exploring the possibility of partnering with a private entity as a way of ensuring the long-term financial sustainability of the system. On Monday, the health system took the next necessary step in pursuing a public-private partnership by releasing a national “Solicitation of Interest” letter. The letter is a request for proposals from health organizations across the country interested in partnering with the Farmington-based health system. (Rigg, 10/22)

Every day, Mayra Garcia wakes up with the same thoughts. Is today going to be the day? Will she get the call telling her there’s a match for her young son? Will he finally get the bone marrow transplant to save his life? “It’s getting harder every day,” she said, fighting back tears. “He’s only a little kid. We need help.”Garcia, 31, who lives in Homestead with her husband Dany Morales, 34, said her life has been a constant waiting game since her 7-year-old son Julian was diagnosed with Dyskeratosis Congenita, a rare genetic disorder in which the marrow does not produce sufficient blood cells, when he was 3. (Teproff, 10/22)

New Hampshire Police Chiefs say a forthcoming report on marijuana legalization shows that now is a bad time to legalize recreational pot here. The Association of Chiefs of Police gathered in Concord on Monday to repeat its opposition.It comes as the legislative commission tasked with studying legalization, taxation and regulation of cannabis is wrapping up its report. (Tuohy, 10/22)

Six local U.S. veterans, including a Milpitas resident and a Willow Glen coach, received free Lasik surgery Oct. 17 as part of the annual Gift of Sight program provided by Furlong Vision Correction in San Jose. Milpitas resident Ethan Provost entered the U.S. Army in 2001 at age 22, serving in the 101st Airborne. He was deployed to Iraq for one year and South Korea for two years. Ethan operated and drove heavy equipment trucks and supplied military supplies in Tikrit, Iraq. His entire deployment was spent in convoys and vehicle maintenance. (Gelhaus, 10/21)

Less than three hours before a 5 p.m. deadline, Gov. Rick Scott’s administration Friday filed a notice to appeal a Tallahassee judge’s order that struck down a 2017 medical marijuana law as unconstitutional. The notice, filed at 2:36 p.m. Friday, came after Scott sought support from Republican legislators and the state’s marijuana operators to appeal Leon County Circuit Judge Charles Dodson’s decision that the 2017 law ran afoul of a voter-approved constitutional amendment. (10/22)

Almost everything a phone call to your doctor can accomplish, an online patient portal can do better and at any time of the day or night. That's the sentiment — and reality — from those on both sides of the patient-care equation in this age of electronic health records (EHR) and online access to everything from ahi tuna to zoo tickets. According to HealthIT.gov, the official website of the Office of the National Coordinator for Health Information Technology (ONC), a patient portal is a secure website that gives patients using a secure username and password convenient, 24-hour access to personal health information from anywhere with an Internet connection. (Terry, 10/22)

UC Davis Medical Center leaders announced last week that the institution once again claimed a place among the upper echelon of nursing employers – the top 8 percent in the United States, to be exact – after the American Nurses Credentialing Center renewed its magnet status. The magnet designation is given only to hospitals that stress giving their nursing staff the authority to make clinical decisions at patient bedsides, according to the credentialing organization, and nurses at these facilities are encouraged to be involved in decisions about the patient-care environment and to collaborate with team members from other disciplines. (Anderson, 10/22)

Four Timberlane Regional Middle School students were sickened after ingesting chocolates believed to have been laced with marijuana, officials said Monday. According to Superintendent Dr. Earl Metzler, the incident last Thursday required that one student to be sent to the hospital for evaluation while the other three were checked out by a school nurse and released to their parents. (Schreiber, 10/22)

This past week, Leader McConnell told the American people exactly what another two years of Republican control of the Senate would look like. If Republicans retain the majority, he said, there will be another attempt to repeal the health care law, which could result in 20 million fewer Americans with health insurance. He then defended the partisan lawsuit that could end protections for Americans with pre-existing conditions — a lawsuit supported by 20 Republican officials, including two attorneys general who are running for Senate seats. Finally, after Republicans already passed a law that blew a $2 trillion hole in the deficit to provide tax breaks to the wealthiest few and the biggest corporations, Leader McConnell said that Social Security, Medicaid, and Medicare need to be cut to reduce the growing deficit. (Senate Minority Leader Charles E. Schumer, 10/23)

What’s driving the enthusiasm on health care and protections for people with pre-existing conditions? The fact that Republicans have have taken a sledgehammer to the pre-existing conditions protections Democrats cemented in federal law.Republicans have taken a few steps  to destroy the pre-existing conditions protections that millions rely upon. Almost all Republicans in Congress have voted to repeal the Affordable Care Act, including its protections for people with pre-existing conditions. (Brad Woodhouse and Jim Duffett, 10/22)

As we have traveled around the country talking to small-business owners and American workers, we’ve consistently heard that health insurance is unaffordable and workers need more options. The data back up their concerns. As insurance costs have risen since 2010, the share of workers at firms with between three and 24 workers covered by employer health benefits has fallen from 44% to 30%. For firms that employ 25 to 49 workers, the share of workers covered by employer health benefits has fallen from 59% to 44%. Small businesses that continue to offer coverage to their workers generally only make a single plan available. In fact, 81% of small employers offering health benefits (those with fewer than 200 employees), and even 42% of large employers, provide only a single option for their employees. (Labor Secretary Alexander Acosta, Treasury Secretary Steven Mnuchin, and HHS Secretary Alex Azar, 10/22)

Without Medicaid, Amanda Gershon says, she would be dead. But she might have avoided a near-death illness had she been covered by Medicaid earlier. Gershon, 36, of Lincoln, Neb., suffers from ischemic colitis, chronic illnesses and pain in her hands, feet and joints. She was an example of the 63 percent of low-income adults a Government Accountability Office report said were left without needed health care in states that didn’t expand Medicaid. (Joe Davidson, 10/22)

(Alex) Azar must stand with science. One the one hand, a coalition of 64 medical organizations and universities, including the American Academy of Pediatrics and Harvard University, have called for preserving funding for fetal tissue research. On the other hand, a loose confederacy of organizations that aligns itself with the notion that women’s bodies have magical prophylactic properties that “shut down” to prevent pregnancy during a sexual assault wants fetal tissue research banned. Azar needs to stand with scientists over political special interests and abandon this extreme ideology, which will only hurt millions of people around the globe. (Mary Alice Carter, 10/23)

At this week’s tuberculosis meeting, participants will be able to see or hear approximately 1,000 scientific presentations. Sadly, only nine of them are focused on using mobile phones to improve tuberculosis care. It is past time for TB researchers and care providers to work with tech innovators, business entrepreneurs, digital companies, and mobile phone operators to adapt the smartphone technology to improve care. At next year’s meeting, I hope to hear presentations describing tuberculosis experts partnering with WhatsApp to raise awareness, with Vodafone to disseminate apps that help patients diagnose themselves, with Yelp to share the quality of their experiences with specific clinics, with Uber to transport clinical samples, and with Amazon to deliver medications directly to patient’s homes. (Peter Small, 10/23)

The people promoting the sitting scare may have been using other statistics, but it’s fair to say that there’s no scientific consensus that sitting is worse than smoking. The message wasn’t an invention of the media, Buman said, but came from researchers trying to raise awareness. Awareness is good, but overplaying a scare is only going to get people to tune out or distrust scientists. (Faye Flam, 10/22)

Most patients arriving at a hospital share the same hopes: Get treatment, get better, and get home. Oh, and maybe get a bill in the mail a few weeks later that doesn’t ruin the family finances. Those are the starting points to evaluate Question 1 on the Nov. 6 ballot, a controversial proposal that would require Massachusetts hospitals to hire thousands more of just one component of a hospital’s workforce: registered nurses. (10/22)

The day Melanie Gamboa showed up on the campus of Loaves & Fishes — her sister, her boyfriend and their four cats in tow — the staff of Maryhouse women’s shelter didn’t have anywhere to put them. As is typically the case in Sacramento, all of the emergency beds had already been filled by other homeless people. So, having nowhere else to go, the trio and their pets joined the huddled masses across the street. They pitched a tent and that’s where they stayed for weeks, until the night Gamboa fell out of her wheelchair and couldn’t get up. (Erika D. Smith, 10/22)