The Associated Press: Health Law's Fines Are Not The Big Stick Everybody Thought
There was one thing that supporters and detractors of former President Barack Obama's health care overhaul agreed on for years: unpopular fines on Americans forgoing coverage were essential for the plan to work because they nudged healthy people to get insured, helping check premiums. Now it turns out that might not be so. (Alonso-Zaldivar, 12/20)

Houston Chronicle: Texas 2019 ACA Enrollment Not Down As Much As Feared 
The number of Texans who enrolled in health plans under the besieged Affordable Care Act was down for the coming year but if numbers hold, not as much as feared. Just under 1.1 million Texans signed up for plans or were automatically re-enrolled through the federal exchange for 2019, according to preliminary figures released by the Centers for Medicare and Medicaid Services. That is a drop of about 40,000, or 3.6 percent, from the close of enrollment for 2018. (Deam, 12/20)

Tampa Bay Times: Why Is Florida Bucking The Trend? Obamacare Signups Are Up, Not Down.
The number of Floridians signing up for health insurance through the Affordable Care Act increased this year despite nationwide declines and repeated efforts in Congress and the courts to undercut the program, according to a final enrollment count this week. With nearly 1.8 million people enrolled for 2019, Florida also topped the 39 states who use the federal exchange. (Griffin, 12/20)

Kansas City Star: Obamacare Enrollment Down Almost 10% In Kansas And Missouri
In the first open enrollment period since Republicans removed the tax penalty for not having insurance, about 4 percent fewer Americans nationwide chose plans on healthcare.gov than the year before. In Kansas and Missouri, enrollment was down almost 10 percent, leaving advocates concerned that more people may be risking going without coverage. (Marso, 12/20)

Georgia Health News: With Late Spurt, Exchange Enrollment Almost Catches Up To Last Year’s Total
Federal health officials announced that the preliminary sign-up number for 2019 coverage was 460,139, about 4 percent lower than the total reached a year ago. The slight year-to-year drop in the state tracked national enrollment trends. (Miller, 12/20)

The Baltimore Sun: Rural Maryland Consumers Snapped Up Cheaper Health Insurance 
While enrollment in health exchange plans in Maryland this year was up about 2 percent, there were places where policies were downright hot sellers. Rural counties reported jumps as high as 28 percent from last year. The reason? A “perfect storm” that made some policies sold under the Affordable Care Act the least expensive in the least populated areas. ...Almost 157,000 people signed up in Maryland by Dec. 15, when open enrollment for next year closed. That compares with 8.5 million on the federal exchange, a drop of 3.4 percent, according to preliminary data, that officials attributed to people gaining workplace insurance or Medicaid coverage. (Cohn, 12/21)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ More On That Texas Lawsuit, And The Best And Worst Health Policy Stories Of The Year
Reaction is still coming in about last week’s federal court ruling that declared the Affordable Care Act unconstitutional. And nearly final numbers for insurance sign-ups at healthcare.gov were surprisingly brisk despite the elimination of the health law’s tax penalty for not having insurance and a dramatically shrunken budget for outreach and enrollment assistance. (12/20)

Arizona Republic: Arizona Attorney General Mark Brnovich Cheers Ruling On 'Obamacare'
Arizona Attorney General Mark Brnovich, a plaintiff in the case, is applauding a Texas court judgment invalidating the Affordable Care Act, saying it should be up to Congress to make better health-care policy. The decision from Texas federal court Judge Reed O'Connor in the Texas v. Azar case does not automatically kill the law. The Affordable Care Act, unofficially known as "Obamacare," remains the law of the land. (Innes, 12/20)

The Hill: California Asks Federal Judge To Block Trump Contraception Rule 
California Attorney General Xavier Becerra (D) asked a federal judge on Thursday to block Trump administration rules that would allow more exemptions to ObamaCare's contraception mandate. The final rules, slated to take effect Jan. 14, would allow most businesses to opt out of covering contraception for their employees if they have moral or religious objections. (Hellmann, 12/20)

Kaiser Health News: Short-Term Health Insurance Plans Highly Profitable For Insurers And Brokers
Sure, they’re less expensive for consumers, but short-term health policies have another side: They’re highly profitable for insurers and offer hefty sales commissions. Driven by rising premiums for Affordable Care Act plans, interest in short-term insurance is growing, boosted by Trump administration actions to ease Obama-era restrictions and possibly make federal subsidies available to consumers to purchase them. (Appleby, 12/21)

ProPublica: In Immigrant Children’s Shelters, Sexual Assault Cases Are Open And Shut
Over the past six months, ProPublica has gathered hundreds of police reports detailing allegations of sexual assaults in immigrant children’s shelters, which have received $4.5 billion for housing and other services since the surge of unaccompanied minors from Central America in 2014. The reports, obtained through public records requests, revealed a largely hidden side of the shelters — one in which both staff and other residents sometimes acted as predators. (Grabell, Sanders and Pensel, 12/21)

The New York Times: Justice Department Investigating Migrant Shelter Provider
The Justice Department is investigating possible misuse of federal money by Southwest Key Programs, the nation’s largest operator of shelters for migrant children, according to two people familiar with the matter. The inquiry could upend shelter care for thousands of children, escalating government scrutiny of the nonprofit even as it remains central to the Trump administration’s immigration agenda. The charity operates 24 shelters to house children who were separated from their parents at the border or arrived on their own. (Ruiz, Kulish and Barker, 12/20)

The Wall Street Journal: Democrats Question Homeland Chief Nielsen Over Girl’s Death At Border
Homeland Security Secretary Kirstjen Nielsen’s testimony before the House Judiciary Committee on Thursday offered 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. Ahead of the hearing, Ms. Nielsen said the U.S. plans to start returning migrants who enter the country illegally to Mexico until their immigration proceedings are complete. (Jamerson, 12/20)

The Wall Street Journal: ICE Drafts Guidelines With Fewer Restrictions On Restraining Pregnant Women
The U.S. is weighing looser standards for some immigration detention centers, including scrapping certain guidelines governing the restraint of pregnant women and ensuring children can visit detained parents. U.S. Immigration and Customs Enforcement has drafted new standards that don’t include a host of current requirements, according to people who have read them. ICE told Congress last year that it planned to issue new standards for scores of detention facilities, such as county jails, that hold both immigrants awaiting deportation and criminal prisoners for more than a week. (Vogt, 12/20)

The Associated Press: Stem Cell Shots Linked To Bacterial Infection Outbreak
Health officials on Thursday reported an outbreak of bacterial infections in people who got injections of stems cells derived from umbilical cord blood. At least 12 patients in three states — Florida, Texas and Arizona — became infected after getting injections for problems like joint and back pain, the Centers for Disease Control and Prevention said. All 12 were hospitalized, three of them for a month or longer. None died. (Stobbe, 12/20)

The New York Times: 12 People Hospitalized With Infections From Stem Cell Shots
The F.D.A. said on Thursday that it had also written to 20 clinics that offer unapproved stem cell treatments, warning them that such products are generally regulated by the agency and encouraging the clinics to contact federal regulators before November 2020, when enforcement will tighten. The names of the clinics have not been released. “We’re going to be going in and inspecting more stem cell operators this year,” Dr. Scott Gottlieb, the agency’s commissioner, said in an email. “We’re focused on outfits that may be engaging in unsafe practices and haven’t been working with F.D.A. to come into compliance with the laws they’re subject to. Unfortunately, there are too many firms that fit this description.” (Grady, 12/20)

The Washington Post: FDA Warns Stem-Cell Company Linked To E. Coli Infections
A year ago, the agency issued a “regulatory framework” spelling out the rules on stem-cell products and procedures. And it said it would exercise “enforcement discretion,” giving companies until November 2020 to comply — as long as they don’t pose safety risks to patients. The for-profit, direct-to-consumer stem-cell industry started in other countries but has grown rapidly in the United States. Today, several hundred clinics sell therapies to treat conditions as varied as arthritis, Parkinson’s disease and multiple sclerosis. Some sell stem cells derived from the patients' own blood, fat or bone marrow, while others use stem-cell products manufactured by outside suppliers. (McGinley, 12/20)

CNN: Infections Put 12 People In Hospitals After They Received Unapproved Stem Cell Products
"We see a lot of promise from stem cell treatments, but we also have a lot of concern, and we started by sending these 20 letters singling out these firms that should be engaging with FDA but haven't been," FDA Commissioner Dr. Scott Gottlieb said. "In addition, we are also stepping up our inspections this year. We are concerned that there are firms whose actions could be putting patients at risk and might be subject to additional action." (Christensen, 12/20)

In other FDA news —

CNN: Certain Antibiotics May Cause Aortic Aneurysm, FDA Warns
The US Food and Drug Administration warned on Thursday that the benefits of fluoroquinolone antibiotics do not outweigh the risks -- which include aortic aneurysm -- for certain patients, according to the latest research. The research is based on reports of patient problems and on studies published between 2015 and 2018. (Christensen, 12/20)

Reuters: Cigna Closes $54 Billion Purchase Of Express Scripts
Cigna Corp on Thursday closed its $54-billion (42.65 billion pounds) deal to buy Express Scripts Holding Co, creating one of the biggest providers of pharmacy benefits and insurance plans in the United States, a combination it says will help it improve healthcare coordination and cut costs. Cigna's deal puts it in direct competition with two other healthcare companies set up the same way - Aetna with CVS Health Corp and UnitedHealth Group Inc with Optum. Cigna's deal has already passed antitrust scrutiny. (Humer, 12/20)

The Wall Street Journal: Cigna And Express Scripts Seal $54 Billion Merger
The Cigna deal, which won an antitrust nod from the Justice Department without requiring divestitures, brings together a health insurer with a strong focus on employers with a major pharmacy-benefit manager. In an interview, Cigna Chief Executive David Cordani said an initial focus of the combined company will be on ensuring continued smooth business-as-usual operations, but it will begin rolling out new initiatives next year that seek to take advantage of the tie-up between medical and pharmacy oversight, including efforts focused on specialty pharmaceuticals and mental health. (Wilde Mathews, 12/20)

Modern Healthcare: Cigna And Express Scripts Close On $67 Billion Merger
"Today's closing represents a major milestone in Cigna's drive to transform our healthcare system for our customers, clients, partners and communities," Cigna CEO David Cordani said in the announcement. "Together, we are establishing a blueprint for personalized, whole-person healthcare, further enhancing our ability to put the customer at the center of all we do by creating a flexible, open and connected model that improves affordability, choice and predictability." (Livingston, 12/20)

In other health industry news —

The Associated Press: Insurance Giants Bankroll Group That Pushes Private Medicare
A group gaining influence in Washington as a champion for Medicare beneficiaries is bankrolled by major health insurance companies that are trying to cash in on private coverage offered through the federal health insurance program. The Better Medicare Alliance's multi-million dollar budget is supplied by UnitedHealthcare, Aetna and Humana. The three insurance giants account for close to 50 percent of all enrollees in private Medicare Advantage plans and stand to benefit as that part of Medicare keeps growing. (Alonso-Zaldivar and Lardner, 12/21)

Nerdwallet: Medical Bills Plague Millennials; These Tips May Be The Cure
Chrystal McKay knew enough about medical care costs that she skipped the ambulance ride after a car accident. A friend drove her to the emergency room. That saved her one bill, but she faces another for more than $20,000 after her ER visit. The 29-year-old Stockton, California, woman must balance paying her debt with getting care for a sprained shoulder that may need surgery: "I have to weigh the pros and cons. I'm already $20,000 in debt, and any more treatment will just put me more in debt." (Pyles, 12/20)

And a look back at KHN and NPR's series that put faces to those astronomical health care bills —

Kaiser Health News: Year One Of KHN’s ‘Bill Of The Month’: A Kaleidoscope Of Financial Challenges
In 2018, KHN and NPR launched “Bill of the Month,” a crowdsourced investigation in which we dissect, investigate and explain medical bills you send us. In telling the story behind one patient’s bill each month, our goal is to understand the genesis of the often exorbitant and baffling charges that pervade the American medical system. But also, we aim to offer ideas for patients and policymakers about how they might redress common patient situations that are frustrating and downright unaffordable. So far, we’ve examined bills for conditions as minor as toenail fungus (a $1,500-per-month topical medicine) and as major as a “widow-maker” heart attack ($109,000 after insurance). We’ve looked at bills for simple exams ($18,000 for a urine test) and ambulance rides ($57,000 for an air ambulance). Many of the bills miraculously get resolved once our reports come out. (12/21)

The New York Times: Climate Team, And Its Boss, Just Got Harder To Find At Top Health Agency
The Centers for Disease Control and Prevention has quietly folded its Climate and Health Program into a branch that studies asthma and expunged the word climate from the name of the newly consolidated office, the agency confirmed on Thursday. An agency spokeswoman, Kathryn Harben, said in a statement that the move was part of a broader reorganization within the agency’s environmental health division that pared eight programs down to four. (Friedman and Kaplan, 12/20)

In other news from the Trump administration —

The Associated Press: Report: US Fails In Funding Obligation To Native Americans
A new report by the U.S. Commission on Civil Rights finds that funding levels for Native American tribes are woefully inadequate despite the federal government's responsibility to provide for education, public safety, health care and other services under treaties, laws and other acts. The report made public Thursday is a follow-up to a 2003 report that described the shortfalls as a quiet crisis. Funding has remained mostly flat since then, leaving tribes unable to tackle an epidemic of suicide, high dropout rates, violence against women and climate change, for example, the report said. (Fonseca, 12/20)

The Washington Post: Lawmaker Demands Reform Of Transplant Network After Washington Post Stories
Sen. Todd C. Young (R-Ind.) said Thursday he would introduce legislation next year calling for greater oversight of the U.S. transplant network, contending 10,000 people die annually in a system that is allowed to hide its flaws from the public and Congress. His announcement followed stories published Thursday in The Washington Post that said the transplant industry could more than double the number of organs available for transplant each year if it expanded efforts to collect and use organs from older and nontraditional donors, such as people with hepatitis C. (Bernstein and Kindy, 12/20)

Modern Healthcare: Congress Eyes Intervention In U.S. Organ Sharing Policy 
The board of the United Network for Organ Sharing, or UNOS, which is charged with overseeing organ allocation policy, made the change. UNOS works on behalf of the Organ Procurement and Transplantation Network, or the OPTN. The OPTN is a not-for-profit organization that contracts with the federal Health Resources and Services Administration to manage the complicated, sprawling system. Representatives of all those with a stake in the policy make up the UNOS board—from transplant surgeons to transplant recipients and organ donors and organ procurement organizations. But because the policy debate pits regions against one another, UNOS members have remained gridlocked over any substantial modifications to the current system that left some regions with a steady shortfall. (Luthi, 12/20)

The Washington Post: Organ Transplant Shortage Could Be Fixed By Expanding Donor Pool
After a week of tests, the doctors came to Angela Sroufe with tragic news: Her 30-year-old daughter, Amie Woodward, was brain-dead from a heroin overdose. Reluctantly, Sroufe agreed to donate her daughter’s organs. As Woodward’s ventilator continued to click, her heart monitor continued to beep and her blood continued to circulate, keeping her organs viable, Sroufe sat combing her daughter’s hair, waiting for the transplant surgeon. (Kindy, Bernstein and Keating, 12/20)

Elsewhere on Capitol Hill —

Stat: Lawmakers Push To Renew Pandemic Preparedness Bill 
The House passed a long-stalled public health bill Thursday, sending it to the Senate in a last-ditch attempt to get the law passed before the end of the year. The bill is actually a combination of two different pieces of legislation: one that helps the government respond to public health emergencies, and another that changes the way the Food and Drug Administration regulates over-the-counter drugs. (Swetlitz, 12/20)

CQ: House Passes Health Bills Held Up By Senate GOP Pair
The House on Thursday passed, 367-9, a measure combining two bipartisan health bills that stalled in the Senate, in an optimistic effort to finish work on the legislation before departing for the year. The new bill (HR 7328) packages two measures the House previously passed this year: one to renew billions of dollars in programs related to preparing for large-scale health emergencies (HR 6378) and another to overhaul how the Food and Drug Administration regulates over-the-counter medicines (HR 5333). (Siddons, 12/20)

The New York Times: Planned Parenthood Is Accused Of Mistreating Pregnant Employees
As a medical assistant at Planned Parenthood, Ta’Lisa Hairston urged pregnant women to take rest breaks at work, stay hydrated and, please, eat regular meals. Then she got pregnant and couldn’t follow her own advice. Last winter, Ms. Hairston told the human-resources department for Planned Parenthood’s clinic in White Plains, N.Y., that her high blood pressure was threatening her pregnancy. She sent the department multiple notes from her nurse recommending that she take frequent breaks. (Kitroeff and Silver-Greenberg, 12/20)

The Hill: Planned Parenthood Employees Accuse Organization Of Mistreating Pregnant Workers
Some women who worked at the reproductive health nonprofit told the Times that they were denied breaks while they were pregnant or saw managers declining to hire women who were pregnant, both in violation of labor laws. “I believe we must do better than we are now,” Leana Wen, the president of the Planned Parenthood Federation of America, said in a statement released to The Hill. “It’s our obligation to do better, for our staff, for their families and for our patients.” (Birnbaum, 12/20)

Bloomberg: Opioid-Industry Claims Proceed As Judge Cites `Man-Made Plague'
Calling the U.S. opioid epidemic a “man-made plague,’’ the judge overseeing local governments’ lawsuits targeting makers and distributors of the painkillers cleared test cases to move forward. U.S. District Judge Dan Polster concluded Wednesday it “would not be appropriate’’ to throw out racketeering, conspiracy and public nuisance claims against drugmakers including Purdue Pharma LP and Johnson & Johnson, and distributors McKesson Corp. and Cardinal Health Inc. “at this early stage’’ of the litigation. (Feeley, 12/20)

In other news on the opioid crisis —

Stat: NY Law Forcing Opioid Makers To Pay Surcharges Ruled Unconstitutional
In a setback to states fighting the opioid epidemic, a federal judge ruled a New York state law that would have required opioid makers and distributors to fund a first-in-the-nation program for covering costs for treatment, prevention, and recovery is unconstitutional. Under the Opioid Stewardship Act, which was enacted last July, opioid makers and wholesalers were expected to pay an estimated $600 million in surcharges over the next six years. The law marked the first time a state government sought to tax these companies as a way to fight the opioid crisis. (Silverman, 12/20)

The CT Mirror: Jepsen Sues Purdue, Saying It Reaped Profits By Boosting Opioid Addiction
Connecticut became the latest state on Thursday to sue Stamford-based Purdue Pharma, saying the company purposefully downplayed the risks of addiction of OxyContin and other opioid painkillers. The suit filed by Connecticut Attorney General George Jepsen in Superior Court in Hartford alleges Purdue “peddled a series of falsehoods” to push patients toward its opioids, reaping massive profits from sales while opioid addiction skyrocketed to the crisis level that is currently impacting Connecticut and states across the country. (Radelat, 12/20)

The Washington Post: CRISPR Babies Spur NIH Director To Call For Public Debate, New Oversight
Last month’s news that Chinese scientist He Jiankui had gone rogue and conducted an (as-yet-unverified) experiment to modify the genes of two twin girls to make them resistant to HIV has left the scientific world scrambling to discourage creation of other genetically edited babies. The World Health Organization’s director general, Tedros Adhanom Ghebreyesus, acknowledged that we had jumped into “uncharted waters” and announced the formation of an expert panel to set guidelines and standards. The Chinese government has condemned He’s work and vowed serious consequences to discourage others from pursuing similar lines of research, but it has not offered any specifics. (Cha, 12/20)

Los Angeles Times: Voters Have High Tolerance For Politicians Who Lie, Even Those Caught Doing It
In a modern democracy, peddling conspiracies for political advantage is perhaps not so different from seeding an epidemic. If a virus is to gain a foothold with the electorate, it will need a population of likely believers (“susceptibles” in public-health speak), a germ nimble enough to infect new hosts easily (an irresistible tall tale), and an eager “Amen choir” (also known as “super-spreaders”). Unleashed on the body politic, a falsehood may spread across the social networks that supply us with information. Facebook is a doorknob slathered in germs, Twitter a sneezing coworker, and Instagram a child returning home after a day at school, ensuring the exposure of all. (Healy, 12/20)

Stat: After Sarepta, Going After The Genetic Causes Of Epilepsies At Stoke
When Dr. Ed Kaye was the CEO of Sarepta Therapeutics, he steered the company through a controversial approval process for its drug to treat Duchenne muscular dystrophy. ...Now he runs Stoke Therapeutics, a startup working on medicines for severe genetic diseases. Its goal is to develop drugs that target RNA splicing — the editing of RNA “messages” copied from our genes — so that more proteins are made in diseases where they are missing or diminished. Kaye talked with STAT recently about both Stoke and lessons learned from Sarepta. (Garde, Robbins and Feuerstein, 12/21)

The Washington Post: 452 Children Died On The Job In The U.S. From 2003 To 2016
Child labor exists in the United States in the 21st century. It's legal and widespread, and it’s also, in some cases, dangerous. Children were killed on the job in construction, retail, transportation and even manufacturing and logging. But most of them, 52%, died working in agriculture. (Van Dam, 12/20)

Kaiser Health News: ‘Don’t Wash That Bird!’ And Other (Often Unheeded) Food Safety Advice 
Rinsing chicken or turkey before cooking it is an ingrained step for many home cooks — passed down through generations and reinforced by cookbooks. Recipes like the “Perfect Roast Chicken” in 1999’s “The Barefoot Contessa Cookbook” advise cooks to “Rinse the chicken inside and out.” But that doesn’t reflect the science. To wash or not to wash? That’s a question home cooks ask experts at the USDA Meat and Poultry hotline a lot around the holidays. (Zuraw, 12/21)

NPR: Specialized Cells In Eye Linked To Mood Regions In Brain
Just in time for the winter solstice, scientists may have figured out how short days can lead to dark moods. Two recent studies suggest the culprit is a brain circuit that connects special light-sensing cells in the retina with brain areas that affect whether you are happy or sad. When these cells detect shorter days, they appear to use this pathway to send signals to the brain that can make a person feel glum or even depressed. (Hamilton, 12/21)

CNN: What Your Nightmares Could Reveal About Your Health
What's your most frequent nightmare? Is it dreaming that you're dying, or that one of your loved ones is suffering but you can't do anything about it? Or maybe you're waking up with confusion and a racing heart, simply glad that the dream ended. Nightmares are classified as dream sequences that seem realistic and often awaken the person. They are a complex experience. Though fear is the dominant emotion felt during nightmares, a 2014 study reported that sadness, anger, confusion, disgust, frustration or guilt were also common. (Avramova, 12/20)

The Wall Street Journal: Food Companies Get Until 2022 To Label GMOs
U.S. food companies must label products containing genetically engineered ingredients by 2022, federal regulators said, a victory for manufacturers who pushed for more time before disclosing use of the controversial crops. The new rules for labeling “bioengineered foods” also allow companies to skip labeling some ingredients, including refined sugars and corn syrups that often are made from genetically modified crops. That decision, outlined Thursday by the U.S. Department of Agriculture, is a win for food makers that argued traces of genetic material from modified crops in those ingredients are eliminated during processing. (Bunge, 12/20)

The Washington Post: Deadly Marburg Virus Found In Bats In Sierra Leone
Scientists have discovered the deadly Marburg virus in fruit bats in Sierra Leone, the first time this cousin of Ebola has been found in West Africa. There have been no reported cases of people or animals with active infections. But the pathogen’s presence in the bats raises the potential for it to infect humans in a new region more than a thousand miles from previously known outbreaks. There have been a dozen known Marburg virus outbreaks in other parts of Africa, most recently in Uganda in 2017. Like Ebola, Marburg virus initially infects people through contact with wild animals. It can then spread person to person through contact with bodily fluids. It kills up to 9 in 10 of its victims, sometimes within a week. (Sun, 12/20)

California Healthline: No-Go On Drunken Driving: States Deploy Breathalyzers In Cars To Limit Road Deaths
’Tis the season to be a little too merry, and law enforcement officials across the country are once again reminding revelers not to drive if they’ve been drinking. Along with those warnings comes a bit of good news: Deaths involving drunken driving are only about half of what they were in the early 1980s, though they have ticked back up in recent years. The long-term decline is largely attributable to greater public awareness, stricter seat belt enforcement and the establishment in 2000 of a national blood-alcohol threshold of 0.08 percent — far below the 0.15 percent standard commonly used before then. (Ibarra, 12/21)

Chicago Tribune: Tummy Tuck For The Holidays? Many Try To Squeeze In Elective Surgeries At Year's End
Each year, elective surgeries spike around the holidays in Chicago and across the nation. Many patients wait to schedule surgeries until after they’ve hit their health insurance deductibles toward the end of the year so they don’t have to pay as much out of pocket for procedures. It’s a trend that shows no signs of slowing, especially as an increasing number of people enroll in high-deductible insurance plans. Last year, more than 43 percent of adults ages 18 to 64 who get health insurance through their employers were enrolled in plans with deductibles of at least $1,300 per individual or $2,600 per family, according to the Centers for Disease Control and Prevention. That was up from about 15 percent of adults enrolled in similar plans in 2007. (Schencker, 12/20)

Reuters: As Ebola Threatens Mega-Cities, Vaccine Stockpile Needs Grow
Doubts are growing about whether the world’s emergency stockpile of 300,000 Ebola vaccine doses is enough to control future epidemics as the deadly disease moves out of rural forest areas and into urban mega-cities. Outbreak response experts at the World Health Organization (WHO) and at the vaccines alliance GAVI are already talking to the leading Ebola vaccine manufacturer, Merck, to reassess just how much larger global stocks need to be. (12/20)

MPR: Young Adults Have A Hard Time Controlling Their Diabetes
It's a struggle to live with Type 1 and Type 2 diabetes, and according to a recent study by the Minnesota Department of Health, young adults in Minnesota may struggle the most when it comes to keeping their blood sugar at healthy levels. Their lives are sometimes transient, their access to health care is limited, and their income is inconsistent. (Davis and Lillie, 12/20)

MPR: African-Americans Struggle To Find Kidney Donors
According to the National Kidney Association, they're more likely to have high blood pressure and diabetes, both diseases that can lead to kidney failure. But on top of that, they're also less likely to be able to find a viable match for a kidney donation. (David and Lillie, 12/20)

CNN: The Most -- And Least -- Healthy States In America
As the new year approaches, many people focus on improving their health -- but how does where you live rank when it comes to health? Hawaii now ranks as the healthiest state in America, beating out Massachusetts to return to the top spot in a new report by the United Health Foundation, a nonprofit division of UnitedHealth Group, which also owns the insurance company United Healthcare and Optum. (Howard, 12/20)

The Associated Press: State Audit Slams San Diego Response To Hepatitis A Outbreak
The city and county of San Diego failed to quickly recognize and control a Hepatitis A outbreak that grew into one of the largest in recent history, killing 20 and sending nearly 400 to hospitals, according to a state audit released Thursday. The county lacked a concrete hepatitis A prevention plan that led to a delay in getting the most vulnerable residents vaccinated, and mass vaccinations did not happen until after a health emergency had been declared, according to the audit conducted by the state auditor at the request of lawmakers. (Watson, 12/20)

The Star Tribune: Minnesota Lawmakers, Families Of Abuse Victims Renew Push For Elder Care Reform
Just weeks before the Legislature convenes, lawmakers and consumer groups are already gearing up for a major push to reform state laws aimed at protecting seniors from abuse and neglect. On Thursday, Sen. Karin Housley, the chairwoman of the Senate Family Care and Aging Committee, renewed her call for strengthening protections for the roughly 85,000 Minnesotans who live in senior care facilities across the state. (Serres, 12/20)

Los Angeles Times: Here’s How California Can Use Fire To Solve Its Wildfire Problem
If California wants to get out in front of its wildfire problem, scientists have some clear but counterintuitive advice: Start more forest fires. Decades of research shows that lighting fires under safe conditions not only clears out the dead plants and thick underbrush that fuel many severe wildfires, it also restores a natural process that once kept forests healthy and resilient. (Rosen, 12/20)

Houston Chronicle: UT Health Science Center Shows Off New High-Tech Teaching Facility 
The University of Texas Health Science Center at Houston unveiled its new School of Biomedical Informatics building Wednesday. The high-tech space is designed to foster technology, innovation and collaboration in biomedical science research and health care delivery. The $15 million building, described by school officials as reminiscent of Google's headquarters, will open its doors next month to some 50 full-time faculty, 58 adjunct faculty and 300 graduate students, more than triple the amount five years ago. (Ackerman, 12/20)

Concord (N.H.) Monitor: Upcoming Health Care Shift For N.H. State Retirees, Explained
On Jan. 1, nearly 10,000 state retirees face a transition: a mandatory change from their present state-funded health care plan to a new one. For Kathleen Zaso, it’s been a process easier said than done. In September, the Concord retiree began working to schedule a surgery under her present plan, Medicomp, available to retirees through the end of December. But with the coming Jan. 1 transfer to the “Medicare Advantage” plan, Zaso wanted to make sure the same hospitals and providers would be continuously covered in the new year. (DeWitt, 12/20)

San Francisco Chronicle: SF Officials Want Health Officer’s Role In Shipyard Home Sales Investigated
San Francisco officials have called for investigations of a city health department employee who helped a powerful developer sell homes on land reclaimed from a toxic Superfund site. Four current or incoming members of the Board of Supervisors said this week they want to know if Amy Brownell, an environmental engineer, should have been directly involved in individual home sales at the former Hunters Point Naval Shipyard — the city’s biggest redevelopment project in a century. (Fagone and Dizikes, 12/21)

Dallas Morning News: DeSoto Psych Hospital To Lose Federal Funds After Inspectors Report Underage Sex, Safety Lapses
Federal officials say a DeSoto psychiatric hospital will lose Medicare funding in two weeks for putting its patients in "immediate jeopardy" of harm. That federal designation for Dallas Behavioral Healthcare Hospital — based on a pair inspections this year citing lapses in patient care and safety — is rare. The resulting loss of funding threatens to further strain a North Texas mental health care system that is still reeling from the February closure of Timberlawn psychiatric hospital. (Chiquillo, 12/20)

Cleveland Plain Dealer: Civil-Rights Lawsuit Against Cuyahoga County Over ‘Deplorable’ Jail Conditions Seeks Independent Monitor To Oversee Reforms
Seven inmates of the Cuyahoga County Jail filed a lawsuit against the county and a host of county and jail officials on Thursday, weeks after the release of a federal report detailing “inhumane” and potentially unconstitutional conditions at the jail. The lawsuit, filed in the U.S. District Court Northern District of Ohio, seeks an independent monitor to oversee changes at the jail, and calls for an immediate fix to the crowding of inmates and understaffing of corrections officers. (Astolfi, 12/20)

Sacramento Bee: Kaiser: Health Giant ‘Quietly’ Settled 2014 Class-Action, Union Says
Kaiser Foundation Health Plan recently settled a 2014 class-action lawsuit stemming from two allegations that it dumped patients with severe mental illness. Plaintiffs Douglas Kerr and Barbara Knighton alleged that in separate incidents, Kaiser psychiatrists told them their sons needed to be transferred to locked residential facilities called IMDs (institutions for mental disease) for treatment, according to court documents. (McGough, 12/20)

Stat: New Details Emerge About A Stealth Startup Backed By Flagship Pioneering
A stealth-mode startup backed by one of Boston’s biggest venture capital firms, Flagship Pioneering, is planning to graduate from shared lab space to a much larger leased lab in Kendall Square, and is expecting to more than triple its staff by 2020, according to new details made public for the first time Thursday. The company — still referred to by its stealth-mode moniker “VL49” — is one of several new startups trying to leverage three buzzy technologies: artificial intelligence, CRISPR, and single-celled sequencing. (Sheridan, 12/21)

KCUR: With Teen Suicide On The Rise In Kansas City, Adults Ask Young People What They Need 
[Bella Price] among a group of students from Johnson County, Kansas, who are helping shape new suicide prevention programs aimed at addressing a spike in teen suicides in the county. The trend is even higher across the state line in Jackson County, Missouri. Both mirror what’s happening across the country. Suicides among young people have increased by 56 percent between 1999 and 2017. Families, friends, school and health officials are all trying to make sense of the rise. (Ziegler, 12/20)

Boston Globe: Cambridge Biotech Relay Therapeutics Raises $400M In Venture Capital Funding
Cambridge-based Relay Therapeutics said Thursday that it has raised $400 million in venture capital — one of the largest hauls this year by a privately held Massachusetts biotech — to advance its drug development programs. The company, which was founded in 2016 by Boston-based Third Rock Ventures, has now raised $520 million in capital. (Saltzman, 12/20)

Denver Post: Denver Health In Home Services' License Revoked Due To "Neglect And Abandonment"
The Centers for Medicare and Medicaid Services’ decision to pull funding from Health in Home Services Inc. came after state regulators revoked the Denver agency’s license, according to a federal report. It was revealed Wednesday that the federal agency would stop paying for care provided by Health in Home to Medicare and Medicaid patients after Friday. Health in Home’s license was revoked on Nov. 29, requiring the agency to cease operations immediately, said Randy Kuykendall, director of the health facilities division with the Colorado Department of Public Health and Environment. (Seaman, 12/20)

WBUR: 'Kids Are Brutally Honest': Program Lets Students Taste Test Healthy, Chef-Made Lunches
[Sam] Icklan is the director of a program known as Chefs in Schools. Chefs in the program temporarily join cafeteria staff in Massachusetts, like the folks at Parthum Elementary, and help them develop healthy recipes kids actually like. Because the school is trying to keep the salt content down, Icklan adds flavor to these tacos with pickled onions and douse the vegetable slaw with some lime juice and cilantro. (Jung, 12/21)

Milwaukee Journal Sentinel: Firm Recommended For Inmate Medical Services Had Problems Elsewhere
A Miami-based company hired under a 2013 court order to correct glaring shortcomings with jail inmate medical services provided by Milwaukee County workers will be ousted because of its own problem-packed record when an extended contract ends March 31. But the company tagged as the possible successor faces nearly identical complaints at several jails around the country. (Behm, 12/20)

Des Moines Register: Fired Iowa Clinic Doctors Prevented From Seeing Des Moines-Area Patients
Hundreds of central Iowa urology patients, including some who had just undergone cancer surgery, have been prevented from seeing their chosen physicians since the doctors were fired by the Iowa Clinic in September, the doctors say in a lawsuit. ...The Iowa Clinic is a large medical practice that includes many of central Iowa’s medical specialists. Five of the practice’s remaining seven urologists submitted their resignations amid the dispute, but are continuing to work. (Leys, 12/20)

Texas Tribune: Death In The Oilfields: Fossil Fuel Boom Brings Mounting Risks
From 2008 through 2017, 1,566 workers died from injuries in the oil-and-gas drilling industry and related fields, according to data from the U.S. Department of Labor’s Bureau of Labor Statistics. That’s almost exactly the number of U.S. troops who were killed in Afghanistan during the same period. (Morris, 12/21)

Health News Florida: High-Stakes Marijuana Ruling Placed On Hold
In a closely watched case, an appeals court this week agreed to put on hold a circuit judge’s ruling that said Florida lawmakers and the state Department of Health have violated a 2016 constitutional amendment that broadly legalized medical marijuana. The 1st District Court of Appeal approved a stay of the ruling but also said consideration of the underlying issues in the case would be “expedited.” (Saunders, 12/20)

Commonwealth Fund: What Is Status Of Women’s Health? U.S. Vs. 10 Other Countries
Women in the United States have long lagged behind their counterparts in other high-income countries in terms of access to health care and health status. This brief compares U.S. women’s health status, affordability of health plans, and ability to access and utilize care with women in 10 other high-income countries by using international data. (Gunja et al, 12/19)

The Henry J. Kaiser Family Foundation: A Look At November State Data For Medicaid Work Requirements In Arkansas
Arkansas is one of five states for which CMS has approved a Section 1115 waiver to condition Medicaid eligibility on meeting work and reporting requirements and the first state to implement this type of waiver. CMS approved Arkansas’ waiver on March 5, 2018, and the new requirements took effect for the initial group of beneficiaries on June 1, 2018. (Rudowitz, Musumeci and Hall, 12/18)

Urban Institute: Tribal Home Visiting: Cultural Traditions Offer Protective Force
At 36, Desirae Sylvia is making plans for a new chapter in her life. She and her toddler daughter, LaRose Leigh, live in Desirae’s childhood home on Wyoming’s Wind River Indian Reservation, land of the Northern Arapaho and Eastern Shoshone Native American tribes. It’s a world away from the Colorado prison where LaRose Leigh was born just 18 months earlier. (Gaynair and Friedman, 12/13)

Pediatrics: Intellectual Disability In Children Conceived Using Assisted Reproductive Technology
To examine whether children conceived using assisted reproductive technology (ART) have a higher risk of intellectual disability (ID) compared with non–ART-conceived children and describe known causes of ID in these groups. ... Children conceived using ART had a small increased risk of ID (risk ratio 1.58; 95% confidence interval 1.19–2.11) even when analyses were restricted to singleton births (risk ratio 1.56; 95% confidence interval 1.10–2.21). (Hansen et al, 12/1)

Health Affairs: How Telehealth Stopped A Contagious Outbreak At A School
A school-based telehealth program helps identify a disease outbreak before it gets out of hand. (Zettler-Greeley, 12/1)

JAMA Neurology: Associations Between Migraine And Type 2 Diabetes In Women: Findings From The E3N Cohort Study.
In this study of 74 247 women in a French national cohort, a lower risk of type 2 diabetes was observed in women with active migraine. We also found a linear decrease of migraine prevalence long before and a plateau long after type 2 diabetes diagnosis. (Fagherazzi et al, 12/17)

Los Angeles Times: Obamacare May Have Popular Features, But It's Not Constitutional 
The finesse built into Obamacare in 2010 allowed Congress to avoid some difficult issues, but it relied on an unconstitutional step. Now our elected representatives will finally have to answer the two questions they dodged in passing the Affordable Care Act: How much health insurance do we want, and how much are we willing to pay for it in taxes? (Tom Campbell, 12/21)

Boston Globe: Democrats Can Fix The Affordable Care Act 
It is time to put a real fix on the table, recognizing that this probably cannot become law until Democrats regain control of the Senate and White House. Simply proposing Medicare-for-all may galvanize the Democratic base, but it might not even pass the House and could well cost Democrats dearly in the 2020 election. But Medicare is popular, and the ACA can be improved by borrowing from it. (Jon Kingsdale, 12/20)

Washington Examiner: Conservatives, Don't Rely On Judges To Fix Healthcare
Conservatives giddy with a recent federal court ruling deeming the Affordable Care Act unconstitutional ought to hold their horses. Yes, the ACA needs to go. But Republican legislators aren't getting away with the eight-year lie that they would repeal and replace the crumbling healthcare law so easily. Republicans hoping that a bit of judicial activism will save them from actually having to do their jobs and rewrite the law are in a fever dream. (Tiana Lowe, 12/17)

Houston Chronicle: The Latest ACA Ruling Is Far From The Rule Of Law
Late Friday night, a district court in Texas declared the entire Affordable Care Act unconstitutional — lock, stock and barrel. That includes not only the individual mandate and the protections for people with pre-existing conditions, but also the entire Medicaid expansion as well as a host of other ACA rules without any connection at all to health insurance. The logic of the ruling is as difficult to follow as it is to defend, and it sets the stage for yet another round of high-stakes constitutional litigation over the future of health care in the United States. (Nicholas Bagley, 12/18)

San Francisco Chronicle: Attempts To Undermine Obamacare Escalate Americans’ Anxiety
For a decade, they decried the intolerable “uncertainty” that Obama-era policies created for businesses. How could entrepreneurs decide how much to invest, and where, and under what terms, they asked, if the rules of the road were in flux? Yet Republicans’ relentless attempts to undermine the ACA — through repeal, arbitrary regulatory changes and delays, funding cuts, elimination of low-income subsidies, a never-ending parade of lawsuits — only escalate this anxiety-inducing uncertainty. (Catherine Rampell, 12/19)

Detroit News: Fix Obamacare In Congress, Not Courts
Conservatives have a plan in their back pocket: the Health Care Choice Proposal. Developed by a coalition of policy experts called the Health Policy Consensus Group, the proposal would allow states to innovate and reverse some of Obamacare's damage."We need to be empowering states to have the health care they need," says Marie Fishpaw, director of domestic policy studies at the Heritage Foundation. The proposal would not cut the trillion dollars in funding that the federal government spends each year on the Affordable Care Act. It would just dispense the money through grants to the states with two rules: States must use the money to make sure those with pre-existing conditions get coverage and to ensure families can get health care subsidies. (12/20)

The Hill: It's Time To Rethink Our National Drug Policy
In America’s ongoing war on drugs, the methamphetamine crisis of the 1990s and 2000s fell from the national consciousness when the opioid epidemic first arrived. Yet, like most drug crises that cycle in and out of public view, abuse of methamphetamines — more commonly known as crystal meth — receded but never went away. Now meth use is resurgent again. (Mitch Rosenthal, 12/20)

Stat: 'Passive' Fentanyl Exposure: More Myth Than Reality 
Reports of fentanyl-related passive toxicity has led to the release of hyperbolic warnings and burdensome recommendations by Drug Enforcement Administration, including the use of extensive personal protective equipment, such as gloves, paper coveralls, eye protection, and even particulate respirators. We believe that such responses to passive casualties from fentanyl are excessive and may actually interfere with the ability of first responders and others to do their jobs. (Lewis S. Nelson and Jeanmarie Perrone, 12/21)

JAMA: Increasing Evidence For The Limited Role Of Opioids To Treat Chronic Noncancer Pain.
In 2017, an estimated 11 to 12 million people in the United States (4.2% of the total population) misused opioids (including heroin).1 What most physicians do not recognize is that 92% of people who misuse opioids do so by taking prescription opioids,1 and that 75% of individuals who use heroin report that they started misusing opioids through the misuse of prescription opioids. (Michael A. Ashburn and Lee A. Fleisher, 12/18)

The Hill: Dietary Guidelines: Blame Big Food, Not Government, For Unhealthy Eating
The dietary guidelines represent the government’s core advice on healthy eating. Importantly, the guidelines form the basis for much federal, state and local food policy — like the school lunch program and congregate meals for older Americans — so the stakes are high for the food industry, which has much to gain from muddying the waters. (Bonnie F. Liebman, 12/20)

Stat: Reinvent Scientific Publishing With Blockchain Technology
If the open flow of scientific information is a fundamental part of science, then the scientific community is in trouble. Academic publishers, which dominate scientific publishing, reap great financial rewards from the work done by scientists, who are often frustrated and handcuffed by the process. I believe that blockchain technology, if harnessed correctly, can enable the change the industry sorely needs. This instrument of transparency can return the power of science to scientists, giving them unprecedented levels of control over their work. (Manuel Martin, 12/21)

Houston Chronicle: Rural Health Care Needs Moonshot To Reverse Downward Trajectory
In many rural communities across Texas, the health care delivery systems are on life-support or nonexistent — leaving too many Texans vulnerable with limited or no access to care. In a state as resourceful as Texas, this is unacceptable.Currently, 170 of the 254 counties in Texas are rural with nearly 20 percent of the state’s population — or more than 3 million people - still residing in what can be considered “rural” areas. (Dan McCoy, 12/20)

San Francisco Chronicle: Alta Bates’ Closure May Be An Economic Necessity For Sutter, But It Will Come At A High Cost To The East Bay
Hospital closures displace patients, overburden the hospitals that remain open and adversely affect regional mortality. Patients also struggle with longer travel times, which can be fatal in emergency situations. Residents in northwest Alameda County and West Contra Costa County are still struggling to absorb the 2015 closure of Doctors Medical Center in San Pablo. (12/20)

The Philadelphia Inquirer: Let’s Make Black Women’s Maternal Mortality A Priority In PA
With the new legislative session approaching, the Pennsylvania legislature must put black women’s health on the top of its list. To make change on this public health crisis at the state level, legislators should look to community members and model federal legislation such as the MOMMA Act, introduced as state legislation in Illinois. (Mashayla Hays, 12/20)

Sacramento Bee: Fighting Wildfire From The Inside Out
In the wake of the Camp Fire, I’ve been reading about the work of wildfire scientist Jack Cohen. During his many years with the U.S. Forest Service, Cohen studied which houses in fire-prone areas tend to burn and which survive. His work is deeply respected and several of his videos are on YouTube. They should be required viewing for anyone living in a wildfire zone. To his surprise, Cohen found that the houses closest to catastrophic blazes often withstood the fires even when those farther away burned. It often wasn’t the approaching flames that threatened houses the most. The bigger danger, it turns out, were the thousands of small embers, called firestarters, that blew off of fires and traveled for miles on the wind. (Karin Klein, 12/19)