The New York Times: States Ask Judge To Declare Health Law Still In Effect While Ruling Is Appealed
California and 15 other states asked a federal judge on Monday to protect current health care coverage for millions of Americans while courts sort out the implications of his ruling that the Affordable Care Act was invalid in its entirety. The states, which support the health care law, said the ruling on Friday, by Judge Reed O’Connor of the Federal District Court in Fort Worth, had caused immense confusion about whether the law was still in effect, and whether consumers were still entitled to its benefits and protections. The states asked Judge O’Connor to clarify whether he meant his decision to have “any immediate legal effect.” (Pear, 12/17)

Boston Globe: 18 States, Including Massachusetts, File Motion To Challenge Ruling Striking Down Affordable Care Act
Massachusetts Attorney General Maura Healey and her counterparts in 17 other states filed a motion Monday challenging a Texas federal judge’s ruling last week that struck down the Affordable Care Act. ... “Millions of Americans who rely on the protections of the Affordable Care Act have been left confused and uncertain about the future of their health care coverage,” Healey said. “We are urging the court to clarify its ruling to avoid massive disruption in the healthcare market.” (Cote, 12/18)

The Wall Street Journal: States Ask For Clarity On Judge’s Ruling On Affordable Care Act
The states filed a motion that asks U.S. District Judge Reed O’Connor in Texas to either clarify his ruling or grant a stay of his decision during litigation. The states also asked for permission to appeal it right away. The judge cast a cloud over the ACA’s future in a sweeping ruling that declared the ACA unconstitutional without a penalty on people forgoing health coverage. Congressional Republicans have eliminated the penalty starting for next year. Because the insurance mandate was central to the law, the whole law must be invalidated, the judge ruled. (Armour, 12/17)

The Hill: Dem AGs Begin Process Of Appealing Court Ruling That Struck Down ObamaCare
The state officials noted in their filing Monday that O'Connor's opinion created confusion about whether ObamaCare will be unenforceable once the repeal of the individual mandate takes effect Jan. 1. They also asked that he certify his opinion so it can be appealed to the Fifth Circuit. They asked for a response by Friday. “The district court’s ruling poses a dangerous threat to the healthcare of millions of Americans. We’re asking the court to make clear that the ACA is still the law and ensure that all Americans can continue to access affordable healthcare under it,” Becerra said in a statement. (Hellmann, 12/17)

Modern Healthcare: Obamacare's Uncertain Fate Leaves Congress, Industry Lying In Wait
Although the effective elimination of the individual mandate penalty starts Jan. 1—before the filing deadline—HHS and the White House say the law will remain in place since O'Connor did not grant an injunction. "This decision does not require that HHS make any changes to any of the ACA programs it administers or its enforcement of any portion of the ACA at this time," HHS said Monday. (Luthi, 12/17)

The Hill: Incoming Dem Chairman Vows Hearings On ObamaCare Lawsuit 'Right Away'
Rep. Frank Pallone Jr. (D-N.J.), the next chairman of the House Energy and Commerce Committee, vowed Monday to hold oversight hearings "right away" on the Trump administration's involvement in a court case over the weekend that ruled that the Patient Protection and Affordable Care Act, often called ObamaCare, was unconstitutional. Pallone will take over the chairmanship of the panel when Democrats assume the House majority next year. He said they will "get to the bottom" of the administration's decision not to defend the health-care law against a lawsuit filed by Republican attorneys general. (Hellmann, 12/17)

Bloomberg: House Democrats Are Said To Plan Joining Obamacare Legal Fight 
In the 2018 election, polls showed health care ranked as the single most important issue to voters. Democrats across the country highlighted the GOP’s attempts to do away with Obamacare’s consumer protections, and it paid dividends as the party won 40 House seats. It wouldn’t be the first time the House has gotten formally involved in a lawsuit or other legal action involving Obamacare. Republicans previously used their majority control to make legal attacks on aspects of the 2010 health-care law. (House, 12/17)

Kaiser Health News: What Just Happened To The ACA And What Happens Now? A Special Bonus Edition
Federal District Judge Reed O’Connor again thrust the Affordable Care Act into uncertainty with his ruling Friday that eliminating the tax penalty for not having insurance renders the entire law unconstitutional. The panelists for this special bonus episode of KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Stephanie Armour of The Wall Street Journal and Paige Winfield Cunningham of The Washington Post. (12/17)

Kaiser Health News: Watch And Listen: Court Decision Rocks ACA
Julie Rovner, KHN’s chief Washington correspondent, was featured on NPR’s “Up First” podcast Monday morning to discuss a federal judge’s ruling late Friday invalidating the Affordable Care Act. She also joined NPR’s Michel Martin on Saturday on “All Things Considered” to talk about the case. (12/17)

Boston Globe: Mass. ‘Not Immune’ To Ripple Effect Of Health Care Law Ruling
A Texas judge’s ruling late last week to throw out the Affordable Care Act could have far-reaching consequences, threatening health coverage for millions and insurance markets nationwide — even in Massachusetts, which has its own universal health care law. The Massachusetts law, which went into effect more than a decade ago, has bipartisan support and was the model for the sweeping federal health care overhaul approved under President Obama in 2010. (Dayal McCluskey, 12/18)

New Orleans Times-Picayune: After Obamacare Ruling, Louisiana Officials Want Pre-Existing Health Conditions Covered
Three days after a Texas judge ruled President Barack Obama’s signature federal health care law unconstitutional, state leaders are assessing their next move pending the likely appeal of the decision. Louisiana Attorney General Jeff Landry, one of 20 attorneys general seeking to overturn the Affordable Care Act, reiterated that he will back state legislation requiring health insurance companies cover people with pre-existing medical conditions if a lawsuit that he’s bringing strikes down the law’s current mandate for such coverage. (O'Donoghue, 12/17)

The Baltimore Sun: Here's How Many People Enrolled In Health Insurance Through Maryland's Marketplace 
Nearly 157,000 Marylanders enrolled in health insurance through the state’s insurance marketplace for 2019, according to the Maryland Health Benefit Exchange. During the open enrollment period from Nov. 1-Dec. 15, 156,963 Marylanders enrolled in health insurance through Maryland Health Connection, marking a 2 percent increase from the 153,571 people that signed up for health insurance through the state’s exchange last year. (Meehan, 12/17)

The Hill: GOP Lawmakers Distance Themselves From ObamaCare Ruling
Republicans are keeping their distance from a recent court ruling that struck down ObamaCare, as GOP lawmakers are wary of the political backlash that could ensue from scrapping the law. Many congressional Republicans remain silent after a federal judge on Friday struck down the Affordable Care Act in its entirety. And those who have spoken out largely steered clear of embracing the decision. (Sullivan, 12/17)

Bloomberg: GOP Stuck In A 'Lose-Lose' Dilemma With Judge's Obamacare Ruling 
Congressional Republicans were handed the gift they said they wanted when a Texas judge invalidated Obamacare late last week. Yet few now seem willing to open it. After spending the eight years since the law passed promising -- and failing -- to repeal the Affordable Care Act, Republicans are no closer to crafting a politically viable alternative to the law, which has gained favor with voters and has transformed the nation’s health-care system. (Kapur, 12/18)

Politico Pro: GOP Has No Backup Plan After Ruling That Struck Obamacare
The Trump administration said it had a contingency plan in case a court struck Obamacare’s patient protections — though it never revealed what the plan was, or how it would keep vulnerable Americans covered. But a federal judge in Texas went further than many expected on Friday, invalidating the entire 2010 law. Now, the administration’s plan is essentially to do nothing for the moment — keeping in place a statute it reviles and letting the courts sort matters out in a process that could drag well into the 2020 election cycle. (Cancryn, Demko and Ollstein, 12/17)

The Washington Post: Trump Suggests A Supreme Court Ruling Invalidating Affordable Care Act Would Lead To Better Health Care
President Trump on Monday suggested that the Supreme Court should affirm a ruling by a federal judge in Texas that the entire Affordable Care Act is invalid, writing on Twitter that doing so “will lead to GREAT HealthCare results for Americans!” The president weighed in on the judicial process as the ruling on Friday cast great uncertainty over the U.S. health-care system, with the expectation that the case would ultimately make its way to the Supreme Court. In his tweet, Trump sought to make the case, as he first did over the weekend, that the ruling presented an opportunity for his Republican administration to work with Democrats to craft a better law than President Barack Obama’s signature achievement, which Trump continued to criticize. (Wagner, 12/17)

Politico: Why Trump Still Needs Obamacare
A Texas judge’s stunning declaration that Obamacare is unconstitutional not only kneecaps the health care law, it would also cripple President Donald Trump’s entire health care agenda. Trump wants lower drug prices, drastic action on the opioid crisis and protection for people with pre-existing conditions. Those are the parts of the law many Republicans do want to keep, but with the entire law invalidated — pending appeal — Trump and Republicans are trying to figure out how to live with a judicial ruling they kind of wanted, but didn’t want in such a big way. (Karlin-Smith, Roubein and Ehley, 12/17)

Reuters: U.S. Healthcare Stocks Drop After Judge Rules Obamacare Unconstitutional
Shares of U.S. health insurers, hospitals and healthcare companies fell on Monday in the aftermath of a ruling by a federal judge in Texas that the Affordable Care Act (ACA), commonly called Obamacare, was unconstitutional. Many legal experts predicted U.S. District Judge Reed O'Connor's decision on Friday eventually will be reversed on appeal considering that the law has been upheld by the Supreme Court, but the uncertainty created by the ruling drove down healthcare stocks on Monday. (12/17)

The Associated Press: Health Care Sector Roils After ACA Court Ruling
Hospital chains HCA Inc. and Tenet Healthcare Corp. dropped 7 percent and 4 percent respectively when markets opened Monday. Centene Corp., a health insurer focused heavily on the government-funded Medicaid program and the ACA’s individual insurance exchanges, fell 8 percent. Other insurers that slipped included Molina Healthcare Inc. and Anthem Inc., companies that have benefited from either the insurance exchanges or the law’s Medicaid expansion.(12/17)

Bloomberg: Health Stocks CYH, THC, HCA Fall After Obamacare Ruling 
Debt investors were also weary of the political uncertainty that was created after the judge’s decision. Tenet and Community Health’s bonds were among the top decliners in the high-yield market on Monday, according to Trace bond trading data. Tenet’s 6.75 percent and 7 percent senior unsecured notes due 2025 and 2022 slipped 2 cents on the dollar to 94.75 and 94.25 respectively, according to Trace. (Darie, 12/17)

Bloomberg: States' Credit Quality Threatened By Obamacare Ruling, S&P Says 
A federal judge’s ruling Friday that Obamacare is unconstitutional poses a threat to the credit quality of some U.S. states, as well as to hospitals and insurance companies, S&P Global Ratings warned. States that expanded Medicaid under the Affordable Care Act -- the signature health-care overhaul under President Barack Obama -- could lose billions of dollars in federal money and could face significant costs if they try to keep coverage for people newly-covered by the program, S&P said in a release Monday. Certain providers of substance abuse treatment, emergency services and mental health services could also be negatively impacted. (Albright, 12/17)

Modern Healthcare: Obamacare Ruling Has Health Insurers Reassuring Customers
Health insurers and the lobbying groups that represent them blasted a Texas federal judge's decision to strike down the Affordable Care Act as unconstitutional on Friday. They moved quickly to ensure plan members that their insurance coverage and any federal financial help they receive will stay unchanged during the long legal fight sure to ensue. "While we remain extremely disappointed in this decision, this is going to be a lengthy legal process and while it continues, we are assuring Blue Cross and Blue Shield members that their health coverage and the financial assistance they may be receiving to help them afford it remains in place," said Justine Handelman, senior vice president in the office of policy and representation at the Blue Cross and Blue Shield Association. (Livingston, 12/17)

Stat: Sen. Alexander, Leading Republican On Health Care, Will Not Seek Reelection
One of Washington’s most influential health policymakers, Sen. Lamar Alexander, will not seek reelection in 2020, he announced Monday. The Tennessee Republican has chaired the powerful Senate Health, Education, Labor, and Pensions Committee since 2015, where he presided over a number of high-profile health care bills, including the 21st Century Cures Act, and the Republican party’s eventually abandoned effort to repeal Obamacare. (Florko, 12/17)

CQ: Alexander Announces He Won't Seek Re-Election In 2020
“I will not be a candidate for re-election to the United States Senate in 2020. The people of Tennessee have been very generous, electing me to serve more combined years as Governor and Senator than anyone else from our state. I am deeply grateful, but now it is time for someone else to have that privilege,” Alexander said in a statement. Alexander had said he would decide by the end of the year whether he’d seek re-election. As recently as last week, it seemed his team was gearing up for him to seek a fourth term, when his pollster released a poll showing the senator with a 65 percent favorability rating among likely Republican primary voters. (Lesniewski, 12/17)

Politico: Lamar Alexander To Exit Polarized Senate: ‘I Just Wish It Were Easier’
Alexander is widely respected by Democrats and Republicans, the rare senator who is close to both Senate Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Chuck Schumer (D-N.Y.). With his retirement, the Senate will lose a key negotiating conduit during times of crisis. (Everett, 12/17)

The New York Times: Senator Lamar Alexander Will Not Seek Re-Election In 2020
It has not been all wins for Mr. Alexander. After Republicans were unsuccessful in repealing the Affordable Care Act, he led an effort to try to reach a bipartisan agreement to shore it up while lawmakers considered broader changes. But the attempt to repair former President Barack Obama’s signature health care legislation — in concert with Senators Patty Murray, Democrat of Washington, and Susan Collins, Republican of Maine — collapsed. That blockade was emblematic of the fate of broader bipartisan measures that tread on politically sensitive turf. (Hulse and Hirschfeld Davis, 12/17)

Nashville Tennessean: Lamar Alexander, Tennessee Senator, Will Not Seek Re-Election In 2020
Like Sen. Bob Corker, the Tennessee Republican last year declined to run for a third term, Alexander’s announcement will send shockwaves throughout Tennessee’s political landscape. (Ebert, 12/17)

Elsewhere on Capitol Hill —

The Hill: Dems To Reframe Gun Violence As Public Health Issue
House Democrats are planning to vote next year on bills that address gun violence as a public health concern, marking the party's first steps back into a divisive debate after being in the minority for eight years. Energized by their midterm victories and a focus on gunshot victims highlighted by a growing chorus of medical professionals, Democrats say they will push for legislation to fund research on gun injuries and deaths. (Weixel, 12/14)

Reuters: J&J Moves To Limit Impact Of Reuters Report On Asbestos In Baby Powder
Johnson & Johnson on Monday scrambled to contain fallout from a Reuters report that the healthcare conglomerate knew for decades that cancer-causing asbestos lurked in its Baby Powder, taking out full-page newspaper ads defending its product and practices, and readying its chief executive for his first television interview since investors erased tens of billions of dollars from the company’s market value. (12/18)

The Hill: Johnson & Johnson Pushes Back On Asbestos Report: 'Our Talc Is Safe'
Johnson & Johnson (J&J) on Monday launched a national ad campaign defending itself following a news report that said the company knew for decades its talc baby powder contained traces of asbestos. The company took out a full-page ad in The New York Times to argue that the findings cited in a recent Reuters investigative piece are not backed by science. (Weixel, 12/17)

The Associated Press: Health Insurance On Demand? Some Are Betting On It
People with health insurance often pay for coverage they never use. A startup wants to shake that up. It's a radical idea: On-demand insurance that lets customers buy some of their coverage only if and when they need it, similar to how TV viewers might rent a new release from Amazon instead of paying every month for a pricey cable package they rarely use. This approach from Bind Benefits is one of the latest wrinkles in a yearslong push by companies and insurers to control costs and make patients smarter health care shoppers. (Murphy, 12/17)

The Hill: Three In 10 Delaying Medical Treatment Due To Costs: Gallup
About three in 10 Americans say they have delayed seeking medical treatment within the past year because of medical costs, according to a new poll published Monday. A Gallup poll found that 29 percent of respondents said they had put off treatment because of costs. About 19 percent said they delayed treatment for serious or somewhat serious conditions, according to the poll. (Burke, 12/17)

In other news on health care costs —

Kaiser Health News: After Her Skiing Accident, An Uphill Battle Over Snowballing Bills
Sarah Witter couldn’t get a break even though her leg had gotten several. As she lay on a ski trail in Vermont last February, Witter, now 63, knew she hadn’t suffered a regular fall because she could not get up. An X-ray showed she had fractured two major bones in her lower left leg. A surgeon at Rutland Regional Medical Center screwed two gleaming metal plates onto the bones to stabilize them. “I was very pleased with how things came together,” the doctor wrote in his operation notes. But as spring ended, the wound started to hurt more. (Rau, 12/18)

The Washington Post: After Migrant Girl’s Death, Democrats Seek To Question Border Patrol Agents Who Detained Her
Democrats with the Congressional Hispanic Caucus say they will tour a Border Patrol station in New Mexico on Tuesday to “investigate” the circumstances leading up to the death of a Guatemalan girl who collapsed hours after she and her father were taken into U.S. custody on Dec. 6. The congressional delegation, led by Rep. Joaquin Castro (D-Tex.), plans to visit the border crossing at Antelope Wells, where Jakelin Caal, 7, and her father, Nery Caal, entered the United States illegally as part of a group of 163 migrants. The caucus members will then visit the Lordsburg Border Patrol station, 90 miles north, where they will be joined by Customs and Border Protection Commissioner Kevin McAleenan. (Miroff, 12/17)

Reuters: U.S. Border Agents Will Not Speak To Lawmakers About Girl's Death
U.S. Border Patrol agents who detained a 7-year-old Guatemalan migrant girl who later died in federal custody will not speak with U.S. lawmakers investigating her death, the U.S. Department of Homeland Security said on Monday, citing their union membership. Members of the Congressional Hispanic Caucus on Tuesday plan to visit the New Mexico patrol station where Jakelin Caal and her father were taken on Dec. 7 to learn more about why she died the next day. (Hay, 12/17)

In other news on immigration policies —

Los Angeles Times: A 2-Year-Old Is On Life Support In Oakland. Trump's Travel Ban Could Keep His Yemeni Mother From Saying Goodbye
The mother of a 2-year-old boy on life support in an Oakland hospital may not receive a travel ban waiver in time to say goodbye to her son, the Council on American-Islamic Relations said Monday. At a news conference in Sacramento, members of CAIR, community activists and faith leaders stood alongside the boy’s father and demanded that the Trump administration expedite the woman’s application for a waiver. (Parvini, 12/17)

The Associated Press: US Defeated Trying To Rid References To Reproductive Health
The United States has faced overwhelming defeat in two attempts to eliminate references to "sexual and reproductive health" from U.N. General Assembly resolutions on preventing violence and sexual harassment of women and girls and on child, early and forced marriage. The reference to "sexual and reproductive health" was approved by nearly 190 countries at the 1994 U.N. population conference in Cairo. But the Trump administration contends the language has accumulated connotations including the promotion of abortion or the right to abortion. (12/17)

Reuters: U.S. Isolated At U.N. Over Its Concerns About Abortion, Refugees
On Monday, Washington unsuccessfully tried to remove two paragraphs from a General Assembly resolution on preventing violence and sexual harassment of women and girls. It was the only country to vote against the language, while 131 countries voted to keep it in the resolution and 31 abstained. The United States also failed in trying to remove similar language in another resolution on child, early and forced marriage on Monday, saying: "We do not recognize abortion as a method of family planning, nor do we support abortion in our reproductive health assistance." (12/17)

The New York Times: The World Needs A Urine Test For TB. But It’s Already Here.
For at least a decade, one of the most urgent needs in public health was a urine dipstick that could quickly diagnose tuberculosis in the most vulnerable population: those with advanced H.I.V. Now that test exists. It’s inexpensive and has been recommended by the World Health Organization since 2015. But it is hardly used in the countries that most need it. (Mandavilli, 12/17)

The New York Times: An Island Nation Starts An Experiment: Vaccines Delivered By Drone
In the village of Cook’s Bay, on the remote side of the remote island of Erromango, in the remote South Pacific nation of Vanuatu, 1-month-old Joy Nowai was given hepatitis and tuberculosis shots delivered by a flying drone on Monday. It may not have been the first vial of vaccine ever delivered that way, but it was the first in Vanuatu, which is the only country in the world to make its childhood vaccine program officially drone-dependent. (McNeil, 12/17)

PBS NewsHour: Responding To Ebola In Congo Is Hard Work, But Made That Much Harder By Violence
Ebola has been reported in a number of locations in eastern Democratic Republic of the Congo, making the current outbreak the second worst in history. Getting medical care to the sick is complicated by ongoing violence. (Aossey, 12/17)

Stat: Recovery Experts Set Up New ‘Religion’ In Maine That May Skirt Drug Laws
The congregation lends structure to a rogue coalition of harm-reduction advocates who work to distribute thousands of syringes — possessing more than 10 is illegal in Maine — as well as hundreds of doses of naloxone. Members of the “church” don’t take that title lightly. The decision to brand the organization as a church could also provide a strange element of legal protection. If [Jesse] Harvey is arrested for his work — and he hopes he will be — he will argue that he was merely carrying out his own First Commandment: harm reduction. (Facher, 12/18)

In other news on the crisis —

Detroit Free Press: 1-Year-Old Treated For 'Possible Critical Overdose' Of Opioids
A 1-year-old Detroit boy is in critical condition after possible ingestion of opioids, police confirmed. The incident took place Monday night on the 9600 block of Coyle on the city's west side. Police were first called to the residence, but were redirected to a local hospital after notice that the child may have ingested some kind of opioid drug, said Officer Holly Lowe. (Kelliher, 12/18)

WTVF: Study Shows Early Postpartum Opioids Are Linked To Persistent Use Thereafter
Findings published by Vanderbilt researchers have indicated that women who fill prescriptions for opioid pain medications in the early postpartum period are more at risk of developing persistent opioid use. The research was outlined in the American Journal of Obstetrics and Gynecology, and was based off the data gathered from 102,541 women who gave birth while covered by Tennessee Medicaid. The intent of this research was to analyze the mothers' use of opioids after birth whether the child was delivered by cesarean section or by vaginal birth. (12/17)

New Hampshire Public Radio: Study: VA Hospitals Compare Favorably To Nearby Private Hospitals
Over the years, studies have shown that VA healthcare is as good as or better than private sector care. In this new study, researchers wanted to look at how a given VA hospital compared to private hospitals nearby. They looked at publicly-available data in 121 different areas across the country and compared things like risk-adjusted mortality rates and safety indicators. With a few exceptions, VA hospitals compared favorably. (Biello, 12/13)

WBUR: VA Still Arbitrarily Cutting Caregivers From Program, Even As It Aims To Expand
Congressional sources confirmed that the VA has missed its first deadline in October to implement new IT for the caregiver expansion — raising serious concerns of further delay. VA says the department will not deploy the new system until it is ready and has been tested thoroughly. (Lawrence, 12/18)

CNN: New Year Brings Altered Landscape For Abortion Battle
Those engaged in the battle over abortion in the United States are looking out at the thorny landscape and gearing up for what is on the horizon in 2019. What they see includes a more conservative US Supreme Court, 85 confirmed judges appointed by President Donald Trump who are reshaping the courts, and legislative bodies -- both state and federal -- transformed by a contentious midterm election. Experts from four groups dedicated to protecting abortion access spoke with reporters on a conference call Monday afternoon to discuss what lies ahead from their perspective. On the call were representatives from the ACLU Reproductive Freedom Project, the Planned Parenthood Federation of America, the Center for Reproductive Rights and the National Network of Abortion Funds. (Ravitz, 12/17)

The New York Times: Set It And Forget It. How Better Contraception Could Be A Secret To Reducing Poverty
When a woman of childbearing age goes to the doctor in most places, she gets standard queries about her smoking, drinking, seatbelt use and allergies. In Delaware, she is now also asked: “Do you want to get pregnant in the next year?” If her answer is no, clinics are being trained to ensure she gets whatever form of birth control she wants that very day, whether a prescription or an implant in her arm. (Sanger-Katz, 12/18)

The Associated Press: Child Abuse Climbs After Friday Report Cards, Study Says
Child abuse increases the day after school report cards are released — but only when kids get their grades on a Friday, a study in Florida suggests. The curious finding startled researchers, who had figured abuse might go up regardless of the specific day kids got their grades. But their study of reports to a child abuse hotline that included broken bones, burns and other confirmed abuse found otherwise. An increase only occurred on Saturdays after a report-card Friday. (Tanner, 12/17)

The New York Times: When Report Cards Go Out On Fridays, Child Abuse Increases On Saturdays, Study Finds
Dr. Randell C. Alexander of Jacksonville, Fla., a pediatrician who specializes in treating victims of abuse, said that for years he and his colleagues had heard children recount episodes of violence arising from unsatisfactory grades. They would see children with black eyes, marks from belts and electrical cords, and at times more serious injuries, he said. “When you say, ‘How did you get it?,’ they say it’s because of their report card,” said Dr. Alexander, an author of the study and the chief of the child protection and forensic pediatrics division of the University of Florida’s College of Medicine, Jacksonville. (Jacobs, 12/17)

Politico Pulse Check: Surgeon General Jerome Adams
The U.S. surgeon general explains why he's issuing a rare warning on e-cigarettes and kids. (12/18)

The Washington Post: Raising Boys Today: Eliot’s Father Wants Him To Be The 8-Year-Old He Is, Not What Society Expects
Brian and Bonnie, who live in Raleigh, N.C., are raising their son at a turbulent time, when the boy next door could be exposed as the next perpetrator of a Me Too moment or grow into the bully in the C-suite. How, in the words of Bonnie, can they make sure to “not raise a jerk?” Such questions are close at hand but not always solvable. Especially at a time when the problems facing boys are mounting. (Joyce, 12/17)

PBS NewsHour: Why Helicopter Parenting May Jeopardize Kids’ Health
Several high-profile news stories, along with increasing rates of childhood obesity, anxiety and depression, have sparked a movement encouraging parents to allow their children greater freedom. The nonprofit Let Grow is leading the call for what’s known as “free range parenting,” in which kids can just be kids. (William Brangham, 12/17)

Austin American-Statesman: Advocacy Groups Demand Child Care Fixes After Statesman Investigation
Nearly two dozen advocacy groups are calling for improvements to the Texas child care system in the wake of an American-Statesman investigation that found dangerous conditions in many day cares across the state. The groups on Monday sent a letter to Gov. Greg Abbott, state legislators and the Texas Health and Human Services Commission, asking them to, among other things, increase the number of caregivers required to look after children at licensed day cares; require the state to collect data on the connection between caregiver-to-child ratios and unsafe day care environments; and improve access to quality day care. (Ball, 12/17)

Arizona Republic: Arizona Vaccine Education Course For Parents, Cut Once, Could Return
The Arizona Department of Health Services confirmed it is working to develop a redesigned program to address falling immunization coverage among schoolchildren in the state. The revamped immunization education program is expected to launch in the 2019-2020 academic year, the state health department said in a statement. (Innes, 12/17)

WBUR: Teen Girls And Their Moms Get Candid About Phones And Social Media
A recent survey by the Deseret News and Brigham Young University showed that technology overuse was the number one concern of parents of teenagers — more than sex, drugs and rock 'n' roll. And teens themselves even admit to being concerned. In a Pew survey in August, over half of teens said they'd tried to cut back on smartphone use and social media. Recently I sat down with two teen girls and their mothers in New York City to get a snapshot of what it's like to grow up with smartphones right now. (Kamenetz, 12/17)

Meanwhile —

The New York Times: Trump Officials Plan To Rescind Obama-Era School Discipline Policies
The Trump administration is planning to roll back Obama-era policies aimed at ensuring that minority children are not unfairly disciplined, arguing that the efforts have eased up on punishment and contributed to rising violence in the nation’s schools, according to documents obtained by The New York Times. (Green and Benner, 12/17)

The Wall Street Journal: Trump School-Safety Panel Targets Obama Policy On Race And Discipline
The commission, formed after the school shooting Feb. 14 that killed 17 people in Parkland, Fla., largely sidesteps making any recommendations to tighten access to firearms, falling far short of what Democrats and most education policy officials say is necessary to reduce the frequency of gun-related violence. The 177-page report, which was reviewed by The Wall Street Journal and will be released publicly Tuesday afternoon, does recommend that individual states or districts consider arming school personnel, either teachers or law-enforcement officials present in school buildings, particularly in rural areas where supplemental help would take longer to arrive. (Hackman, 12/18)

The Associated Press: As US Life Expectancy Falls, West Virginia Offers Lessons
If you want to understand why U.S. life expectancy is declining, West Virginia is a good place to start. The state is a bellwether of bad health, portending major problems years before they became severe nationally. "It seems that the worst outcomes happen here first," said Dr. Michael Brumage, a West Virginia University public health expert who formerly ran the health department in Charleston. "We're the canary in the coal mine." (12/18)

The Associated Press: Unemployment, Income Affect Life Expectancy
New government data show just how much your neighborhood can impact the length of your life. The Associated Press has analyzed life expectancy and demographic data from the National Center for Health Statistics. The AP looked at more than 65,000 census tracts. It found that certain demographic qualities —unemployment, household income, race and education — affect life expectancy in most neighborhoods. (12/18)

Stat: Scientists Start To See Breast Milk As Rich Source For New Therapeutics
They’re studying how certain human milk components might ward away superbugs, treat diseases of the gastrointestinal system, improve vaccine efficacy, reduce inflammation, or kill cancer. ...But breast milk is not some kind of magical panacea. Some cancer patients have taken to drinking breast milk for therapeutic gains, though it’s highly unlikely they will see any, [Lars] Bode said. Some bodybuilders have fueled a black market for breast milk — paying high premiums to drink it in hopes of boosting their muscle mass. (Keshavan, 12/18)

The New York Times: Is There An Optimal Diet For Humans?
Nutrition experts have long debated whether there is an optimal diet that humans evolved to eat. But a study published this month adds a twist. It found that there is likely no single natural diet that is best for human health. The research, published in the journal Obesity Reviews, looked at the diets, habits and physical activity levels of hundreds of modern hunter-gatherer groups and small-scale societies, whose lifestyles are similar to those of ancient populations. They found that they all exhibit generally excellent metabolic health while consuming a wide range of diets. (O'Connor, 12/18)

The Washington Post: Gene-Edited Farm Animals Are Coming. Will We Eat Them?
Three cows clomped, single-file, through a chute to line up for sonograms — ultrasound “preg checks” — to reveal if they were expecting calves next summer. “Right now. This is exciting, right this minute,” animal geneticist Alison Van Eenennaam said as she waited for a tiny blob of a fetus to materialize on a laptop screen on a recent afternoon at the Beef Barn, part of the University of California at Davis’s sprawling agricultural facilities for teaching and research. The cows had been implanted a month and a half earlier with embryos genetically edited to grow and look like males, regardless of their biological gender. (Johnson, 12/17)

WBUR: An Epidemic Is Killing Thousands Of Coal Miners. Regulators Could Have Stopped It
A federal monitoring program reported just 99 cases of advanced black lung disease nationwide from 2011-2016. But NPR identified more than 2,000 coal miners suffering from the disease in the same time frame, and in just five Appalachian states. (Berkes, Jingnan and Benincasa, 12/18)

The Star Tribune: Continued Rise In Minn. Suicides Prompts Plea For Better Prevention 
Suicides rose in Minnesota in 2017 with an alarming increase in men taking their own lives, but fewer suicides among women. Those findings were released Monday by the Minnesota Department of Health, along with a plea from the state health commissioner to halt a decadeslong trend of rising suicide numbers by increasing public awareness, mental health treatment and prevention programs. (Olson, 12/17)

Sacramento Bee: Kaiser Permanente Accused Of Not Negotiating Contracts
Health care giant Kaiser Permanente has been dinged by federal labor regulators, the Coalition of Kaiser Permanente Unions announced Monday. But Kaiser disputes the conclusion reached by the Coalition of Kaiser Permanente Unions, representing 85,000 employees, including some 1,300 in Fresno, who are seeking a new contract. The coalition also represents more than 2,000 workers based at Kaiser South Sacramento. (Amaro, 12/17)

Dallas Morning News: 27 Dallas-Fort Worth Hospitals Earn A Grades In New Patient Safety Ranking
The Leapfrog Group, a national nonprofit that works to improve health care quality, says Texas took a big jump up in its fall hospital safety grades ranking. Texas moved from 14th nationally to fifth on the strength of a 20 percent increase in hospitals earning A grades. The grading system uses 28 measures of publicly available data and assigns A-F letter grades based on hospitals' ability to protect patients from errors, injuries, accidents and infections. Here is how hospitals in the 19-county North Texas region fared. (O'Donnell and Joseph, 12/17)

The New York Times: Cuomo Moves To Legalize Recreational Marijuana In New York Within Months
Gov. Andrew M. Cuomo announced that he would push to legalize recreational marijuana next year, a move that could generate more than $1.7 billion in sales annually and put New York in line with several neighboring states. The highly anticipated proposal came in a speech in Manhattan on Monday, in which the governor outlined his agenda for the first 100 days of his third term. Mr. Cuomo framed the speech as a reflection on what Franklin Delano Roosevelt — the former president who was once a New York governor himself — would do today, mixing sweeping rhetoric about American ideals with grim warnings about the Trump administration. (Wang, 12/17)

San Francisco Chronicle: Report: Berkeley Hospital Closure Would Mean Longer ER Waits, Ambulance Rides
The planned closure of Berkeley’s Alta Bates Summit Medical Center would severely restrict health care access for poor, elderly and minority East Bay residents, increase wait times for emergency care, and result in a loss of jobs, according to a new report by UC Berkeley’s Institute of Urban and Regional Development. Sutter Health, which owns Alta Bates, said in 2015 it would close the 347-bed hospital on Ashby Avenue by 2030, the year that California hospitals must comply with new seismic retrofitting standards or be decommissioned. (Ho, 12/17)

Chicago Tribune: 'I Was Given A Gift:' United Airlines CEO Recalls Heart Transplant 
United Airlines CEO Oscar Munoz had just finished working out at home when his knees buckled. He remembers thinking, “That was weird.” But he recalled the words of a doctor friend who had warned him not to ignore seemingly odd symptoms that could indicate heart problems. ...Munoz runs one of the world’s largest airlines. But on Monday, the 59-year-old wasn’t at United’s Chicago headquarters or on a plane. He was sitting alongside others who had also undergone heart transplants at Northwestern Memorial Hospital. They gathered as Northwestern doctors announced that this year they’ve broken the record for performing the most heart transplants ever at an Illinois hospital in one year. (Schencker, 12/17)

Los Angeles Times: State Utility Regulators Delayed Implementing Law Aimed At Preventing Wildfires
Long before the Camp fire raced through Northern California, claiming at least 86 lives and all but erasing the Gold Rush town of Paradise, state law required the three big power monopolies to file detailed strategies to prevent wildfires. Under Senate Bill 1028, San Diego Gas & Electric, Southern California Edison and Pacific Gas & Electric were supposed to prepare annual wildfire mitigation plans for reducing fire threats and identify who specifically would be responsible for implementing them. (McDonald, 12/17)

Modern Healthcare: When Tax Forms Don't Tell The Whole Story Of Community Benefits
Her inhaler was always nearby in case she had an asthma attack, resting by her pillow every night. Asthma was holding the fifth-grader back in school, putting her aspirations to be a writer and an artist further out of reach. Multiple visits to the emergency room took her away from schoolwork. She embodied a statistic compiled by Sinai Health System's Urban Health Institute: Nearly 1 in 4 kids in Chicago's West Side community of North Lawndale suffers from the chronic respiratory disease. (Kacik, 12/15)

The Star Tribune: UnitedHealth Group Will Pay $500M Less For Colorado-Based Physicians Group
In hopes of winning regulatory approval for a deal first announced last year, the parent company of DaVita Medical Group has agreed to lower by more than $500 million the sale price of its clinic business to UnitedHealth Group, according to a Monday regulatory filing. The filing from Colorado-based DaVita Inc. with the Securities and Exchange Commission also cites "underlying business performance" in explaining why the purchase price has been lowered from $4.9 billion to $4.34 billion. (Snowbeck, 12/17)

The CT Mirror: Public Vs. Private Social Services Debate Reaches The Lamont Transition
Advocates for public- and private-sector social services workers offered competing recommendations on how to finance and deliver state-sponsored human services amidst lean budget conditions. During a presentation at the state Veterans’ Home and Hospital in Rocky Hill, the leader of one of the largest, private, nonprofit agencies in Connecticut called for redeploying resources to the private sector in the coming years as state workers retire. (Phaneuf, 12/17)

The CT Mirror: Connecticut Faces Long Crawl Out Of Wealth Extremes, Crushing Debt
While economists and politicians differ over how to address the problem, those on all sides of the inequality debate generally agree there is an economic tipping point: when disparities become too extreme and too many are struggling. When adequate investment in human capital — higher education, adequate health care and decent housing — are impossible because of debt or under-employment, inequality becomes a significant drag on economic growth. (Phaneuf and Silber, 12/18)

The New York Times: Nebraska Petition Seeks Medical Marijuana Ballot Measure In 2020
As more and more surrounding states have legalized some form of medical marijuana, advocates in Nebraska say it’s time for their state to accept the reality and embrace the medicinal use of cannabis. And they want it written into the State Constitution. Two lawmakers started a petition drive last week hoping to build on legalization efforts elsewhere, including other deep red bastions like Utah and North Dakota, and put a Constitutional Amendment on medical marijuana on the state ballot in 2020. (Stack, 12/17)

Los Angeles Times: Police Investigate 'Reprehensible' Behavior Of Camp Fire Cleanup Workers Who Posted Offensive Photos 
One photo from the wreckage of the Camp fire’s devastating march through Paradise, Calif., shows the remains of a charred cat with a glass bottle sticking out of its mouth. In another, two workers pretend to go on a drive to “unknown destinations” in someone’s burned-out recreational vehicle. Some of the captions, including one that accompanied a photo of a man mimicking jumping on what’s left of a scorched trampoline in someone’s yard, included jokes: “Trampolines are stupid. BTW, it used to be called a Jumpoline until your mom got on it.” (Fry, 12/17)

Kansas City Star: NC Woman Pleads Guilty In Nationwide Adoption Scam
Prosecutors say the North Carolina woman posted on adoption websites and social media looking for people who are trying to adopt a baby, according to WECT. She had victims around the country send her money to cover food, housing and doctor appointments, the station reports. But she wasn’t actually pregnant. (Duncan, 12/17)

The Washington Post: Republicans’ Relentless Attempts To Undermine Obamacare Escalate American Anxiety
“How many times do we have to go through this?” That’s what Kathy Tomasic wants to know. Painstakingly, she has planned her life — and that of her teenage son, who has a rare genetic disorder — around access to health care. She did so based on a specific set of assumptions about what kinds of insurance would be available to her family, under what conditions and for how many years. (Catherine Rampell, 12/17)

Bloomberg: Obamacare Stock Market Panic Creates A Buying Opportunity
The words “Obamacare” and “unconstitutional” in quick succession made for scary weekend reading in the health-care community, and that fear played out in a market rout on Monday — the first chance shareholders had to react to a Texas judge’s decision late last week to strike down the law. But a massive sell-off arguably isn’t warranted. Uncertainty is unpleasant, but the Affordable Care Act isn’t going away any time soon, and most likely isn’t going anywhere at all. (Max Nisen, 12/17)

Axios: The GOP's Health Problem: They Like Big Chunks Of The Affordable Care Act
Now that a Texas judge has ruled that the entire Affordable Care Act is unconstitutional — all because of its individual mandate — Republicans may find themselves wishing for a different outcome.The big picture: There is little hope of a deal with Democrats on health reform in a divided Congress if the decision is upheld. Democrats will now use the 2020 campaign to paint Republicans as threatening a host of popular provisions in the ACA. And here’s the kicker: protections for pre-existing conditions, the provision that played such a big role in the midterms, is not even the most popular one. (Drew Altman, 12/18)

St. Louis Post Dispatch: Now That Republicans Have Put Obamacare On Its Deathbed, What's The Plan?
Last week’s ruling by a federal judge in Texas that the Affordable Care Act is unconstitutional may yet be reversed on appeal. But that shouldn’t let Republicans off the hook for endangering the health care of millions of Americans, especially those with pre-existing medical conditions.President Donald Trump, Sen.-elect Josh Hawley, R-Mo., and other Republicans have insisted they won’t abandon those people. They now have an obligation to explain how they intend to replace their coverage if this flawed ruling survives. (12/17)

The Washington Post: Republicans Still Can’t Decide How To Go About Destroying The American Health Care System
Can you recall a case in which a political party united to bring a lawsuit demanding that a law they bitterly opposed for the better part of a decade be struck down, they won a ruling in their favor, and then not only didn’t they celebrate, but they seemed to desperately hope no one would notice? That’s what’s happening right now. Some months ago, Republicans filed a lawsuit demanding that the entire Affordable Care Act be struck down on some ludicrously tendentious grounds; the lawsuit was supported by 20 Republican-controlled states and the Trump administration. (Paul Waldman, 12/17)

The Detroit News: Why Obamacare Enrollment Is Down
Thanks to President Donald Trump’s slashes to the federal government’s Affordable Care Act advertising budget and his administration’s “sabotage” of "Obamacare," hundreds of thousands of clueless people have been left in the dark and aren’t enrolling in Obamacare—at least, that’s what countless reporters and pundits would have you believe. However, the truth is this issue is far more complex that what many on the Left suggest. (Justin Haskins, 12/17)

USA Today: Obamacare Without Coverage Mandate: Can It Survive Courts And Congress?
When federal Judge Reed O’Connor effectively struck down the Affordable Care Act on Friday, there was a chorus of shock and dismay across the country from politicians and pundits alike. However, the decision is in many ways a bill come due for a number of key players in the ACA’s history. Not the least of them is Chief Justice John Roberts. Roberts saved the ACA in 2012 by defining a key provision as a tax. That tax is now gone and, with it, Roberts’ very narrow rationale for preserving the original health care scheme. (Jonathan Turley, 12/17)

San Francisco Chronicle: The Affordable Care Act Is Still Alive, Despite Latest Court Decision
A federal judge in Texas struck down the Affordable Care Act on Friday, but it’s not the end of the line for the crucial, long-beleaguered health insurance program. The judge, Reed O’Connor, did not rule that the law must be enjoined immediately. That effectively means the Affordable Care Act can proceed as usual while the latest legal challenge works its way through the appeals courts. (12/17)

The Washington Post: It’s Time To Let The Government Manufacture Generic Drugs
Forty-seven states and the Justice Department are investigating a price-fixing conspiracy that’s driving up the cost of generic drugs in the United States. One investigator called it “most likely the largest cartel in the history of the United States .” This crisis calls for action. That is why I’m introducing legislation to authorize the public manufacture of generic drugs wherever drug companies have warped markets to drive up prices. Drug companies use the “free market” as a shield against any effort to reduce prices for families. But they’re not operating in a free market; they’re operating in a market that’s rigged to line their pockets and limit competition. (Sen. Elizabeth Warren, 12/17)

The Hill: Put The Brakes On The CVS And Aetna Merger To Sustain Competition And Choice
One person stands between the American public and further increases in health-care costs and further decline of care: U.S. District Judge Richard Leon. He is single-handedly questioning the government-approved $70 billion merger between CVS and the health insurer Aetna over public interest concerns. A court hearing is scheduled for today, where Judge Leon may demand the companies halt integration while he reviews the antitrust issues. CVS and Aetna have argued that the vertical integration of their businesses would lead to better and more efficient care for consumers. (Ken Fisher and Marion Mass, 12/17)

The Wall Street Journal: Single Payer’s Misleading Statistics
Critics of American heath care—and advocates of single-payer insurance or other forms of socialized medicine—point to poor U.S. rankings in infant mortality and life expectancy. It turns out both are grossly flawed calculations that misleadingly make the U.S. rank low. America’s rate of infant mortality—death within the first year after birth—was 5.9 per 1,000 live births in the latest statistics, 32nd among 35 developed countries, according to the Organization for Economic Cooperation and Development. But these aren’t apples-to-apples comparisons. Unlike many other countries, the U.S. strictly adheres to the World Health Organization’s definition, recording as a live birth any baby, “irrespective of the duration of the pregnancy,” who “breathes or shows any other evidence of life.” (Scott W. Atlas, 12/17)

Stat: Did Merck Circumvent Its Duty To Warn On 'Fosamax Fractures'?
The women suing Merck claim that the company failed to warn them about a known adverse event. Merck is claiming that the FDA did not allow the company to change the label, making it impossible for Merck to warn women or their doctors. If Merck prevails, the disingenuous tactic it used for Fosamax could be replicated by other pharmaceutical companies and have far-reaching effects. (Suzanne Robotti, 12/18)

USA Today: Improve Addiction Treatment By Rating The Providers.
Addiction is a treatable disease with success rates comparable to other chronic illnesses. But the treatment system for addiction is broken, fragmented and centered on outdated models. Only one in 10 Americans with a substance use disorder receives any treatment at all — and far fewer receive treatment based on proven research. Desperate families need credible informationThis is unacceptable. Access to legitimate addiction treatment shouldn’t be a roll of the dice depending on where you live, what kind of insurance you have or what hotline you happened to call for help. (Gary Mendell, 12/18)

Stat: Coordinated Care Teams Can Improve The Doctor-Patient Relationship
There’s no question that the doctor-patient relationship is sick in some ways. But I directly witnessed how a disciplined approach to coordination through CARE could improve my own relationship with my patients. Our intervention included building integrated teams of social workers, care navigators, nurses, and physicians — and supporting them with technology — to help them quickly identify patients who needed help after a hospitalization, transportation to an upcoming appointment, or access to community services to address challenges at home. These changes drove my team to see the value of engaging patients outside of the office so we could spend more quality time addressing their pressing needs and health issues when they came to see me. (David Rubin , 12/18)

Los Angeles Times: 7-Year-Old Jakelin Caal Maquin Died At The Border. What Happened To Her Is Not An Aberration
A Customs and Border Protection spokesman insisted to the Washington Post that “Border Patrol agents took every possible step to save the child’s life under the most trying of circumstances.” That may well be technically true. But even if individual Lordsburg agents rushed to save Jakelin’s life, it won’t erase another truth: The institutional culture of the Border Patrol regularly dismisses even the most basic needs of detained migrants. (Francisco Cantu, 12/18)

Miami Herald: Medicare Advantage Should Provide What Patients Truly Need, Not Just What’s Covered
Beginning in January, Medicare Advantage, or MA, Medicare’s managed-care plans, will offer some relief by providing health-related supplemental benefits to beneficiaries with chronic conditions. Some plans will offer new benefits such as smoking cessation programs, in-home personal assistance, caregiver support and adult daycare.But that’s not enough. (Katherine Jett Hayes, 12/17)

Columbus Dispatch: DeWine Must Make Medicaid PBM Reform A Top Priority
We’ve learned a lot over the past year about one glaring problem: an enormous lack of transparency in the deal taxpayers are getting from pharmacy benefit managers, the middleman companies that control what drugs Medicaid will pay for and who will pay how much. In Ohio, a big piece of that will change in January, with a new rule requiring more transparency in those contracts. That’s a significant improvement, but it won’t guarantee an end to abuses that stem from the PBM model. The state should continue reform efforts. In particular, it should look to West Virginia, where that state’s Medicaid program has shed PBMs altogether, relying instead on a state university to do the work. (12/16)

WBUR: Good Childcare Is Out Of Reach For Too Many. It Doesn't Have To Be This Way
If Massachusetts ensured that families never paid more than 10 percent of their income toward childcare for children from 0 to 3, it could be revolutionary. It would also be a massive undertaking and hugely expensive. But the costs do not represent a net loss. (Elizabeth Gibbons, 12/18)

The Lexington Herald: We Have A Moral Obligation To Ensure Black-Lung Benefits
Hal Quinn, president and CEO of the National Mining Association, argued in a recent commentary that a boost to the black-lung fund was an unfair burden on the industry.It’s worth pushing back on some of his talking points, which we can expect to soon hear parroted back from Sen. Mitch McConnell and our state representatives when they meet in January. (Jim Brutsman, 12/14)

Cleveland Plain Dealer: Moving Ohio’s Medicaid Debate Forward
On Jan. 14, 2019, Mike DeWine will be sworn in as the 70th governor of Ohio. Three months later, he will have to submit his first two-year budget proposal to the Ohio General Assembly. One issue likely to get a lot of attention in this first budget is Medicaid -- the single largest source of health-care coverage in the state -- covering one out of four Ohioans. (John Corlett, 12/16)

Tampa Bay Times: Thank Pam Bondi If Floridians Lose Health Care Benefits
Now the future of those benefits, from coverage on the federal marketplace to protections for people with pre-existing conditions, has been put at risk by a partisan lawsuit from Republicans who have failed for years to improve the Affordable Care Act or craft a viable alternative. Those plaintiffs include the most partisan Florida attorney general in memory, who fortunately has just three weeks left in office before she heads to Fox News or parts unknown. Merry Christmas, from Pam Bondi. (12/17)

Cincinnati Enquirer: It's Time To Stop Workplace Violence Against Nurses
Regardless of the genesis of the violence, members of the Kentucky Nurses Association (KNA), the professional association for nurses, felt it imperative that a group of nursing leaders and administrators from across the state come together to begin dialogue about the events and craft some responses toward a solution. To that end, the KNA recently hosted a "Workplace Forum," and those attending stressed the critical importance of bringing this safety concern that impacts nurses and health care workers, to the forefront of public discussion. (Ruth Carrico, 12/17)