Politico: Will GOP Finally Take Down Obamacare With A Tax Bill?
After spending nearly a year on a failed effort to repeal Obamacare, Republicans on Capitol Hill are on the verge of repealing the law’s individual mandate as a footnote to their rewrite of the American tax system. At least two of the three Senate Republicans who blocked the repeal effort over the summer have no problem undoing the requirement that nearly all Americans carry insurance — a provision Democrats say is vital to keeping the Affordable Care Act afloat. (Haberkorn, 11/30)

Kaiser Health News: Congress Isn’t Really Done With Health Care — Just Look At What’s In The Tax Bills
Having failed to repeal and replace the Affordable Care Act, Congress is now working on a tax overhaul. But it turns out the tax bills in the House and Senate also aim to reshape health care. Here are five big ways the tax bill could affect health policy. (12/1)

The New York Times: Without Obamacare Mandate, ‘You Open The Floodgates’ For Skimpy Health Plans
The drive by Senate Republicans to repeal the requirement that most Americans have health insurance is not only likely to discourage people from signing up for coverage during the current enrollment period, but also could result in higher premiums. If repeal is approved, people could opt out of buying policies because they would no longer face a tax penalty and millions could go uninsured. With the Affordable Care Act already weakened by the Trump administration, big drops in enrollment would deal yet another body blow to the law and wreak more havoc in the individual insurance market. (Abelson, 11/30)

CQ: Health Lobby Frets Over Lack of Insurance Mandate Alternative
The health care industry is increasingly concerned that lawmakers could roll back a requirement that most Americans have health insurance coverage without putting a replacement policy in place. Senate Republicans could vote to repeal the requirement that most Americans purchase health insurance or pay a fine under the 2010 health care law  as part of a sweeping tax bill as soon as this week. Unlike the health care bills considered by Congress earlier this year, Republicans have not put forward an alternative policy that would incentivize people to buy health insurance coverage. (McIntire, 12/1)

Modern Healthcare: Healthcare Industry Braces For Multiple Hits From Senate Tax Bill
The sprawling tax cut legislation speeding through Congress is likely to result in major changes in healthcare, including significant insurance coverage losses, higher premiums, tighter access to capital, and greater margin pressure for not-for-profit health systems. Senate Republicans are making last-minute changes to their version of the Tax Cuts and Jobs Act before they expect to pass it on a straight party-line vote Friday. ... Then House Republicans, who passed their own tax bill earlier this month, either will simply pass the Senate bill or negotiate differences between the two bills in conference committee. (Meyer, 11/30)

The Hill: AARP Comes Out Against Senate GOP Tax Bill, Warns Of Medicare Cuts
The AARP said on Thursday that it opposes the Senate GOP tax bill, warning senators it could lead to billions of dollars in Medicare cuts. In a letter to senators, the influential seniors group urged lawmakers to work on a bipartisan version that won’t result in entitlement cuts. (Weixel, 11/30)

The Oregonian: Threat To Medical Deduction In GOP Tax Plan Worries Oregonians
But a Republican-sponsored tax proposal in the U.S. House of Representatives would eliminate the deduction, which is taken by nearly 9 million people, U.S. tax data show. That includes about 165,000 people in Oregon, according to an analysis by the Oregon Center for Public Policy. The Senate version of the bill, up for a vote Friday, would preserve the medical deduction. The provision allows medical bills above 10 percent of income to be deducted in calculating federal taxes. (Terry, 11/30)

The Hill: McConnell Promises Collins Tax Bill Won't Lead To Medicare Cut
Senate Majority Leader Mitch McConnell  (R-Ky.) is promising the GOP tax bill, which is projected to add $1.4 trillion to the deficit over the next decade, will not result in cuts to Medicare next year. McConnell offered the vow to Sen. Susan Collins (R-Maine), a key swing vote, during a Wednesday meeting in his office. (Bolton, 11/30)

The Hill: House Conservatives Won't Back Spending Bill With ObamaCare Payments
House conservatives said they won't support a short-term spending bill to fund the government if it contains provisions to "bail out" insurance companies. A deal between moderate GOP Sen. Susan Collins (R-Maine), President Trump and Senate Majority Leader Mitch McConnell (R-Ky.) would likely attach two bipartisan measures to stabilize ObamaCare's insurance markets to the spending bill in exchange for her vote on tax reform. (Hellmann, 11/30)

CQ HealthBeat: House Republicans Split On Senate Health Care Deal
House Republicans are divided on a health care deal a Senate colleague struck on the GOP tax bill, potentially setting up a hurdle for a major item on the party’s agenda. Some members of the conservative House Freedom Caucus stand opposed to funding cost-sharing subsidies for low-income consumers on the health insurance exchanges, a key provision that Sen. Susan Collins, R-Maine, indicated is important to her support for a tax bill that would repeal the current requirement that most Americans get insurance. She said President Donald Trump also agreed to her request for additional money for a federal reinsurance fund that would pay for high-cost patients. (Clason, 11/30)

The Hill: Collins: Health-Care Fix Will Pass Before Tax Bill
Sen. Susan Collins (R-Maine) said early Thursday that she expects legislation to lower health-care premiums to pass Congress before senators take a final vote on a $1.5 trillion tax-reform bill that would repeal the Affordable Care Act's individual mandate. Collins, speaking to reporters at a Christian Science Monitor breakfast, said it’s a mistake to scrap the individual mandate without making other reforms to the health-care system. (Bolton, 11/30)

The Wall Street Journal: House GOP To Propose Short-Term Spending Bill
Since the short-term bill through Dec. 22 will be a must-pass piece of legislation, lawmakers are certain to try to cram other measures onto it. Most prominently, Sen. Susan Collins (R., Maine) said this week that her support for the Senate GOP tax-overhaul bill—which repeals the Affordable Care Act requirement that most people have health insurance or pay a penalty—will depend on whether Congress also passes a bipartisan health-care bill aimed at offsetting any resulting increases in premiums. Ms. Collins said that bipartisan bill, from Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.), would likely be folded into the short-term spending bill. (Peterson, 11/30)

The CT Mirror: Access Health Projecting 2018 Enrollment Will Match Last Year’s
With about three weeks left in open enrollment, Access Health CT CEO Jim Wadleigh estimates that the health insurance exchange will end the enrollment period with about the same number of customers it had at the end of last year's signup. (Rigg, 12/1)

The Wall Street Journal: Charlottesville Residents Unite To Protest Likely Surge In Health-Insurance Premiums
The college town of Charlottesville, Va., is fast becoming the exemplar for millions of people without federal subsidies whose health-insurance premiums will rise sharply next year. Its county, Albemarle, will have the highest costs in the nation in 2018 for people on the Affordable Care Act’s exchanges. Hundreds of residents who buy their own insurance, but earn too much for federal help, have banded together in the past two weeks, trying to pressure Congress for some kind of relief. (Armour, 11/30)

Kaiser Health News: Desperate For Coverage: Are Short-Term Plans Better Than None At All?
When one of Cindy Holtzman’s clients told the Woodstock, Ga., broker he was considering dropping his Affordable Care Act plan because next year’s cost approached $23,000 for his family of four, she suggested a new option: a back-to-back set of four, 90-day short-term plans, which would effectively give them a modicum of medical coverage for 2018. An Obama administration rule limited short-term coverage to three months at a time because it was meant as a stopgap between more substantial policies. But several insurers, including big players Golden Rule and National General, now are sidestepping that rule by packaging three or four consecutive 90-day plans, with a one-time medical review upfront. (Appleby, 12/1)

The Associated Press: Trump Donates Third-Quarter Salary To Health Department
President Donald Trump has donated his third-quarter salary to the Department of Health and Human Services to help fight the opioid epidemic. Acting Health Secretary Eric Hargan on Thursday accepted a check from the president in the amount of $100,000. Trump previously donated salary in the amounts of $78,333 and $100,000 to the National Park Service and the Education Department, respectively. (Superville, 12/1)

The Hill: Trump Donates Third Quarter Paycheck To Battling Opioid Epidemic
President Trump will donate his third-quarter salary to help his Health and Human Services Department battle the opioid epidemic, the White House announced Thursday. Trump has pledged to donate his entire salary to various causes and has so far dedicated each of his quarterly $100,000 paychecks to different federal programs. (Kamisar and Roubein, 11/30)

Stat: Trump Is Donating His Salary To Fight The Opioid Crisis. Here's What It Would Buy
President Trump has pledged to donate his third-quarter salary to fight the opioid crisis. So what will that buy, exactly? We’re not sure yet. But it won’t go too far — considering the White House itself has said the opioid epidemic costs the nation about $500 billion a year in costs for medical care, law enforcement, and lost productivity. (Blau, 11/30)

The Associated Press: Health Nominee Azar Is No Stranger To Management Controversy
Alex Azar, who’s in line to replace a Trump Cabinet secretary who was forced out in controversy, is no stranger to sticky management problems. In Washington, he’s been nominated to replace Tom Price, who resigned in September over questions about his use of private jets. Back in Indiana, Azar was an influential member of a public airport board, tasked with oversight of human resources matters, when he defended the conduct of the airport CEO who was under fire for spending public money on travel, golf fees, steak dinners and Super Bowl tickets. (Slodysko, 12/1)

Bloomberg: Trump Health Nominee Embraces Obamacare Programs The Last Guy Ended
President Donald Trump’s nominee to oversee Medicare says he’s a fan of paying doctors and hospitals in new, potentially more efficient ways through experimental payment programs set up under Obamacare. The federal agency he’s been picked and that administers the programs to run just killed off three of them. (Armstrong, 11/30)

The Wall Street Journal: CVS Health Closes In On Deal To Buy Aetna
CVS Health Corp. is moving closer to a deal to buy Aetna Inc. for more than $66 billion in cash and stock. The deal, which could be announced by Monday, would create a health-care behemoth selling everything from drugs to insurance. The companies are in advanced stages of negotiating a deal, according to people familiar with the matter. It would likely be valued at between $200 and $205 per Aetna share and consist mainly of cash, some of the people said. (Mattioli and Wilde Mathews, 11/30)

Bloomberg: CVS Nears Deal To Acquire Health Insurer Aetna
CVS Health Corp. is nearing an agreement to acquire health insurer Aetna Inc. for more than $65 billion, according to a person familiar with the negotiations, in a deal that could reshape the pharmacy and health insurance industries. An announcement could come as soon as Monday, said the person, who asked not to be identified because the talks are private. CVS is likely to agree to pay at least $200 a share for Aetna, with more than 30 percent paid for with cash, according to the person. Talks could still be delayed or fall apart. (Langreth and Tracer, 11/30)

Bloomberg: Express Scripts CEO Open To Insurer Deal, Ties With Amazon
Express Scripts Holding Co.’s chief executive said he’s open to a deal with a health insurer or partnering with Amazon.com Inc. CEO Tim Wentworth’s pharmacy benefits company has been battered by departing clients and the vague specter of Amazon’s entry into the drug business. If a major insurer was interested in a deal, “I would be open to it,” Wentworth said on the sidelines of a conference in New York sponsored by Forbes. “We don’t need to sell to be very successful in the future, but we are always open to others who may all of sudden conclude they want what we have.” (Langreth, 11/30)

Bloomberg: Purdue Pharma Discloses Negotiations With AGs On Opioids
Purdue Pharma LP acknowledged in a letter that the maker of the opioid painkiller Oxycontin is in “negotiations’’ with state attorneys general over lawsuits accusing the company of creating a public-health crisis with its mishandling of the drug. Maria Barton, Purdue’s general counsel, chastised Ohio Attorney General Mike DeWine for pulling out of a multistate probe of the drugmaker by 41 of his fellow attorneys general. He did so shortly after signing an agreement to preserve his state’s legal claims “while the investigation and negotiations were conducted,’’ according to a copy of the Nov. 28 letter provided by Purdue officials. (Feeley and Hopkins, 11/30)

Minnesota Public Radio: County Attorneys In Minnesota Sue Opioid Manufacturers, Distributors
A group of Minnesota county attorneys announced lawsuits Thursday against the manufacturers and distributors of opiate-based pain medications. ... A number of manufacturers issued statements in response to requests for comment from MPR News, saying they only support the appropriate use of the medications for pain relief, and try to prevent illegal sales. (Nelson, 11/30)

Pioneer Press: Minnesota County Attorneys Plan Lawsuits Over Opioid Crisis
Minnesota county attorneys from across the state plan to sue opioid manufacturers and distributors for allegedly using marketing tactics akin to the tobacco industry to flood communities with addictive and deadly narcotics. At a news conference Thursday, Washington County Attorney Pete Orput said he feared late-night phone calls because so often it’s law enforcement contacting him about “another dead kid” who overdosed. (Magan, 11/30)

The Associated Press: More US Kids In Foster Care; Parental Drug Abuse A Factor
The number of children in the U.S. foster care system has increased for the fourth year in a row, with substance abuse by parents a major factor, according to new federal data released on Thursday. The annual report from the Department of Health and Human Services counted 437,500 children in foster care as of Sept. 30, 2016, up from about 427,400 a year earlier. (Crary, 12/1)

The Washington Post: A Navy Admiral Lost His Son To Opioid Addiction. Now He’s Marshaling Support To End The Epidemic.
Retired Navy Adm. James “Sandy” Winnefeld once had the ability to project military power anywhere on Earth. But when it came to finding help to pull his son Jonathan back from the depths of drug addiction, the former vice chairman of the Joint Chiefs of Staff was at a loss. ... The Winnefelds and military health-care experts stressed that Tricare’s limitations mirror the civilian health-care system, where care for drug addiction and mental health issues has not kept pace with the widening opioid epidemic. (Horton, 12/1)

New actions from the government: The FDA OKs a new injectable opioid treatment and House Democratic lawmakers introduce a bill —

Stat: FDA Approves Indivior’s Monthly Injection To Treat Opioid Addiction
A new form of a widely used opioid addiction treatment that is injected monthly instead of taken daily as a tablet was approved Thursday by the Food and Drug Administration. Experts say the eagerly anticipated new version of the drug may help patients reduce relapses, disrupt the treatment market, and possibly dispel misconceptions about the drug’s potential for abuse. Indivior is the first company to gain approval for a monthly injection of buprenorphine. The company is best known for Suboxone, a daily formulation that combines buprenorphine with naloxone into a film that dissolves under the tongue. (Blau, 11/30)

The Associated Press: US Approves Monthly Injection For Opioid Addiction
U.S. health officials on Thursday approved the first injectable form of the leading medication to treat patients recovering from addiction to heroin, prescription painkillers and other opioids. The Food and Drug Administration approved once-a-month Sublocade for adults with opioid use disorder who are already stabilized on addiction medication. (Perrone, 11/30)

The Hill: House Dems Introduce Bill To Provide $45B For Opioid Epidemic
Four House Democrats introduced a bill Thursday to provide $45 billion over 10 years to fight the opioid epidemic. In late October, President Trump declared the opioid epidemic a national public health emergency — a move that didn’t free up millions of dollars to fight the increasing rate of opioid overdose deaths. (Roubein, 11/30)

And in news out of Florida, Wisconsin and Minnesota —

Tampa Bay Times: As Politicians Pledge Solutions To The Opioid Epidemic, Advocates Say The Key Will Be Money
The opioid epidemic has grabbed the spotlight of late, with state and national leaders promising action. ... But local advocates, medical professionals and researchers who work every day with those affected by opioid addiction are hesitant to celebrate until they see meaningful action. (Griffin, 12/1)

Milwaukee Journal Sentinel: Opioid Epidemic: Drug Deaths In Milwaukee County Are Worse Than Ever
The toll from the heroin and opioid epidemic has steadily continued in Milwaukee County, with more than 330 drug-related deaths so far this year. But what's arguably more striking is the number of people who have suffered an opioid overdose and survived — 2,909 in the city of Milwaukee as of Nov. 9, according to Milwaukee Fire Department data. (Luthern, 11/30)

Minnesota Public Radio: St. Paul Cops To Have Opioid Overdose Antidote On Hand
The Saint Paul Police Department is arming its officers in the ongoing battle to prevent opioid overdose deaths. The department is teaming up with Regions Hospital Emergency Medical Services to teach officers how to administer the opioid overdose antidote, Narcan. (Sapong, 11/30)

The Wall Street Journal: FDA To Allow Quicker Approval Of Some Promising Cancer Drugs
The Food and Drug Administration plans to allow quick approval of some cancer drugs if they show early and “outsized” survival benefits for patients even in small studies, the FDA’s commissioner said Thursday. Scott Gottlieb told the House Energy and Commerce subcommittee on health that the agency expects to see this situation more, given the advent of drugs that precisely target the genetic underpinnings of diseases. (Burton, 11/30)

Stat: Gottlieb Signals Support For Both ‘Gold Standard’ And Expedited Review For Drug Approvals
Regulatory standards for some clinical trials may soon slacken, per a new statement from Food and Drug Administration Commissioner Scott Gottlieb. And though his words are vague, they’ve been enough to raise red flags in some corners. Testifying today before a Congressional committee on the 21st Century Cures Act, Gottlieb sent a mixed message: He wants the agency to “remain steadfast to our gold standard for safety and efficacy,” while making the development of breakthrough products “more scientifically modern and efficient, to meet the urgent needs of patients.” (Keshavan, 11/30)

In other agency news —

Boston Globe: FDA Approves Foundation Medicine’s Cancer Gene Test
Federal regulators Thursday approved a diagnostic test by Cambridge-based Foundation Medicine Inc. that company leaders say will enable them to sequence the DNA of different cancer tumors to tailor treatments. The Food and Drug Administration approved the test, called FoundationOne CDx, which can detect all four classes of alterations in 324 cancer-related genes that cause solid tumors. (Saltzman, 11/30)

Kaiser Health News: If Your Insurer Covers Few Therapists, Is That Really Mental Health Parity?
It’s been nearly a decade since Congress passed the mental health parity act, with its promise to make mental health and substance abuse treatment just as easy to get as care for any other condition. Yet today, in the midst of the opioid epidemic and a spike in the rate of suicide, patients still struggle to access treatment. (Gold, 11/30)

Stat: Despite Laws Requiring Equal Coverage, Gaps Are Still Wide Between Coverage For Behavioral And Physical Health
A new report paints a grim picture of compliance with laws mandating parity in health coverage for physical and behavioral health conditions — increasingly a focus as health officials turn their attention to insurers’ role both in perpetuating and solving the nation’s drug addiction crisis. The report, published by the consulting firm Milliman and commissioned by the Bowman Family Foundation, highlights coverage gaps and significantly lower reimbursement rates stemming from the non-enforcement of decades-old laws meant to ensure those with mental and behavioral health needs — an umbrella term that includes treatment for substance use disorders — have equal access to care. (Facher, 11/30)

NPR: How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis
A severe shortage of inpatient care for people with mental illness is amounting to a public health crisis, as the number of individuals struggling with a range of psychiatric problems continues to rise. The revelation that the gunman in the Sutherland Springs, Texas, church shooting escaped from a psychiatric hospital in 2012 is renewing concerns about the state of mental health care in this country. A study published in the journal Psychiatric Services estimates 3.4 percent of Americans — more than 8 million people — suffer from serious psychological problems. (Raphelson, 11/30)

The Associated Press: Health Care Fallout: Fate Of 8M Low-Income Children In Limbo
TC Bell knows what life is like without health insurance after growing up with a mother who cobbled together care from a public health clinic, emergency room visits and off-the-books visits to a doctor they knew. That memory makes Bell, of Denver, grateful for the coverage his two daughters have now under the Children's Health Insurance Program — and concerned about its uncertain future in Congress. "There's an incredible security that I have with CHIP," said Bell, 30, who has gone back to community college to reboot his life after working a series of low-paying jobs. (Karnowski, 11/30)

WBUR: States Sound Warning That Kids' Health Insurance Is At Risk
This week, Colorado became the first state to notify families that children who receive health insurance through the Children's Health Insurance Program are in danger of losing their coverage. Nearly 9 million children are insured through CHIP, which covers mostly working-class families. (Simmons-Duffin and Lopez, 11/30)

Texas Tribune: Hey, Texplainer: How Much Money Does Texas Spend Per Child Through CHIP?
The state's budget for fiscal years 2018 and 2019 allocates about $200 per child per month to the roughly 400,000 CHIP-eligible Texans. Without federal funding, Texas has enough money for CHIP to last until February 2018, according to estimates by the Texas Health and Human Services Commission, the state's health agency. (Samuels, 12/1)

Chicago Sun Times: City Retirees Want To Know Why City Kept $2.1M In Health Overcharges
Fresh from a crushing blow in the long-running battle over retiree health care, retired city employees are demanding to know why the city kept for itself $2.1 million in overcharges instead of refunding that money to retirees. An audit and reconciliation process was required annually before Mayor Rahm Emanuel’s now-completed, three-year phaseout of retiree health care coverage and a 55 percent city subsidy for anyone who did not retire by Aug. 23, 1989. (Spielman, 11/30)

Des Moines Register: Abrupt Medicaid Shift Won't Cause Loss Of Services, UnitedHealthcare Leader Vows
This week’s departure of Iowa’s largest Medicaid management firm shouldn’t cause poor or disabled Iowans to suddenly lose health-care services, the leader of the main remaining company said. ...UnitedHealthcare is taking responsibility for almost all 215,000 Iowans who previously received their Medicaid benefits via AmeriHealth Caritas, which abruptly pulled out of Iowa after a contract dispute with state officials. The change, which took effect Friday, means more than two-thirds of Iowans on Medicaid are now signed on with one private management company. (Leys, 11/30)

Kaiser Health News: Whistleblower: Medicaid Managed-Care Firm Improperly Denied Care To Thousands
In early October, an executive at one of the nation’s largest physician-practice management firms handed her bosses the equivalent of a live grenade — a 20-page report that blew up the company and shook the world of managed care for poor patients across California. For years, she wrote, SynerMed, a behind-the-scenes administrator of medical groups and managed-care contracts, had improperly denied care to thousands of patients — most of them on Medicaid — and falsified documents to hide it. (Terhune, 12/1)

The Oregonian: 15 Percent Of Residents Could Lose Health Coverage In One Oregon County. See Other Counties' Rates.
In less than two months, Oregon voters will decide whether to impose hundreds of millions of dollars in health care taxes that lawmakers passed earlier this year. The stakes for the Jan. 23 referendum are huge: If voters reject the $210 million to $320 million in taxes, lawmakers could be forced to make cuts or find other ways to raise money in order to close a hole in the state budget. ...But supporters of the health care taxes say lawmakers would likely respond by kicking as many as 300,000 low-income Oregonians off Medicaid and other health insurance programs included in the Oregon Health Plan.  (Borrud, 11/30)

Reuters: Lawsuit Seeks To Block Illinois Abortion Coverage Expansion
Abortion opponents in Illinois filed a lawsuit on Thursday to block a recently approved law expanding state-funded coverage of abortions for low-income Medicaid recipients and state workers. (Kenning, 11/30)

Boston Globe: Partners Defends Potential Cost Hikes In Mass. Eye Proposal
Partners HealthCare and Massachusetts Eye and Ear on Thursday challenged the conclusions of a state watchdog agency that said Partners’ acquisition of the specialty hospital would significantly raise costs for consumers. The Health Policy Commission said the transaction would result in higher prices for Mass. Eye and Ear’s services, increasing spending by $20.8 million to $61.2 million a year — costs that would be felt in the form of higher health insurance premiums. (Dayal McCluskey, 12/1)

Denver Post: Teen Pregnancy And Abortion Rates See Big Drops, Which Colorado Officials Attribute To IUD Program
The steep drop in teen pregnancies and abortions in Colorado since 2009 is mainly due to one thing: free, low-cost access to IUDs. Intrauterine devices — tiny, T-shaped pieces of plastic placed in the uterus — are the main reason Colorado’s teen birth rate fell 54 percent and the teen abortion rate declined 64 percent in the last eight years, state health officials said Thursday. (Brown, 11/30)

The Associated Press: Possible Link Found Between Some Utah Suicides, Electronics
Researchers studying a spike in teen suicides in Utah found that 18 of the 150 youngsters who took their own lives in a five-year period had recently lost privileges to use their electronic devices such as phones, tablets and gaming systems, according to a U.S. Centers for Disease Control and Prevention report made public Thursday. (McCombs, 11/30)

Kaiser Health News: Texans With HIV Cope With Homes And Medicines Ruined By Hurricane Harvey
Many Houstonians with HIV faced similar problems. [Hurricane Harvey] closed pharmacies and clinics for a week — or longer. Floodwaters ruined drugs. People who fled to other states couldn’t get their prescriptions filled for HIV medicine. As the days ticked on, many worried the amount of HIV in their blood would increase and become resistant to treatment. (Varney, 12/1)

Los Angeles Times: Costa Mesa Paramedic Is On The Front Line In Effort To Prevent First-Responder Suicides
After the mass shooting at the Route 91 Harvest festival in Las Vegas, Orange County fire departments deployed support counselors to help first-responders cope with the trauma they had experienced. Like members of many public safety agencies in Southern California, current and retired employees of the Costa Mesa Fire and Rescue Department attended the country music festival as spectators. Some suffered from survivor’s guilt and trauma from what they saw the night of Oct. 1. (Langhorne, 11/30)

Milwaukee Journal Sentinel: Impact Of Childhood Trauma Reaches Rural Wisconsin
Marquette County also has another epidemic that gives its rural underclass a kindred bond to its urban peers, one that researchers say sticks families in a cycle of dysfunction from one generation to the next. It’s called childhood trauma – growing up in an environment of violence, neglect and abuse that can leave neurological scars that saddle children with the lifelong burden of physical and mental illness. (Schmid and Mollica, 11/30)

Sacramento Bee: County Where ‘Madman’ Killed Five Has Just Two Psychiatrists
Only two psychiatrists work in the rural county where Kevin Janson Neal shot and killed five people earlier this month, state records show. ...Neal suffered from delusions and other mental health issues for years, according to his sister, Sheridan Orr. (Reese, 11/30)

KQED: High Levels Of Lead Detected In Tap Water At Some San Francisco Schools
New documents obtained by KQED reveal that half of San Francisco schools have lead in their water, though levels vary widely from school to school. Information obtained as a result of a request under the California Public Records Act shows water from one tap measured more than 370 times the allowable concentration of lead. (Hossaini, 11/30)

The Star Tribune: Autism, Sleep Apnea Added To Minnesota List For Medical Marijuana
Minnesotans with autism and obstructive sleep apnea will be able to use medical marijuana starting next July to manage their conditions, the state Health Department announced Thursday. (Olson, 11/30)

JAMA Oncology: Trends In Cancer Survival By Health Insurance Status In California From 1997 To 2014
In this large population-based study, improvements in survival between January 1997 and December 2014 were limited to patients with private or Medicare insurance. Survival disparities for uninsured or other publicly insured patients with prostate, lung, or colorectal cancer increased significantly over time. (Ellis, Canchola, Spiegel et. al., 11/30)

JAMA Internal Medicine: Consumer Behaviors Among Individuals Enrolled In High-Deductible Health Plans 
Our study examined the prevalence and reported results of these consumer behaviors among individuals enrolled in HDHPs in the United States. ...The most common consumer behavior was saving for future health services (685 individuals [40%]), followed by talking with a provider about the cost of a service (445 [25%]), comparing prices (248 [14%]), comparing quality (204 [14%]), and trying to negotiate a price for a service (98 [6%]). (Kullgren, Cliff, Krenz et. al., 11/27)

RAND: Barriers To Gender Transition-Related Healthcare: Identifying Underserved Transgender Adults In Massachusetts 
The present study sought to examine whether individual (e.g., age, gender), interpersonal (e.g., healthcare provider discrimination), and structural (e.g., lack of insurance coverage) factors are associated with access to transition-related care in a statewide sample of transgender adults. ...Overall, 23.6% reported being unable to access transition-related care in the past 12 months. (White Hughto, Rose, Pachankis et. al., 11/30)

Urban Institute: What Explains Attitudes Toward The Individual Mandate?
This brief uses data from the September 2017 Health Reform Monitoring Survey to examine attitudes toward the Affordable Care Act’s individual mandate. We found that although the individual mandate is unpopular, only 4 in 10 adults support repealing it, and the remainder either support keeping it or are not sure what to do. (Holahan, Karpman and Zuckerman, 11/21)

USA Today: Senate Tax Bill Fails Individual Insurance Responsibility
The Senate tax bill in its final stages of debate has many flaws. But none is more disconcerting — and none represents a more thorough reversal of what used to be bedrock Republican principles — than its ending of the requirement that all Americans have health insurance. This requirement, known as the individual mandate, is a centerpiece of the Affordable Care Act. Senate Republicans tacked repeal of the mandate on to their tax bill as a way to help fund a host of cuts for corporations and wealthy interests. (11/30)

USA Today: End The Individual Mandate
The Senate Republican tax reform bill doesn’t end the health insurance mandate; it just eliminates the tax penalty if people choose not to buy, or can’t afford, government-approved health coverage. That’s like a huge tax cut for uninsured Americans. The subsidies that help moderate-income families buy coverage — the most effective inducement to join Obamacare — remain in place, as do the insurance regulations. (Merrill Matthews, 11/30)

The Wall Street Journal: Think Of Tax Reform As The Trump Family’s Christmas List
Statements from the White House suggest that Mr. Trump doesn’t much care whether the bill undermines ObamaCare, cuts individual taxes permanently or temporarily, or abolishes the deduction for state and local taxes. But no matter how the House and Senate provisions reconcile, the Trump family will get a magnificent Christmas present while millions of Americans will get lumps of coal. (Alan S. Blinder, 11/30)

Los Angeles Times: Sen. Rubio Tells A Secret: After Giving A Tax Cut To The Rich, GOP Will Cut Social Security And Medicare
Advocates for seniors and the middle class have been warning for weeks that the Republican drive to cut taxes for the wealthy is the prelude to a larger attack on Social Security and Medicare. In a videotaped interview with two Politico reporters Wednesday, Sen. Marco Rubio (R-Fla.) said the quiet parts out loud. Asked by interviewers Anna Palmer and Jake Sherman how to address the federal deficit, he replied: “We have to do two things. We have to generate economic growth which generates revenue, while reducing spending. That will mean instituting structural changes to Social Security and Medicare for the future.” (Michael Hiltzik, 11/30)

And in commentaries on other aspects of the Affordable Care Act and health policy being considered by Congress.

San Diego Union-Tribune: How An Independent Panel Could Ration Medicare Services
The U.S. Senate has its own opportunity to help promote greater choice for older adults in Medicare by joining the House in voting to repeal the Independent Payment Advisory Board (IPAB). IPAB was included as a last-minute addition to the Affordable Care Act (ACA) in 2010. It would establish a 15-member commission all appointed by the president and vested with the responsibility to make arbitrary reductions in Medicare. These changes would be mandatory and would automatically become law unless Congress passed legislation by a two-thirds majority to make equivalent cuts. (Bob Blancato and Paul Downey, 11/30)

Forbes: Poverty Trends Under Obamacare
There has been a marked reduction in poverty rates since the inception of Obamacare. Children, non-elderly adults and the elderly all have benefited from the slow, but steady economic growth we observed between 2010 and 2016. Correlation, of course, should not be mistaken for causation. And what I found when I unpacked the details may surprise some readers. First, for children and non-elderly adults, the absolute decline in poverty rates was nearly identical whether or not out-of-pocket medical spending was taken into account. (Chris Conover, 11/30)

Richmond Times-Dispatch: Congress Is Creating A Nightmare For Virginia Families
Beginning today, thousands of families will receive a letter stating that their child’s health insurance will end at the end of January 2018. After months of consideration, Congress has yet to reauthorize funding for the Children’s Health Insurance Program (CHIP) — locally, the Family Access to Medical Insurance Security plan, or FAMIS — and it is heading toward allowing the funding to expire completely. (Greg Peters, 11/30)

The New York Times: Kellyanne Conway Might As Well Be ‘Opioid Czar’
Kellyanne Conway, counselor to President Trump, has no public health background, a reputation for bending the truth, and a knack for generating government ethics complaints. Yet Ms. Conway does have the ear of the president. She has also studied America’s opioid epidemic in recent months as part of her portfolio. She is not the “opioids czar,” as some news outlets reported this week, but her stepping out as point person on the government response to this public health crisis stirred hope of concrete action from a White House that so far has offered little more than talk. (11/30)

USA Today: On World AIDS Day, Let’s Remember Disease Is Still A Brutal Killer
Today, Dec. 1, World AIDS Day, we all wear red ribbons to show our support and unity with the 36.7 million individuals who are living with HIV/AIDS — a disease responsible for taking the lives of approximately 2,000 Floridians alone, according to the Center for AIDS Research at Emory University. ... While raising awareness about prevention can minimize its continual spread, we must also be committed to helping those who live with this disease and its symptoms, many of whom are underprivileged. (State Sen. René Garcia, 11/30)

The Washington Post: Trump Wants To Gut America’s Progress Against AIDS
Trump’s tweets are also distracting from other important matters of governance. And here is one that can’t get lost in the general madness: The Trump administration is proposing a reduction in funding and a shift in strategy in the fight against global AIDS that together would increase infections, cost lives and threaten the extraordinary progress of the past 15 years. (Michael Gerson, 11/30)

The Washington Post: Why Abortion — Not Sexual Misconduct — Is Likely To Decide The Alabama Senate Race
If Republican Roy Moore survives allegations of sexual misconduct (several involving minors) and beats Democrat Doug Jones in Alabama’s Senate election Dec. 12, evangelical single-issue abortion voters will likely deliver the victory. A Pew Research Center study conducted in 2014 showed that the vast majority (58 percent) of adults in Alabama who say that abortion should be “illegal in all or most cases” are churchgoing, white Protestant evangelicals who self-identify as political conservatives and vote or lean Republican. They have long been an important part of the Republican political base — and Moore must turn them out if he hopes to win (three new polls out this week show that after falling behind Jones, Moore is now up 5 to 6 percentage points). (Stacie Taranto, 11/30)

Forbes: Fact-Checking The Left's Dubious Arguments In Favor Of Obamacare's Contraception Mandate
Last month, Bryce Covert, a contributor to The Nation (purportedly "the most widely read weekly journal of liberal/progressive political and cultural news, opinion, and analysis") penned an op-ed piece in the New York Times so riddled with errors that it begged for refutation. Arguing that "birth control fuels economic growth," Ms. Covert offered a ringing defense of efforts by 41 Democrats to reverse Trump administration efforts that he believes "paves the way for virtually any employer to deny its employees access to contraception without a copayment." (Chris Conover, 11/30)

The New York Times: How Doctors Fail Women Who Don’t Want Children
Doctors ought to be women’s greatest allies in the fight for contraceptive and reproductive rights. And yet many of them are failing one subset of women — those, like me, who know they never want to have children. (Alanna Weissman, 11/30)

Stat: New Vaccine Against Typhoid Fever Will Help Fight Antimicrobial Resistance
Until relatively recently, antibiotics were a major part of the solution in the fight against typhoid fever. Their introduction dramatically reduced the death rate from one death in every five cases to one death in every hundred cases. But through the widespread overuse and misuse of antibiotics, the typhoid-causing pathogen has developed resistance to multiple drugs. It is now one of biggest drivers of all drug resistance in Southeast Asia and probably in other regions as well. Not only does this mean that we could see the number of deaths from typhoid fever once again start to rise, but it also has implications for the spread of other drug-resistant pathogens, posing major regional and transcontinental threats. ... The solution to this problem is to prevent typhoid fever in the first place. Vaccination can do that. (Seth Berkley, 11/30)

Stat: Drug-Price Reforms That Limit Incentives For Innovation Could Harm, Not Help
The ongoing furor over the price of prescription pharmaceuticals has become so intense that even an august, establishment group like the National Academy of Sciences, Engineering and Medicine (NAS) cannot help but weigh in. ... The panel gets more things right than wrong. However, in failing to emphasize strongly the importance of continuing adequate financial incentives for biomedical innovation and the safeguarding of intellectual property, the report ignores a central tenet of medicine itself — do no harm. Moreover, the call for direct price negotiations by the government on behalf of Medicare Part D for outpatient drugs largely ignores the risk that this scheme will exacerbate rationing through the expansion of restrictive formularies. (John Osborn and David Beier, 11/30)

Stat: If Biden Runs For President, He'll Need To Reboot His Record On Drug Prices
Joe Biden wants to be president, the champion of working families. But there is another side to the former vice president: protector of big pharmaceutical companies, indifferent to the harsh consequences of high drug prices. If Biden wants to pursue a future in politics, he ought to consider a reboot on drug pricing issues. (James Love, 11/30)

The New England Journal Of Medicine: Chasing Seasonal Influenza — The Need For A Universal Influenza Vaccine
As clinicians in the United States prepare for the start of another influenza season, experts have been watching the Southern Hemisphere winter for hints of what might be in store for us in the North. Reports from Australia have caused mounting concern, with record-high numbers of laboratory-confirmed influenza notifications and outbreaks and higher-than-average numbers of hospitalizations and deaths. ... Influenza A (H3N2) viruses predominated, and the preliminary estimate of vaccine effectiveness against influenza A (H3N2) was only 10%. ... As we prepare for a potentially severe influenza season, we must consider whether our current vaccines can be improved and whether longer-term, transformative vaccine approaches are needed to minimize influenza-related morbidity and mortality. (Catharine I. Paules, Sheena G. Sullivan, Kanta Subbarao and Anthony S. Fauci, 11/29)

Des Moines Register: Mental Illness And Violence: Let’s Change The Conversation
Whenever there is a mass shooting or act of violence, people tend to resort to the same, tired talking points: calls for “thoughts and prayers,” pros and cons of gun control, and, when the perpetrator turns out to have a history of mental illness, the need for improved mental health care. ... Those being treated for their mental illnesses are no more prone to violence than the general population. In addition, most people with severe mental illnesses weren’t violent or criminals prior to becoming ill. I propose a change in the way we discuss this. I propose that we describe things more accurately, by saying that sometimes crimes are committed by a person with an untreated or under-treated severe mental illness. (Leslie Carpenter, 11/30)

The New York Times: Happy Anniversary, Heart Transplant
Fifty years ago this Sunday, the first human heart transplant was performed in Cape Town. It was an epoch-making advance in science — and also, perhaps, in human culture. The heart, heavy as it is with symbolism, has always occupied a special place in our collective imagination. Despite our relatively sophisticated biomedical understanding of its function, many people still think of the heart as the seat of affection and courage. (Sandeep Jauhar, 11/30)