The New York Times: Senate Passes Budget Bill And Sends It To Obama
The Senate approved a crucial bipartisan budget agreement early on Friday that would avert a government default and stands to end nearly five years of pitched battles between congressional Republicans and the Obama administration over fiscal policy. The measure, which was approved 64 to 35, now goes to the White House, where President Obama is ready to sign it. (Herszenhorn, 10/30)

The Associated Press: Senate OKs Budget And Debt Deal, Sends Measure To Obama
The deal would also avert a looming shortfall in the Social Security disability trust fund that threatened to slash benefits, and head off an unprecedented increase in Medicare premiums for outpatient care for about 15 million beneficiaries. (10/30)

The Wall Street Journal: U.S. Senate Passes Budget Bill, Averting Risk Of Default
Friday’s early morning vote of 64-35 will enact a sweeping deal that came together only days before. Congressional leaders reached an agreement with the White House late Monday increasing spending by $80 billion through September 2017 and increasing the federal government’s borrowing limit until mid-March 2017. ... The latest agreement split Republicans, dividing those who wanted to see higher defense spending from those who said the bill didn’t extract enough spending reductions in exchange for increasing the debt limit. (Peterson, 10/30)

The Washington Post: Senate Approves Two-Year Bipartisan Budget Agreement
To offset this cost, negotiators tapped a number of sources, including making changes to Medicare and Social Security, auctioning off government-controlled wireless spectrum, selling crude oil from the Strategic Petroleum Reserve and tightening tax rules for business partnerships. ... The agreement also will prevent a potential 20 percent across-the-board cut to Social Security Disability Insurance benefits scheduled to take place next year, by transferring resources from the main Social Security fund and making changes to the program. The cost-saving revisions include allowing some recipients who can still work to receive partial payments while earning outside income, and expanding a program requiring a second medical expert to weigh in on whether an applicant is legitimately disabled. (Snell, 10/30)

USA Today: Senate Approves Two-Year Budget Deal That Prevents Default On Debt
Senate Majority Leader Mitch McConnell, R-Ky., had a harder time convincing Republican senators to support the bill. Many conservatives objected to lifting the budget caps and raising the debt limit. ... By pushing the deal quickly through the House, outgoing Speaker John Boehner, R-Ohio, eased pressure on his successor, Rep. Paul Ryan, R-Wis. Ryan, who was sworn in as the new speaker on Thursday, will not have to begin his tenure by facing an imminent fiscal crisis. (Kelly, 10/30)

The Wall Street Journal: Congressional Moves May Help Business
A burst of legislative activity in Congress this week, culminating in a two-year budget deal, could lift the cloud of uncertainty and modestly boost the economy by rolling back fiscal austerity. ... Lawmakers also included two important changes that will avert potential payment spikes and benefit cuts for seniors and the disabled. The budget agreement takes steps that will block a 52% jump in Medicare premiums for about 30% of beneficiaries next year. Premiums will now increase by 15% for those beneficiaries. AARP, a lobby for older Americans, praised lawmakers for heading off the premium increase. (Timiraos, 10/29)

NBC News: Senate Approves Two-Year Budget Deal, Sends Bill To Obama
Sen. Ted Cruz (R-Texas) cancelled campaign events and returned to Washington to speak out against the deal, telling NBC News as he left that he had returned "because this budget deal is a disaster, it's Republican leadership joining with Democrats to fund all of President Obama's big government priorities." Sen. Marco Rubio (R-Fla.) also made a appearance on the Senate floor, voting against the budget measure but not giving a speech. Rubio had not voted since October 20, and before today had missed 18 of 19 votes the Senate had taken in the month of October. (Thorp and Duchon, 10/30)

CBS News: Senate Passes Ambitious Budget Deal, Sends It To Obama
While the deal lifts spending levels, it doesn't completely eliminate the risk of government shutdowns in the future. Congress must pass a new spending package, based on the budget deal's guidelines, by Dec. 11. If controversial policy provisions are inserted into that spending package, they could easily cause problems and increase the threat of a shutdown. (Shabad, 10/30)

The New York Times: As Speaker, Paul Ryan May Need To Pare Lofty Goals
Paul D. Ryan, a son and grandson of Midwestern lawyers, ascended rapidly in American politics as a man with big plans: to overhaul the tax code, slash federal spending and rewrite the social contracts for Medicare and Social Security. Mr. Ryan, 45, who was elected in a celebratory Capitol Hill pageant on Thursday as the 54th speaker of the House, the youngest to grip the gavel since the late 1860s, now confronts a fundamental question: Will his new post provide a platform to pursue his bold visions for a renewed America, or will those big ideas weigh him down in an era defined by confrontation and small-bore compromises? (Herszenhorn and Huetteman, 10/29)

The Wall Street Journal: House Elects Paul Ryan As New Speaker
Mr. Ryan’s plan to listen to ideas from the rank and file doesn’t mean he takes the gavel without his own policy views, developed through a career that began with odd jobs like mowing lawns and waiting tables and led to chairmanships of two powerful House committees. The most ambitious plans in Mr. Ryan’s idea chest are based on a pull-yourself-up-by-your-bootstraps philosophy that inflames Democrats as much as it energizes Republicans. In closed-door meetings with House Republicans, Mr. Ryan has said he wants to overhaul the tax code, replace President Barack Obama’s health law, and rewrite federal poverty programs—and in the process draw a contrast with Democrats heading into the 2016 presidential election. (Hughes, 10/29)

The Wall Street Journal: Newly Elected House Speaker Paul Ryan Takes Gavel With Focus On Overhauling Taxes
His budget plan, which came to be known as the Ryan budget, called for deep cuts in spending and an overhaul of Medicare. As a head of the tax panel, Mr. Ryan had slated 2016 as the year to roll out his big tax ideas. It remains to be seen if he can use the speaker’s gavel to implement his ideas. His predecessor, Ohio Republican John Boehner, had aimed high in 2011 when he came close to reaching a broad budget deal with President Barack Obama, only to end his tenure with incremental changes that left big fiscal fights unsettled. (McKinnon and Hughes, 10/29)

The Associated Press: Obama And Ryan: Political Foils, Occasional Policy Partners
Still, there’s no doubt that Ryan was the White House’s favored choice for speaker after John Boehner resigned and No. 2 Republican Kevin McCarthy withdrew from the race to succeed him. Aides say the president views Ryan as a policy wonk driven more by legislative results than appeasing GOP hardliners. ... Despite these areas of common interest, the most notable exchanges between Obama and Ryan have come when they’ve been at odds. During a televised health care summit in 2010, Ryan derided the president’s health care legislation as rife with “gimmicks and smoke and mirrors” techniques to shade the real cost. His detail-rich, six-minute commentary was praised by Republicans as among the most effective arguments against the “Obamacare” bill. (Pace, 10/29)

The Washington Post: Mental Health In The Spotlight Thursday On Capitol Hill
The federal government's top mental health researcher told lawmakers Thursday that the country needs to do much more to apply research to improve treatments, as a Senate committee heard testimony to address comprehensive mental health legislation. Speaking on his second-to-last day in his job as director of the National Institute of Mental Health, Thomas Insel said his 13-year tenure had convinced him of two “abiding truths.” (Sun, 10/29)

The Connecticut Mirror: Senate Tackles Mental Health Care Reform
A Senate panel took up the issue of mental health care Thursday, discussing legislation promoted by Sen. Chris Murphy to overhaul the system, an unusual move since Congress hasn’t tackled comprehensive reform in decades. While a number of senators from both sides of the aisle said they wanted changes to the federal government’s role in mental health care, there won’t be action for a while. (Radelat, 10/29)

The New York Times: Obama Administration Campaign Will Publicize Health Care Subsidies
The Obama administration on Thursday said that it would wage a national advertising campaign to counter a perception among people with low incomes that health insurance under the Affordable Care Act was not affordable. (Pear, 10/29)

USA Today: Feds Unveil New Obamacare Ads That Target Low Income Consumers
Federal health officials are targeting low-income consumers with new advertisements unveiled Thursday that emphasize the affordability of health insurance, two days after new data showed the average increase in premiums was higher than for 2015 plans. In a meeting with reporters, Department of Health and Human Services Secretary Sylvia Burwell emphasized that about 80% of consumers shopping on the federal Healthcare.gov exchange that serves 38 states are eligible for tax credits that lower their premiums to less than $100 a month. (O'Donnell, 10/29)

The Washington Post: Third ACA Enrollment Begins With New Ads And Modest Expectations
The insurance exchanges created under the Affordable Care Act are scheduled to open for a third sign-up season Sunday, with the Obama administration setting modest enrollment expectations and focusing its energies on a niche of people who remain uninsured. The impending open-enrollment will be devoid of the movie stars and basketball heroes who served as White House megaphones two years ago, when the online marketplaces debuted. (Goldstein, 10/29)

Kaiser Health News: Exchanges Face Sign-Up Challenges As Health Law’s 3rd Open Enrollment Begins
On fishing piers in Maine, inside public libraries in rural Iowa and at insurer-run retail stores in Minnesota, the hunt for uninsured Americans will reignite Sunday when Obamacare’s third open enrollment season starts. But the job will be more difficult this time as the number of uninsured Americans has fallen dramatically. (Galewitz, 10/30)

NPR: Obamacare Deploys New Apps, Allies To Convince The Uninsured
Ten million people still don't have health insurance two years after the Affordable Care Act went into effect. Some never bought a policy. But 20 percent went to the trouble of signing up on HealthCare.gov, or one of the state insurance exchanges, and even made payments. Then, those 2 million people let their insurance lapse. NPR asked visitors to our Facebook page to tell us why. (Kodjak, 10/30)

Insurance companies still see a good market in the health law exchanges.

The Associated Press: Big Insurers Remain Upbeat On Fledgling ACA Exchanges
Slipping enrollment and struggling competitors have done little to shake the faith that the nation’s biggest health insurers have placed in the Affordable Care Act’s public insurance exchanges. Aetna executives said Thursday that the exchanges, a key element in the overhaul’s push to cover millions of uninsured people, remain a good market, even though the insurer’s enrollment in them fell 11 percent to about 814,000 people in the third quarter. Leaders of the Blue Cross-Blue Shield insurer Anthem have voiced a similar sentiment, and UnitedHealth said earlier this month that it will expand into 11 more exchanges next year. (Murphy, 10/29)

Minnesota Public Radio: MNsure Looks Forward To Busy, But Smooth, Enrollment Period
Year Three of open enrollment for private health insurance plans starts Sunday. MNsure officials expect to be busier than ever. Unlike last year, there's not much speculation this year about whether the state's online health insurance marketplace will crash, or whether its call center will have unacceptably long wait times. MNsure turned in a respectable performance a year ago following a disastrous open enrollment in Year One. (Zdechlik, 10/30)

Cleveland Plain Dealer: In Year Three Of Obamacare, Insurance Costs In Northeast Ohio Drop 6.3 Percent
Round three of Obamacare began Thursday in a crowded church off Cleveland's East Avenue. That's the spot government officials and health care advocates chose to launch a campaign to enroll hundreds of thousands of uninsured Ohioans over the next several weeks. This year, they will have more than clergy and community volunteers on their side. In Northeast Ohio, premiums for plans offered through the state's health care exchange are down 6.3 percent, a reduction officials hope will significantly boost enrollment. (Ross, 10/30)

The Associated Press: Cost Of Insurance Under Health Law Likely To Drop
Many Indiana consumers who get their health insurance through the federal health care law can expect to pay less in the coming year, according to estimates from the U.S. Department of Health and Human Services. The cost of health insurance under the President Barack Obama's Affordable Care Act is expected to climb across much of the U.S. — in some cases by double digits. (10/29)

The Richmond Times-Dispatch: Number Of Uninsured Children In Virginia Was 107,000 In 2014
Nearby states are doing better than Virginia when it comes to children with health insurance, according to a report that shows the uninsured rate of children nationally reaching a historic low of 6 percent since implementation of national health care reform. (Crowe, 10/29)

Georgia Health News: More Georgia Kids Insured As ACA Takes Hold
The number of uninsured children in Georgia dropped by nearly 50,000 after the full implementation of the Affordable Care Act in 2014, a new report has found. But the state’s 189,000 children who remain uninsured make Georgia’s rate relatively high – 7.6 percent, versus 6 percent nationally. (Miller, 10/29)

The New York Times: Groups Want Federal Health Exchange To Register Voters, Too
When the Affordable Care Act’s new enrollment season begins next month, people seeking health insurance through the online federal exchange will also be offered something they may not expect: a chance to register to vote. But voting rights groups say the offer — a link to a voter registration form that they can print and mail, deep inside the application for health coverage — does not go far enough. This week, the groups accused the Obama administration of violating federal law by not doing more to ensure opportunities for voter registration through the exchange, HealthCare.gov, which serves 38 states. (Goodnough, 10/29)

The Huffington Post: Voting Rights Groups Say Obamacare Should Be Helping Americans Register To Vote
Voting rights groups are calling on President Barack Obama’s administration to provide better voter registration opportunities to Americans signing up for health insurance in the more than 30 states where the federal government runs exchanges. (Lachman, 10/29)

The New York Times' DealBook: Health Care Companies In Merger Frenzy
In a fast-paced financial version of musical chairs, health care companies of all kinds — drug makers, hospital groups and insurers — have been frantically circling to be sure they are not left out of the latest frenzy of deal making. Mergers and acquisitions worth about $270 billion have been announced in the first nine months of 2015 in the United States, easily outpacing the activity in recent years, according to a tally by Mergermarket. On Thursday, Allergan, itself the product of a recent merger, said it was in talks to be bought by Pfizer in a deal that could easily become the year’s biggest deal. Allergan’s current market value is $113 billion. (Abelson, 10/29)

Los Angeles Times: An Allergan-Pfizer Deal Could Be Biggest Merger This Year
Drug giant Pfizer Inc. and Botox maker Allergan confirmed Thursday that they're in early talks to merge in a blockbuster deal that, if completed, would cap a remarkable consolidation wave roiling the U.S. healthcare industry. A deal between the companies — with an expected price tag well above Allergan's current stock market valuation of about $120 billion — would be the largest corporate merger this year. (Peltz and Masunaga, 10/29)

The Associated Press: Pfizer, Allergan In Deal Talks To Create Drug Giant
A merger could enable Viagra maker Pfizer, the world’s second-biggest drugmaker by revenue, to surpass Switzerland’s Novartis AG and regain the industry’s top spot. In separate statements, both companies on Thursday said they were in “preliminary friendly discussions.” Allergan Plc said there’s no certainty that the talks with Pfizer Inc. will lead to a deal. (Johnson, 10/29)

The Wall Street Journal: Former Executive At Allergan Unit Arrested On Kickback Charge
In a rare move against a pharmaceutical executive, federal agents arrested the former president of an Allergan PLC division Thursday on a charge of conspiring to pay kickbacks to physicians to induce them to prescribe the company’s drugs. (Loftus, 10/29)

Bloomberg: Valeant Says It's Cutting Ties With Troubled Pharmacy Philidor
Valeant Pharmaceuticals International Inc. will terminate its relationship with Philidor Rx Services, the closely-associated pharmacy that the drugmaker has used to distribute its products and that is under scrutiny for its business practices. Philidor will shut down operations as soon as possible, Valeant said in a statement Friday, and the drugmaker will continue to ensure patients’ access to treatments. The decision came after Bloomberg News reported that Philidor altered doctors’ prescriptions to wring more reimbursements out of U.S. health insurers. (Armstrong and Kitamura, 10/30)

The New York Times: Express Scripts And CVS Health Cut Ties With A Pharmacy Linked To Valeant
The nation’s three largest drug benefit managers said on Thursday that they would cease doing business with a mysterious pharmacy that has been bolstering sales of products made by Valeant Pharmaceuticals International. Express Scripts, CVS Health and OptumRx said they would stop paying for drugs dispensed by the pharmacy, Philidor Rx Services. (Pollack, 10/29)

The Wall Street Journal: CVS, Express Scripts, UnitedHealth Group Cut Off Philidor, Pharmacy Used By Valeant
The three largest pharmacy-benefit managers in the U.S. said they are ceasing work with a pharmacy that has helped drive sales growth at Valeant Pharmaceuticals International Inc., dealing another blow to the drug maker. CVS Health Corp. on Thursday said it is terminating mail-order pharmacy Philidor Rx Services LLC from the network of its Caremark pharmacy-benefit unit, after audits found the pharmacy wasn’t complying with terms of its agreement. Express Scripts Holding Co. released a similar statement about an hour later, saying it was cutting off Philidor and also evaluating four additional pharmacies with which Valeant “has a similar relationship.” UnitedHealth Group Inc.’s OptumRx also said it was dropping Philidor from its networks, beginning the process after an audit late last year. (Wilde Mathews, Whalen and Copeland, 10/29)

And after a hot start, Theranos founder and chief executive Elizabeth Holmes is now facing marketplace hurdles -

The New York Times: The Narrative Frays For Theranos And Elizabeth Holmes
Few people, let alone those just 31 years old, have amassed the accolades and riches bestowed on Elizabeth Holmes, founder and chief executive of the blood-testing start-up Theranos. This year President Obama named her a United States ambassador for global entrepreneurship. She gave the commencement address at Pepperdine University. She was the youngest person ever to be awarded the Horatio Alger Award in recognition of “remarkable achievements accomplished through honesty, hard work, self-reliance and perseverance over adversity.” She is on the Board of Fellows of Harvard Medical School. (Stewart, 10/29)

The Wall Street Journal: Aetna’s Earnings Rise Amid Moderate Medical Costs
As for 2016, Aetna said it was aiming for at least low double-digit earnings growth, saying it sees potential for expansion in Medicare and Medicaid membership. But it flagged challenges including losing some business from large national employers that decided to offer workers plans from multiple insurers. Aetna also said the individual business remained “challenging,” and that it would shrink its footprint in the Affordable Care Act’s marketplaces to 15 states, down from 17 this year. (Wilde Mathews and Steele, 10/29)

The Wall Street Journal: Sanofi Recalls Auvi-Q Allergy Injectors
Sanofi SA voluntarily recalled all 2.8 million of its Auvi-Q epinephrine injectors from the U.S. and Canada, sending allergy patients and anxious parents scrambling to replace them with rival EpiPen devices. Millions of allergy sufferers carry epinephrine injectors and administer shots themselves in case of life-threatening anaphylactic reactions. Sanofi said it had received 26 reports of the devices potentially delivering inadequate doses, which could have “significant health consequences,” although no fatalities have been reported. (Beck, 10/29)

NPR: If A New Cancer Drug Is Hailed As A Breakthrough, Odds Are It's Not
Miracle. Game changer. Marvel. Cure. Lifesaver. For Dr. Vinay Prasad, each one of these words was a little straw on the camel's back. At oncology conferences, they were used "indiscriminately" to describe new cancer drugs. Journalists bandied them about in stories. Finally, the pile of hyperbole broke the camel's back. The hype can bubble up false optimism in patients struggling with cancer, Prasad, an oncologist at Oregon Health and Sciences University, writes Thursday in the journal JAMA Oncology. (Bichell, 10/29)

The Wall Street Journal's Real Time Economics: Five Revealing Economic Exchanges From The Republican Debate
Several of the candidates, notably Kentucky Sen. Rand Paul, New Jersey Gov. Chris Christie and former Florida Gov. Jeb Bush called for changes that would put Social Security and Medicare on sounder ground by increasing retirement ages, decreasing benefits for higher-income retirees or changing the formula used to calculate living-cost adjustments. Mr. Paul said Medicare was paying out around 2.5 times more per person than it had collected, raising an important point about demographics. “We have this enormous mismatch because we have smaller and smaller families,” he said. Messrs. Bush and Christie have both made the case that Social Security will need to be reoriented towards a program that offers a more progressive payment structure. “The simple way to do it is to make sure that the wealthiest don’t receive the same benefits as the people that are lower-income,” Mr. Bush said. (Timiraos, 10/29)

McClatchy: Ben Carson's Proposed Health Care Overhaul Is Short On Specifics
Ben Carson’s rise to Republican presidential front-runner has come without serious scrutiny of his domestic policy proposals. But his high-flying campaign has hit some turbulence since he began discussing his desire to replace the Affordable Care Act with a health care system that offers all Americans a government-funded health savings account. (Pugh, 10/29)

Detroit Free Press: UAW-GM Deal Would Improve Newer Workers' Health Plan
UAW negotiators bargained significantly better health care coverage for about 11,000 General Motors workers hired since October 2007 and the automaker will pay for most of it. But if a majority of 52,700 workers ratify the tentative agreement reached last weekend, they could face more out-of-pocket expenses, if the company gets hit by a new tax, dubbed the "Cadillac Tax," that looms in 2018 if lobbyists lose their efforts to have it repealed. (Gardner, 10/29)

Meanwhile, the federal government is announcing an expansion of coverage to domestic partners.

The Washington Post: Eligibility For Federal Employee Long-Term Care Insurance To Expand
Opposite-sex domestic partners would gain the right to apply for a long-term care insurance program for federal employees under the same terms now applying to same-sex partners, under a policy change to be published Friday. Rules from the Office of Personnel Management represent another step in the evolution of eligibility for benefits associated with federal employment in recent years, some driven by the Obama administration and others by court rulings. (Yoder, 10/29)

The Washington Post: Some New Doctors Are Working 30-Hour Shifts At Hospitals Around The U.S.
Some first-year doctors are working 30 hours in a row at dozens of hospitals around the country in a test of work-hour limits that were imposed in 2011 because of fears that inexperienced, sleep-deprived physicians might jeopardize patients. The 30-hour shifts, which were banned four years ago, are one element of a $9 million research project partly funded by the National Institutes of Health to determine the best way to train novice physicians while maintaining patient care. (Bernstein, 10/28)

The Washington Post: Having Trouble Finding A Primary Care Doc? Here’s What Med Schools Are Doing About It.
The extent of the nation’s overall shortage of physicians remains a matter of considerable debate, but almost no one disputes that primary care physicians for adults — internists and family care doctors — are in short supply. This is especially true in rural communities such as Greensboro (population 2,500) and inner cities, as well as places in between. In the Washington region, there is a shortage of primary care specialists in the eastern half of the District, stretching into Prince George’s County, portions of Southern Maryland and much of the Eastern Shore, federal data show. (Bernstein, 10/29)

Lincoln (Neb.) Journal Star: Ricketts Swipes At Medicaid Expansion
Gov. Pete Ricketts took a shot Thursday at proposed Medicaid expansion in Nebraska, warning that "we can't trust the federal government" to honor its commitment to always pay at least 90 percent of the costs. "If we expand Medicaid, it will cost the state $158 million over six years," the governor told a Platte Institute legislative summit. "That's money that could go to roads, education, investments to grow our state," Ricketts said. (Walton, 10/29)

California Healthline: From $17 Billion to $7 Billion So Far ... How Far Will Medicaid Waiver Drop?
Federal officials have asked California officials to trim back a Medicaid waiver plan by more than half, and they could be looking to trim it again. (Gorn, 10/29)

Louisiana Cuts To Planned Parenthood Medicaid Funds Blocked: Bloomberg
Louisiana was blocked by a judge from cutting Planned Parenthood’s Medicaid funds in a defeat for Governor Bobby Jindal as he seeks to raise his profile among Republican presidential candidates. The federal judge’s decision Thursday followed a similar ruling in Alabama Wednesday as abortion opponents nationwide seek to block Planned Parenthood’s government funding after circulating undercover videos claiming out-of-state affiliates illegally profited from the sale of fetal tissue. (Calkins and Hasselle, 10/29)

The Associated Press: Audit: NY Enrolled Dead In Medicaid, Offered Health Coverage
Flaws in New York's health exchange resulted in 21 dead people being enrolled in Medicaid and 333 getting continuing government-funded health coverage after they died, according to audit results released Thursday. The state comptroller's office reported that its auditors found overpayments of $3.4 million for the year starting Oct. 1, 2013, when the exchange began operating. That included $325,000 in coverage for the deceased. (Virtanen, 10/29)

Providence Journal: Wallack Leaves HealthSource RI To Become RI's Medicaid Director
At the helm of HealthSource RI for less than a year, Anya Rader Wallack is already leaving the post for another state job. Beginning Monday, she will become Rhode Island's next Medicaid director. (Salit, 10/29)

Des Moines Register: Did Politics Taint Iowa Medicaid Bid Process?
A private company that ultimately won a contract to help manage Iowa’s $4.2 billion Medicaid program asked two former state lawmakers for assistance in determining who was on the committee that would be evaluating the bids and how it might influence their decisions, according to evidence presented in court on Thursday. That company, WellCare, also sought information and received a response from a key member of Gov. Terry Branstad’s staff during a so-called "blackout" period when bidders were prohibited from making contact with state employees about the project, the documents show. (Clayworth, 10/29)

The Associated Press: California Appeals Court Rejects Right-To-Die Lawsuit
A California appeals court on Thursday rejected a lawsuit by three terminally ill patients that sought to clear the way for doctors to prescribe fatal medication to them and others like them who want the option of taking their lives. A state law that makes helping someone commit suicide a crime clearly applies to physicians who provide patients lethal drugs, a division of the Fourth District Court of Appeal ruled. (10/29)

News Service Of Florida: Court Backs Hospital On Shielding Medical Documents
More than a decade after Florida voters approved a constitutional amendment expanding access to records in medical-malpractice cases, an appeals court Wednesday sided with a Jacksonville hospital system in a battle about whether federal law shields some documents from disclosure. The ruling by the 1st District Court of Appeal centered on the interplay between a 2004 state constitutional amendment and a 2005 federal law. (10/29)

WUKY: Legacy On The Line: Beshear Makes Final Pitch For Conway, Kynect
Gov. Steve Beshear stepped into the well-worn role of health reform defender earlier this week as he touted the launch of the next open enrollment for kynect, Kentucky’s celebrated health insurance exchange. But the program’s future – along with the state’s Medicaid expansion – face a fork in the road next Tuesday. The two-term Democratic governor won’t be on the ballot next week, but a centerpiece of his administration’s legacy is on the line as voters select his successor. An enthusiastic champion of President Obama’s signature healthcare law, Beshear could see that initiative undone if Republican Matt Bevin steps into the top office. (James, 10/29)

The Associated Press: NY To Mandate Meningitis Vaccines For 7th, 12th-Graders
The new law requires students in the seventh and 12th grades to be vaccinated against meningitis beginning next year. More than 20 states already require the shot as part of standard immunizations that also vaccines against mumps, measles, polio and other deadly diseases. (10/29)

Minnesota Public Radio: Does State Dentistry Board Protect Dentists Over The Public?
In a move to protect public health, the Minnesota Board of Dentistry earlier this year considered following the example of 11 other states and establishing a system of inspections of dentists' offices. The proposed random inspections were to make sure the dentists and their staffs were following proper sanitary procedures. (Scheck, 10/30)

The Bulletin: More Dentists, Patients Turning To Discount Plans
No matter how well people take care of their teeth, things start to fall apart in old age. Eighty-year-old Betty Williams of Redmond found that out recently when she needed a crown, a bridge and an implant. The dental work set her back about $10,000. Like more than 70 percent of the population age 65 and older, she doesn't have private dental insurance. Medicare doesn't cover dental care, nor is it included in the retirement benefits her husband earned as a Washington firefighter. (McLaughlin, 10/29)

The Milwaukee Journal-Sentinel: Doctors' Use Of Medical Services Varies Up To 10% Across Southeast Wisconsin
When treating patients with similar health problems, the amount of medical services used by physician groups affiliated with southeastern Wisconsin health systems can vary by as much as 10%, a new study shows. The study is the area's first to look at how physician practices vary in their use of health care resources — and dollars — when treating similar patients. (Boulton, 10/29)

The Kansas Health Institute News Service: Four Adult Care Facilities Still Resisting Malpractice Fund
Dave Achey has owned and operated Country Club Estates, an adult care facility in Paola, for 19 years. For most of that time he has purchased professional liability insurance for medical malpractice claims from a well-known insurer: Lloyd’s of London. But now that his facility is included under the Kansas Health Care Stabilization Fund, the state is telling him Lloyd’s is not an approved carrier and he must buy different insurance that comes with a fund surcharge. Achey is not happy about it. (Marso, 10/29)

Health News Florida: A Downside Of Country Living: Roadside Birth
There is a seven-county stretch in North Central Florida -- an area larger than Puerto Rico -- where every county health department has gotten out of prenatal care. Since then, the rate of women getting in to see a doctor in the first trimester has dropped in all seven counties. In Dixie County, state data show, the rate of women giving birth without ever seeing a doctor has more than doubled. It’s the worst rate in Florida. (Aboraya, 10/29)

Health News Florida: 'Trauma Copters' Free For Florida Keys Resident
Getting to a trauma center quickly can be critical, and in the Florida Keys, there are no trauma centers. That leaves you the option of being airlifted out. And that can cost you nothing -- or tens of thousands of dollars. But Monroe County is trying to make sure patients have the chance to choose that first financial option. (Klingener, 10/29)

The Miami Herald: Leader Of Family-Run Health Care Fraud Ring In Miami-Dade Sentenced To 10 Years
One of the leaders of a family-run ring that tried to rip off more than $100 million in healthcare insurance payments by the city of Miami, Miami-Dade County public schools and numerous major companies was sentenced to 10 years in prison on Thursday. Hendris Castillo Morales, who pleaded guilty to conspiring to commit healthcare fraud, sought a more lenient sentence from U.S. District Judge Robert Scola. The Castillo case is unusual because the family’s network of clinics targeted major private insurance companies that managed healthcare plans for self-insured public and private entities. The city of Miami, Miami-Dade County public schools and several companies lost millions of dollars in health insurance payments as a result of being scammed by the Castillo-run clinics that submitted bogus claims for pain injections, physical therapy and other purported services, according to two indictments. (Weaver, 10/29)

The Associated Press: Drug Manufacturer To Plead Guilty In Health Care Fraud Case
A subsidiary of pharmaceutical manufacturer Warner Chilcott PLC that was accused of offering kickbacks to doctors for drug prescriptions has agreed to plead guilty to a felony charge of health care fraud, prosecutors announced Thursday. A former company president was arrested. Warner Chilcott ex-president W. Carl Reichel was arrested in Boston. He was accused of conspiring to pay kickbacks to doctors. (10/29)

Los Angeles Times: Glendale Hospitals Receive Stroke Certifications
Glendale Adventist Medical Center and Dignity Health Glendale Memorial Hospital both received stroke certifications recently. Glendale Adventist is now certified as a Comprehensive Stroke Center by DNV GL Healthcare USA Inc., making it the first hospital in the state to be awarded that certification, according to Glendale Adventist officials. (Tchekmedyian, 10/29)

Health Affairs: Physician Compare (Updated)
Measuring physician performance and quality of care is a critical component of the move to greater accountability and improved value in health care. ... The federal government significantly enhanced its presence in this realm with the launch in 2010 of Physician Compare, a website mandated by the Affordable Care Act (ACA). Additionally, in April 2015 a new law--the Medicare Access and CHIP Reauthorization Act (MACRA)--altered the landscape of physician quality measurement and payment beginning in 2019. MACRA accelerates Medicare's shift away from fee-for-service physician payment toward payment based on performance assessment, quality metrics, patient outcomes, and patient experience. ... This brief focuses on the rollout and evolution of Physician Compare .... An earlier version of this brief--pre-MACRA--was published in December 2014. (Findlay, 10/29)

Urban Institute: Tax Preparation Services And ACA Enrollment Potential Contributions And Issues
We examine the ACA’s target population of consumers who were uninsured before the law’s main coverage provisions took effect in 2014. In every state, tax returns were filed for 56% or more of those who now qualify for Medicaid and 84% or more of those eligible for health insurance tax credits. The minority of tax preparers who help their clients apply for health coverage have developed several effective models. States could test the impact of measures to increase tax preparation services’ contribution to enrollment while guarding against unethical or incompetent conduct. Federal policy could also play an important role. (Dorn, Buettgens and Dev, 10/29)

Pediatrics: Physician And Nurse Nighttime Communication And Parents’ Hospital Experience
We sought to examine relationships between nighttime communication and parents’ inpatient experience. ... [with] a prospective cohort study of parents .... Parents rated their overall experience, understanding of the medical plan, quality of nighttime doctors’ and nurses’ communication with them, and quality of nighttime communication between doctors and nurses. ... A total of 42.5% of parents reported a top overall experience .... top-rated overall experience scores were associated with higher scores for communication and experience with nighttime doctors ..., for communication and experience with nighttime nurses ... and for nighttime doctor–nurse interaction .... As hospitals seek to improve the patient-centeredness of care, improving nighttime communication and teamwork will be valuable to explore. (Khan et al., 10/26)

Urban Institute: The ACA's "Cadillac" Tax Versus A Cap On The Tax Exclusion Of Employer-Based Health Benefits: Is This A Battle Worth Fighting?
In recent weeks, prominent business and labor groups and leaders across the political spectrum have called to repeal the “Cadillac tax,” which is an important source of funding for the ACA’s coverage expansion. This excise tax is similar in practical effect to a cap on the current-law tax exclusion of employer contributions to health insurance. ... Our analysis shows that the incidence of the ACA’s excise tax is identical in most circumstances to a cap on the employer exclusion that would raise the same revenue. ... Because capping the exclusion would have the same distributional effects regardless of employer benefit decisions and would be more progressive than the scenario in which employers choose to pay the excise tax, the cap might be the preferred option. (Blumberg, Holahan and Mermin, 10/22)

The Urban Institute: The Road To Making Patient-Centered Care Real
Although patient-centered care is not new, increasing emphasis on quality measurement as part of health care reform has led to a renewed focus on it. The path to achieving patient-centered care is not always clear, even to those who believe in its importance. This paper informs a discussion of federal policies affecting patient-centered care. The authors recommend that (1) federal efforts toward patient-centered care be catalogued and scrutinized, (2) better measures and information on effective implementation are used, and (3) this intervention’s ability to enhance the doctor-patient bond is emphasized. (Millenson and Berenson, 10/16)

The Kaiser Family Foundation: Medicare Advantage And Traditional Medicare: Is The Balance Tipping?
A growing share of Medicare beneficiaries have been enrolling in Medicare Advantage plans over the past decade, prompting some to question whether the balance between traditional Medicare and Medicare Advantage could be on the verge of tipping. Since 2006, the share of Medicare beneficiaries enrolled in a Medicare Advantage plan has nearly doubled, from 16 to 31 percent, but in some counties, the percentage is much higher. In this brief, we look beneath national trends to examine Medicare Advantage penetration rates and growth rates in counties across the country to assess the extent to which Medicare Advantage plans are poised to cover more beneficiaries than traditional Medicare across the country. (Neuman, Casillas and Jacobson, 10/20)

The Kaiser Family Foundation: Medicaid's Role For People With Dementia
Most people with dementia have Medicare, but due to high out-of-pocket costs and lack of long-term services and supports (LTSS) coverage, low-income people with disabilities resulting from dementia may need Medicaid to fill in the coverage gaps. Medicaid plays an important role in providing LTSS and is increasingly focused on efforts to help seniors and people with disabilities remain in the community rather than reside in institutions. Given the expected growth of the elderly population over the coming decades6 and barring medical breakthroughs, a larger share of Americans likely will have dementia, which has implications for Medicaid coverage, delivery system design, financing, and quality monitoring. This fact sheet describes Medicaid’s role for people with dementia who live in the community. (Garfield et al., 10/19)

Here is a selection of news coverage of other recent research:

Reuters: After Prostate Cancer Surgery, Blacks Have More Complications, Higher Costs
Older black men who have surgery for prostate cancer may have more complications and pay higher out-of-pocket costs than white men, a U.S. study suggests. Researchers focused on men with localized prostate tumors who would be good candidates for removal of the prostate gland, which is recommended for higher-risk cases. They didn’t find a difference in overall or cancer-specific survival based on race. (Rapaport, 10/27)

CBS News: Do Men's Health Supplements Help Prostate Cancer Patients?
A new study finds no evidence that men's health supplements help prostate cancer patients. Although popular, such supplements do not appear to lower the risk for experiencing radiation treatment side effects; the risk that localized cancer will spread; or the risk that prostate cancer patients will die from their disease, researchers found. The study focused on supplement use among more than 2,200 men newly diagnosed with localized prostate cancer. (Mozes, 10/19)

NPR: Most E-Cigarette Users Are Current And Ex-Smokers, Not Newbies
It's become an emotional debate: Do e-cigarettes help people get off regular cigarettes or are they a new avenue for addiction? Until now, there has been little solid evidence to back up either side. But a new study from the Centers for Disease Control and Prevention could help fill that void. E-cigarettes work by heating up a fluid that contains the drug nicotine, producing a vapor that users inhale. The CDC found that nearly 48 percent of current tobacco smokers said they had tried e-cigarettes at least once. Among those who recently quit smoking, more than 55 percent said they'd tried the devices. (Stein, 10/28)

NPR: Doctors, Not Parents, Are The Biggest Obstacle To The HPV Vaccine
Vaccination rates against human papillomavirus have remained far lower than rates for other routine childhood and teen immunizations. But a big reason for those low rates comes from a surprising source. It's not hesitant parents refusing the vaccine. Rather, primary care doctors treat the HPV vaccine differently from other routinely recommended immunizations, hesitating to recommend it fully and on time and approaching their discussions with parents differently, a study finds. (Haelle, 10/22)

Reuters: Even Doctors And Nurses Don’t Always Have Healthy Lifestyles
Even doctors and nurses don’t always follow the healthy lifestyle choices they recommend for patients to reduce the risk of medical problems like obesity, heart disease and diabetes, a U.S. study suggests. Although rates of these conditions appeared lower among health care workers than other people, the diseases were still common. They also rose over time at rates similar to increases in the general population, researchers reported in Mayo Clinic Proceedings. (Rapaport, 10/22)

The Oregonian: Kaiser Reduces Complications After Surgery For Patients With Diabetes, Study Says
A study by Kaiser Permanente at its Sunnyside Medical Center in Clackamas found that monitored patients were more than twice as likely to have their blood sugar under control the day after surgery. They were also less likely to be readmitted to the hospital or be rushed to the emergency department with complications. (Terry, 10/27)

The Washington Post: Sleep Study On Modern-Day Hunter-Gatherers Dispels Notion That We’re Wired To Need 8 Hours A Day
Modern life's sleep troubles — the chronic bleary-eyed state that many of us live in — have long been blamed on our industrial society. The city lights, long work hours, commutes, caffeine, the Internet. When talking about the miserable state of our ability to get enough rest, sleep researchers have had a tendency to hark back to a simpler time when humans were able to fully recharge by sleeping and waking to the rhythms of the sun. It turns out that may not be quite right. In fact, it now appears that our ancestors may not have been getting the doctor-recommended eight hours of sleep, either. (Cha, 10/16)

NBC News: Regular Staph Kills More Babies Than 'Superbugs', Study Finds
Ordinary staph infections are just as likely to kill newborn babies as infections caused by a superbug, researchers reported Monday. ... They surveyed 48 neonatal intensive care units around the United States from 1997 through 2012 and found most staph infections — 72 percent of them — caused by ordinary Staphylococcus aureus germs. Just 28 percent were caused by the headline-generating methicillin-resistant Staphylococcus aureus or MRSA. In fact, more babies die from drug-susceptible staph than from MRSA. (Fox, 10/19)

CBS News: Is Any Amount Of Alcohol Safe During Pregnancy?
While some research suggests that small amounts of alcohol may be harmless during pregnancy, a new report from a leading U.S. pediatricians' group warns that drinking is never a good idea for expectant moms. ... According to the paper, published online today in the journal Pediatrics, "there is no safe trimester to drink alcohol" and "all forms of alcohol, such as beer, wine, and liquor pose similar risk." (Welch, 10/19)

CBS News: Got Back Pain? Narcotic Painkillers Won't Help, Study Says
Naproxen -- a drug available over-the-counter and by prescription -- appears to provide as much relief for low back pain as a narcotic painkiller or a muscle relaxant, a new study suggests. The study compared the use of prescription-strength naproxen (Naprosyn) alone to the use of naproxen with the narcotic painkiller oxycodone with acetaminophen (Percocet), or the muscle relaxant cyclobenzaprine (Amrix). Patients who took a combination of drugs fared no better than when they took naproxen alone, the researchers said. (Reinberg, 10/20)

Milwaukee Journal Sentinel: Study: Two-Thirds Of New Cancer Drugs Not Found To Extend Life
Two-thirds of new cancer drugs in the past five years were approved not because they extended or improved life but based on so-called surrogate measures of effectiveness, such as scans showing tumor shrinkage, according to a paper published Monday in JAMA Internal Medicine. What's more, even four years after being allowed on the market by the U.S. Food and Drug Administration, many of the drugs still had not showed they were making people live longer, according to the paper, which closely echoes findings from a Journal Sentinel/MedPage Today investigation from last October. (Fauber, 10/19)

NBC News: Can Infertility Point To Ovarian Cancer Risk?
A woman's need for fertility treatments may point to a higher risk of ovarian cancer, researchers reported Tuesday. A large study of women getting fertility help in Britain shows that those women had a 60 percent higher risk of developing the hard-to-treat cancer. (Fox, 10/20)

The New York Times' Taking Note: Undeserved Payments To Hospitals
The American Hospital Association is attacking a bipartisan budget deal that would serve the American people well. ... The association’s complaint is that the bill ... would reduce a rapidly-growing source of unjust payments to hospitals. ... Section 603 of the bill would effectively force hospitals to stop pretending that physician offices and clinics they acquire as part of a merger are actually part of the main hospital campus. The distinction is important because Medicare pays outpatient clinics located at hospitals a lot more than it pays off–site clinics and doctors for the same services. For certain ambulatory surgeries, for example, Medicare pays roughly 80 percent more in a hospital outpatient department than in a freestanding off-site clinic. ... In fact, Section 603 is a much weaker reform than is needed. It would apply only to outpatient clinics acquired in the future. (Phillip M. Boffey, 10/29)

Bloomberg: Republicans Just Killed Their Own Health-Care Idea
In 2009, prominent Republicans, skeptical of requiring people to buy health insurance under the legislation that became Obamacare, proposed an alternative approach: making large employers automatically sign employees up for health insurance, while also allowing them to opt out. A version of this idea made its way into the Affordable Care Act. But as a result of this week’s budget deal, it is now out -- and Republicans are celebrating. How come? The answers shed new light on some thorny issues in behavioral economics, and also on contemporary politics. (Cass R. Sunstein, 10/29)

The Wall Street Journal: Ryan’s House Revival Project
We know the Wisconsinite has the principles and skills to succeed, but his speakership will be as much a test of the conservative movement as it is of Mr. Ryan. The question is whether conservatives can muster the unity and wit to revive Congress as a governing body. Mr. Ryan is promising to communicate better with the likes of the Freedom Caucus, to cut fewer backroom deals, and to advance an agenda that offers a clearer sense of conservative principles. This all sounds good, especially the last point. That would mean, say, trying to pass a plan to replace ObamaCare, not merely repeal it. Or pushing specific tax cuts or social-welfare reforms that could front-run major reform in 2017. (10/28)

The Washington Post: Ben Carson’s Health-Care Prescription Is No Cure For What Ails Americans
Ben Carson began rolling out his policy alternatives for the American health-care system this week. Like many prescriptions, it’s a bit difficult to decipher at first glance — though not because of poor handwriting. To put it bluntly, CarsonCare is a muddle. It’s hard to know precisely what he’s proposing when he says, as he did in Wednesday’s debate, that it gives people “the option of opting out” of government health care. But based on what we know, it would neither expand access to health care nor improve quality, nor save a whole lot of money. (Ezekiel J. Emanuel and Andrew Steinmetz. 10/29)

Forbes: Crocodile Tears Over The Failing Obamacare Co-Ops--The Canaries In The Obamacare Coal Mine
Let me also suggest that these struggling Obamacare co-ops are tantamount to the canaries in the Obamacare coal mine. These plans are exclusively in the business of the Obamacare insurance exchanges. If you want to segregate the Obamacare insurance business model from the overall insurance business to examine it, the co-ops are pure Obamacare. Just how well have all of the co-ops done? As the Washington Post recently reported, of the 23 Obamacare insurance co-ops in business on June 30, 2015, each of them charted in the article, 20 of them were losing money–most of these relatively tiny insurance start-ups showed staggering losses in the range of $4,000,000 to $50,000,000! (Robert Laszewski, 10/26)

The New England Journal of Medicine: Health Care Reform's Unfinished Work — Remaining Barriers To Coverage And Access
The Affordable Care Act (ACA) has passed its fifth birthday and completed two enrollment periods for coverage in the state-based insurance exchanges and Medicaid. The U.S. uninsured rate is lower than ever, and coverage gains appear to be improving access to primary care and medications, affordability of care, and self-reported health. But challenges for health care reform persist: millions of Americans are still uninsured, and even for those with coverage, substantial barriers remain to obtaining affordable, high-quality care. More than 30 million U.S. children and adults still lack insurance. Who are they, and what policy options exist for covering them? (Benjamin D. Sommers, 10/28)

Louisville Courier-Journal: Health Should Be Priority Of Next Governor
We need to keep and strengthen implementation of the Affordable Care Act under kynect, our state’s health benefit exchange. More than 413,000 people in Kentucky and 105,000 people in Louisville have gained health insurance coverage under Medicaid expansion and Qualified Health Plans through kynect. While Kentucky has historically ranked at or near the bottom of all states in the nation on most health indicators, since 2014, Kentucky, along with Arkansas, has led the nation in reducing rates of uninsured adults. Expanding insurance coverage to so many more people in our state and city promises to vastly improve the health of present and future generations of Kentuckians and Louisvillians. (The Louisville Metro Board of Health, 10/29)

The New England Journal of Medicine: Hospital Charity Care — Effects Of New Community-Benefit Requirements
The Internal Revenue Service (IRS) recently finalized new requirements for nonprofit hospitals to maintain their tax-exempt status under the Affordable Care Act (ACA). Section 501(r) of the Internal Revenue Code now requires each hospital to establish a written financial-assistance policy that applies to all “emergency and medically necessary care.” ... Although the new requirements may do little to increase the scope of existing charity care policies, they could increase the proportion of people eligible for charity care who do receive it. As these requirements are fully enforced by the IRS in 2016, nonprofit hospitals will have to ensure that patients eligible for partial or full charity care receive it. If physicians practicing in nonprofit hospitals familiarized themselves with the charity care policies of their hospitals, they could encourage their patients to apply for charity care when appropriate and thereby reduce their burden of medical debt. (Sayeh S. Nikpay and John Z. Ayanian, 10/29)

The New England Journal of Medicine: Medical-Imaging Stewardship In The Accountable Care Era
Medical-imaging technology plays an essential role in the timely diagnosis and management of many conditions. Lately, however, it's become equally well known for its low-value uses and as the single largest source of per capita radiation exposure. Imaging is by far the most common service on the lists of unnecessary tests and procedures of the Choosing Wisely campaign, and an estimated 20 to 50% of imaging is unnecessary. Medical imaging is thus a valuable resource in dire need of better stewardship. (Daniel J. Durand, Jonathan S. Lewin and Scott A. Berkowitz, 10/29)

JAMA: Options To Promote Competitive Generics Markets In The United States
In August, the price of the 62-year-old drug pyrimethamine (Daraprim), used to treat many potentially fatal parasitic infections, was increased practically overnight from $14 to $750 per tablet. This colossal increase attracted renewed attention to generic pharmaceutical price spikes, prompting public outrage and a new round of proposals to address this issue. Over the past few years, increasing drug shortages and price spikes have affected generic drugs, which now account for 86% of prescriptions and 29% of pharmaceutical spending. A stable supply of affordable generic pharmaceuticals is crucial to improve health care access and appropriate utilization for many Americans. (Clay P. Wiske, Oluwatobi A. Ogbechie and Kevin A. Schulman, 10/29)