Reuters: Americans Want Trump To Focus On Healthcare First: Poll
Healthcare is the top issue Americans want Donald Trump to address during his first 100 days in the White House, according to a Reuters/Ipsos poll released on Thursday, an apparent rebuke of outgoing President Barack Obama's signature reform, Obamacare. Some 21 percent of Americans want Trump to focus on the healthcare system when he enters the White House on Jan. 20, according to the Nov. 9-14 poll, conducted in the week after the Republican won the U.S. presidential election. (Khan, 11/17)

The Washington Post: The Ultimate Q&A About Health Care Under A Trump Presidency
While it's pretty much a given that the Affordable Care Act won't survive a Trump presidency and Republican Congress in its current form, there are sweeping implications of reversing a law that has reached in so many ways into our health care system. The government has never undone a major benefits program after it has taken effect — and neither the incoming administration nor GOP lawmakers know exactly how they'll replace it. (Cha and Goldstein, 11/17)

And in other health law news —

Cleveland.com: Obamacare Could Remain In Force Through 2017
Just as open enrollment for Obamacare in 2017 wraps up in January, a newly elected president and Congress will try to unravel the insurance program. So should you bother signing up at all? And if you like your coverage at the start of 2017, will you be able to keep it through 2017? Yes and probably yes, say healthcare authorities. (Koff, 11/17)

The CT Mirror: Average Obamacare Prices Drop For Those With Subsidies, Rise For Others
Despite double-digit rate hikes taking effect Jan. 1, customers of Connecticut’s health insurance exchange who already picked plans for 2017 and qualify for subsidized coverage will, on average, save a few bucks on their monthly premiums, according to figures released Thursday by Access Health CT, the exchange. (Levin Becker, 11/17)

Kansas Health Institute: One Family’s Growing Worry: Paying For Their Child’s Cancer Care In A Post-ACA World 
Last week’s election results stunned a lot of people who get health insurance coverage through the Affordable Care Act. President-elect Donald Trump and the Republican-controlled Congress say they want to scrap the law, but what might replace it remains unknown. That has left some Missouri and Kansas families in limbo, unsure what will become of their medical care. (Smith, 11/17)

Sacramento Bee: California Officials, Health Advocates Say They Stand Ready To Defend Covered California Amid Changing Federal Policies 
As President-elect Donald Trump threatens to “repeal and replace” the Affordable Care Act, which provides health care to millions, supporters of Covered California are joining forces to come up with ways to defend the public health exchange they’ve spent the last five years building. (Caiola, 11/17)

California Healthline: State Senate’s Health Chairman Vows To Defend California Coverage Gains
A key state health care figure vowed Thursday to defend the coverage gains California has seen under the Affordable Care Act in the face of widely expected efforts by President-elect Donald Trump to overturn much of the health reform law. “I want to assure you, your staff and Californians that we stand ready to fight to keep what is working in this state,” Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee, told the board members of Covered California, the state’s health insurance exchange, in their first public meeting since Trump was elected on Nov. 8. (Ibarra, 11/18)

San Jose Mercury News: Whither Obamacare? Covered California Board, Experts Address Future Of Healthcare Law
It was all hands on deck at Covered California’s monthly board meeting Thursday as leaders of the state insurance exchange and a panel of experts spent hours trying to divine a health care world according to President-elect Donald Trump. The worst-case scenario is clear: On the campaign trail, Trump promised to repeal and replace the Affordable Care Act, President Barack Obama’s signature health care law that has insured 20 million Americans who had lacked health coverage. (Seipel, 11/17)

California Healthline: Blue Shield, California’s Biggest Obamacare Insurer, Vows It’s Not ‘Running For The Hills’
The chief executive of Blue Shield of California, the largest insurer on the state-run marketplace, says he’s committed to selling coverage there even as Republicans pursue a repeal of the federal health law. In an interview this week with California Healthline, Paul Markovich also criticized President-elect Donald Trump’s support for the sale of insurance plans across state lines in order to boost competition and consumer choice. (Terhune, 11/17)

Morning Consult: Alexander Warns Drafting ACA Replacement Could Take Time, Bipartisan Consensus
Drafting a sustainable replacement to the Affordable Care Act could take years, Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander warned Thursday. Alexander said replacing Obamacare could take longer than the education bill he worked to pass last year, which took six years. ... While Republicans will likely be able to repeal major parts of the 2010 health care law with a simple majority using a budget tool called reconciliation, Alexander said he expects passing a replacement would require 60 votes, meaning Senate Republicans would need at least eight Democrats to vote in favor of a replacement law. “Before the process is over, we’ll need a consensus,” he said. “I imagine this will take several years to completely make that sort of transition to make sure we do no harm, create a good health care system that everyone has access to, and that we repeal the parts of Obamacare that need to be repealed.” (McIntire, 11/17)

Morning Consult: House GOP Settles on Path Forward for Government Funding, Obamacare Repeal
House Republicans and Vice President-elect Mike Pence on Thursday agreed on a plan to punt the government funding debate into early next year and begin preparations to repeal Obamacare. ... Lawmakers also discussed passing two budget resolutions next year, which would enable them to use the reconciliation process twice to undo some of President Barack Obama’s signature policies. Rep. Mark Meadows (R-N.C.) said Republicans aim to have instructions ready for the first round of budget reconciliation by Inauguration Day. Their first target, according to Meadows, is repealing the Affordable Care Act. (Reid, 11/17)

The Washington Post Fact Checker: Are There Really 10,000 Diseases And Just 500 ‘Cures’?
“You know, there’s 10,000 diseases, and we only have 500 cures," [said] House Majority Leader Kevin McCarthy (R-Calif.). McCarthy made this comment while arguing for the need to replace Obamacare during a Trump administration. The numbers seemed so perfect and round — 10,000 and 500 — that we decided they had to be checked out. (Kessler, 11/17)

In other news from Capitol Hill —

Morning Consult: Cornyn: Congress Could Vote On Cures, Mental Health As One Package
It’s unlikely that a medical innovation measure or mental health legislation will move as standalone bills this year, but the measures could be voted on as one package, Senate Majority Whip John Cornyn said Wednesday. The Texas Republican said lawmakers are discussing combining the 21st Century Cures Act with a mental health care bill into one measure that the House and Senate could vote on before the end of the year. “I think if either one of them move, they’re going to move together,” Cornyn told reporters. (McIntire, 11/16)

USA Today: Can President Trump Undermine Abortion Rights? Not So Fast
President-elect Donald Trump opposes abortion, but even he admits that overturning the Supreme Court's 43-year-old decision in Roe v. Wade "has a long, long way to go." After Trump nominates a justice to replace the late Antonin Scalia, the Supreme Court will remain one or two votes short of a majority to send abortion decisions back to the states, experts on both sides of the issue agree. (Wolf, 11/16)

Boston Globe: Planned Parenthood Receives Donations In Honor Of Vice President-Elect Mike Pence 
In the wake of president-elect Donald J. Trump’s recent victory, people have been putting safety pins in their clothes as a show of support for victims of racism and misogyny. But others are taking a different approach to protest the Republican’s election: They’re sending donations to groups that support women’s rights and health care in honor of Trump’s running-mate, Indiana Gov. Mike Pence. (Annear, 11/17)

Modern Healthcare: CHS Has Buyer For Hospitals In Spokane, Wash.
Struggling Community Health Systems has agreed to sell its two-hospital system in Spokane, Wash. for $425 million. MultiCare Health System is buying Rockwood Health System, which includes 388-bed Deaconess Hospital in Spokane, 123-bed Valley Hospital in Spokane Valley and the multi-specialty Rockwood Clinic. The companies said the price is subject to certain unidentified adjustments. CHS is divesting hospitals and other assets to reduce a crushing $15 billion debt. “Rockwood Health System is a strong healthcare system, and we have carefully considered how to position it for future success,” said CHS CEO Wayne Smith. (Barkholz, 11/17)

Boston Globe: Beth Israel, Lahey Resume Merger Talks. Will Fourth Time Be The Charm? 
The hot and cold relationship between Beth Israel Deaconess Medical Center and Lahey Health is hot again. Top executives from the two hospital systems are discussing a possible merger, according to people with direct knowledge of the negotiations, the fourth time they have explored a deal in the past five years. (Dayal McCluskey, 11/17)

Kansas Health Institute: State Issues Request For Proposals To Privatize Osawatomie State Hospital
The state is seeking a private partner to operate Osawatomie State Hospital under a proposal that would allow the contractor to shift more than half the hospital’s beds to other parts of eastern Kansas. A request for proposals to operate Osawatomie State Hospital was posted Monday on the Kansas Department of Administration website. It would require a contractor to maintain 206 beds for inpatient mental health treatment but said only 94 would have to be at Osawatomie State Hospital. Any remaining beds would have to be in the hospital’s catchment area, which covers eastern Kansas. (Wingerter, 11/17)

Stat: Is Zika Still A Public Health Emergency?
On Friday, almost a year to the day from that first warning, experts who advise the UN’s global health agency on Zika will grapple with the question of whether this most unusual of outbreaks still constitutes a crisis. It won’t come as a huge surprise to the global health community if the experts tell WHO Director-General Margaret Chan that Zika, while still alarming, no longer meets the criteria for a “public health emergency of international concern,” as its known in the agency’s vernacular. But some observers worry that if the WHO downgrades Zika’s status, an outbreak that continues to bedevil scientists and threaten the health of developing fetuses will slip further down the priority list for research funding. They are also concerned that efforts to detect and report spread around the world will ease. (Branswell, 11/17)

Stat: How A Device To Ease Stress Came To Be Tested In A Trailer Park
Its first wearable device, priced at $199, promised to energize you with a few zaps of electrical pulses to the neck.Now, the startup Thync is developing a new model aimed at reducing stress. After sinking $30 million into research and development at Thync, the team set out recently to test the second-generation model — in a trailer park in Warren, Mich....Though Thync has published a safety study to show that the product won’t harm users, the studies Thync cites as evidence it’ll actually work are thin. (Thielking, 11/18)

The Washington Post: Scientists Catalogue The Yucky Stuff On New York City ATMs
Bacteria found on human skin. Microbes from bony fish, mollusks, chicken and baked goods. These are part of the long list of life-forms that live on the surfaces of ATM keypads in Manhattan, Queens and Brooklyn, according to a new analysis. The study was published in the American Society for Microbiology's open access journal mSphere. It is one of a number of fascinating research projects in recent years to catalogue and understand the microbes that live among, on or inside us and how they impact human health. (Cha, 11/17)

Stat: One Percent Of Cucumbers Carry Salmonella, FDA Says
One in a hundred cucumbers carries salmonella bacteria, according to new data from the Food and Drug Administration — and for fresh hot peppers that number rises to three per hundred. Both the vegetables were targeted by the agency’s proactive testing because of their role in previous outbreaks. Because cucumbers are often eaten raw, bacteria on them are more likely to make it into food; raw cucumbers have been blamed in five outbreaks of illness from 1996 to 2014. (Raffensperger, 11/17)

Minnesota Public Radio News: Rethinking End-Of-Life Dread 
New research shows the emotional and social quality of life near its end may not be nearly as bad as many expect. MPR's Cathy Wurzer spoke with Sandy Schellinger, one of the researchers on the project. She's a palliative nurse at Allina Health LifeCourse and her team will be presenting their work at the Gerontological Society of America's annual meeting later this week. (Wurzer, 11/17)

Stat: NFL Doctors' Conflicts Of Interest Could Endanger Players, Report Says
Doctors that work for professional football teams have conflicts of interest that could jeopardize players’ health, according to a report by Harvard researchers. The report released Thursday, funded by the NFL players’ union, states that because doctors are paid by the teams, they may put teams’ business above players’ health interests. However, it doesn’t identify any specific instances when this has occurred. League sources flatly denied the existence of any such conflict of interest, calling the report nothing more than an academic exercise. (Swetlitz, 11/17)

The Washington Post: Life And Death In The United States, In Two Maps
The latest news about preventable deaths in the United States has some encouraging data and one sobering statistic. On the good-news front, fewer people are dying prematurely from three of the five leading causes of death between 2010 and 2014: cancer, stroke and heart disease. But there was a significant increase in preventable deaths from unintentional injuries, mostly because deaths from opioid overdoses are increasing. (Sun, 11/17)

Los Angeles Times: In America, The Rich Outlive The Poor By Up To 9.5 Years, Study Says
The United States is one of the richest countries in the world, but it would look dramatically different if its 50 states were organized according to income instead of geography. If that were the case, residents of the poorest state in the union would have a median household income that’s just above the federal poverty line for a family of four. They would also expect to live shorter lives than people in more than half of the world's countries. (Kaplan, 11/17)

Kansas Health Institute: Report: KanCare Delivered On Cost, Not Quality Of Care
An analysis of KanCare performed by a former Republican governor’s think tank found that the switch to managed care Medicaid in Kansas has delivered on cost-cutting promises but not on quality of care. Leavitt Partners, a policy consulting shop founded by former Utah Gov. Michael Leavitt, performed the analysis between May and October by interviewing KanCare providers and reviewing federal and state data. “Across the providers that we interviewed and surveyed, there was general agreement that KanCare has not met its original rationale and commitments,” Robin Arnold-Williams, a principal at Leavitt Partners who specializes in Medicaid, said in a written summary of the analysis. (Marso, 11/17)

Kansas City Star: Frustrations In Kansas Keep Growing Over State's Private Medicaid Program 
In Sabetha, Kan., Jody Reel and her husband own a pharmacy and do their own plumbing because they can’t afford a plumber. That part they can understand — if you own a small business, sometimes you have to be flexible. But what troubles her is how changes in Kansas to the Medicaid program have made things more difficult for both her and her customers. Because of those changes, she said, she’s technically losing money on every Medicaid prescription. (Woodall, 11/17)

Topeka Capital Journal: Report Questions Health Claims Of Medicaid Privatization In Kansas
Frustration among legislators and Medicaid service providers with management of Kansas’ privatized system resurfaced Thursday in conjunction with a consulting firm’s report asserting the overhaul failed to deliver on promises of improvement in quality of health care. The critique occurred as the administration of Gov. Sam Brownback faced a $350 million tax revenue shortfall in the current state budget and worked to develop new contracts with insurance companies running the $3 billion KanCare system serving 400,000 poor, disabled and elderly Kansans. (Carpenter, 11/17)

New Orleans Times-Picayune: Louisiana Budget Deficit: Higher Education, Medicaid Providers Likely To Be Affected 
Gov. John Bel Edwards will be proposing that higher education be cut by $18 million and the state delay Medicaid payments again to health care providers to deal with the state's $315 million midyear budget deficit. ... But the bulk of the $315 million midyear budget deficit will be dealt with by pushing off $152 million worth of financial payments to Medicaid providers into the next year. The payments will eventually have to made -- so the expense doesn't go away -- but delaying them will help the state avoid substantial cuts in the short term. (O'Donoghue, 11/17)

WFPL (Louisville, Ky., Pubic Radio): More ER Patients Now Paying With Medicaid, Report Says
The number of emergency room visits in Kentucky hasn’t gone up much since Medicaid expanded or people started getting coverage on the individual market. That’s according to a new report from the Foundation for a Healthy Kentucky. ... Now, more of them have Medicaid coverage, but they’re using the coverage for the same type of ER visit. The percentage of people in the emergency room with Medicaid coverage did increase quite a bit by 2015, with almost half covered by Medicaid. That’s up from 30 percent in 2012. (Gillespie, 11/18)

Nashville Tennessean: State Health Care Task Force To Engage Congressional Delegation
Not only will state lawmakers’ efforts to establish a TennCare expansion pilot program using federal Medicaid funding continue under a Trump administration, Tennessee’s congressional delegation is likely to be engaged in the coming months, members of a special task force said Thursday. “It’s going to be very important … to be very close to our congressional delegation to give us guidance to make sure that what we’re doing is going to maximize the ability of Tennessee,” said Tony Spezia, CEO emeritus of Covenant Health. Spezia, who joined the task force for the first time Thursday, discussed the idea of engaging the delegation as part of a larger discussion on the prospect that the federal government could issue block grants for Medicaid funding under a Trump administration. (Ebert, 11/17)

The Associated Press: Michigan May Require Lead Screening Of All Young Children
Michigan, where a man-made water crisis is roiling one of its biggest cities, will consider requiring all infants and toddlers to be tested for lead poisoning as part of an initiative to eradicate children's exposure to the neurotoxin statewide. The recommendation is among many unveiled Thursday by a state board that Gov. Rick Snyder tasked with proposing a strategy to protect children from all sources of lead poisoning. (11/17)

The Washington Post: Michigan Fights Court Order To Deliver Bottled Water To Flint Residents
The state of Michigan on Thursday challenged a federal court order demanding that officials deliver bottled water to Flint residents who can’t easily pick up their own from distribution sites around the city, calling the requirement “unnecessary” and saying it would require “a tremendous expenditure of taxpayer funds.” (Dennis, 11/17)

Minnesota Public Radio News: Task Force Takes Aim At Delays In Mental Health Care System 
A state mental health task force has issued nine recommendations aimed at relieving the bottlenecks that delay Minnesotans from getting care. The panel, appointed by Gov. Mark Dayton, focused on closing well-known pinch points that make it difficult to get timely mental health treatment or leave people languishing in hospitals and jail cells. (Benson, 11/17)

Sacramento Bee: Health Insurer Could Bring 1,500 Jobs To Sacramento 
Backed by a state tax credit, the Sacramento region is in the running for 1,500 back-office jobs with a major health insurance company, including about 1,000 information technology jobs. With Sacramento bidding against Arizona, Texas and Illinois, the Governor’s Office of Business and Economic Development on Thursday approved a $7 million tax credit for Centene Corp., a St. Louis-area company that runs Medicaid programs for states. (Kasler, 11/17)

Arizona Republic: Phoenix Abortion Clinic Sues Arizona Attorney General's Office
An east Phoenix abortion clinic has filed a lawsuit against the Arizona Attorney General’s Office, asking a judge to block investigators from inspecting names and unredacted records of "patients who have had abortions and donated fetal tissue." The suit, filed Thursday in Maricopa County Superior Court, says the AG’s Office has issued a "civil investigative demand" requiring Camelback Family Planning to produce information regarding fetal-tissue procurement and disposal. (Cassidy, 11/17)

Chicago Tribune: In Illinois Group Homes, Adults With Disabilities Suffer In Secret
As Illinois steers thousands of low-income adults with disabilities into private group homes, a Tribune investigation found Powers was but one of many casualties in a botched strategy to save money and give some of the state's poorest and most vulnerable residents a better life. In the first comprehensive accounting of mistreatment inside Illinois' taxpayer-funded group homes and their day programs, the Tribune uncovered a system where caregivers often failed to provide basic care while regulators cloaked harm and death with secrecy and silence. The Tribune identified 1,311 cases of documented harm since July 2011 — hundreds more cases than publicly reported by the Illinois Department of Human Services. (Berens and Callahan, 11/17)

Des Moines Register: Elderly May Be Forced To Move Before Christmas
Anxiety was high Thursday at an assisting living center across from Mercy Medical Center in Des Moines, where dozens of elderly residents were notified this week they might have to move before Christmas. The owners of Walden Point Assisted Living gave the state 90 days’ notice that it was no longer going to be licensed as an assisted living complex, instead becoming an independent living facility, because their primary contractor, Brightstar Care of Ankeny, abruptly ended services. Residents who feel they need a higher level of care in assisted living will have to move from the facility at 1200 Fourth St. by Dec. 16. In the interim, services are being provided by a temporary contractor. (Rood, 11/17)

Cleveland Plain Dealer: Cleveland Schools Find Dangerous Lead Levels In Water From 60 Buildings; Will Replace 580 Outlets 
Water testing in the Cleveland Municipal School District has uncovered dangerously high levels of lead in samples taken from drinking fountains, sinks and other water sources in 60 older school buildings, the district reported today. The school district voluntarily tested more than 5,000 water samples in 69 schools, starting over the summer, and found 582 were above the Environmental Protection Agency's drinking water standards. These included 79 drinking fountains and 40 faucets in common areas. (Zeltner, 11/18)

Georgia Health News: State Is Underpaying Child Service Groups, Memo Confirms 
Georgia programs that provide child welfare services for kids who are under state supervision say they’ve been underpaid for years. A memo from a state official agrees with them. (Miller, 11/17)

Annals of Internal Medicine: Association Between Patient-Centered Medical Homes And Adherence To Chronic Disease Medications: A Cohort Study
[Researchers sought to] assess the association between medication adherence and medical homes in a national patient and provider population, given the strong ties between adherence to chronic disease medications and health care quality and spending. ... [They analyzed patients] with common medications for chronic diseases (diabetes, hypertension, and hyperlipidemia) between 2011 and 2013. ... Of 313 765 patients meeting study criteria, 18 611 (5.9%) received care in patient-centered medical homes. Mean rates of adherence were 64% among medical home patients and 59% among control patients. ... Receipt of care in a patient-centered medical home is associated with better adherence, a vital measure of health care quality, among patients initiating treatment with medications for common high-cost chronic diseases. (Lauffenburger et. al, 11/15)

JAMA Cardiology: Existing And Emerging Payment And Delivery Reforms In Cardiology
Although there is widespread agreement that payment reform is needed, existing programs have significant limitations and the adoption of new programs has been slow. New payment reforms address some of these problems, but many details remain undefined. ... The [fee-for-service] payment model has often generated perverse incentives, and existing and emerging payment models aim to shift the emphasis from volume to value. Early models have not performed as well as hoped. They have imposed substantial administrative burdens, have not been adequately transparent, and have often not delivered clear incentives at the physician level. New approaches are needed that encourage closer collaboration and coordination across the health system. (Farmer et al., 11/15)

JAMA Surgery: Hospital Factors Associated With Care Discontinuity Following Emergency General Surgery
In an analysis of the 100% Medicare inpatient claims file from January 1, 2008, to November 30, 2011, patients who underwent emergency general surgery and were subsequently readmitted to a nonindex hospital were significantly more likely to have had their index surgery at a large, teaching, safety-net hospital. (Havens et al., 11/16)

JAMA Pediatrics: Association Between Neighborhood Violence And Biological Stress In Children
A matched, cross-sectional study of 85 children examined whether the rate of violent crime in a neighborhood, rate of reports of domestic violence, and density of liquor or convenience stores were associated with telomere length and cortisol functioning. Each neighborhood stressor was significantly associated with biological stress, with greater exposure associated with shorter telomere length, lower acute cortisol levels and blunted recovery, and steeper diurnal cortisol declines. (Theall et al., 11/14)

JAMA Internal Medicine: Evaluating The Impact Of Florida’s “Stand Your Ground” Self-Defense Law On Homicide And Suicide By Firearm
Did the implementation of Florida’s “stand your ground” self-defense law have an impact on homicide and homicide by firearm between 2005 and 2014? Findings: This study used an interrupted time series design to analyze changes in rates of homicide and firearm-related homicide. We found that the implementation of Florida’s stand your ground law was associated with a 24.4% increase in homicide and a 31.6% increase in firearm-related homicide. (Humphreys, Gasparrini and Wiebe, 11/14)

The Kaiser Family Foundation: Where President-Elect Donald Trump Stands On Six Health Care Issues
While health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic. President-elect Donald Trump has laid out different approaches to addressing these and other health care issues. Central among these is his position to fully repeal the ACA. (11/9)

The Wall Street Journal: Medicaid Explodes
On Donald Trump’s victory Republicans in Congress are primed for an ambitious agenda, and not a moment too soon. One immediate problem is ObamaCare’s expansion of Medicaid, which has seen enrollment at least twice as high as advertised. Most of the insurance coverage gains from the law come from opening Medicaid eligibility beyond its original goal of helping the poor and disabled to include prime-age, able-bodied, childless adults. (11/17)

The New York Times: The Medicare Killers
During the campaign, Donald Trump often promised to be a different kind of Republican, one who would represent the interests of working-class voters who depend on major government programs. “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” he declared, under the headline “Why Donald Trump Won’t Touch Your Entitlements.” It was, of course, a lie. (Paul Krugman, 11/18)

Huffington Post: Not Just Obamacare: Medicaid, Medicare Also On GOP’s Chopping Block
Donald Trump and Republican leaders in Congress have made clear they are serious about repealing Obamacare, and doing so quickly. But don’t assume their dismantling of government health insurance programs will stop there. For about two decades now, Republicans have been talking about radically changing the government’s two largest health insurance programs, Medicaid and Medicare. (Jonathan Cohn and Jeffrey Young, 11/15)

The New England Journal Of Medicine: The End Of Obamacare
Donald Trump’s triumph in the 2016 presidential election marks the beginning of an uncertain and tumultuous chapter in U.S. health policy. In the election’s aftermath, the immediate question is this: Can Republicans make good on their pledge to repeal Obamacare? The Affordable Care Act (ACA) has persisted largely thanks to President Barack Obama’s protection. With Trump in the White House and Republicans maintaining House and Senate majorities, that protection is gone. (Jonathan Oberlander, 11/16)

The New England Journal Of Medicine: Maintaining Insurance Access Under Trump — A Strategy
Donald Trump’s election as President puts the future of the Affordable Care Act (ACA) in jeopardy. Full repeal is unlikely, given a probable filibuster by Senate Democrats, but major changes through the budget reconciliation process (which cannot be filibustered) are nearly certain. At the same time, eliminating insurance coverage for the millions of people now aided by the ACA carries its own political risks for the new administration. Complicating matters further is growing concern even among ACA supporters about the long-term viability of many of the insurance exchanges, through which more than 10 million people currently purchase private coverage (typically with federal subsidies). Several commercial insurers are either exiting or scaling back their participation in these marketplaces, and many smaller nonprofit insurers have shut their doors. One study predicts that 35% of U.S. communities will soon have only one available exchange insurance option. (Michael Sparer, 11/16)

Bloomberg: The Messy Politics Of Obamacare Repeal
Donald Trump and Republicans are about to encounter a political nightmare: unraveling Obamacare. Already there are tensions between Trump, who's been shaky on the specifics of the 2010 health-care law and says he wants to keep the popular parts, and congressional leaders like House Speaker Paul Ryan and conservative think tanks who ideologically, almost theologically, oppose anything associated with the Affordable Care Act. (Albert R. Hunt, 11/17)

The New England Journal Of Medicine: Covering Undocumented Immigrants — State Innovation In California
The proportion of undocumented immigrants in the United States who lack health insurance continues to be high — around 40%1 — even as the country’s overall uninsured rate has dropped to historic lows under the Affordable Care Act (ACA). Insuring undocumented immigrants would be an important step toward achieving universal coverage, but in an increasingly hostile national political climate, the likelihood of addressing this challenge at the federal level is low. Because the ACA continues a long-standing restriction on using federal funds to insure undocumented immigrants, covering this population will probably remain largely a state prerogative in terms of both policy and funding. (Rachel Fabi and Brendan Saloner, 11/16)

The New England Journal Of Medicine: Out-Of-Network Emergency-Physician Bills — An Unwelcome Surprise
Patients who seek care at in-network emergency departments may learn later that they owe thousands of dollars for a treating physician who isn't in their plan's network. But states could require hospitals to sell a bundled ED care package including physician services. (Zack Cooper and Fiona Scott Morton, 11/16)

Los Angeles Times: I Had A Health Crisis In France. I’m Here To Tell You That ‘socialized Medicine’ Is Terrific
On Sunday, March 29, 2015, two days after my 54th birthday, I came very close to dying. I was sitting in an armchair in my Paris apartment, reading a newspaper, when I became dizzy. The next thing I knew, my heart was beating violently. When the paramedics arrived, it was racing at 240 beats per minute. I was taken to Lariboisière, a major hospital in the north of Paris. .. In the United States, opponents of the Affordable Care Act often raise the nightmarish specter of European “socialized medicine.” For what it’s worth, here is a brief account of my experience with a single-payer system in the face of a life-threatening crisis. (Jake Lamar, 11/18)

Des Moines Register: Branstad's Medicaid Is Not Working For Iowa
The U.S. health care system most of us are familiar with comprises three main parts: Patients who receive care, health professionals who provide it and insurers (including government programs) that pay for it. How is each of these faring under Gov. Terry Branstad’s privatization of Medicaid? A look at Iowa newspapers over only a few days this month reveals two of the three are not doing so well. (11/17)

Bloomberg: Valeant's Pharmacy Ties Get Even Murkier
It turns out that the relationship was much hazier than I thought. ... Today U.S. federal prosecutors brought criminal charges against former senior Valeant executive Gary Tanner and Philidor Chief Executive Officer Andrew Davenport, alleging that they built the Valeant/Philidor relationship, used it to enrich themselves, and concocted a whole mess of squiggles to conceal it from everyone else. (Matt Levine, 11/17)

The Washington Post: Those OR Horror Stories Are The Exception, Not The Rule
I work as a “device rep” in the operating room. The headline “Why is that salesman in the operating room for your knee replacement?” [Nov. 15] makes it seem as though someone is selling a device or procedure inside the operating room. All procedures must be presented to the hospital or facility. Then, medical and operating staff decide whether to use it based on efficacy and financial impact. In-service programs and operative training are offered to surgeons prior to use. (Michael Goldberg, 11/17)

Stat: To Be True Healers, Physicians Need To Learn More About Nutrition
Most primary care doctors find it relatively easy to talk with their patients about topics like depression or cancer. Yet many shy away from talking about nutrition, or find it difficult to do. Avoiding that conversation is costly. For someone with diabetes, it may mean the difference between losing a foot or keeping it. For someone with heart disease, that conversation could free them from workplace disability or empower them to work harder. For someone who is steadily gaining weight, it could save them from gastric bypass surgery or from a lifetime of medications to treat obesity and weight-related complications. (Agustina Saenz, 11/17)

USA Today: Police Not Adequately Trained On Mental Health
Since Deborah Danner was killed by law enforcement in her New York apartment on Oct. 18, police in the U.S. have killed at least 10 other people whose behavior may have been connected to a mental health issue. A recent report by the Ruderman Family Foundation estimated that up to half of the people killed by police in America are disabled in some way, and a good number of them suffer from some sort of mental illness. While the majority of these killings may be legally justified, this is still a tragic outcome that demands steps be taken to reduce the likelihood of these deadly encounters. (Alex S. Vitale and Owen West, 11/17)

Lexington Herald Leader: Clergy, Others Must Join City’s Fight Against Opioid Deaths
In Lexington, we are fortunate to have Ronnie Bastin, our public-safety commissioner, on the forefront of the fight against the heroin-overdose epidemic we are currently experiencing. As a pastor and chaplain, I have seen the devastating effects of heroin addiction up close. The pain, the brokenness and the heartache of the lives lost and those impacted is wreaking havoc on our community. (Jonathan Smith, 11/17)

The New England Journal Of Medicine: Rethinking The Ban — The U.S. Blood Supply And Men Who Have Sex With Men
After the magnitude of the June 12, 2016, massacre at the Pulse nightclub became clear, people throughout Orlando wanted to help in any way they could. Thousands volunteered to give blood; local restaurants offered free food and water to those waiting in hours-long blood-bank lines in the central Florida heat. Yet after this attack that specifically targeted the lesbian, gay, bisexual, and transgender (LGBT) community, one group was notably absent from these donation lines: men who have sex with men, who have been prohibited from donating blood in the United States since 1985. This prohibition was, of course, not the tragedy that day, but the added insult that gay and bisexual men were unable to offer this measure of help to their community was deeply felt. One week later, 24 U.S. senators wrote to Food and Drug Administration (FDA) Commissioner Robert Califf asking the agency to revisit this ban, and on July 28, 2016, the FDA announced a call for input about changes to this policy. (Chana A. Sacks, Robert H. Goldstein and Rochelle P. Walensky, 11/16)