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David Branch knew that his job, helping people sign up for Obamacare, would be harder this year. But Mr. Branch didn’t fully realize the scope of his challenge until a group that he approached with his fliers insisted that the Affordable Care Act had been repealed. “They said: ‘Why are you guys here? Obamacare is done,’ ” Mr. Branch recalled Friday as he finished a training session here. (Goodnough and Pear, 10/31)

Two big blue states on opposite sides of the country have a mission: Save Obamacare. California and New York, which run their own health insurance exchanges and will spend tens of millions this year on marketing and outreach, don’t expect to have a stellar year in the sign-up season that starts Wednesday. (Colliver and Goldberg, 11/1)

Insurers, some states and former Obama administration officials are heavily promoting the Affordable Care Act (ACA) open enrollment that starts��Wednesday to make up for the lack of marketing��the law is getting by President Trump's administration. "We are as an industry doing everything we can," says Kelly Turek, an executive director with trade group America's Health Insurance Plans. (O'Donnell, 10/31)

Can a puppy video get you to buy health insurance through the Affordable Care Act exchanges? Florida Blue, a major insurer in that state, hopes the answer is yes. "It's hard to resist puppies, right? Let's just be honest," says Penny Shaffer, the insurer's South Florida regional market president, who talked to WLRN's Sammy Mack. In the video, puppies tumble while the announcer pitches, in Spanish, affordable plans and personalized service. (Grayson, 10/31)

Open enrollment began Wednesday for Minnesota shoppers who buy health insurance on their own, and the head of the state's health insurance exchange says Minnesota is well-positioned to help residents sign up for coverage amid the federal confusion about health care. (11/1)

The Trump administration has instituted several changes to ACA implementation, including cutting payments to insurers that help millions of lower-income Americans afford coverage — which has driven up premiums — and slashing advertising and outreach budgets. (Miller, 10/31)

Wednesday marks the beginning of open enrollment for Minnesotans buying health insurance on the individual market. Only about 170,000 Minnesotans buy insurance on that market — a small percentage of the state's population — but they've been a focus of the heath care debate because rates have increased dramatically in recent years. (Weber and Erickson, 10/31)

Now is the time to enroll in health insurance for 2018, whether you’re looking for Medicare, Medicaid, Affordable Care Act plans or — like more than half of Nebraskans and Iowans — employer-based coverage. Although health insurance details and sign-up dates vary, there’s one thing in common, even for TriCare, the government health system for military families: It’s up to you to find the best plan to fit your needs — and most people have only a few weeks to do that. (Jordan, 11/1)

A summer assault on the Affordable Care Act by the Trump administration and Congress has confused consumers as annual enrollment for the health-insurance program opens Wednesday. “Every year is a challenge, and this year we have a unique set of challenges,” said Michael Marchand, chief marketing officer and spokesman for the Washington Health Benefit Exchange, which runs the state’s health-insurance marketplace. (Blethen, 10/31)

The Trump administration’s efforts to undermine the Affordable Care Act have health care advocates and insurers concerned that the open enrollment period will be one of chaos and confusion. That’s not true everywhere.A dozen states operate their own health insurance marketplaces, maintaining control over advertising and the help they can offer consumers. That will create a striking difference when open enrollment begins Wednesday between those states and the others that rely on the federal marketplace, essentially creating a tale of two countries. (Potter, 10/29)

Kaiser Health News: Funding For ACA Sign-Up Campaigns Varies Widely From State To State

If you buy insurance on your own and have been paying attention to the Affordable Care Act, you’ve probably heard that open enrollment for 2018 plans has just started and the government is spending a lot less money this year to get the word out. That’s true in the 39 states that rely on healthcare.gov. But circumstances are different in some of the��11 states plus the District of Columbia��that run their own ACA websites and marketplaces. (Zdechlik, 11/1)

Wednesday marks the beginning of an enrollment period for the federal health insurance marketplace that will last half as long as previous years — but most people don’t know that. A Kaiser Family Foundation poll found that 75 percent of those who are already enrolled in a marketplace plan, and 95 percent of the uninsured, are unaware that the enrollment period ends this year on Dec. 15. (O'Connor, 10/31)

It’s time to shop for coverage again on HealthCare.gov, and for some it’ll mean steep increases and restrictive networks. Wednesday marks the fifth time consumers across the country can begin shopping for health insurance coverage through HealthCare.gov, a product of President Barack Obama’s landmark health bill. (Liss, 11/1)

Kaiser Health News: Timeline: Roadblocks To Affordable Care Act Enrollment

President Donald Trump’s decision last month to cut off payments to insurers for discounts they provide to some low-income people who buy individual health coverage was big news. But it was far from the first time the president and his administration have sought to deter enrollment on the insurance marketplaces set up by the Affordable Care Act. Enrollment for 2018 plans begins Nov. 1 and runs through Dec. 15. Over the course of the year, the administration has announced a variety of changes that affect sign-ups. (Rovner, 11/1)

For some lower-income people in Obamacare, the rising premiums President Donald Trump has talked so much about will barely be felt at all. Others, particularly those with higher incomes, will feel the sharp increases when insurance sign-ups begin Wednesday. Richard Taylor is one of the people on the wrong end. The 61-year-old, self-employed Oklahoman has meticulously tracked his medical costs since 1994. In 2013, he signed up for an Affordable Care Act plan for the law’s first year offering coverage to millions of Americans. (Rausch and Tracer, 11/1)

As open enrollment kicks off on Colorado’s health insurance exchange Wednesday, people who buy coverage on their own could be in for a surprise: dramatically lower prices for some and higher prices for others. While underlying premiums will climb more than 30 percent, in part because of a Trump administration decision to end key payments to insurers, what many people will actually end up paying is expected to drop. That’s because the amount available in federal tax credits to help pay premiums is also rising. (Ingold, 10/31)

Kaiser Health News: Rising Health Insurance Costs Frighten Some Early Retirees

Don and Debra Clark of Springfield, Mo., are glad they have health insurance. Don is 56 and Debra is 58. The Clarks say they know the risk of an unexpected illness or medical event is rising as they age and they must have coverage. Don is retired and Debra works part time a couple of days a week. As a result, along with about 20 million other Americans, they buy health insurance in the individual market — the one significantly altered by the Affordable Care Act (ACA). (Findlay, 11/1)

President Donald Trump is lashing out at Democrats in a new TV ad that incorrectly blames his critics in the opposing party for blocking fixes to the nation's health care system. The new ad, set to begin airing on cable stations nationwide on Tuesday, seizes on "skyrocketing" insurance premiums "all while Democrats in Washington, D.C., block a better plan to repeal and replace Obamacare once and for all — obstructing our president just to score political points with the radical left." (Peoples, 10/31)

A new ad from the Republican National Committee (RNC) claims ObamaCare is “failing," and blames Democrats for congressional Republicans' failure to repeal and replace the law earlier this year.��The ad points to "skyrocketing" insurance premiums as an example of ObamaCare failing, and hits Democrats for blocking “a better plan to repeal and replace Obamacare once and for all — obstructing our president just to score political points with the radical left.” (Weixel, 10/31)

Democrats say they have not had any negotiations with the White House about its demands for changes to a bipartisan ObamaCare fix, indicating a murky future for the legislation aimed a shoring up insurance markets.��Sen. Lamar Alexander (Tenn.), the lead Republican sponsor of the bill, said last week that he wanted the White House to negotiate with Democrats on the administration's proposed changes. Democrats at the time countered by pressuring GOP leaders to bring the bill up for a vote as it is. (Sullivan, 10/31)

House Ways and Means Chairman (R-Texas) is rejecting a push by Sen. (R-Ark.) to add��a repeal of ObamaCare’s individual mandate to tax reform.��Brady said in an interview with radio host Hugh Hewitt on Tuesday that he fears��the move could jeopardize tax reform, a concern held by many Republicans. (Sullivan, 10/31)

Two national advocacy groups filed a federal lawsuit in Indiana on Tuesday challenging a rule change by President Donald Trump's administration allowing more employers to opt out of no-cost birth control for workers. The suit was filed on behalf of five women at risk of being denied birth control coverage, including three University of Notre Dame students. (Crary, 10/31)

The University of Notre Dame is reportedly ending its free contraceptive coverage after the Trump administration rolled back an ObamaCare requirement that employers include birth control coverage in their health insurance plans.��The Catholic university��will stop��the coverage starting on Jan. 1, 2018, according to The South Bend Tribune. (Savransky, 10/31)

Aetna trumped third-quarter earnings expectations and raised its 2017 forecast again, even as the health insurer's withdrawal from the Affordable Care Act's insurance marketplaces contributed to a revenue miss. The nation's third-largest insurer balanced a 5-percent drop in revenue with a bigger decrease in health care costs and improvements in its Medicare Advantage business. Overall net income jumped 39 percent, to $838 million. (Murphy, 10/31)

During a call with analysts to discuss earnings, Aetna executives declined to address a report in The Wall Street Journal that CVS Health Corp. was in talks to purchase the company for more than $66 billion. Chief Executive Mark T. Bertolini said the company won’t “comment on rumors or speculation.” He did, however, say that Aetna aims to announce its plans for the future of its pharmacy-benefit contract with CVS by the middle of next year, and that CVS’s agreement to service the new pharmacy-benefit manager being launched by Anthem Inc. is “not a problem for us.” The existing Aetna contract with CVS goes through 2022, but Aetna has the ability to opt out at the start of 2020. (Wilde Mathews and Prang, 10/31)

Fifteen U.S. hospitals��— including two in Washington, D.C.��— received failing grades in a new report on 2,600 hospitals released Tuesday that includes all 50 states for the first time.��Maryland, which was previously exempted from providing hospital safety reports due to a special waiver, now ranks 46th on the non-profit Leapfrog Group's latest state rankings. (O'Donnell, 10/31)

The latest Hospital Safety Grade report released Tuesday by the Leapfrog Group again demonstrates the large differences in patient safety between hospitals, even among those in the same state or region. In the 10th edition of the report, patient safety performance by hospitals in states varied widely. For example, the report showed Connecticut had seven hospitals that received "A" grades, four that got a "B" grade and 13 that received "C" grades. (Castellucci, 10/31)

Twenty-two hospitals in southeastern Pennsylvania and South Jersey that received the top “A” grade in the fall 2017 Leapfrog hospital safety grades announced Tuesday. The Leapfrog Group uses 27 national performance measures to grade a hospital’s overall performance in keeping patients safe from preventable harm and medical errors. Taken together, those performance measures produce a single letter grade from “A” to “F.” (George, 10/31)

Hospitals in D.C. and Maryland lag far behind Virginia hospitals when it comes to patient safety, according to a new scorecard released Tuesday by nonprofit health watchdog Leapfrog. Leapfrog released its Hospital Safety Grades on Tuesday, assigning hospitals nationwide an A, B, C, D or F grade based on a variety of criteria. The study focuses on how safe patients are at each facility from preventable harm or medical errors. (Nadeem and Moore, 10/31)

Three area hospitals -- Doctors Hospital of Sarasota, Englewood Community Hospital and Sarasota Memorial Hospital -- retained their A grades in the Leapfrog Hospital Safety Grade report for fall 2017. This places them among the top 31 percent of health care systems nationwide, and the top 30 percent in Florida. (10/31)

Connecticut hospitals rank 30th nationwide when it comes to avoiding medical errors, injuries and infections, a new report released Tuesday finds. Some 2,630 hospitals across 50 states were assigned letter grades based on a range of patient safety measures and ranked based on their percentage of “A” hospitals, according to Leapfrog Group, a national nonprofit health care ratings organization. (10/31)

Indiana ranks in the middle of the country for its hospitals’ safety grades. About one-third of 59 Indiana acute care facilities surveyed by the LeapFrog Group received As in a report released Tuesday. (Flanery, 10/31)

Georgia stayed in 40th place among states in percentages of hospitals with top safety ratings, in the latest report from the Leapfrog Group. ... Fourteen of the 74 Georgia hospitals that were rated got “A’s” from Leapfrog, a patient safety organization founded by employers, which issues the rankings semi-annually. (Miller, 10/31)

The preterm birth rate in the U.S. has increased for the second consecutive year, according to a new report, and minorities are suffering a disproportionate share of those births.��The increases, which follow nearly a decade of declines, raise concerns that gains made in women’s health care are now slipping, experts say. The annual��report on preterm births by the March of Dimes, released Wednesday, found that 9.8 percent of U.S. infants were born preterm in 2016, up from 9.6 percent in 2015. And rates found in some parts of the U.S. are on par with those found in undeveloped countries in Africa and the Middle East. (Ross, 11/1)

Columbus received a D grade on this year’s March of Dimes Premature Birth Report Card, barely avoiding a failing mark and ranking 15th from the bottom among 100 cities with the largest number of births. The report, issued Wednesday, based its grade on Columbus’ 11.4 percent preterm birth rate in 2015, compared with the March of Dimes’ goal of 8.1 percent nationwide by 2020. (Viviano, 10/31)

Cleveland's premature birth rate is the worst among 100 U.S. cities with the highest number of births, according to a new report from the March of Dimes released today. The city's rate of 14.9 percent is more than two and a half times that of the best ranked city, Irvine, California, at 5.8 percent. (Zeltner, 11/1)

The rate of babies born prematurely in Virginia has reached its highest point in seven years, but researchers say the reason remains a mystery. According to the March of Dimes’ annual premature-birth report card, Virginia’s 2016 rate was 9.6 percent, nearly half a percentage point higher than the previous year. (O'Connor, 11/1)

It was a small town, so small that it wasn’t officially a town, but a village tucked inside the municipality of Greenburgh. Occupying 1 square mile, and counting only 4,600 souls, it was a commuter’s dream: a tight-knit hamlet just north of Manhattan, seemingly immune from 21st-century isolation. As the deputy fire chief put it, “You know, it’s like living in a fishbowl. Everybody knows what’s going on.” (Boodman, 11/1)

When a person’s distress, depression or discouragement appears to have taken a sharp turn for the worse, it’s time to ask him or her a weighty question: Are you thinking of harming yourself? If only the answer were a better guide. One study has found that nearly 80% of patients who took their own lives denied they were contemplating suicide in their last contact with a mental healthcare professional. Friends and family suffer the guilt and anguish of not having divined a loved one’s intentions, but mental health professionals rarely fare much better at doing so. (Healy, 10/31)

People who carry the stomach bacteria known as Helicobacter pylori are at increased risk for ulcers and stomach cancer. But even when antibiotic treatment has eliminated the bacterium, stomach cancer may still arise. A new study suggests that one reason may be the long-term use of proton pump inhibitors, or P.P.I.s, acid-reducing medicines sold under brand names such as Prilosec and Prevacid. (Bakalar, 10/31)

As part of a series of polls titled “Discrimination in America,” people from varied backgrounds were asked questions about their experiences with discrimination — from interactions with law enforcement to applying for jobs, seeking health care, and being the target of racial slurs. ...Among the findings: 71 percent agreed that African-Americans where they live have fewer employment opportunities because of the color of their skin, and 64 percent of African-Americans polled believe black children do not have the same opportunities as white children for a quality education. (Guerra, 10/31)

Experts with the FDA advise moderation after finding that adults over 40 who eat two ounces of black licorice a day for two weeks could experience irregular heart rhythm, arrhythmia or even a trip to the hospital, according to news release posted Monday. The agency based their findings off medical journals, and reported that the danger in black licorice lies in the compound glycyrrhizin. (McGough, 10/31)

For those seeking help for mental illness or addiction in Massachusetts, the path can be long and tortuous, often taking several months before treatment begins. That’s what members of focus groups told researchers commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, as part of a study released Tuesday on barriers to outpatient mental health services in Massachusetts. (Freyer, 10/31)

San Diego’s hepatitis A outbreak has now claimed 20 lives across the region. The county Health and Human Services Agency published new weekly totals late Tuesday morning, raising by one the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, up to 536 from the previous total of 516. (Sisson, 10/31)

The Detroit Health Department is investigating separate Hepatitis A cases connected with two Detroit restaurants. The first case is in connection with a Detroit resident who worked��at Firewater Bar and Grill,��107 E. Milwaukee. The second case involves another Detroit resident who worked��as a crew member at Little Caesars Pizza located at 12712 Fenkell. (10/30)

Gov. Dannel P. Malloy used his line-item veto to reject a new taxing arrangement on hospitals, but signed into law the bulk of a new, two-year state budget negotiated without direct input from his administration. (Phaneuf and Pazniokas, 10/31)

In a bipartisan 13-6 vote on Tuesday, the House Labor, Industrial and Rehabilitative Services Committee voted to move forward with HB 628, establishing paid family and medical leave insurance in New Hampshire. The bill, filed by Concord Democratic Rep. Mary Gile, would require New Hampshire Employment Security to establish and administer a family and medical leave insurance fund. (Solomon, 11/1)

Steward Health Care System, escalating a long-running dispute with state officials, has filed a lawsuit against a Massachusetts agency for demanding details about the company’s operations. Boston-based Steward, a for-profit company that owns nine Massachusetts hospitals, has failed to submit several years’ financial data to the state, racking up more than $300,000 in fines for its lack of transparency. (Dayal McCluskey, 10/31)

Testimony is resuming in a criminal case against Michigan’s health director, who is accused of keeping the public in the dark about Legionnaires’ disease during the Flint water disaster. Nick Lyon is charged with involuntary manslaughter and misconduct in office. A judge must decide whether there is enough evidence to send him to trial. The case picks up again Wednesday. (11/1)

A Utah nurse who was arrested for refusing to let a police officer draw blood from an unconscious patient settled Tuesday with Salt Lake City and the university that runs the hospital for $500,000. Nurse Alex Wubbels and her lawyer, Karra Porter, announced the move nearly two months after they released police body-camera video showing Detective Jeff Payne handcuffing Wubbels. The footage drew widespread attention online amid the national debate about police use of force. (Whitehurst, 10/31)

Oakland County Circuit Judge Karen McDonald is facing online harassment, including calls for her to "die a painful death," for her handling of two controversial cases involving divorced parents who disagree about vaccines. McDonald has drawn the online ire of vaccine critics, upset with her decision to order a 9-year-old boy immunized over the objections of his mother. In a separate case, McDonald has questioned the qualifications of a witness brought in to argue vaccines are harmful. (Wisely, 10/31)

The city council Wednesday is expected to tighten restrictions on the sale of flavored tobacco, adding menthol, mint, and wintergreen to the list of products banned from gas stations and corner stores. ... Some convenience store owners who rely on menthol cigarette sales worry they'll be driven out of business entirely. (Sepic, 11/1)

The woman who last year accused Sheriff John Urquhart of raping her years earlier has obtained a temporary protection order against Urquhart, claiming he’s disseminating her medical information to discredit her during his re-election campaign. King County Superior Court Commissioner Pro Tem Terence Wong on Monday signed the temporary sexual-assault protection order, which prohibits Urquhart from knowingly coming within 500 feet of the woman. The sheriff was served with the order later Monday. (Kamb, 10/31)

The St. Louis transgender community and others are cheering a ruling that blocks President Donald Trump’s attempt to ban trans people from serving in the military. Monday’s decision by a federal court judge in Washington, D.C. will allow transgender people to continue serving for the foreseeable future. (Fowler, 10/31)

A��Wisconsin mother searching for a late-night snack in her child’s trick-or-treat bag was frightened to find a small packet of methamphetamine among the candy, authorities said. About 2:30 a.m. Monday, the mother��contacted Menominee Tribal Police and told them how she’d found the small, yellow��bag��containing a crystal powder after dumping her child’s Halloween candy onto a table. The police came to her house, located on the Menominee Indian Reservation, and picked up the substance. It tested positive for methamphetamine, said Master Sgt. Warren Warrington. (Eltagouri, 10/31)

Glenn Rowley would like the medical marijuana entrepreneurs that come to Bangor Township “to make a pile of money so tall that they’ll need a Sherpa to get to the top of it.” As a result, the Bangor Township supervisor told members of the House Judiciary Committee on Tuesday that his township has passed an ordinance that will allow for up to 100 grow licenses and 15 dispensaries. Since opening up their permitting process on Sept. 1, township officials have approved permits for 27 grow operations and six dispensaries in the town that has a population of 14,641 people in a county that has 2,327 medical marijuana card holders. (Gray, 10/31)

Will pharma be the next business Amazon disrupts?In industry after industry, the company has turned practices and expectations inside out — and the pharmaceutical world is the latest poised for change as speculation mounts that Amazon will soon start selling prescription medicines. Anticipation has been building for months, in fact, but it heightened last week on the news that Amazon (AMZN) obtained wholesale pharmacy licenses in at least a dozen states. (Silverman, 10/30)

The looming threat of Amazon.com Inc. siphoned billions in market cap from Under Armour Inc. to FedEx Corp. to Walgreens Boots Alliance Inc. -- more than $30 billion combined -- in October.��Companies are gearing up to face Bezos’s behemoth heading into the holiday season, with some appearing ready to get creative��as the state of their industries is shaken. (Smith, 10/31)

When drug companies give gifts to doctors, the doctors prescribe more — and more expensive — drugs. The more lavish the gifts, the greater the effect. Researchers used data from the Center for Medicaid and Medicare Services on the prescriptions written by doctors in Washington, and information from the D.C. Department of Health on gifts from pharmaceutical and medical device companies given to providers in 2013. (Bakalar, 10/25)

Doctors, nurse practitioners, and physicians who were given meals, fees, grants, and other goodies by drug makers were much more likely to prescribe a larger number of medicines for each patient than health care providers who did not receive such payments, according to a new study. And often, the prescriptions were written for more-expensive, brand-name drugs. The study examined $3.9 million in gifts and payments made to more than 1,100 Medicare Part D prescribers in Washington, D.C., in 2013, and found those health care providers prescribed 2.3 more claims per patient than providers who did not receive anything from drug companies. (Silverman, 10/25)

President Trump says drug makers are “getting away with murder” — and these days, there are few companies that better embody his frustrations than Celgene. The drug maker keeps lots of cash overseas. It does some of its manufacturing abroad. Three times this year, it’s hiked the price of its best-selling cancer drug. And the man presiding over the company, Bob Hugin, donates lots of money to “political people,” which Trump has blasted as a bald attempt to curry favor with the establishment. (Though, inconveniently, Hugin has also donated to Trump himself.) (Robbins, 10/30)

A U.S. independent nonprofit organization that evaluates the clinical and cost effectiveness of new medicines said on Tuesday it has received significant new funding that will enable it to greatly expand its work. The Boston-based Institute for Clinical and Economic Review (ICER) announced a three-year, $13.9 million grant from the Laura and John Arnold Foundation, which follows its initial two-year $5.2 million award from the foundation in 2015. (Berkrot, 10/31)

More than a dozen U.S. senators have asked the Trump administration to proceed “as soon as possible” with a rule that would punish drug makers for overcharging hospitals, clinics, and other providers for medicines purchased under the federal government’s 340B drug discount program. The request comes after the Trump administration recently delayed implementation until July 2018, a move that followed previous delays and prompted fresh criticism that the White House was kowtowing to the pharmaceutical industry. (Silverman, 10/30)

Botox is a $2.8 billion revenue stream for the pharmaceutical giant Allergan, and that number could grow closer to $4 billion by 2020. Botox is also the end user product of the neurotoxin Clostridium botulinum, a substance so lethal that the U.S. government puts safeguards on the Botox production process. (Ryssdal, Henderson and McHenry, 10/31)

In a move that could lead to lower drug prices for Medicaid programs across the country, Massachusetts is asking the Trump administration for the authority to exclude some new medicines from the state’s health program for the poor. Amid a steep rise in prices for some medications that has strained state budgets in recent years, Massachusetts said that the change would give it leverage to extract lower prices from pharmaceutical manufacturers. And if the request is approved, health analysts say, many other states likely would follow suit. (Ollove, 10/26)

Kaiser Health News: Flurry Of Federal And State Probes Target Insulin Drugmakers And Pharma Middlemen

With the price of a crucial diabetes drug skyrocketing, at least five states and a federal prosecutor are demanding information from insulin manufacturers and the pharmaceutical industry’s financial middlemen, seeking answers about their business relationships and the soaring price of diabetes drugs. Attorneys general in Washington, Minnesota and New Mexico issued civil investigative demands this year and are sharing information with Florida and California, according to various corporate financial filings. (Tribble, 10/30)

A global pharma company is teaming up with federal research labs and academics in an ambitious effort to slash the time spent screening potential cancer drugs before they make it into the clinic for testing. The new consortium��— dubbed Accelerating Therapeutics for Opportunities in Medicine, or ATOM��—�� unveiled its plans on Friday, after a nearly two years of planning. Its goal: To cut the preclinical development time from six years to one. (Piller, 10/27)

Seeking a way to alleviate high drug prices, a Utah lawmaker hopes to introduce a bill that would allow the state to import prescription medicines from Canada, a move that is likely to accelerate a fierce debate over drug costs and patient safety. Over the next several weeks, Rep. Norman Thurston, a Republican, plans to submit legislation to authorize state officials to designate an existing pharmaceutical wholesaler to purchase prescription drugs from a wholesaler in Canada. His hope is that retail pharmacies based in Utah would then be able to buy and sell medicines at lower prices. (Silverman, 10/26)

The Swiss pharmaceutical giant Novartis said on Monday that it had offered to buy Advanced Accelerator Applications of France for $3.9 billion in cash, as it seeks to bolster its portfolio of cancer treatments. The acquisition comes amid a slowdown in the value of deals in the pharmaceutical sector this year. Typically, large companies in the industry have made a major impact on merger activity in the wider health care sector, often buying up smaller drugmakers with emerging treatments rather than spending billions of dollars on their own research and development. (Bray, 10/30)

Sales fell for a third straight quarter at the consumer-products business that Pfizer Inc. may offload, a slump that could pressure the price that the drug giant could get for the division.��The drugmaker plans to decide next year what to do with the consumer business, which sells brands including��Advil, ChapStick, Centrum. The decision could impact a bigger, later deal that investors have been speculating about since Pfizer’s failed attempts to buy Allergan Plc and AstraZeneca Plc. (Hopkins, 10/31)

Gilead Sciences’ (GILD) hepatitis C business is still shrinking and executives don’t seem to know (or won’t say) when it will stabilize, sending shares lower by 4 percent Thursday night. In what was otherwise a benign third-quarter earnings report, Gilead lowered the top end of hepatitis C sales guidance for 2017 and warned that the fourth quarter would be rough. The problem: Competition from a newly launched and less expensive hepatitis C drug marketed by Abbvie (ABBV) that is taking market share. (Feuerstein, 10/26)

Drug companies opposed to a statewide ballot issue aimed at lowering prescription prices have raised a record-smashing $58 million this year to defeat the proposal going before Ohio voters Nov. 7. Ohio’s previous high came in 2009 when the successful campaign to bring casino gambling to the Buckeye State drew $47.1 million. And campaign finance reports filed Thursday on state Issue 2 only include money raised through Oct. 18, so the new record could climb higher. (Candisky, 10/26)

The opponents to Issue 2 outraised and outspent the proponents by a nearly 4-to-1 margin since July in the effort to upend the ballot initiative seeking to lower the price the state pays for pharmaceuticals. The pharmaceutical companies dwarfed the proponents by raising more than $41 million, all of it from the pharmaceutical industry, though exactly which companies are giving the money isn't known. In-kind contributions of more than $800,000 bumped that sum to about $42 million total. (Richardson, 10/26)

We are fortunate to live in an era of tremendous medical advances. In the last few weeks alone, the Food and Drug Administration (FDA) has approved breakthrough products for pediatric cancer, a rare form of blindness, and now adult non-Hodgkin's lymphoma. These breakthroughs have been enabled by tremendous progress in science, as genetic technologies are beginning to live up to some of hopes of the scientists who sequenced the human genome two decades ago. (Kevin A. Schulman, 10/26)

We’re in an era of increasing scrutiny toward the cost of medications. Health care providers, patient groups, and even our president have criticized the disproportionately high prices that patients in the U.S. pay for drugs compared to other countries. Much of the responsibility, of course, falls to the chain of businesses that develop, manufacture, distribute, and sell medications — and those in between — all of which determine how much it costs to fill a prescription. (Ashish Advani and Ashley Dolphus, 11/1)

The news that CVS Health is making a $66-billion play for health insurer Aetna inevitably raises two key questions for consumers: What would this do to insurance rates? What would this do to drug prices? At this point, the answer to both questions is nobody knows for sure. We’re heading into uncharted territory. (David Lazarus, 10/31)

Silence may still be golden for Aetna shareholders.��On its earnings call Tuesday morning, Aetna Inc. refused to��discuss "rumors and speculation" about a possible acquisition by CVS Health Corp.��But don't take that as a sign the company isn't interested.�� (Max Nisen, 10/31)

Slow and steady has been winning the race for Merck & Co. Inc.'s Keytruda in the multi-billion-dollar market for immune-boosting cancer medicines.��Now it's being punished for that approach. Merck on Friday revealed a change to a highly anticipated trial of Keytruda��in combination with chemotherapy in newly diagnosed lung-cancer patients.��It may push trial results into 2019, a year past previous expectations.��Merck revealed later on Friday it was withdrawing an application for European approval of the combo based on a smaller earlier study. Shares dropped 6 percent on Friday and fell another 6 percent on Monday after analyst downgrades. (Max Nisen, 10/30)

Celgene Corp.'s public vision of the future has consistently featured unrelenting optimism and rapidly expanding sales growth. Now it's reaping the rewards of over-promising. Celgene on Thursday reported third-quarter revenue that fell short of analysts' estimates and cut its 2020 revenue targets, hurt by��a slowdown for key medicines and a drug-trial failure. Shares fell nearly 20 percent. (Max Nisen, 10/26)

Few in Ohio are unaware of Issue 2, thanks to the avalanche of ads. From listening, you could be either scared of rising drug prices or fighting mad at the greedy drug companies.�� But most are just confused and totally uncertain as to how to vote!�� And the real underlying questions are not addressed at all. (J.B. Silvers, 10/29)

Even for those who have insurance, the cost of prescription drugs can be a budget buster. And yet, many of these people don’t talk to their doctor about it. A recent national poll conducted by the University of Michigan found that 27 of the respondents who were 50 to 80 years old considered their prescription drug bills to be a financial burden, the UC Berkeley Wellness Letter reports. Nearly half of them never told their doctor about this, even thought this is clearly a medical issue that their doctor should know about. (Herb Weisbaum, 10/31)

Another Obamacare health insurance enrollment period dawns Wednesday with millions of Americans facing harsh reality: They’ll pay more for less next year. Just like they did last year. And the year before. They’ll find the Obamacare marketplace even more confusing. Some silver plans, for instance, will cost more than gold plans. But bronze plans could be free for some working-class customers; that’s because tax credits increase along with the costs of plans. Be alert, shoppers. (10/31)

If you’re confused about the state of health insurance, join the club. On Nov. 1, the fifth annual open enrollment begins on the insurance marketplaces created by the Affordable Care Act. And, given what’s been going on in Washington, there is, understandably, a lot of confusion. Here are a few points to remember for the 90,000 Kentuckians who buy their health insurance on the ACA exchanges (healthcare.gov) and their friends and families: (10/31)

Iowa is scheduled for the largest premium increases in the land next year, a whopping 69 percent according to health care consultancy Avalere. The average premium on the benchmark “silver” plans will rise to $1,000 a month. What is going on in the state of Iowa? A rash of tragic combine accidents? Are Iowans getting lung diseases from all that corn pollen blowing about on the wind?Not quite. What’s happening in Iowa is sick people. Lots and lots of sick people cramming into an individual market that doesn’t have enough healthy patients to offset their costs. (Megan McArdle, 10/31)

Here’s a strange paradox: Health-care costs have increased by an unsustainable rate of about 8.5% each year over the past decade, according to PwC’s Health Research Institute. Already, the average employer-based family health insurance plans costs more than $18,000 annually. But Medicare spending has been relatively stable. Over the past three years, the program’s payouts to hospitals have increased by only 1% to 3% a year, roughly even with inflation. The prices paid for some core services, such as ambulance transportation, have actually gone down. (Keith Lemer, 10/31)

Regardless of your political persuasion, every Iowan can agree that health care in America is at a crossroads. The Affordable Care Act (ACA) continues to be the law of the land, and each passing day moves us closer to implementation of one of the more controversial aspects of the program – the Independent Payment Advisory Board (IPAB). (Joe Hrdlicka, 10/31)

During the last 20 years, low-income families have had their incomes plateau or decline as their housing costs soared. Public aid has not been expanded to meet the growing need: only 1 in 4 households that qualify for housing assistance receives it. As a result, today most renting households below the federal poverty line spend more than half of their income on housing costs, and 1 in 4 spends more than 70% of its income on rent and utility costs alone. Rent-burdened families not only have less money to spend on wellness and health care but also regularly face eviction and homelessness, which further threaten their health. According to recent estimates, 2.8 million renting households are at risk of eviction and more than 500 000 people are homeless on any single night. (Megan Sandel, and Matthew Desmond, 10j/31)

Homelessness is not a new phenomenon in the United States, but its visibility has increased, and the composition of the homeless population has changed. Formerly the province primarily of single men, the homeless population today increasingly includes women, children, and families. The exact number of homeless persons has always been difficult to estimate because of differences in who is defined as homeless (eg, living on street [unsheltered] only or persons also living in an unstable housing arrangement), differences in time course (eg, on a given night or within the last year), and the fact that some homeless persons hide from view. Nevertheless, the best estimates are that on a given night in 2016, approximately 550 000 individuals were homeless, of whom 32% were unsheltered and 35% involved families with children.1 Los Angeles had the highest number of homeless persons (32 803) of any US city, 82% of whom were unsheltered. (Mitchell H. Katz, 10/31)

That’s what worries me about the president’s approach to the opioid crisis. It isn’t focused on curing addiction or adequately treating the pain that fuels it. We’re just making it harder for people to get drugs — which adds to the burden of human suffering and desperation — and calling it a solution. (Wayne Jonas, 10/31)

President Donald Trump declared the opioid epidemic a public health emergency last week, a move that waives some federal regulations and eases state access to federal funds. ...The declaration is long overdue, but the limited funding is worrisome, as is the tone than evokes antiquated and failed measures: expecting a drug-free America, dubbing drug use a moral failing, and reverting to the turf of the marijuana battle. (Bachaar Arnaout, 11/1)

If I do my job right, this column might actually change your life. More important, it might change the lives of the people you love. But first, I need to talk about Elton John’s glasses. It was my first concert. Philadelphia Spectrum, 1972. Elton opened up with “Tiny Dancer” on solo piano. Later, during “I Think I’m Going to Kill Myself,” a character named Legs Larry Smith came out and tap danced. (Jennifer Finney Boylan, 10/31)

Some of the information that physicians convey to their patients can inadvertently amplify patients’ symptoms and become a source of heightened somatic distress, an effect that must be understood by physicians to ensure optimal management of patient care. This effect illustrates the iatrogenic potential of information, as opposed to the iatrogenic potential of drugs and procedures. (Arthur J. Barsky,10/31)

Doctors often don’t adequately convey these grim outcomes; many patients remain falsely optimistic, tending to overestimate their chances of surviving a cardiac arrest. And few people understand what the resuscitation process truly entails, and how these efforts often lead to a painful, undignified death. Recent research also shows that patients and caregivers tend not to be on the same page when it comes to what level of disability or pain might be acceptable to a patient in the future, including after a code. There’s got to be a way to close these gaps. (Allison Bond, 10/31)

The US Centers for Disease Control and Prevention (CDC) recently released updated interim guidance for when pregnant women should receive serologic testing for the Zika virus. The circumstances within which these recommendations emerge are complex: the public concern about the Zika virus is declining, the severity of epidemics around the globe is abating, and as a critical consideration in the development of recommendations, the rate of false-positive Zika virus test results (and the consequential unnecessary anxiety) is high. (Ilona Telefus Goldfarb, Elana Jaffe, Anne Drapkin Lyerly, 10/31)

When recreational cannabis becomes legal in California on Jan. 2, part of the focus — in Los Angeles, at any rate — will be on “social equity.” That’s the term for a set of guidelines meant to spread legalization’s wealth to neighborhoods that have gotten the worst of the drug wars. According to draft legislation currently moving through the City Council, for every general license approved for a pot shop, one license must also be approved for social equity reasons. (David L. Ulin, 11/1)