The Associated Press: Democrats Spar At Debate Over Health Care, How To Beat Trump
Democratic presidential candidates clashed Wednesday in a debate over the future of health care in America, racial inequality and their ability to build a winning coalition to take on President Donald Trump next year. The faceoff came after hours of testimony in the impeachment inquiry of Trump and at a critical juncture in the Democratic race to run against him in 2020. With less than three months before the first voting contests, big questions hang over the front-runners, time is running out for lower tier candidates to make their move and new Democrats are launching improbable last-minute bids for the nomination. (Barrow, Weissert and Colvin, 11/20)

The New York Times: 5 Takeaways From The November Democratic Debate
The story of the debate was more of punches pulled than landed. A month after her rivals hammered Ms. Warren for a lack of “Medicare for all” specifics, her fresh $20.5 trillion package to remake the health care system received surprisingly little scrutiny. (Goldmacher, Epstein and Lerer, 11/20)

The Associated Press: Takeaways From The Democratic Presidential Debate
So it was again. Within minutes of the start, Warren found herself on the defensive as she explained she still supports a single-payer government run insurance system — “Medicare for All” — despite her recent modified proposal to get there in phases. Not to be outdone, Sanders reminded people that he’s the original Senate sponsor of the “Medicare for All” bill that animates progressives. “I wrote the damn bill,” he quipped. Again. Biden jumped in to remind his more liberal rivals that their ideas would not pass in Congress. The former vice president touted his commitment to adding a government insurance plan to existing Affordable Care Act exchanges that now sell private insurance policies. (Riccardi and Barrow, 11/20)

Los Angeles Times: Democratic Debate: Key Takeaways From Atlanta
Wednesday night, she leaned into more popular aspects of her healthcare plan, saying “on day one as president” she would act to bring down the cost of prescription drugs and vowing to “defend the Affordable Care Act from the sabotage of the Trump administration.” She soft-pedaled Medicare for all, which would force millions of Americans off their private insurance plans, by saying she would move in that direction only after people “have had a chance to feel it and taste it and live with it.” (Barabak, 11/20)

The Washington Post: Democratic Presidential Candidates Debate In Atlanta.
The more-moderate candidates onstage also defended their approaches. Buttigieg said that Americans would not like to be told what to do. “Commanding people” to go into Medicare, he said, “is not the right approach to unify the American people.” Biden used skepticism of Medicare-for-all on the part of House Speaker Nancy Pelosi (D-Calif.) to bolster his own plan. “Nancy Pelosi is one of those people who doesn’t think it make sense,” he said. “We should build on Obamacare.” (Viser, Linskey and Olorunnipa, 11/21)

The New York Times: Fact-Checking The November Democratic Debate
What Mr. Biden Said: “The fact is that right now the vast majority of Democrats do not support ‘Medicare for all.’ It couldn’t pass the United States Senate right now with Democrats. It couldn’t pass the House.” This is exaggerated. Depending on how you measure, a majority of Democratic voters do support Medicare for all. Support among Democrats in Congress is weaker than that, but it is hard to find any measure that shows a vast majority who oppose the policy. (11/20)

The Associated Press: Claims From The Democratic Debate
That statement is at odds with a Kaiser Family Foundation poll out this week. It found that 77% of Democrats support Medicare for All. Even more — 88% — support a “public option” proposal such as the one Biden advocates. It would allow people to buy into a new government insurance plan modeled on Medicare, but it would not completely replace private insurance. Overall, 53% of Americans support Medicare for All, while 43% oppose it, according to the Kaiser poll. (11/20)

The Wall Street Journal: Democratic Candidates Unite Against Trump, Divide On Taxes, Health Care
New Jersey Sen. Cory Booker criticized Ms. Warren’s signature proposal for higher taxes on the wealthy, calling it “cumbersome.” Mr. Booker said he agrees with her policies for universal preschool, funding for historically black colleges and universities and raising corporate tax rates, but he disagreed with Ms. Warren’s plan to pay for them. “It’s been tried by other nations. It’s hard to evaluate. We can get the same amount of revenue through just taxation,” he said. Ms. Warren responded that she was “tired of freeloading billionaires.” (Collins, Day and Glazer, 11/21)

The Hill: Debate Crowd Erupts In Laughs As Sanders Chimes In 'I Wrote The Damn Bill' On Medicare For All 
Sen. Bernie Sanders (I-Vt.) scored the first laugh of the fifth Democratic presidential debate on Wednesday by dredging up an old line: "I wrote the damn bill." Sanders first made the quip — a reference to his signature "Medicare for All" legislation — during the second Democratic primary debate in July after one of his rivals, Rep. Tim Ryan (D-Ohio), suggested that the Vermont senator was unaware of what the single-payer health care proposal actually entailed. (Greenwood, 11/20)

The Washington Post Fact Checker: Fact-Checking The Fifth Democratic Presidential Debate
“Five hundred thousand people go bankrupt because of medically related issues. They come down with cancer, and that’s a reason to go bankrupt?” — Sanders. Sanders often repeats this talking point, asserting that 500,000 people go bankrupt every year from medical issues. That’s approximately two-thirds of the 750,000 total bankruptcies per year. For this debate, however, the senator modified the wording of his claim. Sanders previously said 500,000 people a year go bankrupt from medical debt, but now he says “medically related issues.” This formulation more accurately reflects the study he’s quoting. (Kessler, Rizzo and Kelly, 11/21)

Kaiser Health News: Do 160 Million Americans Really Like Their Health Plans? Kind Of
Articulating his proposal for health care reform, former Vice President Joe Biden emphasized the number of Americans who, he said, were more than perfectly satisfied with the coverage they have. “160 million people like their private insurance,” Biden said during the November Democratic presidential primary debate. (Luthra, 11/21)

The New York Times: Which Candidates Got The Most Speaking Time In The Democratic Debate
Senator Elizabeth Warren of Massachusetts and Pete Buttigieg, mayor of South Bend, Ind., had the most speaking time in the November Democratic presidential debate. Here are the issues that have gotten the most time at the debates before this one. (Cai, Leatherby and Lee, 11/20)

The Washington Post: Transcript: The November Democratic Debate
Democratic presidential candidates squared off in Atlanta on Wednesday in a debate hosted by The Washington Post and MSNBC. Below is a transcript of the debate. (11/21)

The Washington Post: Elizabeth Warren Wins Endorsement From Ady Barkan
Ady Barkan, an influential liberal activist who has ALS, endorsed Sen. Elizabeth Warren for president Wednesday, giving her a boost in the sometimes contentious Democratic debate over health care and Medicare-for-all. “She has the brains and the brawn and the moral clarity to overcome the challenges that we face,” Barkan said in a video. “I’ve seen up close how she confronts a problem. She listens to the people most affected, she does her homework and then she comes up with a plan. A brilliant, workable plan.” (Wang, 11/20)

Reuters: Healthcare Battles In Democratic White House Race Could Carry Risk In 2020, Polls Show
A trio of polls released ahead of Wednesday's Democratic presidential debate showed a majority of Americans support Medicare for All, but offered conflicting signals about whether the proposed healthcare overhaul could hurt the party in the November 2020 general election. As with the previous four debates, Wednesday's televised clash in Atlanta is likely to be dominated by the intra-party battle over how best to expand healthcare coverage to millions of Americans. (Ax and Becker, 11/20)

USA Today: Democratic Candidates Traded Barbs And Attacks But Agreed Trump Should Be Impeached
Two days after an association of Democratic state attorneys general became the first national party committee to impose an explicit abortion litmus test on its candidates, Warren was asked whether there’s room in the party for those who oppose abortion. Saying abortion rights are human rights and economic rights, Warren said they’re fundamental to what the party stands for. She was pressed on whether the party should exclude recently-re-elected Louisiana Gov. John Bel Edwards who has signed anti-abortion legislation. (Groppe, Fritze and Collins, 11/21)

The Hill: Warren On Anti-Abortion Democrats: 'I'm Not Here To Drive Anyone Out Of This Party'
When pushed on whether there was room within the party for Bel Edwards, Warren said, “I have made clear what I think the Democratic Party stands for.” Warren and virtually all of the 2020 Democratic contenders are staunch advocates of abortion rights. Bel Edwards describes himself as "pro-life" and earlier this year signed a bill limiting abortion rights in his state. Several conservative governors have implemented restrictions on abortion access this year, but Bel Edwards is the only Democrat. (Axelrod, 11/20)

Vox: At The Democratic Debate, Female Moderators Ask 2020 Candidates About Paid Family Leave
On Wednesday, something unheard of happened on the 2020 Democratic debate stage: Moderators asked candidates what they would do about high child care costs and the lack of paid parental leave in the US. It just took five debates and a panel of all-women moderators for this to happen. Ashley Parker, a White House reporter for the Washington Post, pointed out that child care and paid family leave are important issues to many voters. (Campbell, 11/21)

MSNBC: Video: Women's Issues Take Center Stage At Democratic Debate
Democratic candidates debated paid family leave, abortion rights, and equal pay. (11/21)

Politico: ‘You Might Have Been High When You Said It’: The Best Zingers On The Debate Stage
Former Vice President Joe Biden and Booker butted heads over their divergent views on whether marijuana should be legalized at the federal level. Booker objected in particular to Biden's assertion at a forum last week that he considers marijuana a "gateway drug" and would like to see more research on it before pushing legalization nationwide. "This week I hear him literally say that I don't think we should legalize marijuana. I thought you might have been high when you said it," Booker said, arguing that "marijuana in our country is already legal for privileged people and ... the war on drugs has been a war on black and brown people." (Oprysko and Marshall, 11/21)

The New York Times: With Impeachment As Backdrop, Democrats Direct Fire At Trump In Debate
Mr. Biden did not appear to incur new damage to his campaign, which has been durable despite some of his self-inflicted errors. Yet at a moment when a pair of new candidates were entering the race in part because of his perceived weakness, the former vice president appeared tongue-tied on more than one occasion. He drew nervous laughter when, in discussing domestic violence, he said it was important to keep “punching at” the problem. (Burns and Martin, 11/20)

Kaiser Health News: In This Democratic Debate, Health Care Issues Took A Backseat
Biden disputed Booker’s accusation, saying he supports marijuana decriminalization, as well as releasing offenders from jail and expunging their records. “But I do think it makes sense based on data that we should study what the long-term effects are for the use of marijuana,” he added. Research on marijuana has been significantly limited by the federal government’s classification of the drug under Schedule 1 of the Controlled Substances Act, making it difficult to access for experimental purposes. The surgeon general, Jerome Adams, has said it can “prime your brain for addiction to other substances,” a claim PolitiFact recently rated “Half True” due to a lack of context. (Huetteman, 11/21)

Bloomberg: Democrats Duck Big Fights In Atlanta Debate, Focus On Trump 
As the first openly gay major presidential candidate, Buttigieg reflected on discrimination, speaking more bluntly about his sexual orientation than he had at any earlier debate. Buttigieg said he knows the pain of discrimination even as a white man. "I do have the experience of sometimes feeling like a stranger in my own country," he said, “turning on the news and seeing my own rights come up for debate, and seeing my rights expanded by a coalition of people like me and people not at all like me, working side by side shoulder to shoulder, making it possible for me to be standing here wearing this wedding ring in a way that couldn’t have happened” decades ago. (Epstein and Pager, 11/20)

The New York Times: Trump’s F.D.A. Nominee Sidesteps Questions About Banning Flavored Vaping Products
President Trump’s nominee for Food and Drug Administration commissioner, Dr. Stephen M. Hahn, declined to answer questions from senators in both parties about whether he would push for a ban on flavored vaping products at a confirmation hearing Wednesday. The questions placed Dr. Hahn, a cancer executive without any Washington or governing experience, at the center of a political battle over the surge in teen vaping and the emergence of mysterious vaping-related illnesses that have killed at least 44 people and sickened more than 2,000. (Thomas, 11/20)

The Associated Press: FDA Nominee Ducks Questions On Trump E-Cigarette Flavor Ban
Hahn also told members of the Senate’s health committee that he had not discussed the issue with the president. The full Senate must vote on whether to confirm him to the position. Senators from both parties pressed Hahn on reports that the Trump administration is backing away from the September announcement that it would remove most vaping flavors, which are popular among underage users. Federal law bans sales to those under 18. (11/20)

The Washington Post: Senators Grill Stephen Hahn, Nominee To Head The FDA, On Vaping Policy
On e-cigarettes, anger about the delay in implementing the flavor ban came from both parties during the Hahn hearing. Sen. Mitt Romney (R-Utah) called youth vaping “the canary in the coal mine, or better, the child in the vaping room,” and asked Hahn whether the FDA could take action to protect teens if the White House were opposed. Hahn responded that while he was “completely alarmed” by federal data showing that almost 28 percent of high schoolers are vaping, he didn’t want to “prejudge” the administration’s vaping policy and “I don’t have all the facts.” (McGinley, 11/20)

The Wall Street Journal: Senate Panel Presses FDA Nominee On Vaping Flavors Ban
Asked by Sen. Mitt Romney (R., Utah) whether he would act to ban flavors, Dr. Hahn said that “final compliance policy is under consideration” at the White House. Later, Sen. Doug Jones (D., Ala.), said he was impressed by Dr. Hahn overall but was “less than happy with the answers you gave to members of the committee on vaping.” “I’m concerned that the administration has…given you an out to dodge and bob and weave a little bit,” Mr. Jones said. (Burton, 11/20)

Politico: Trump FDA Pick Stops Short Of Committing To Flavor Ban
Sen. Maggie Hassan (D-N.H.) asked Hahn to commit FDA to disclose any meetings with Juul, saying the popular e-cigarette brand had told her it had multiple meetings with the agency despite publicly promising to suspend lobbying. The company told her that the meetings were not about policy. Hahn said that he was not familiar with the rules around disclosures of meetings but would familiarize himself with it and follow the law. (Owermohle, 11/20)

Bloomberg: FDA Nominee Gets Senate Grilling About Trump’s Vaping Policy 
Hahn treated cancer patients immediately upon gaining his medical license, working as a radiation oncologist in Santa Rosa, California, and his last position before being nominated to head the FDA was serving as the chief medical executive at MD Anderson at the University of Texas in Houston, one of the nation’s premier cancer centers. While at MD Anderson, he helped lead a group working to raise the age to 21 for the purchase of tobacco and e-cigarettes. (Porter and Cortez, 11/20)

Politico Pro: Trump's FDA Pick Navigates Confirmation Hearing Without Major Bumps
Committee Chairman Lamar Alexander (R-Tenn.) said he hoped to confirm Hahn by the end of the year, with a committee vote on his nomination as early as Dec. 3, when lawmakers return from Thanksgiving recess. Alexander noted the timeline would throw Hahn into the job amid the ongoing outbreak of vaping-linked lung disease and persistently high rates of teen vaping — issues that consumed many lawmakers' questions during the hearing. (Owermohle and Karlin-Smith, 11/20)

Stat: Stephen Hahn, Trump’s FDA Nominee, Pledges ‘Bold Action’ On Vaping But Sidesteps Questions On Flavor Ban
While drug pricing has dominated health policy discussions across Washington in 2019, few senators pressed Hahn on the FDA’s role in facilitating lower drug costs, either via generic or biosimilar drug approvals or by certifying the safety of the Trump administration’s proposal to let states import prescription drugs from Canada. Still, Hahn acknowledged the urgency of action to lower high drug prices in response to questions from Sen. Mike Braun (R-Ind.). (Facher, 11/20)

The Associated Press: Trump To Meet On Teen Vaping As Plans For Flavor Ban Fade
President Donald Trump will meet with medical experts, health advocates and industry representatives on the problem of underage vaping later this week, White House officials said Wednesday. Electronic cigarette use by teenagers has surged, but federal authorities have not yet finalized a plan for regulating e-cigarettes. At the White House meeting set for Friday, administration officials said Trump will hear from representatives from “all sides” of the vaping issue as he weighs “responsible guidelines.” (Perrone, 11/20)

The Wall Street Journal: Trump To Convene Meeting On Vaping
Friday’s meeting “will allow the president and other administration officials an opportunity to hear from a large group, representing all sides as we continue to develop responsible guidelines that protect the public health and the American people,” according to the statement. (Leary, 11/20)

Reuters: White House: Vaping Rules Not Stalled, Trump Plans Friday Meeting
"The policy making process is not stalled," White House spokesman Judd Deere said in a statement. Trump on Nov. 11 said he would be meeting with industry representatives after previously saying his administration would release its position on vaping last week, though it never was. The Trump administration in September announced a sweeping plan to ban all e-cigarette and vaping flavors aside from tobacco flavors. Trump earlier this month said he would raise the age to buy such products to 21. (11/20)

The Hill: Trump To Hear From 'All Sides' In Meeting On Youth Vaping Rates Friday 
An estimated 27.5 percent of high school students and 10.5 percent of middle school students said they had used e-cigarettes in the past month, according to one of the studies conducted by government researchers. (Hellmann, 11/20)

Bloomberg: Trump To Meet With E-Cigarette Advocates And Critics On Friday 
On Wednesday, the administration also appears to have shelved a plan to cut nicotine levels in traditional cigarettes to non-addictive levels, a policy pushed by Gottlieb. The FDA said that while it was still working on that effort, it was not a near-term priority. (Wingrove, 11/20)

Politico Pro: Nicotine Reduction Plan For Cigarettes Left Off Trump Agenda
The Trump administration is tabling a proposal to set a maximum nicotine level in cigarettes. The effort, originally put forward in 2017 and refined last year, does not appear on the regulatory agenda for the next several months that HHS released this morning. Former FDA Commissioner Scott Gottlieb proposed the rule as a way to make it harder for youths to get addicted to cigarettes and make it easier for smokers to quit or switch to replacement products like nicotine patches or gums. FDA was working on the rule as recently as this summer. (Allen, 11/20)

The New York Times: A.M.A. Urges Ban On Vaping Products As Juul Is Sued By More States
Lawsuits filed against Juul this week by the attorneys general of New York and California claim that the embattled company deliberately marketed and sold vaping products to young people — and helped create a public health crisis. On Tuesday, the American Medical Association echoed those concerns and called for a sweeping ban on vaping products. (Zraick, 11/19)

The Hill: American Medical Association Calls For Immediate Vaping Ban 
“It’s simple — we must keep nicotine products out of the hands of young people and that’s why we are calling for an immediate ban on all e-cigarette and vaping products from the market,” AMA President Patrice Harris said in the statement. “With the number of young people using e-cigarettes spiking it is not only critical that there is research into nicotine addiction treatments for this population, but it is imperative that we continue efforts to prevent youth from ever using nicotine.” The AMA said it would advocate for additional research on using these products to quit tobacco use and on the effects of nicotine dependence and tobacco use disorder on youth populations. (Coeman, 11/20)

The Hill: Congress Feels Heat To Act On Youth Vaping 
Pressure is building on Congress to act on rising youth vaping rates amid inaction from President Trump. House Democrats plan to pass a bill by year’s end that would ban flavored e-cigarette products they say helped to spark a teen vaping epidemic. Democrats found themselves in rare agreement with Trump when he vowed to clear the market of those products two months ago, but he has since backed off after facing a backlash from vapers, conservative groups and the industry. (Hellmann, 11/20)

The Wall Street Journal: Massachusetts Lawmakers Pass Bill To Ban Flavored Tobacco, Menthol Cigarettes
Massachusetts lawmakers passed a bill in the early morning hours Thursday to enact the country’s most stringent state ban on flavored tobacco, including menthol cigarettes, in an effort to combat youth tobacco use. The Democratic-led legislature sent the bill to Republican Gov. Charlie Baker after a final preholiday session at the state capital stretched beyond midnight. The House passed the flavor ban last week, but needed to clear it again after the Senate added some amendments following a long floor debate. (Kamp, 11/21)

Boston Globe: State Lawmakers Pass Nation’s Toughest Restrictions On Sale Of Flavored Tobacco And Vaping Products
“This nation-leading step will save lives,” House Speaker Robert A. DeLeo said of the bill. The legislature’s relatively swift action stands in contrast to the retreat the Trump administration appears to be beating on the issue, after the president backtracked on a similar ban on fruit, candy, and mint-flavored e-cigarettes a few months after saying he intended to “clear the market” of flavored vaping products. (Stout and McGrane, 11/21)

The Wall Street Journal: Second New Yorker Dies From Vaping-Related Illness
A Manhattan man is New York state’s second vaping-related death, Gov. Andrew Cuomo said. The man, in his 30s, had a reported history of using e-cigarettes and vape products, the governor said Wednesday. A spokesman for the state’s Department of Health said the agency is investigating whether both THC, the psychoactive compound in marijuana, and nicotine were a factor in his death. (West, 11/20)

The Washington Post: Critics Say ‘Junk Plans’ Are Being Pushed On ACA Exchanges
The Trump administration is encouraging consumers on the Obamacare individual market to seek help from private brokers, who are permitted to sell short-term health plans that critics deride as “junk” because they don’t protect people with preexisting conditions, or cover costly services such as hospital care, in many cases. Consumers looking at their health insurance options on the website for the federal marketplace, called healthcare.gov, may be redirected to other enrollment sites, some of which allow consumers to click a tab entitled “short-term plans” and see a list of those plans, often with significantly cheaper premiums. (Abutaleb, 11/20)

The Associated Press: Some Family Doctors Ditch Insurance For Simpler Approach
Dr. Emilie Scott was only a few months into her first job when she started hearing the complaint: She was spending too much time with each patient. Like many primary care doctors working in large medical systems, Scott was encouraged to see a new patient every 20 minutes. But that was barely enough time to talk and do a physical. (11/20)

Bloomberg: Mental Health Coverage Continues To Fall Short, Study Shows 
More Americans turn to out-of-network providers when seeking mental health care than when seeking medical care, and the trend continues to worsen, a new study shows, despite a law designed to prevent this problem for people seeking treatment for conditions such as depression and addiction. In an update of a landmark report about access to mental health treatment, researchers found that the disparity between medical coverage and mental and behavioral health coverage continued to grow in 2016 and 2017. (Koons, 11/20)

California Healthline: Affordable Mental Health Care? It’s Getting Even Tougher To Access
A report published Wednesday by Milliman, a risk management and health care consulting company, found that patients were dramatically more likely to resort to out-of-network providers for mental health and substance abuse treatment than for other conditions. The disparities have grown since Milliman published a similarly grim study two years ago. The latest study examined the claims data of 37 million individuals with commercial PPO health insurance plans in all 50 states from 2013 to 2017. (Gold, 11/20)

And —

Bloomberg: Cigna CEO Says Health Insurer Is Open To More Acquisitions
Cigna Corp. is open to making more acquisitions, Chief Executive Officer David Cordani said, almost a year after the health insurer bought drug-benefit manager Express Scripts. An expected $8 billion in free cash flow in 2020 should give Cigna “strategic optionality,” Cordani said in an interview with Bloomberg TV’s David Westin at the Economic Club of New York on Wednesday. (Tozzi, 11/20)

The Hill: Crunch Time For Congress On Surprise Medical Bills
Lawmakers are facing crunch time in a bipartisan push to pass legislation protecting patients from getting hit with massive “surprise” medical bills. Staff in both chambers and both parties are having what Sen. Bill Cassidy (R-La.) called “intense meetings” to try to come to an agreement in time to be included in a government funding package ahead of a Dec. 20 deadline. (Sullivan, 11/21)

Miami Herald: Employer-Sponsored Healthcare Costs Rising, Study Finds
Americans who get health insurance through their employers are finding their coverage unaffordable as out-of-pocket expenses have outpaced earnings over the past decade, according to a new study, which shows Floridians were especially hard hit. Florida was one of the nine most expensive states for premium contributions, which equated to 8% or more of the median income in 2018, according to a study released Thursday by the Commonwealth Fund, a New York-based nonprofit that advocates for expanded health insurance coverage. (Conarck, 11/21)

San Francisco Chronicle: Health Care Costs For California Workers Are Growing Far Faster Than Incomes
Californians who get health insurance through their jobs are having to spend a greater share of their paychecks on health care costs, according to a new analysis of employer-sponsored health plans to be released Thursday by the Commonwealth Fund, a nonprofit foundation that researches health industry trends. California workers went from spending 8% of their income on health insurance premiums and deductibles in 2008, about $4,100, to nearly 12% of their income on premiums and deductibles in 2018, about $6,900. (Ho, 11/20)

The Virginian-Pilot: Virginians Spend More On Their Health Insurance Than People In Almost Every Other State
The sums Virginians spend on health insurance through their employers are higher and have climbed faster than the national average, a new study shows — even as employers pay a lower share here than in other states. Typical out-of-pocket costs for employer-provided health insurance rose by 7.1% in Virginia over the past two years to reach $8,143, according to data compiled by The Commonwealth Fund, a century-old foundation that aims to improve health care in the United States. That’s the sixth highest total in the nation. (Ress, 11/21)

Portland Press Herald: Mainers With Employer-Based Health Plans See Deductibles Soar
In Maine, the average employee’s out-of-pocket costs – a combination of premiums, copays and deductibles – surged from $4,670 in 2008 to $7,879 in 2018, according to the report by the New York City-based The Commonwealth Fund. Across the United States, average employee costs rose from $4,160 in 2008 to $7,388, an increase of 78 percent. (Lawlor, 11/21)

Read the study in our Research Roundup section below.

Reuters: U.S. Lawmakers Question Google About Collection Of Health Records
U.S. Presidential candidate Elizabeth Warren along with fellow Senators Richard Blumenthal and Bill Cassidy wrote a letter to Alphabet's Google on Wednesday to raise questions about its access to the health records of tens of millions of Americans. Warren and Blumenthal, who are Democrats, along with Cassidy, a Republican, were focused on a business partnership that Google formed with Ascension Health. (11/20)

Vox: Google’s Ascension Deal Gave The Company Access To Millions Of Medical Records. Here Are The Pros And Cons.
Google has been venturing into new areas of business and recently made huge news when it got access to the health records of millions of Americans through a partnership with the Ascension hospital network. Both companies insist their goal is “to provide better care to patients,” but the program, code-named Nightingale, is already creating major privacy concerns. Just 48 hours after it was announced, federal regulators from the Department of Health and Human Services announced an investigation into whether the partnership violates HIPPA, the Health Insurance Portability and Accountability Act. (Paunescu, 11/19)

And in other news from the intersection of health and technology —

Kaiser Health News: No Safety Switch: How Lax Oversight Of Electronic Health Records Puts Patients At Risk
In fall 2009, several dozen of the best minds in health information technology huddled at a hotel outside Washington, D.C., to discuss potential dangers of an Obama White House plan to spend billions of tax dollars computerizing medical records. The health data geeks trusted that transitioning from paper to electronic records would cut down on medical errors, help identify new cures for disease and give patients an easy way to track their health care histories. (Schulte and Fry, 11/21)

Modern Healthcare: Physicians Score EHRs An 'F' On Usability, Study Finds
Electronic health record systems score in the bottom 9th percentile of technologies when evaluated for usability, according to a recent study published in the journal Mayo Clinic Proceedings. That's a problem, because physicians who rate their EHR experience poorly are more likely to report symptoms of burnout, study authors wrote. (Cohen, 11/18)

The Wall Street Journal: Hospitals Push Back On Price-Disclosure Rule
Hospitals are pushing back against the Trump administration’s new health-pricing disclosure rule, with the industry planning a legal challenge to block it. The final rule, released Friday along with a proposed rule aimed at insurers, would require hospitals to disclose the secret rates they negotiate with insurers for all services, including supplies and care provided by doctors who work for the facility. (Wilde Mathews, 11/20)

In other news on hospital costs —

The Hill: Critics Seek More Scrutiny On Hospitals In Health Cost Fight 
Sen. Bernie Sanders (I-Vt.) often bashes “the drug companies and the insurance companies” as he makes the case for “Medicare for All.” But there’s another major health industry player, also fiercely opposed to Medicare for All, that Sanders usually does not mention: hospitals. Sanders is not alone. In the Medicare for All fight and in the push to lower health care costs in general, hospitals usually fly under the radar. (Sullivan, 11/21)

Kaiser Health News: ‘An Arm And A Leg’: A Medical Bill Ninja Shares Her Secrets
Meredith Balogh has spent years learning to navigate the financial side of the health care system. Balogh, who has Type 1 diabetes, has saved herself and her family many thousands of dollars. She has made a habit — even a hobby — of helping others: people with diabetes, co-workers and strangers on the internet. “There’s only three things that you’re fighting,” she said. “Problems with competence, problems with greed and problems with maliciousness. And, luckily, most things are incompetence.” (Weissmann, 11/21)

The Wall Street Journal: As New York Faces Big Medicaid Cost Overruns, Cuomo Stays Mum
New York’s Medicaid program expenses are running at least $3 billion over budget, but the administration of Gov. Andrew Cuomo has so far said little about its plans to deal with the issue. Administration officials are three weeks past their legal deadline to release a midyear budget report, which will include details about the overruns. The delay in disclosure has left advocates and lawmakers wondering about Mr. Cuomo’s plans for the Medicaid program—the state’s largest expenditure—and the possibility of immediate service cuts. (Vielkind, 11/20)

The Associated Press: California Agency Predicts $7 Billion State Budget Surplus
California is expected to have a $7 billion budget surplus next year, but lawmakers were urged Wednesday not to spend all of it because a sizable chunk depends on an upcoming decision by the Trump administration as it feuds with state Democratic leaders. ... However, nearly $2 billion of the initial $7 billion projected surplus depends on whether the Trump administration lets California tax organizations that manage the state’s Medicaid plans. (Beam, 11/20)

Los Angeles Times: California's Extra Budget Cash Could Soon Top $26 Billion, Analysts Say
The $7-billion surplus would be in addition to an expected $18.3 billion in “rainy day” reserves that must be set aside for an economic downturn and another $900 million that will be earmarked to assist social services programs in the event that recession pressures mount. The LAO report assumes the first signs of a recession appear in early 2021. Any acceleration or delay of that economic weakening could substantially change the size of the projected cash reserves. (Myers, 11/20)

Sacramento Bee: CA Politicians Team To Stop Federal Cuts To Hospital Payments
California’s congressional leaders urged the U.S. House leadership Tuesday not to cut off supplemental Medicaid payments to hospitals because doing so could jeopardize care for millions. These supplemental payments, known as disproportionate share allotments, provide “an essential funding source helping safety-net hospitals serve the uninsured and underinsured residents of their communities,” a group of 47 legislators stated in a letter to House Speaker Nancy Pelosi and House Minority Leader Kevin McCarthy. (Anderson, 11/20)

Politico Pro: Tennessee Sends Request To Cap Medicaid Funds To CMS
State officials sent the overhaul about a week after CMS Administrator Seema Verma vowed to soon release federal guidance allowing states to pursue Medicaid spending caps. The state's plan would apply to people traditionally covered by the program, including children, pregnant women, poor seniors in nursing homes and people with disabilities. (Pradhan, 11/20)

The Hill: Tennessee Becomes First State To Ask Permission For Medicaid Block Grants
Imposing block grants in Medicaid has long been a major conservative goal and has been encouraged by the Trump administration, but it is not clear if the administration alone has the legal authority to allow such drastic changes. Administration officials had drafted a guidance that would make it easier for states to apply for a capped payment or block grants, but the document was quietly removed from the White House Office of Management and Budget last week. (Weixel, 11/20)

Bloomberg Law: Conservative Group Goes State By State For Medicaid Work Rules
When Idaho’s Legislature voted to expand Medicaid coverage for people in the state, a key debate involved whether to require some recipients to work to receive benefits. Republicans, who favored the requirement, gained a key ally—the “Opportunity Solutions Project,” a little-known new group with opaque funding. While Republicans found the organization’s suggestions on how to make “workfare” a success useful, opponents of the idea felt very differently. (Stein, 11/21)

Columbus Dispatch: Medicaid And Its Contractor Shed Little Light On Network Reduction
Ohio Medicaid’s largest Medicaid managed-care provider has dramatially shrunk its pharmacy network by dropping Walgreens. But despite promises of new transparency, neither the agency has done much to explain the change. (11/21)

Reuters: Charity To Pay $4 Million To Resolve U.S. Pharma Kickback Probe
A Florida-based charity will pay $4 million to resolve claims that it acted as a conduit for companies including Biogen Inc and Novartis AG to pay kickbacks to Medicare patients using their high-priced multiple sclerosis drugs, the U.S. Justice Department said on Wednesday. The settlement with the patient assistance charity The Assistance Fund marked the third so far with a foundation linked to an industry-wide probe that has resulted in $850 million in settlements with drugmakers and charities. (Raymond, 11/20)

Stat: Patient Charity Settles Allegations It Helped MS Drug Makers Pay Kickbacks
The Assistance Fund, based in Orlando, says its mission is to help patients manage copays, coinsurance, deductibles, and other expenses related to their disease or chronic condition. But the government alleges that it conspired with Teva, Biogen (BIIB), and Novartis (NVS) to funnel money donated by the drug makers to MS patients to ensure the patients took their drugs, not their competitors’, regardless of price. The Assistance Fund blamed previous management for the payments. (Cooney, 11/20)

The Hill: Trump, Senators Push For Drug Price Disclosures Despite Setbacks 
President Trump and senators from both parties are not giving up the fight over forcing drug companies to disclose list prices in TV ads. Both the White House and Congress are searching for an easy political win on drug prices, but so far have found little success. The disclosure rule was one of Trump’s highest-profile initiatives and the first policy released after the administration unveiled its drug pricing “blueprint” in 2018. (Weixel, 11/21)

Bloomberg: Drug For Ultra Rare Disease Comes With Ultra High Price Tag
Alnylam Pharmaceuticals Inc.’s Givlaari became the first drug to win U.S. approval for patients with an ultra-rare and devastating metabolic disorder. Shares jumped on the news. It will come with an annual wholesale price tag of $575,000. Patients will need to take it for life. There are about 3,000 people in the U.S. and Europe diagnosed with acute hepatic porphyria, where a genetic mutation leaves patients unable to produce an enzyme essential for the function of hemoglobin, the red blood cells that carry oxygen throughout the body. The condition causes a buildup of toxins that can lead to chronic debilitating symptoms and bouts of stomach and muscle pain so severe patients require hospitalization. (Cortez, 11/20)

The Washington Post: Shooting Victims Have Increased Risk Of Mental Harm Long After Physical Injuries Have Healed, Study Finds
Years after being shot, a large proportion of gun victims continue to suffer from increased unemployment, alcohol and drug abuse, and post-traumatic stress disorder, a new study shows, and the effects persist even when the injuries were minor. The authors point out that treatment for gun injuries may need to change: Currently, patients may be discharged quickly from the hospital, often with no checks on their mental health or follow-up care. And they say growing evidence suggests that gunshot trauma is harder to recover from than other types of injuries. (Wan, 11/20)

MPR: A Cry For Help Summoned The Police — And Ended In His Death
About 1 in 5 fatal police shootings across the country last year involved a person with mental illness, according to a Washington Post database of police shootings. So far this year, numbers are on track for the same. In Minnesota, out of the 47 people shot and killed by police over roughly the past five years, at least 18 had mental illness. (Roth, 11/21)

The Associated Press: Minnesota Violence Project Aims To Understand Mass Shootings
Minnesota researchers have created a new database that seeks to help understand circumstances that contribute to mass shootings in the United States. The nonpartisan Violence Project’s database went online Tuesday, Minnesota Public Radio News reported. The project’s researchers chronicled traits related to 171 people who committed mass shootings, which are defined as shooting and killing four or more people in a public space. (11/20)

The New York Times: Scientists Are Just Beginning To Understand Mysterious DNA Circles Common In Cancer Cells
There’s no image in biology more iconic than our chromosomes — all 23 pairs of DNA bundles arrayed in a genetic lineup. But in a surprising number of cases, this picture leaves out something very important. In some cells, extra circles of DNA float alongside the regular chromosomes. Scientists first noticed this so-called extrachromosomal DNA five decades ago. But for years they weren’t exactly sure what to make of it. (Zimmer, 11/20)

Stat: Study: Measles Immunity Passed To Babies May Erode Quicker Than Thought
Measles antibodies passed by pregnant women to their babies in the womb, protecting infants early in life, actually disappear quicker than had been previously recognized, leaving babies vulnerable to the sometimes fatal infection for much of their first year of life, according to a new study. The authors say their findings underscore the importance of widespread immunization against measles, which produces a phenomenon known as “herd immunity” — whereby measles viruses brought into the country by sick travelers can’t get to the vulnerable because so many people are protected. In the case of measles, that’s particularly important for infants; in babies, the risk of complications from the illness and of death is higher than in older children. (Branswell, 11/21)

The New York Times: Sleeping Fewer Than 5 Hours A Night Tied To Bone Problems
Sleeping too little may increase the risk for osteoporosis. A study of menopausal women has found that sleeping less than five hours a night is associated with significantly increased low bone mineral density. The report, in the Journal of Bone and Mineral Research, compared 1,080 women who slept less than five hours with 4,025 who slept the recommended seven hours. (Bakalar, 11/20)

NPR: Brain Uses Loudness Of Vowels To Process Speech Into Syllables
When we hear a sentence, or a line of poetry, our brains automatically transform the stream of sound into a sequence of syllables. But scientists haven't been sure exactly how the brain does this. Now, researchers from the University of California, San Francisco, think they've figured it out. The key is detecting a rapid increase in volume that occurs at the beginning of a vowel sound, they report Wednesday in Science Advances. (Hamilton, 11/20)

Kaiser Health News: Efforts To Move The Needle On Flu Shot Rates Get Stuck
It’s free and available everywhere. Yet most Americans skip the annual flu shot ― with the number of dispensed vaccines barely changed in the past decade, despite government removal of cost and access obstacles. “We are kind of spinning our wheels trying to reach a larger portion of the population,” said Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville, Tenn., and medical director of the National Foundation for Infectious Diseases. (Galewitz, 11/21)

The New York Times: Catherine Pugh, Former Baltimore Mayor, Indicted On Fraud Charges Over Book Scandal
Catherine Pugh, the former mayor of Baltimore, has been indicted on corruption charges connected to money she received for a series of children’s books she wrote, prosecutors made public on Wednesday. Ms. Pugh, who resigned as mayor in May amid state and federal investigations over the sale of her “Healthy Holly” books to companies that had business ties to the city, faces multiple charges, including wire fraud, conspiracy to defraud the United States government and tax evasion. (Williams and Goldman, 11/20)

The Washington Post: Former Baltimore Mayor Catherine E. Pugh Charged With Wire Fraud And Tax Evasion Over Financial Deals For Her Healthy Holly Books
Prosecutors accuse Pugh of running a sham business dating to 2011, when she was a state senator and before her days overseeing Maryland’s largest city. She is accused of ripping off nonprofit organizations and taxpayers by accepting payments for tens of thousands of books she never intended to deliver. Pugh used the money, according to court papers, to fund her mayoral bid and to buy and renovate a house in Baltimore. (Marimow, Bui and Hermann, 11/20)

The Associated Press: Ex-Baltimore Mayor Charged In ‘Healthy Holly’ Book Scandal
“There are many victims in this case,” said U.S. Attorney Robert Hur in announcing the indictment. “The victims are all of us, the taxpayers and the people of Baltimore, who expect and deserve integrity from their public officials.” Federal authorities say Pugh and two city employees double-sold the books or failed to deliver them to institutions they were purchased for, including the Baltimore City Public Schools. Pugh then allegedly used the proceeds to fund straw donations to her mayoral campaign and to renovate a house. (11/20)

Reuters: Former Baltimore Mayor Charged With Wire Fraud Over 'Healthy Holly' Book Sales
Pugh's former legislative aide Gary Brown, who helped her promote and distribute the books, pleaded guilty to charges including conspiracy to commit wire fraud, the indictment said. The former mayor faces a maximum sentence of up to 20 years for wire fraud if convicted. (11/20)

The Baltimore Sun: Former Baltimore Mayor Pugh Indicted On 11 Counts Of Fraud, Tax Evasion In Children's Book Scandal
Federal prosecutors have charged former Baltimore Mayor Catherine Pugh with 11 counts of fraud, tax evasion and conspiracy in what they allege was a corrupt scheme involving her sales of a self-published children’s book series. In a grand jury indictment made public Wednesday, prosecutors allege Pugh defrauded area businesses and nonprofit organizations with nearly $800,000 in sales of her “Healthy Holly” books to unlawfully enrich herself, promote her political career and illegally fund her campaign for mayor. (Broadwater and Rector, 11/20)

ProPublica: Illinois To Take Emergency Action To Halt Isolated Timeouts In Schools
The Illinois State Board of Education announced Wednesday that it will take emergency action to end the seclusion of children alone behind locked doors at schools, saying the practice has been “misused and overused to a shocking extent.”Responding to a Chicago Tribune and ProPublica Illinois investigation published a day earlier, Gov. J.B. Pritzker called the isolation of children in the state “appalling” and said he directed the education agency to make emergency rules for schools. (Smith Richards, Cohen, Chavis and Petrella, 11/20)

San Francisco Chronicle: California Supreme Court Turns Down Abortion Challenge By Missionary Group
The state Supreme Court rejected a challenge by a Catholic missionary organization Wednesday to decisions by state health regulators and an appeals court that voluntary abortions are “medically necessary” procedures that must be provided by health care service plans in California. Regulations requiring the coverage, adopted by the California Department of Managed Health Care in 2014, were upheld in August by a state appeals court in Sacramento. (Egelko, 11/20)

The Advocate: Group Wants FDA Investigation Of Louisiana Prisons Offering Unapproved Addiction-Fighting Implant 
A Washington, D.C.-based advocacy group is calling for a federal investigation into a short-lived pilot program that involved treating Louisiana prisoners addicted to opioids using a surgical implant never approved by regulators. The group, Public Citizen, sent a letter to the U.S. Food and Drug Administration Wednesday demanding they “launch a formal compliance investigation” into a program developed through a partnership between the Louisiana Department of Public Safety and Corrections and a California health care company that distributes the implant. (DeRobertis, 11/20)

The CT Mirror: Courtney Bill To Protect Health Workers From Violence Set For House Vote
he U.S. House is expected to vote on a bill this week sponsored by Rep. Joe Courtney that aims to protect nurses and other health care and social workers who are physically attacked by patients or their family members. Under Courtney’s bill, the Labor Department would have to issue a rule requiring health care and social service employers to implement workplace violence prevention plans. (Radelat, 11/20)

The Star Tribune: Minnesota Hospitals Using Antibiotics More Carefully 
Minnesota hospitals have ramped up their efforts to prevent antibiotic overuse and the drug-resistant infections that can follow. The share of hospitals in the state meeting national guidelines for appropriate use of antibiotics is now 76% — up from a rate of 24% in 2015 that was one of the lowest in the nation, the Minnesota Department of Health announced on Wednesday. Minnesota still trails the national rate of 85% but has closed the gap through efforts at its many small, rural hospitals, said Jan Malcolm, state health commissioner. (Olson, 11/20)

St. Louis Public Radio: Cancer Risk From St. Louis Air Pollution Highest In Poor Black Neighborhoods
Predominantly black neighborhoods in the St. Louis region where poor people live have a much higher exposure to carcinogenic air pollution than white middle-class neighborhoods, according to a study from Washington University. Researchers analyzed the Environmental Protection Agency’s data on risk of cancer from air pollutants, like ozone, among census tracts in the St. Louis metropolitan area. (Chen, 11/20)

The Associated Press: Officials: Multistate Hepatitis A Cases Traced To Berries
A hepatitis A outbreak in Nebraska, Indiana and Wisconsin has been traced to blackberries sold in Fresh Thyme grocery stores and federal authorities on Wednesday warned consumers in 11 states against eating some berries bought from that chain. The Nebraska Department of Health and Human Services said in a news release that the outbreak began several weeks ago in Nebraska. (11/20)

The Oregonian: New Measles Risk At Portland International Airport After Infected Child Passes Through
An unvaccinated child under 11 returned with measles from a country experiencing an outbreak of the disease, Clark County Public Health officials said Wednesday. The child passed through Portland International Airport on Nov. 14. Health officials did not say where the child had traveled. The agency warned that people in Vancouver and Portland may have been exposed to the virus. If somebody was exposed to the measles and is susceptible to an infection, they might start showing symptoms between Nov. 18 and Dec. 9. (Zarkhin, 11/20)

The Oregonian: Multnomah County Staff Mishandled Hundreds Of Mental Health Abuse Complaints, Report Finds 
Multnomah County employees in charge of protecting adults with mental health issues failed to do so on multiple fronts, according to District Attorney Rod Underhill and county officials. Those determinations, both made public Tuesday, came in the midst of a wide-ranging review in the wake of findings that county staff knew about deaths and abuse at the main psychiatric facility in the county yet did nothing. (Harbarger, 11/20)

The Oregonian: In Multnomah County, Mental Health Services Are Increasingly Scarce 
Caught between stagnant funding, an insurance maze and an affordable housing crisis, Multnomah County is struggling to deliver its mental health services to the people that need it the most. That’s according to an audit released Wednesday from the Multnomah County Auditor’s Office. The county’s ability to deliver its services is “limited and faces imminent risks,” the audit states. (Goodykoontz, 11/20)

Milwaukee Journal Sentinel: Childhood Trauma In Wisconsin And The Nation A 'Public Health Crisis'
If such a world of trauma-free households could ever exist, national unemployment would fall 15%. There would be 24% fewer heavy drinkers and 33% fewer smokers. Cases of coronary heart disease — the leading cause of death in the U.S. —would fall 13%. Those are among the findings in a new study that has special relevance to Milwaukee and Wisconsin, regions that already have been studying the impact of nonmilitary psychological trauma on their populations. (Schmid, 11/20)

New Orleans Times-Picayune: Talks Between LCMC And East Jefferson Hospital Focus On Likely Sale, Sources Say 
Seven months after East Jefferson General Hospital officials began discussions with LCMC Health about LCMC operating the financially troubled Metairie hospital, it appears the parties may be headed toward a sale, according to sources familiar with the negotiations. The talks, which began in April, have been conducted in strict secrecy and have explored various strategic partnerships that would allow the New Orleans-based LCMC to operate the public hospital. (Faimon, 11/20)

WBUR: 'We're Here Standing In Solidarity': Health Care Providers As Immigrant Advocates In The Age Of Trump
Boston-area health care providers are increasingly finding themselves in the middle of the Trump administration's crackdown on immigration. New policy proposals and partisan politics are combining, making it more difficult for immigrant patients to access health care and in turn, leading more physicians to push back. (Dooling, 11/21)

Commonwealth Fund: Trends In Employer Health Care Coverage, 2008–2018
Average annual growth in the combined cost of employees’ contributions to premiums and deductibles outpaced growth in U.S. median income between 2008 and 2018 in every state. Middle-income workers spent an average 6.8 percent of income on employer premium contributions in 2018; per-person deductibles across single and family plans amounted to 4.7 percent of median income. Recent proposals would enhance the affordability and cost protection of Affordable Care Act marketplace plans, allow people with employer plans to buy coverage on the marketplaces, or replace private insurance with a public plan like Medicare. (Collins, Radley and Baumgartner, 11/21)

JAMA Internal Medicine: HIV Preexposure Prophylaxis—The Role Of Primary Care Clinicians In Ending The HIV Epidemic
A global human immunodeficiency virus (HIV) epidemic persists despite data to support multiple effective and safe tools that prevent HIV transmission and acquisition. Human immunodeficiency virus preexposure prophylaxis (PrEP) for HIV-uninfected at-risk populations using tenofovir disoproxil fumarate emtricitabine is highly effective, safe, and recently endorsed by the US Preventive Services Task Force (USPSTF) as a grade A recommendation. (Khalili and Landovitz, 11/18)

Health Affairs: Measles, Mumps, And Communion: A Vision For Vaccine Policy
A pediatrician offers a vision for vaccine policy that promotes public health while respecting religious beliefs. (Williams, 11/ 20)

JAMA Internal Medicine: Disparities In Care And Mortality Among Homeless Adults Hospitalized For Cardiovascular Conditions
In this cross-sectional study of 24 890 hospitalizations for cardiovascular conditions among homeless adults and 1 827 900 hospitalizations for cardiovascular conditions among nonhomeless adults in New York, Massachusetts, and Florida between 2010 and 2015, homeless individuals hospitalized with acute myocardial infarction were significantly less likely to undergo coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft surgery compared with nonhomeless adults and had higher mortality rates for ST-elevation myocardial infarction. Homeless persons hospitalized for cardiac arrest or stroke also received less procedural care and had higher mortality rates. (Wadhera et al, 11/18)

The New York Times: Statin Drugs Not Linked To Memory Decline In Study
There has been some evidence that statins cause cognitive problems, and enough case reports to make the Food and Drug Administration require a warning label on the medicines. But a large Australian study reports that the cholesterol-lowering drugs are not associated with a decline in memory or thinking ability. Over six years, researchers periodically measured mental acuity in 1,037 men and women aged 70 to 90. They used M.R.I. brain scans to calculate the brain volume of 526 of the subjects at the beginning and at two years into the study. (Bakalar, 11/18)

Stat: The FDA Tried To Regulate E-Cigarettes But Others Tied Its Hands 
When it comes to the public’s health, it always seems to take a crisis before protections are put in place. The Food, Drug, and Cosmetic Act of 1938 — the bedrock law that first required companies to conduct safety studies of medications before they could be sold — was passed only after a tainted drug killed scores of children. In 1962, a scare over birth defects caused by thalidomide led to groundbreaking standards for clinical trials. Medical device controls? Enacted in 1976 after the Dalkon Shield caused infertility and infections in thousands of women. Food safety legislation? It received bipartisan support only after the recall of 500 million eggs tainted by salmonella. My public health students often ask an obvious question: Why is it so challenging for regulatory agencies to prevent calamities in the first place? In years past, I have struggled with a concise answer to this question — until now. (Joshua M. Sharfstein, 11/21)

USA Today: Amid Shootings, Let's Finish Bipartisan Gun Deal With Trump: 3 Senators
There is no escaping gun violence in America.In the sleepy hamlet of Sandy Hook, Connecticut, a disturbed young man needed only five minutes to murder 20 first-graders and six educators. In Philadelphia, this year is on track to end with the city suffering more homicides, most of them perpetrated with a gun, than any other year in the past decade. In rural West Virginia, suicides are on the rise, with the firearm as the common method of choice. In under a week, we’ve seen shootings in Santa Clarita, San Diego and Fresno, California; in Pleasantville, New Jersey; and, just this Monday, in Duncan, Oklahoma. (U.S. Senators Chris Murphy, Pat Toomey and Joe Manchin, 11/19)

The Hill: Doctor's Orders: Support Land And Water Conservation
Humans are a part of nature. We can’t be healthy if the world around us isn’t healthy enough to sustain, nourish and protect us. And without a healthy population, we can’t achieve our full potential for generating strong economies, driving innovation and securing a safe future. Nature is at the heart of it all. Supporting nature and supporting ourselves is one and the same task, and it is a critical task. Right now, Congress has a chance to make big gains in supporting nature by enacting a solution that already has broad bipartisan support: Fully fund the Land and Water Conservation Fund (LWCF). (Former Sen. Bill Frist, 11/20)

The Washington Post: Yes, Marijuana Has A Gateway Effect. But So Do Most Addictive Substances.
When former vice president Joe Biden asserted over the weekend that marijuana shouldn’t be legal because it might be a “gateway” to hard drug use, pro-legalization critics were quick to paint him as an out-of-touch codger still fighting the last drug war. But the reaction isn’t entirely fair: Yes, the marijuana gateway theory that was omnipresent in the 1980s was at best distorted and at worst dishonest. Nevertheless, gateways between marijuana and other addictive substances are real — and they swing in both directions. (Keith Humphreys, 11/20)

Boston Globe: Boston’s Pot Equity Law Long Overdue
At long last, Boston has a plan for how it will license marijuana businesses to open up shop in the new era of legalized recreational use. The city has now finally spelled out how it intends to help people from communities most affected by the war on drugs to become local marijuana business operators. This was a long-overdue step to outline how Boston will fulfill the principle of social equity made explicit in the marijuana law Massachusetts voters passed via ballot initiative in 2016. (11/21)

The Washington Post: A Debate That Actually Covered The Issues? This Time, We Don't Have To Imagine. 
Imagine a debate that drove the political pundits crazy and warmed the hearts of policy wonks and voters curious about how politicians might solve problems. What would it be like to have presidential candidates score few points against each other but lay out in some detail what they’d do about family leave, housing, climate change, voting rights and a slew of other issues? You don’t have to imagine. That pretty well describes the fifth Democratic presidential debate on Wednesday night. It covered a much broader range of concerns than the earlier encounters, including an extensive set of queries on foreign policy. While the contenders tangled over a few issues — notably, as always, health care — they avoided fireworks, cracked the occasional joke (Sen. Amy Klobuchar of Minnesota especially) and spent far more time in vehement agreement than they did in loud disagreement. (E.J. Dionne Jr. , 11/20)

The Columbus Dispatch: A Question Of Health In The White House
The presidency is a job unlike any other and imposes physical and mental demands like no other. So when the White House says President Donald Trump used a rare free Saturday afternoon to pop in at Walter Reed National Medical Military Center for an unscheduled “partial physical,” the public is right to have questions. (11/21)

USA Today: Trump Health Hypocrisy After Clinton Smears: Speculation Is Dangerous
When I heard about President Donald Trump's unexpected weekend visit to Walter Reed National Military Medical Center, honestly, my first thought was the stress and strain of impeachment coupled with his Big-Mac-KFC diet finally got the better of him.Instead, White House Press Secretary Stephanie Grisham issued a statement saying, “Anticipating a very busy 2020, the President is taking advantage of a free weekend here in Washington D.C. to begin portions of his routine annual physical exam at Walter Reed.” Grisham would later add via tweet that “further speculation beyond the extensive & honest info I put out is wholly irresponsible & dangerous for the country.” But how “routine” was this medical visit? And can you blame many of us for asking? (Kurt Bardella, 11/19)

The Hill: Presidential Candidates Should Use Their Platforms To Elevate Oral Health
The debate over “Medicare for All” has sucked the oxygen from many other important health policy issues. Though 28 million Americans lack health insurance in the United States, there is an untold crisis of more than four times that population — 114 million Americans — without dental coverage. Millions of Americans are suffering from decaying teeth, gum disease, and chronic pain. Yet, in the Democratic presidential debates thus far, barely a word has been spoken about this crisis. When we spend so much time talking about health care, why is oral health so easy to ignore? (Arielle Kane, 11/20)

Des Moines Register: Background Checks Can Reduce Abuse In Nursing Homes
This fall, the Senate Finance Committee, led by our own Senator Grassley, is expected to unveil a bill to address abuse and neglect in nursing homes and other long-term care settings. The bill is long overdue, given countless government studies addressing these horrific problems and specifying solutions.Lawmakers are set to announce a series of policies to provide more funding for detection and reporting of elder abuse. Will they also take meaningful steps to prevent abuse in long-term care settings? (Dean Lerner, 11/20)

The Hill: Could Health Data Privacy Kill You?
Last week, the Wall Street Journal reported on Project Nightingale — a controversial initiative spearheaded by Google’s parent company Alphabet and its health-care cloud-computing customer Ascension Health. Millions of patient records had been copied to Google servers and were viewable by hundreds of Alphabet employees. This was done without the knowledge of the patients or their physicians. (Piers Nash, 11/20)

The CT Mirror: Being A Woman Of Color In Connecticut Is Bad For Your Health
Being a woman of color in Connecticut is bad for your health.As a nurse working in an inner-city hospital, I have seen this first hand. I have seen women delay or forgo prenatal care because they do not have insurance. I have seen women who are here illegally ignore cancers growing inside them for years because of fear of medical providers, or fear of deportation. (Molly Montano, 11/21)