The Associated Press: Obama Health Law Sign-Ups Beat Forecast Despite Headwinds
The Affordable Care Act has yet again beaten predictions of its downfall, as government figures released Wednesday showed unexpectedly solid sign-ups for health coverage next year. The Centers for Medicare and Medicaid Services said nearly 8.5 million people had enrolled as of last Saturday's deadline, with about a dozen states, including California and New York, still left to report. The preliminary number was down about 4 percent, when a much bigger loss had been expected. (Alonso-Zaldivar, 12/19)

The New York Times: Despite Challenges, Health Exchange Enrollment Falls Only Slightly
In the open enrollment period that ended on Saturday, the number of sign-ups totaled 8.45 million, down from 8.82 million at the same point last year, a drop of about 367,000, or 4 percent, despite warnings that a more precipitous drop could be in the offing. Democrats have repeatedly accused President Trump of sabotaging the Affordable Care Act and its marketplace by promoting short-term health policies with skimpier coverage, substantially cutting enrollment promotion efforts and nearly eliminating funds for “navigators” who help potential enrollees through the process. Congress also zeroed out the health law’s penalty for not being covered, starting in 2019. But Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said that “enrollment remained steady through HealthCare.gov.” (Pear, 12/19)

Reuters: Sign-Ups For 2019 Obamacare Insurance Fall To 8.5 Million People
Enrollment had been running about 10 percent lower but picked up during the past week, reflecting a typical trend of last-minute shopping, the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said in a call with reporters. Verma said the decrease was due to increased employment, which typically means more people had employer-based health insurance, and that about 100,000 people with Obamacare insurance in Virginia became eligible for the expanded Medicaid program there. (Humer, 12/19)

The Hill: ObamaCare Enrollment Drops For Second Year In A Row Under Trump
More than 4.3 million people signed up for coverage in the final week, which ended Saturday. That compares to the 4.1 million people who signed up in the final week last year. (Hellmann, 12/19)

The Washington Post: Last-Minute Scramble For ACA Plans Appears Unaffected By Court Ruling
After just completing its sixth annual enrollment season, the federal insurance marketplace created under the ACA “is far from dead and remarkably resilient,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a nonpartisan health policy group. He noted, however, that the number of first-time enrollees dropped by 15 percent from last year. The number of returning customers was marginally higher than last year. (Goldstein, 12/19)

The Wall Street Journal: Affordable Care Act Sign-Ups Lag Behind Last Year’s
Analysts say many factors are behind the enrollment slowdown. They cite a general lack of public awareness about open enrollment; repeal of the federal penalty on people who don’t have health insurance; and the proliferation of health plans that don’t comply with the ACA. In addition, last week’s ruling by a Texas federal judge in Texas invalidating the ACA, at least for now—which came just before the busiest enrollment days—may have affected sign-ups. (Armour, 12/19)

Politico: Obamacare Sign-Ups See Late Surge
Though the federal judge's ruling against the health care law appears not to have dampened interest in the final day of open enrollment, Democratic lawmakers say it may have ramifications in the coming weeks. “Right now, a single mother who signed up for coverage during the open enrollment period is trying to make a decision about whether or not she ought to pay her premium," said Sen. Ron Wyden (D-Ore.), the top Democrat on the Finance Committee. (Ollstein and Demko, 12/19)

CQ: Federal Health Insurance Sign-Ups See Small Dip From Last Year
The final tally of people obtaining health insurance in 2019 through the marketplaces set up under the 2010 health care law won’t be set until early next year. That final count will include current HealthCare.gov consumers who are automatically enrolled in policies and people who buy plans in states that run their own separate exchanges, many of which haven't completed their enrollment periods. (McIntire, 12/19)

Austin American-Statesman: Obamacare Enrollment Dips 3.6% In Texas, 4% Nationally
Enrollment in health insurance plans for 2019 under the Affordable Care Act has slipped about 4 percent from the signup period last year, according to federal data, after a late surge prevented the decline from reaching double digits. Nearly 8.5 million people in states that use the federal HealthCare.gov marketplace signed up for 2019 coverage by the Dec. 15 deadline, the federal Centers for Medicare and Medicaid Services reported, off from about 8.8 million last year. (Sechler, 12/19)

Des Moines Register: Obamacare Iowa Enrollment Slips But Not As Much As Fans Feared
The number of Iowans signing up for private health insurance under Obamacare slipped this fall, but not as much as the program's fans feared. Federal officials reported Wednesday that 49,376 Iowans enrolled in private insurance plans for 2019 by the Dec. 15 deadline. The preliminary numbers were down about 7 percent from the 2018 total of 53,217, although officials said the new estimate could edge up as all last-minute enrollees are counted. (Leys, 12/19)

Concord (N.H.) Monitor: Insured Pharmacy Costs Actually Fell In N.H., But Don’t Expect That To Last
About 10 percent fewer New Hampshire residents bought health insurance through the federal marketplace this year than last, which is less of a decline than had been expected. According to Covering New Hampshire, 44,930 residents signed up for a plan for 2019 through the Health Insurance Marketplace between Nov. 1 and Dec. 15. (Brooks, 12/19)

The Washington Post: Why Republicans (Secretly) Want The ACA To Survive
A Texas judge’s decision to declare the Affordable Care Act unconstitutional has spooked Republicans who are unsure whether they have realized the long-sought victory celebrated by President Trump or stumbled into a nightmare that will haunt them through the next election cycle. They had already killed or softened its most loathed sections: The reviled penalty for not having health insurance was zeroed out as part of last year’s tax overhaul. The Trump administration had expanded access to far less robust — and much cheaper — insurance than the law mandated. It even allowed states to impose work rules on those eligible for expanded Medicaid benefits. (Johnson, 12/19)

The Hill: Senate GOP Blocks Bid To Intervene In ObamaCare Case 
Senate Republicans on Wednesday blocked a vote on a resolution that would have allowed the Senate to intervene in a federal lawsuit against ObamaCare. Democrats asked for unanimous consent to authorize the Senate legal counsel to defend ObamaCare in court after a district judge in Texas declared the entire law unconstitutional last week. The case is almost certainly headed for an appeal. (Hellmann, 12/19)

CQ: GOP Blocks Senate Democrats' Bid To Join Texas Health Law Case
Sen. Joe Manchin III, D-W.Va., sought unanimous consent on the Senate floor to advance the resolution. Sen. John Barrasso, R-Wyo., objected to the unanimous consent request. “Trying to unravel this entire thing is absolutely something that we’re going to fight,” Manchin said at a Wednesday press conference. Manchin's move was a response to a decision by Judge Reed O’Connor of the Northern District of Texas Friday night. The judge ruled that the health care law is invalid because last year, Congress eliminated a central part of it, the penalty for the so-called “individual mandate” requiring most Americans to get coverage.(McIntire, 12/19)

Kaiser Health News: 5 Ways Nixing The Affordable Care Act Could Upend The Entire Health System 
If Friday night’s district court ruling that the Affordable Care Act is unconstitutional were to be upheld, far more than the law’s most high-profile provisions would be at stake. In fact, canceling the law in full — as Judge Reed O’Connor in Fort Worth, Texas, ordered in his 55-page decision — could thrust the entire health care system into chaos. “To erase a law that is so interwoven into the health care system blows up every part of it,” said Sara Rosenbaum, a health law professor at the George Washington University School of Public Health. “In law they have names for these — they are called super statutes,” she said. “And [the ACA] is a super statute. It has changed everything about how we get health care.” (Rovner, 12/20)

Modern Healthcare: ACA Repeal Wouldn't Stop Transition To Value-Based Payment, Efforts To Lower Drug Spending 
Even if the Affordable Care Act is ultimately deemed unconstitutional, stakeholders wouldn't allow the momentum surrounding value-based care models and biosimilars to stall, experts and provider groups said. A Texas federal judge ruled last week that the Affordable Care Act couldn't stand without the individual mandate, rendering the entire law unconstitutional. The decision is likely to weave its way up to the Supreme Court. If the decision is upheld, it has the potential to upend efforts to bolster value-based care models instituted under the ACA as well as the pathway for biosimilar drugs. (Kacik and Castellucci, 12/19)

Politico Pro: Obamacare Ruling Chills Medicaid Expansion Push
In the three states where voters approved expansion through the ballot, the program still looks on track, though obstacles may emerge when legislatures convene in 2019. But in most of the Medicaid expansion holdout states where Democrats won governorships, in part because of pledges to join the program, the lawsuit may be strengthening Republican lawmakers' resolve. (Goldberg, 12/19)

NPR: Texas Judge's Decision To Overturn Obamacare Fits With His Past Rulings
U.S. District Judge Reed O'Connor has a history of siding with Republicans on ideologically motivated lawsuits. His ruling last week, in which he sided with the GOP on a challenge to the Affordable Care Act, was not a one-off. In fact, critics say, his history is ultimately why that case was before him in the first place. (Lopez, 12/19)

Meanwhile, in Maryland, a judge grapples with a case that seeks to reaffirm the health law and challenge the validity of the U.S. acting attorney general's role in the suit —

The Wall Street Journal: Maryland Asks Judge To Affirm Obamacare, Nix Whitaker’s Appointment
A federal judge on Wednesday grappled with the most significant challenge so far to President Trump’s appointment of Matthew Whitaker as acting attorney general in a case that also raises questions about the Affordable Care Act. U.S. District Judge Ellen Hollander spent nearly three hours considering a lawsuit by the state of Maryland that presents a rare combination of hot-button legal issues. Maryland Attorney General Brian Frosh, a Democrat, filed the suit in September against then-Attorney General Jeff Sessions and other Trump administration officials, seeking a declaration that the ACA, also known as Obamacare, was constitutional and must be enforced by the administration even if it opposed the law. (Kendall, 12/19)

Reuters: Judge Signals Skepticism In Trump Team's Bid To Block Obamacare Suit
Whitaker, a Trump political loyalist named after the Republican president ousted Jeff Sessions as attorney general last month, is facing a series of legal challenges to the legality of his appointment. The lawsuit by Democratic Maryland Attorney General Brian Frosh asks Hollander to declare Obamacare constitutional and to find that Whitaker was unlawfully appointed. Trump's administration has worked to undermine Obamacare after Congress failed in a Republican effort to repeal the law. (12/19)

Bloomberg: DOJ Lawyer Won’t Say If Whitaker Involved In Obamacare Suit 
Attorneys for Maryland say the state is being harmed by Whitaker’s role because his appointment was illegitimate, as it is by the uncertainty over the future of the Affordable Care Act. A federal judge in Fort Worth, Texas, last week ruled that without the tax penalty, a rule requiring people to buy insurance was invalid. Since that can’t be separated from the rest of the law, the judge ruled the whole thing had to go. (Harris, 12/19)

The New York Times: Congress Grills Head Of V.A. Over New Health Care Law
Foreshadowing a likely partisan battle next year, Robert L. Wilkie, the secretary of Veterans Affairs, faced sharp questioning from Democrats on Wednesday over how the department will carry out a new expansion of private-sector medical care for veterans. Lawmakers attending a joint House-Senate hearing scrutinized evolving standards at the V.A. that dictate how and when veterans can get care outside of the system’s 1,300 government hospitals and clinics. The Trump administration is expected to better define the standards next year, but some at the hearing were not satisfied. (Steinhauer, 12/19)

ProPublica: VA Was “Taken Advantage Of” By Paying Billions In Fees, Secretary Says
Veterans Affairs Secretary Robert Wilkie acknowledged on Wednesday that his agency got a bad deal in paying nearly $2 billion in fees to companies responsible for booking veterans with private doctors. ... Wilkie was responding to lawmakers’ questions about an investigation published this week by ProPublica and PolitiFact into the Veterans Choice Program. (Arsndorf, 12/19)

Modern Healthcare: VA Has Yet To Detail Criteria For Community Care 
Six months after Congress passed a sweeping bill aimed at streamlining and expanding the private sector's role in veterans' healthcare, the Veterans Affairs Department has yet to disclose the criteria it will use to send a veteran out to a community physician or hospital. These criteria, or "designated access standards" in VA and congressional parlance, will determine how expansive the community program will be. As a result, debate over what they should be is a political linchpin, driving sharp warnings from key Democrats that the Trump administration's handling of them will lead to a privatizing of the VA. (Luthi, 12/19)

And in other military and health care news —

The Washington Post: They Tested Positive For HIV. Then The Military Kicked Them Out.
Testing positive for HIV was difficult enough. Getting forced out of the military by the Air Force because of the diagnosis proved even harder. So say two U.S. airmen who filed suit on Wednesday against Defense Secretary Jim Mattis in the U.S. District Court for the Eastern District of Virginia, arguing that the Pentagon’s decision last month to discharge them from the military owing to their HIV status violates the Constitution’s equal protection clause and federal law. They have asked the court to strike down the decision. (Sonne, 12/19)

The Associated Press: 'A Moral Disaster': AP Reveals Scope Of Migrant Kids Program
Decades after the U.S. stopped institutionalizing kids because large and crowded orphanages were causing lasting trauma, it is happening again. The federal government has placed most of the 14,300 migrant toddlers, children and teens in its care in detention centers and residential facilities packed with hundreds, or thousands, of children. As the year draws to a close, some 5,400 detained migrant children in the U.S. are sleeping in shelters with more than 1,000 other children. Some 9,800 are in facilities with 100-plus total kids, according to confidential government data obtained and cross-checked by The Associated Press. (Burke and Mendoza, 12/19)

The Wall Street Journal: Homeland Security Chief Set To Testify On Child’s Death At Border
Homeland Security Secretary Kirstjen Nielsen’s scheduled testimony before the House Judiciary Committee on Thursday is set to offer a glimpse of the strict oversight to come from Democrats still fuming over the Trump administration’s “zero tolerance” immigration policy along the Southern border. Ms. Nielsen is expected to answer questions from lawmakers about the recent death of a 7-year-old Guatemalan girl, Jakelin Caal Maquin, who died this month at a hospital in El Paso, Texas. She died a little more than a day after she and her father were arrested with a group of about 160 people on Dec. 6 in Antelope Wells, N.M., a remote border crossing in southern New Mexico. (Jamerson, 12/20)

Politico: Trump Administration To Notify Congress And Media About Border Deaths Within 24 Hours
U.S. Customs and Border Protection this week said that Congress and the media will be notified within 24 hours of any death that happens in custody following criticisms of the agency's delayed announcement of the death of a 7-year-old girl. "To secure and maintain the public trust, CBP's intent is to be accessible and transparent by providing appropriate information to the Congress and the public regarding any death occurring in custody," according to the guidelines. "Maintaining this trust is, in part, dependent on timely and sufficient notification to the extent permitted by law and CBP policy." (Morin, 12/19)

Nashville Tennessean: Sen. Lamar Alexander To Focus On Health Care, Higher Education In Final Stint
During a wide-ranging interview at his Nashville office on Monday, [U.S. Sen. Lamar] Alexander said he wants to focus on the cost of health care and education during his remaining time in office.  ... Alexander, chairman of the Senate Committee on Health, Education, Labor and Pensions, said this year, over the course of five hearings, he and other lawmakers have heard from industry experts that nearly half of what Americans spend on health care is unnecessary. Tennessee's senior senator said he has already talked with U.S. Sens. Patty Murray, D-Washington, and Chuck Grassley, R-Iowa, about finding ways to reduce costs. (Ebert and Allison, 12/19)

The Associated Press: Do's And Don'ts Of Helping Loved Ones Pay Medical Bills
Relief from medical debt doesn't top the typical holiday wish list. But help with unexpected medical bills could be a welcome gift for millions of Americans. Four in 10 U.S. adults received a surprisingly high medical invoice within the last year, according to a September survey from the nonprofit Kaiser Family Foundation. And medical bills topped the list of financial commitments that Americans are afraid they won't be able to afford, ahead of prescription drugs, rent or gas, according to the results. (Perrone, 12/19)

ProPublica and The New York Times: Top Cancer Doctor Resigns As Editor Of Medical Journal
Dr. José Baselga, the former chief medical officer of Memorial Sloan Kettering Cancer Center, resigned under pressure on Wednesday as one of the editors in chief of Cancer Discovery, a prominent scientific journal, after he failed to accurately disclose his conflicts of interest in dozens of articles in medical journals. The American Association for Cancer Research, which publishes the journal, said a panel of experts and the group’s board of directors had concluded that “Dr. Baselga did not adhere to the high standards pertaining to conflict of interest disclosures that the AACR expects of its leadership.” (Ornstein and Thomas, 12/19)

In other news on medical research —

Stat: University Of California Squares Off Against Major Publisher Elsevier
There’s a high-stakes fight in California that could shape the way that academic research gets read and published far beyond the West Coast. The battle is pitting the University of California system against Elsevier, the Netherlands-based publisher of academic journals. At issue is how open-access research gets paid for. (Robbins, 12/19)

The New York Times: Juul May Get Billions In Deal With One Of World’s Largest Tobacco Companies
E-cigarette maker Juul, which has vowed to make cigarettes obsolete, is near to inking a deal to become business partners with Altria, one of the world’s largest tobacco companies. The union — which would create an alliance between one of public health’s greatest villains and the start-up that would upend it — entails cigarette giant Altria investing $12.8 billion for a 35 percent stake in Juul, at a $38 billion valuation, according to two people briefed on the negotiations. (Richtel and Kaplan, 12/19)

In other health industry news —

Modern Healthcare: Cigna-Express Scripts Merger Slated To Close Thursday 
The $67 billion deal between Cigna Corp. and Express Scripts is expected to close on Thursday after snagging approval from regulators in New Jersey—the last state needing to sign off on the merger. "All required regulatory approvals now have been received and the parties expect to close the transaction on December 20, 2018, subject to the satisfaction of all other closing conditions," Cigna noted in a filing Wednesday with the Securities and Exchange Commission. (Livingston, 12/19)

Bloomberg: Glaxo Shares Soar After Consumer Health Venture With Pfizer
GlaxoSmithKline Plc paved the way for a split into two companies, agreeing to create a consumer-health joint venture with Pfizer Inc. to be listed on the stock market, sending the U.K. company’s shares to their biggest gains in a decade. Glaxo will have a 68 percent controlling stake in the new entity, with combined sales of $12.7 billion and led by Brian McNamara, the CEO of the U.K. pharmaceutical giant’s consumer arm. The deal lets Pfizer exit a business after a yearlong sale process failed to find a buyer. (Paton, 12/19)

The New York Times: Heroin Addiction Explained: How Opioids Hijack The Brain
Getting hooked is nobody’s plan. Some turn to heroin because prescription painkillers are tough to get. Fentanyl, which is 50 times more potent than heroin, has snaked its way into other drugs like cocaine, Xanax and MDMA, widening the epidemic. To understand what goes through the minds and bodies of opioid users, The New York Times spent months interviewing users, family members and addiction experts. Using their insights, we created a visual representation of how the strong lure of these powerful drugs can hijack the brain. Dr. Pedro Mateu-Gelabert, one of the nation’s top opioid researchers, said this work brings “an emotional understanding” to the epidemic but “without glamorizing or oversimplifying.” (Sinha, 12/18)

The Associated Press: US Urges Doctors To Write More Rx For Overdose Antidote
The U.S. government told doctors Wednesday to consider prescribing medications that reverse overdoses to many more patients who take opioid painkillers in a move that could add more than $1 billion in health care costs. Assistant Secretary for Health Brett Giroir, a doctor appointed by President Donald Trump, announced the guidance, saying it's important for doctors to discuss overdose dangers with patients. (Johnson, 12/19)

CQ: HHS Unveils Opioid Overdose Drug Prescribing Guidelines
Surgeon General Jerome Adams has recommended that anyone taking opioids or with a family member doing so carry naloxone as a preventive measure, but the new guidance will likely increase the number of physicians who prescribe the medication. This could curb the rapidly rising number of deaths from opioid overdoses. (Raman, 12/19)

Stat: Wyden Probes Ties Of Opioid Makers, Advocacy Groups, And Federal Panel 
A leading lawmaker is intensifying his scrutiny of the financial ties between opioid makers, advocacy groups, and government panels that provide advice on the controversial and lucrative business of managing patient pain. In a letter to the Department of Health and Human Services, Sen. Ron Wyden (D-Ore.) asked the agency to review various conflicts of interest among some members of the Pain Management Best Practices Inter-Agency Task Force, which was created two years ago to make recommendations for combating chronic and acute pain. Those directives may affect Medicare and Medicaid reimbursements. (Silverman, 12/19)

The Washington Post: African American Heroin Users Are Dying Rapidly In An Opioid Epidemic Nobody Talks About
Spoon, whose product could be trusted, wasn’t answering his phone. So just after 9 a.m. on a fetid August morning, Sam Rogers had trekked to a corner two miles east of the U.S. Capitol on Pennsylvania Avenue, hoping to find heroin that wouldn’t kill him. Now Rogers, 53, was back in his bedroom at the hot, dark house on R Street SE. Sitting in a worn swivel chair, he cued a Rob Thomas song on his cellphone and bent over his cooker and syringe. The heroin — a tan powder sold for $10 a bag — simmered into a cloudy liquid with the amber hue of ginger ale. Palliative or poison: He would know soon enough. (Jamison, 12/19)

The Washington Post: D.C.’s Opioid Epidemic: As African American Heroin Overdoses Skyrocketed The City Ignored Life-Saving Strategies
For the past four years, the nation’s capital has undergone its worst public-health crisis since the arrival of AIDS: an explosion of fatal drug overdoses among African Americans. The rate of death, caused by heroin cut with the lethal synthetic opioid fentanyl, is comparable to the opioid epidemic’s worst ravages in rural and suburban parts of the United States. More people died of opioid overdoses than homicides last year in the District. But the city’s overdose victims are different from those in areas of the country more commonly associated with opioid abuse. Many are black men who have been addicted to heroin for decades. And unlike drug users elsewhere, they have often been left by their government without basic help. (Jamison, 12/19)

Reuters: Judge Blocks New York From Enforcing Opioid Surcharge On Companies
A Manhattan federal judge on Wednesday blocked New York state from enforcing a recently enacted law that aimed to collect $600 million from drug manufacturers and distributors to defray the costs of combating the opioid addiction epidemic. U.S. District Judge Katherine Polk Failla ruled that while the concerns driving New York's decision to adopt the law were valid, the means by which the state would extract payments from the companies violated the U.S. Constitution. (12/19)

The Philadelphia Inquirer: Meth Goes Hand-In-Hand With Opioids In Much Of Pennsylvania
The state Attorney General’s Bureau of Narcotics Investigation has recovered just under 12,000 grams of meth this year. In some rural areas and small towns, a gram can sell for up to $80. In DuBois, Police Chief Blaine Clark said his city has seen a 129 percent jump in drug reports from July 2017 to July 2018, most of them possession arrests. (Nark, 12/19)

Kansas City Star: Wyandotte County, Kan., Sues Opioid Industry Giants
Wyandotte County joined the parade of local governments lining up to sue opioid manufacturers and distributors Tuesday, filing suit in federal court against 14 industry giants and their affiliates. Wyandotte County is at least the 20th local government in Kansas and Missouri to file suit against the companies, accusing them of getting rich by hooking people on pain meds while costing citizens large amounts of money in health care and law enforcement to deal with drug addiction, diversion and overdoses. (Marso, 12/19)

Atlanta Journal-Constitution: GBI: Prescription Drug Deaths Declining In Georgia
Preliminary 2018 data that the Georgia Bureau of Investigation provided to The Atlanta Journal-Constitution shows prescription drug deaths are declining sharply, while fatal overdoses from illegal drugs are slightly down. Statewide, emergency room visits for overdoses are also mostly down in recent months, according to available Georgia Department of Public Health data. (Sharpe, 12/19)

The New York Times: Fewer Births, More Deaths Result In Lowest U.S. Growth Rate In Generations
The population of the United States grew at its slowest pace in more than eight decades, the Census Bureau said Wednesday, as the number of deaths increased and the number of births declined. Not since 1937, when the country was in the grips of the Great Depression and birthrates were down substantially, has it grown so slowly, with just a 0.62 percent gain between July 2017 and July 2018. With Americans getting older, fewer babies are being born and more people are dying, demographers said. (Tavernise, 12/19)

The Wall Street Journal: U.S. Population Grew At Slowest Pace In More Than 80 Years
The numbers, which cover the year ended July 1, show the country’s population rose by 0.6% to 327.2 million people. That was the lowest rate since 1937 in data going back to 1901, according to William Frey, a demographer at the Brookings Institution. The figures offer fresh clues to which states are likely to gain or lose congressional seats after the 2020 census. If the House of Representatives were apportioned based on this year’s data, Texas would gain two seats, while Arizona, Colorado, Florida, North Carolina and Oregon would each gain one. (Adamy and Overberg, 12/19)

Politico: Population Boom Could Remake 2020 Map
A handful of presidential battleground states experienced a population explosion over the past year, altering the landscape in at least three key states that stand to play a pivotal role in the 2020 election. Those population shifts are poised to have a tangible impact in 2020 — with demographic shifts cementing Florida’s premier swing-state status, vaulting Arizona onto the list of 2020 swing states and perhaps putting Nevada further out of reach for President Donald Trump’s reelection campaign. (Caputo, Shepard and Bland, 12/19)

Los Angeles Times: More Than 15% Of Childhood Deaths In America Are Due To Guns, Study Says
More than 3,000 children and adolescents died of a gunshot wound in the United States in 2016, a new tally of childhood deaths finds. These episodes accounted for 15.4% of all Americans between the ages of 1 and 19 who died in 2016, and a quarter of those killed by injury rather than disease. As they inch their way back to rates last seen in 1999, childhood deaths attributed to firearms — 3,143 — generated 70% more grieving families than those produced by pediatric cancer — 1,853. Guns also broke the hearts of more than three times as many families than did childhood drownings — 995 — or the combined category of poisoning deaths and fatal drug overdoses — 982. (Healy, 12/19)

NPR: Study: Kids More Likely To Die From Cars And Guns In U.S. Than Elsewhere
Lead author Rebecca Cunningham of the University of Michigan, who has been an emergency room physician for 20 years, wasn't surprised. "I've been taking care of kids and unfortunately giving bad news to families for several decades," she says. Cunningham sees some good news in the motor vehicle number. Death rates from crashes have dropped dramatically over the years, from 10 deaths per 100,000 children and adolescents in 1999 to 5.21 deaths per 100,000 in 2016. (Silberner, 12/19)

The Philadelphia Inquirer: How Your Child’s Primary-Care Doctor Can Prevent Gun Injury And Death
A simple intervention involves primary-care doctors asking parents whether their children have access to guns and providing parents with mechanisms such as cable locks to help store the firearms more safely. In a 2008 study conducted in 137 pediatric primary-care practices across the country, families who received this brief intervention were more likely to store their guns safely than families who did not receive the intervention. (Beinas, 12/20)

The Associated Press: US Debuts Childhood-Lead Plan That Critics Say Falls Short
The Trump administration released an "action plan" Wednesday against devastating childhood exposure to lead, but critics said it held little new to protect millions of American children living with high levels of the metal. Children in at least 4 million American households are exposed to high levels of lead, including through old, chipped lead-based paint, or contaminated dust and soil, water and air, according to the federal Centers for Disease Control and Prevention. A half-million children ages 5 or younger have blood-borne lead at levels that should trigger public-health intervention, the CDC said. (Knickmeyer, 12/19)

The Washington Post: In Detroit, One School Leader’s Reaction To Lead In The Water: Shut Off The Taps
The results landed on Nikolai Vitti’s desk on a late summer afternoon, days before Detroit’s nearly 50,000 public school students would return to class. The findings were definitive and disturbing: In initial tests, two-thirds of schools showed alarming levels of lead in the water. It was the latest in a growing list of crises for Detroit’s new schools superintendent, barely a year into his job. (Dennis, 12/19)

The New York Times: What We Learned In 2018: Science
It’s not easy to say that any particular scientific development was the most important in a given year. But if we had to choose some highlights, we’d opt for these unforgettable events and findings. (12/20)

The New York Times Podcast: The Ethics Of Genetically Editing Babies
Ever since scientists created the powerful gene-editing technique Crispr, they have braced for the day when it would be used to produce a genetically altered human being. Now, the moment they feared may have come. What’s likely to happen next? (Barbaro, 12/19)

The Washington Post: As Teens Grapple With Me Too, Jayden Castillo Just Wants To Be A ‘Good Guy’
On a sunny autumn afternoon, Jayden Castillo and Janelle Moore sit at a suburban Wendy’s, sipping strawberry lemonades and talking about the realities of sex for American teens. The old friends, both seniors at Oxon Hill High School in Maryland, believe access to porn has warped their generation’s concept of sex — especially in the minds of boys. “They learn everything from online,” Janelle explains. (McCarthy, 12/19)

The Associated Press: US Adults Aren't Getting Taller, But Still Putting On Pounds
You don't need to hang the mistletoe higher but you might want to skip the holiday cookies. A new report released Thursday shows U.S. adults aren't getting any taller but they are still getting fatter. The average U.S. adult is overweight and just a few pounds from obese, thanks to average weight increases in all groups — but particularly whites and Hispanics. (Stobbe, 12/20)

Cleveland Plain Dealer: Where You Live Determines How Long You Live
The AP found that certain demographic qualities — high rates of unemployment, low household income, a concentration of black or Native American residents and low rates of high school education — affected life expectancy in most neighborhoods. Their findings support the idea that many people experience bigger obstacles to good health because of their race or ethnic group, gender, age, geographic location and other social factors. (Washington, 12/19)

The New York Times: The Bullet Lodged In His Knee. Then The Injuries Really Began.
The 46-year-old man showed up at hospital emergency room in Chicago, complaining that his left knee hurt. The X-rays above showed why. Fourteen years earlier, he’d been shot in the knee. That’s the image on the left. The bullet was not removed, and over the years his knee had ground it into tiny pieces, as shown on the right. (Kolata, 12/19)

The New York Times: More Pets, Fewer Allergies
Children who live with cats and dogs when they are infants are less likely to develop allergies later in childhood — and the more pets they have, the better, a Swedish study of 1,278 children has found. Researchers interviewed the parents of 249 of the children when they were 6 to 12 months old, gathering information on pet ownership, and had clinical evaluations done at 18 months, 3 years and 8 to 9 years. (Bakalar, 12/19)

Kaiser Health News: When Needs Arise, These Older Women Have One Another’s Backs 
Like many women aging alone, Eileen Kobrin worried that an accident could compromise her independence. Then, two years ago at age 71, the New Yorker fell while on vacation, breaking her left ankle, and her Caring Collaborative network sprang into action. One member recommended an ankle surgeon at the nearby Hospital for Special Surgery, who operated successfully. Others brought over a wheelchair, a bath chair and an elevated toilet seat after Kobrin returned to her apartment with instructions to stay off her feet for several months. (Graham, 12/20)

Arizona Republic: Romaine Lettuce Is Hiding Answers To A Deadly Mystery: E. Coli
Growers, scientists, epidemiologists, farm researchers and industry analysts know romaine lettuce sooner or later will carry E. coli onto America's salad plates. They just don't know why. Romaine has proven to be a reliable vehicle for the foodborne illness, and percentages dictate more outbreaks likely will occur. (Anglen, 12/19)

Los Angeles Times: How George Tyndall Went From USC Gynecologist To The Center Of LAPD’s Largest-Ever Sex Abuse Investigation
Dr. George Tyndall arrived on the USC campus in the summer of 1989. The university had advertised for a full-time gynecologist for the student health center, and Tyndall, then 42, was an enthusiastic candidate. “My mission will be to do everything I can to help Trojan women avoid the many preventable catastrophes that I have seen,” Tyndall declared during the job interview, according to a written account he provided to The Times. “And I will do so for as long as I am mentally and physically able, hopefully well into my 80s.” (Hamilton and Ryan, 12/19)

Cleveland Plain Dealer: Ohio’s Heartbeat Bill Aims To Trigger Supreme Court Battle. Here’s What That Means
The so-called heartbeat bill would outlaw abortions in Ohio before many women know they’re pregnant. It would be one of the strictest abortion laws in the country, designed to trigger a Supreme Court battle that could knock down Roe v. Wade. The bill on Gov. John Kasich’s desk would prohibit abortion once doctors can detect a fetal heartbeat, normally around six weeks into a pregnancy. (Kilpatrick, 12/19)

Reuters: Johnson & Johnson Baby Powder Verdict Stands, Missouri Judge Rules
Johnson & Johnson failed to persuade a Missouri trial judge to set aside a July verdict awarding a record $4.69 billion to 22 women who blamed their ovarian cancer on asbestos in the company’s Baby Powder and other talc products. The health-care company faces thousands of lawsuits over the safety of talc in its Baby Powder. The trial was the first in which plaintiffs claimed that asbestos fibers in J&J’s talc caused ovarian cancer. It relied on unsealed internal company documents detailing J&J’s alleged knowledge of asbestos contamination since at least the 1970s. (12/19)

The CT Mirror: Denied: A Look Into Inmate Health Care
With no record-keeping system – which was required under UConn Health’s contract with the state – it is impossible to determine if appropriate health care was delivered to the 13,000 inmates in state prisons on any given day. That leaves lawmakers and civil rights groups – who have growing concerns about the quality of health care provided to inmates – with no way to gauge whether recent disturbing stories shared by inmates and their families, as well as numerous lawsuits against the state, are proof of a systemic failure or simply isolated incidents in an otherwise functioning process. (Thomas and Silber, 12/20)

Dallas Morning News: 8 Pharmacy Owners, Marketers Charged In Alleged $9.1 Million Dallas-Area Kickback Scheme 
Eight pharmacy owners and marketers have been charged in what authorities allege was a Dallas-area scheme in which kickbacks were paid after doctors prescribed compounded drugs covered by federal insurance, according to a federal indictment unsealed Wednesday. The scheme, the indictment alleges, involved $92 million in claims and $9.1 million in kickbacks. The indictment alleges that the men "did knowingly and willfully combine, conspire, confederate and agree" to defraud the U.S. through bribes and kickbacks for the referral of TRICARE and Department of Labor beneficiaries. (Emily, 12/19)

The Washington Post: Virginia Jail’s Lack Of Medical And Mental Health Care Probably Violates Constitution, Justice Department Report Finds
A major Virginia jail probably violates the constitutional rights of prisoners by failing to provide adequate medical and mental-health care, according to a report released Wednesday by the Justice Department. The Hampton Roads Regional Jail in Portsmouth does not provide proper emergency care for sick inmates, risks harm to mentally ill prisoners by placing them in solitary confinement for long periods, and fails to adequately screen or administer medicine for those needing psychological treatment, the report found. (Jouvenal, 12/19)

Denver Post: No More Medicare Funding For Health In Home Services In Denver
A federal agency announced Wednesday that it will end Medicare funding to Health in Home Services in Denver, citing the home health organization’s failure to meet “basic health and safety requirements.” The Centers for Medicare and Medicaid Services will stop paying for care provided by Health in Home to Medicare and Medicaid patients after Friday, according to a news release. (Seaman, 12/19)

The Washington Post: Barack Obama Dons A Santa Hat And Hands Out Gifts In Surprise Visit To D.C. Children’s Hospital
Watch out, Santa: Former president Barack Obama is coming for your sleigh. With a fluffy red cap and a bulging bag slung over his shoulder, Obama delivered presents (and more than a few gasps) to the young patients at Children’s National hospital in Northwest Washington on Wednesday. (Andrews-Dyer, 12/19)

Denver Post: UCHealth Makes Newborn Footprints Digital At Northern Colorado Hospitals
In July, Loveland’s UCHealth Medical Center of the Rockies and Fort Collins’ UCHealth Poudre Valley became the first two hospitals in the state to electronically scan a baby’s footprints minutes after birth to create an electronic identification record that can be used for the child’s whole life. Hospitals have long used ink and paper to record infant footprints. Infants dislike flexing their hands, which makes taking handprints difficult. However, that traditional method came with many pitfalls that are resolved with the new technology. (Albani-Burgio, 12/19)

KQED: Camp Fire Caused Nearly 2 Straight Weeks Of Bay Area's Worst Air Quality On Record
From Nov. 8 to Nov. 20, the region was choked by dangerously high levels of fine particulate matter, ranking among the worst periods of hazardous smoke since the Bay Area Air Quality Management District began keeping such records in 1999. All of the district's 17 monitoring stations — spread through eight Bay Area counties — detected high concentrations of the pollutant. (Goldberg, 12/19)

Chicago Tribune: Ten Presence Hospitals Getting A Name Change 
Ten hospitals that were formerly part of the Presence Health system have officially dropped that name from their titles, adding Amita Health in its place. The name change follows the acquisition of Presence Health by Catholic hospital system Ascension in March, making Presence part of Amita Health. Amita is a joint operating company formed by Adventist Midwest Health and Ascension's Alexian Brothers Health System in 2015. (Schencker, 12/19)

Houston Chronicle: Houston Police Barred From Kingwood Pines Hospital During Teen ‘Riot’ 
Houston police dispatched to the troubled Kingwood Pines Hospital last Saturday as at least six teenagers staged a riot inside were barred from entering the building because of their duty weapons. The response by law enforcement to the psychiatric hospital in northeast Harris County over the weekend is now the subject of a Houston Police Department investigation, spokesman Kese Smith confirmed. (Hensley, 12/19)

MPR: Minnesota Officials Consider How To Reduce Prison Populations
A bipartisan bill aimed at reducing prison populations appears likely to become law and could affect some of the roughly 2,400 federal inmates housed in Minnesota. But a larger number of prisoners go through state courts and are housed in state facilities. (Williams, 12/20)

Richmond Times-Dispatch: Study Shows Local Company's Copper-Infused Hospital Linens Can Reduce Infection Rates
Cupron recently announced that an 8-month-long study at six Sentara hospitals in Virginia and North Carolina showed that replacing regular linens such as patient gowns, bedsheets, washcloths and towels with copper-embedded linens significantly reduced occurrences of drug-resistant organisms, including methicillin-resistant Staphylococcus aureus, or MRSA. (Blackwell, 12/19)

Arizona Republic: Female Prison Population On The Rise In Arizona
A recent report on Arizona's criminal-justice system has found incarcerations are increasing sharply for women, spurred by the state's tough drug laws. In the third and final report in a series that takes a magnifying glass to Arizona's criminal-justice system, FWD.us, a bipartisan political group founded by Silicon Valley leaders, show a sharp increase in the number of women being incarcerated for drug and property-related crimes. (Vandell, 12/19)

Richmond Times Dispatch: Hampton Roads Regional Jail Not Providing Proper Medical And Mental Health Care, Department Of Justice Finds
Prisoners at Hampton Roads Regional Jail were subjected to medical and mental health care so bad that it violated their constitutional rights in a facility where officials didn’t fix problems even after becoming aware of them, the Department of Justice Civil Rights Division said in a report released Wednesday. The investigation of the jail, located in Portsmouth, began after press coverage of the death of Jamycheal Mitchell, 24, who was mentally ill and died in the jail in August 2015 after wasting away in a cell without adequate mental health treatment. (Wilson, 12/19)

Boston Globe: Depression Shadows Old Age For Nearly A Third Of Massachusetts Residents
A report released this month by the Gerontology Institute of the John W. McCormack Graduate School of Policy and Global Studies at the University of Massachusetts Boston shows the share of state residents over 65 who’ve been treated for depression has climbed to 31.5 percent from 28.6 percent three years ago. The report, which compiles a broad range of aging health data culled from Medicare records, was funded by the Tufts Health Plan Foundation. (Weisman, 12/19)

Stat: Judge Dismisses Lawsuit Accusing Craig Venter Of Stealing Trade Secrets
A California judge has dismissed a suit in which genomics pioneer Craig Venter’s old company accused him of stealing trade secrets. The decision on Tuesday brings to a close a messy breakup between Venter, the 72-year-old celebrity scientist who helped sequence the human genome, and Human Longevity, the struggling San Diego genomics company that Venter founded in 2013 and departed this past spring. (Robbins, 12/19)

The Associated Press: Missouri Begins To Process Toward Medical Marijuana
Missouri has begun the move toward legalized medical marijuana by naming an outgoing lawmaker to a leadership role and announcing the start of the process for those who want to grow, make or sell marijuana products. The Missouri Department of Health and Senior Services said Wednesday it will begin accepting application fees for cultivation, infused product manufacturing and dispensaries on Jan. 5. Forms are available on the health department website. Application fees are non-refundable. (12/19)

Stat: The Right Way To Address Prescription Drug Costs 
With a new Democratic majority in the House pledging to address the rising cost of health care — including prescription drugs — a fundamental question arises: Will lawmakers focus on the real issues that can drain a family’s finances, or simply adopt extreme policies that fail to take on the underlying problems in our health care system? As policy professionals from different sides of the aisle, we believe there is a right way to address these issues and a wrong way. The right way will reduce out-of-pocket costs for Americans, improve access to new medicines, and allow the United States to remain the global leader in medical innovation. The wrong way leads to price controls, weakened intellectual property protections, and restricted access to medicines, not to mention stifling innovation and doing little to make drugs more affordable. (Jim Greenwood and David Beier, 12/20)

The Hill: Government Drug Price Controls Will Wind Up Harming Medicare Patients
The Trump administration wants to use an average of the drug prices paid by other countries to limit what Medicare Part B pays for some drugs. This is a bad idea. Pricing reflects preferences, and the Trump administration plan would replace the needs of American patients with the preferences of foreign bureaucrats. (Linda Gorman, 12/19)

Bloomberg: Medicare Advantage Is Helping To Address The Opioid Crisis 
Since most of Medicare Advantage provides both drug and medical insurance, the authors surmise that the insurance plans have a stronger incentive to mitigate opioid problems. As the authors argue, the Medicare Advantage plans have “the incentive to account for the spillover effects of prescription drug use on the cost of care overall and can choose which physicians to include in its network and how it manages care.” Stand-alone plans providing only Part D drug coverage, by contrast, do not face the same incentives, since the cost of addressing medical problems is not their responsibility. (Peter R. Orszag, 12/19)

The Hill: Health-Care Access And Delays: A True Crisis In America
A recent Gallup poll notes that three in 10 Americans delayed seeking medical care due to cost — a true testament as to why America needs to solve its health-care access crisis.The notion that approximately 19 percent of all U.S. adults delayed treatment for serious or somewhat serious conditions or illness carries serious consequences particularly for diseases such as cancer, cardiovascular disease and a myriad of other acute and chronic conditions that may be amenable to early diagnosis and treatment. (Janice Phillips and Maria Alonso, 12/19)

Stat: Delivering New Gene Therapy To Patients Almost As Hard As Making It
After a career spent in pharmaceutical commercial strategy and operations, I thought I had a handle on what was required to launch a new therapy. But I’ve learned many lessons — and faced a few curveballs — in the 12 months since the FDA approved Luxturna (voretigene neparvovec), a one-time gene therapy for the treatment of patients with vision loss due to inherited retinal dystrophy caused by confirmed biallelic RPE65 mutations and who have sufficient viable retinal cells. (Ron Philip, 12/19)

The Hill: The Baby Powder Scandal — Is It Really Going To Impact You?
All of this research, combined with the Reuter’s report, makes me hesitant to recommend regular, heavy use of talcum powder for either babies or women. I am not alone in such caution. I would say to be aware of a possible associated risk and to be judicious in your use. At the same time, since I am anything but a fear-monger, I will gladly reassure patients who have been exposed to daily talcum powder use that the risk of developing cancer from it remains extremely small. (Marc Siegel, 12/19)

The Washington Post: Tammy Duckworth: I’m A Combat Veteran. We Cannot Allow Our Country To Be Turned Into A War Zone. 
I come from a long line of combat veterans who have taken up arms to defend this nation since before George Washington crossed the Delaware, and I spent decades in the military myself. So I understand why these kinds of weapons exist.But what I don’t get is why semiautomatics that U.S. service members carry around Fallujah are being sold to teenagers at the corner gun store.What I don’t understand is how some politicians can consider the National Rifle Association’s dollars more important than our kids’ lives.Or how our streets have become deadlier than war zones, with more Americans killed by gun violence over the past 50 years than in every war in American history combined. (Sen. Tammy Duckworth, 12/19)

Forbes: Has Childhood Obesity Become A National Security Threat?
As a physician and lawmaker, I have long argued that federal global health aid improves America’s standing in the world and makes us safer by steadying unstable nations. Countries with healthy workforces have improved economic outputs, stronger family units, and are less likely to become havens for terrorists.  But what many may not realize is that the health of our population here at home also impacts our national security. (Bill Frist, 12/19)

The Washington Post: Alexandria Ocasio-Cortez And The Problem Of Self-Care
Burnout is a real thing. Vacations and breaks, even coffee breaks, make us more productive and more engaged with both our work and our day-to-day life. However, to say all that already plays into the dominant narrative that we need to rationalize our time away from work as good for the work, and our desire that we not live on scraps alone as something bigger than a simple desire to relax and enjoy our life. It’s a set of beliefs so dominant even Ocasio-Cortez felt impelled to make a nod to it. So let me say this: It is the holidays and the end of the year. We can all rest and enjoy ourselves — for any reason we want. (Helaine Olen, 12/19)

New England Journal of Medicine: The Anti-Trans Memo — Abandoning Doctors And Patients
A proposed redefinition of gender as a “biological, immutable condition determined by a person’s genitalia at birth” would have damaging repercussions for vulnerable communities that have faced discrimination from health care providers, hospitals, insurers, and others. (Jocelyn Samuels and Mara Keisling, 12/19)

New England Journal of Medicine: Persons Of Nonbinary Gender — Awareness, Visibility, And Health Disparities
As our society’s concept of gender evolves, so does the visibility of contemporary nonbinary people. Yet many members of the medical community may not know how to interact with nonbinary patients respectfully or recognize their unique needs and barriers to care. (Walter Liszewski, J. Klint Peebles, Howa Yeung, and Sarah Arron, 12/20)

New England Journal of Medicine: Training In Sexual And Gender Minority Health — Expanding Education To Reach All Clinicians 
“If a man says he is a woman, does that mean he is mentally ill?” The staff member asking this question was attending a mandatory training session on health care for sexual and gender minority (SGM) patients at an urban hospital. She spoke timidly and seemed genuinely curious. We explained that incongruence between the sex assigned at birth and gender identity — denoted by the term “transgender” — is not a mental illness, and that transgender people’s mental health often improves with care that affirms their gender identity. She thanked us for the explanation, and we moved to the next topic, but her question lingered in our minds. We were surprised that concepts we took for granted were unknown to this clinician, who practiced in a large, diverse medical center. And yet questions such as hers are becoming more common as continuing medical education on SGM health expands. (Kevin L. Ard and Alex S. Keuroghlian, 12/20)

San Francisco Chronicle: To Help The Homeless, Offer Shelter That Allows Deep Sleep
What if homeless people were provided with more comfortable sleeping environments, where they could get the rest required to function better? Would homelessness then be reduced? I definitely think so. After all, without the clarity that a decent night’s sleep provides, how can someone climb the herculean mountain of self-sufficiency that housing oneself demands? (Lori Teresa Yearwood, 12/19)