The Wall Street Journal: Health Law Faces Its Toughest Stress Test Yet
This is also the first open-enrollment period under a Trump-administration change expanding access to cheaper plans that don’t cover the panoply of benefits mandated by the ACA. Those less-expensive plans can also deny coverage to people with pre-existing conditions. Both of these change could weaken the exchanges where millions of Americans who don’t get insurance from an employer or government program go to obtain coverage. Health analysts say the moves will likely siphon off younger and healthier consumers who are needed to offset the health costs of older, sicker people remaining on the exchanges because they need more robust coverage. (Armour, 11/1)

The Washington Post: Affordable Care Act Open Enrollment Begins And Will Test Republican Health Policies
During the enrollment season — which lasts six weeks, half as long as it used to be — consumers may buy the health coverage created under the ACA. This is the first enrollment since Congress removed the law’s penalty for people who fail to carry health insurance. With that federal fine scheduled to vanish in January, this year’s marketplaces will furnish evidence for a long-simmering debate: How much of the nation’s gains lately in health coverage have happened because of the law’s insurance mandate, and will coverage tumble without it? (Goldstein, 10/31)

The Associated Press: Stable Premiums, More Options As Health Law Sign-Ups Begin
The Affordable Care Act's sixth sign-up season opens Thursday amid stabilizing premiums and more choice for consumers. Nationally, average premiums are going up only by low single-digit percentages for 2019. In some states, and for some types of plans, premiums will decline. Fewer areas will see increases. Insurers also are expanding their participation. (Alonso-Zaldivar, 10/31)

NPR: ACA Insurance Sign-Ups For 2019 Are Starting. Here's What To Expect
It's time for consumers who buy their own health insurance to start shopping for policies for next year. Open enrollment for Affordable Care Act coverage starts Thursday across most of the country. But the shopping and buying experience will vary widely, depending on where people live. (Kodjak, 10/31)

And in enrollment news from across the states --

Arizona Republic: 5 Things Arizonans Should Know For Affordable Care Act Open Enrollment
More insurers are in the marketplace this year, though 13 of Arizona's 15 counties still have only one choice. Blue Cross Blue Shield of Arizona will be the only insurance company selling plans in most Arizona counties this year, and will be selling plans in all counties except Maricopa. Residents of Maricopa and Pima counties will have more choices this year, with four insurance companies selling plans in Maricopa County and three in Pima County. (Innes, 10/31)

The CT Mirror: ACA Enrollment Begins As Voters Say Health Care Is Top Concern
In Connecticut, those who aren’t covered through their employment or government-run plans like Medicare and Medicaid are urged by officials at Access Health CT, the state’s ACA marketplace, to shop for a policy on the exchange from the two insurers that participate, Anthem and ConnectiCare. ... There will be much less “sticker shock” this year because 2019 premiums did not increase much in Connecticut or across the nation. In contrast, premiums rose sharply in 2018, largely because the Trump administration said it would end payments to insurers that allowed them to lower out-of-pocket costs for low-income customers. (Rigg and Radelat, 10/31)

Georgia Health News: Decision Time Is Near . . . For People Enrolling In Insurance Exchange
And for some Georgians returning to the exchange, there may be good news on prices. Two of the four health insurers are set to make reductions in monthly premiums from the rates they offer this year. Such easing of prices, coming on the heels of a year of increases of more than 50 percent, has added more stability to the exchanges in states around the country. ... Another big change for this enrollment period is the drastic cut in funding for the insurance counselors known as navigators, both in Georgia and nationally. The total navigator funding for Georgia’s 2019 enrollment period, $499,995, is about one-third of the funding for the 2018 sign-ups in Georgia. (Miller, 10/31)

Texas Tribune: Affordable Care Act Enrollment Period Begins In Texas
The sign-up period comes months after a U.S. Census report showed Texas still has the largest percentage of uninsured residents in the country at 17.3 percent, nearly twice the national rate. ... Health insurance premiums have increased minimally across the market compared to last year. But Texans still have access to help paying for coverage if they need it. Last year, Texas residents received an average of $477 in tax credits to help help pay for their health insurance, according to U.S. Department of Health and Human Services data. They paid an average of $79 per month after subsidies. But some residents make too much money to qualify for subsidy help. (Evans, 11/1)

Kansas City Star: Obamacare Enrollment Begins With More Stability In KC Area
Last year’s Affordable Care Act open enrollment was tumultuous, with longtime insurers out of the marketplace, new players in and consumers scrambling to figure out who was covering what. This year’s enrollment period, which begins Thursday, promises to be more mundane. Last year’s insurers are back, and Molly Moffett, who heads ACA enrollment efforts for the Community Health Council of Wyandotte County, said the premiums are relatively stable too. (Marso, 10/31)

Tampa Bay Times: Obamacare Open Enrollment Begins Amid Confusion Over New Short-Term Plans
Open enrollment begins today for the Affordable Care Act, and local advocates worry that health insurance changes this year might confuse consumers and keep them from selecting the best plans for their health. A recent change by the Trump administration will allow insurance companies to sell short-term health care plans that are generally cheaper, less comprehensive and not on the federal health care exchange. (Griffin, 11/1)

Richmond Times Dispatch: As Medicaid Enrollment Expands, State Officials Say Challenges Remain To Reach The Needy
The beginning of enrollment in the state’s expanded Medicaid program is expected to extend health care coverage to as many as 400,000 Virginians, most of them with no insurance and others who currently are covered by policies purchased on the federal insurance marketplace with hefty premium subsidies under the Affordable Care Act. ...Chief among the challenges is finding a way to provide dental benefits to people whose medical outcomes often correspond to oral health care that isn’t covered by Medicaid. (Martz, 10/31)

The Associated Press: Enrollment To Start For Medicaid Expansion Population
About 400,000 newly eligible low-income Virginia adults can start enrolling in Medicaid. Medicaid expansion enrollment starts Thursday in Virginia for coverage that will start at the beginning of 2019. Gov. Ralph Northam is set to provide remarks at St. Mary’s Hospital in Richmond. Expanding Medicaid was one of Northam’s biggest legislative priorities. (11/1)

Kansas City Star: Trump Rolled Back Regs On Obamacare Alternatives. Kansas And Missouri Are Stricter
Cheaper alternatives to the health insurance plans offered under the Affordable Care Act may be available to some individuals this year after the Trump administration rolled back some Obamacare regulations. The changes mean that it is up to each state to mandate what those plans cover. Kansas health insurance laws — and to a lesser extent Missouri laws — are now more strict than the new federal rules, requiring insurers to cover more conditions and pay more benefits. (Marso, 11/1)

Even plans on the Affordable Care Act's marketplaces can bring surprise costs for consumers -

Kaiser Health News: In Search Of Insurance Savings, Consumers Can Get Unwittingly Wedged Into Narrow-Network Plans
[Donna] Catanuchi’s switch to a more affordable but restrictive plan reflects a broad trend in insurance plan design over the past few years. The cheaper plans offer far narrower networks of doctors and hospitals and less coverage of out-of-network care. But many consumers are overwhelmed or unaware of the trade-offs they entail, insurance commissioners and policy experts say. With enrollment for ACA health plans beginning Nov. 1, they worry that consumers too often lack access to clear information about which health plans have “narrow networks” of medical providers or which hospitals and doctors are in or out of an insurer’s network, despite federal rules requiring plans to keep up-to-date directories. (Findlay, 11/1)

The New York Times: First Up If Democrats Win: Campaign And Ethics Changes, Infrastructure And Drug Prices
If they win, they would then turn to infrastructure investment and the climbing costs of prescription drugs, answering voter demands and challenging President Trump’s willingness to work on shared policy priorities with a party he has vilified. The idea, said Representative Nancy Pelosi of California, the Democratic leader, is to show voters that Democrats are a governing party, not the leftist mob that Mr. Trump describes — and to extend an arm of cooperation to the president after an electoral rebuke. (Fandos, 10/31)

Reuters: Privacy, Drug Price Bills Have A Fighting Chance In A Post-Election U.S. Congress
If Democrats win control of the House of Representatives in next week’s elections and create a divided U.S. Congress, as they are seen as likely to do, the number of bills with a chance of passing falls dramatically. But two areas of general agreement between the Democrats, Republicans and President Donald Trump stand out as having a high potential of successful legislation: lowering prescription drug prices and new regulations to protect online privacy. (Bartz, 10/31)

The Associated Press: Washington Doctor Uses Experience To Fuel US House Campaign
In her election ads, Dr. Kim Schrier wears a white doctor’s coat as she declares that health care is a right. She talks about her Type 1 diabetes, her concern as a parent over President Donald Trump’s policies and how she counsels families of depressed teen boys as a longtime pediatrician. The Democrat running for an open U.S. House seat in Washington state is framing her candidacy around health care issues with a personal touch, hoping the popularity of aspects of former President Barack Obama’s health care law and support for improving access to medical care drives her to victory. (Ho, 11/1)

The Washington Post: Fact Checker: GOP Hopefuls Say They Fight Insurance Companies, Just Like Obama
When Barack Obama first ran for president in 2008, he promised to force insurance companies to cover preexisting conditions, contrasting his stance with Republican nominee John McCain, who the ad said would let insurance companies “continue to do as they please.” ... Now some Republicans are stealing Obama’s rhetoric and claiming they will do what the ACA – which remains largely intact, despite President Trump’s efforts – already does. It’s certainly an interesting turnaround. (Kessler, 11/1)

And about those state ballot initiatives, they range from Medicaid expansion to a number of other health policy questions -

NPR: Voters In 4 States Set To Decide On Medicaid Expansion
On Election Day, Utah residents will be going to the polls to vote on whether the state will join 33 others and Washington, D.C., in expanding Medicaid coverage to a lot more low-income adults. Democrat and Republican states have expanded. Nebraska and Idaho also have the Medicaid question on ballots in their states. Idaho Gov. Butch Otter, a Republican, endorsed the expansion initiative Tuesday. And in Montana, voters will decide whether to approve a tobacco tax to continue that state's Medicaid expansion or let it roll back next year. (Kodjak, 10/31)

The Washington Post: Abortion, Marijuana, Redistricting And Voting: What’s On State Ballots This Fall
This November, voters in 37 states will face 155 ballot questions. Taxation and bonds are common nationwide. Other ballots are more state-specific. ... In many states, however, ballot questions echo larger national trends. Voters in West Virginia and Oregon will decide whether to amend their state constitutions to limit Medicaid abortion funding to cases of life endangerment, rape and incest, the minimum federal requirement. Officials in both states had tried to curb Medicaid funds for abortion, but state courts overruled them. (Rabinowitz, 10/31)

WBUR: Politics Aside, New Bathroom Designs Move The Boundaries On Gender
State ballot Question 3, which asks voters if they want to keep a transgender civil rights law, has put the spotlight on bathrooms. But the marketplace for bathrooms isn’t waiting for election day. There’s a wide range of changes underway. (Bebinger, 11/1)

The Wall Street Journal: San Francisco Businesses Are Split On Tax Boost To Fight Homelessness
Christin Evans and Gwen Kaplan both run small businesses in neighborhoods they say have become overrun with homeless encampments. Like most San Francisco residents, they agree the problem has grown to an unprecedented scale, with homeless people taking drugs, using the streets as toilets and showing signs of mental breakdown. ... But Ms. Kaplan and Ms. Evans hold opposing views on Proposition C, a ballot measure Nov. 6 that would impose a tax increase on large corporations to raise money to assist the homeless. Recent polling showed San Franciscans evenly divided on the proposal. (Carlton, 11/1)

USA Today: Seema Verma Tweet: 'Scariest Halloween Costume' Is Medicare For All
The head of Medicare and Medicaid was being criticized online Wednesday after she took a Halloween-inspired jab at Medicare for all on Twitter. Seema Verma, Administrator for the Centers for Medicare & Medicaid Services, posted a photo of a man wearing a black T-shirt emblazoned with "Medicare for All" Wednesday afternoon with the comment "this year’s scariest Halloween costume goes to..." ... Verma, in a statement to USA TODAY, said the post was a way to get attention and said critics weren't wrong, changing the U.S. healthcare system isn't a joke. (Hayes, 10/31)

Milwaukee Journal Sentinel: Medicare-For-All: What You Need To Know
Costs, particularly deductibles, seem to increase year after year at a faster rate than inflation. And therein lies at least part of the political appeal of Medicare-for-all, which would have been quickly dismissed a few years ago, but now is drawing a surprising amount of attention and support. (Boulton, 10/31)

Reuters: Anthem Predicts Better 2019 Than Wall Street Forecast, Shares Rise
Anthem Inc on Wednesday said its own expectations for 2019 earnings are ahead of current Wall Street estimates and the health insurer also raised its 2018 profit forecast, and its shares rose as much as 5 percent. The company also reported higher-than-expected third quarter profit as it reined in costs. (Mathias and Babu, 10/31)

The Wall Street Journal: Anthem Reports Earnings Growth, Raises Outlook
Anthem’s medical loss ratio, or the share of premiums spent on health costs, was slightly worse than analysts’ expectations for the third quarter, according to early notes from analysts. But the company also said the number was consistent with its expectations and improved its full-year MLR outlook. During the insurer’s earnings call, analysts asked about slightly higher costs it cited in Medicaid, and Ms. Boudreaux said the business was “performing solidly within our target margins” and should show “continued ongoing strong performance for the full year.” (Prang and Wilde Mathews, 10/31)

The Wall Street Journal: Glaxo’s Shingles Vaccine Gave Earnings A Shot In The Arm
Demand for Shingrix, which is aimed at people age 50 and over, has outpaced Glaxo’s expectations since it launched the vaccine late last year. The company says it now expects sales of £700 million to £750 million ($893 million to $957 million) this year, up from previous guidance of £600 million to £650 million. The vaccine protects against shingles, a disease that leads to a painful rash and that is caused by the reactivation of the chicken pox virus in people whose immune systems have weakened with age. Shingrix got a boost when the U.S. Centers for Disease Control and Prevention last year gave the vaccine favored status over a rival, Merck & Co’s Zostavax. The CDC also recommended that adults who had previously received Zostavax should still receive Shingrix. (Roland, 10/31)

Reuters: GSK Feels Shingles Vaccine Boost, But Shares Slip On Drugs Mix
GlaxoSmithKline’s third-quarter earnings were lifted by demand for its new shingles vaccine on Wednesday, but the British drugs firm’s shares slipped despite an improved outlook as analysts focused on some drugs missing forecasts. (Sandle, 10/31)

In other pharmaceutical and biotech news —

Reuters: Vaccines And Genzyme Help Sanofi Keep Promise Of Return To Growth
Sanofi lifted its 2018 profit target for the second time this year after robust sales of its vaccines and rare diseases division, Genzyme, helped it beat third-quarter profit expectations. (Blamont, 10/31)

Boston Globe: Cambridge Biotech Tango Signs $50m Deal With Drug Giant Gilead
Tango Therapeutics Inc. has cut its first major business deal since debuting last year, a collaboration with the big California drug maker Gilead Sciences Inc. that will pay the Cambridge biotech $50 million up front. Tango, a privately held firm developing a new generation of targeted cancer therapies using the latest advances in DNA sequencing, will work with Gilead to identify new immunotherapy targets. (Saltzman, 10/31)

The Wall Street Journal: Biotechs With No Drugs In Trial Are Raising Millions In IPOs
Biotech IPOs are on track for a near-record year, with a crop of offerings that are younger, more highly valued—and some say riskier—than any in recent memory. Driven by swift advances in medical science and an accommodative Food and Drug Administration that is increasingly willing to accelerate approval of innovative drugs, biotechnology companies are tapping the public markets at very early stages of development—some even before they have a drug in a clinical trial. (Walker, 10/31)

NPR: Cervical Cancer Patients Face Greater Risks With Minimally Invasive Surgery
A treatment for early stage cervical cancer that has rapidly gained acceptance in the United States turns out to be worse than standard surgery, according to two studies. The practice, now thrown into question, is called minimally invasive surgery. Instruments are threaded through small incisions, and surgeons use those to remove a diseased uterus. This technique has been growing in popularity since 2006 and has been widely adopted. (Harris, 10/31)

The New York Times: Studies Warn Against Minimally Invasive Surgery For Cervical Cancer
Compared with the older, open abdominal operation, the minimally invasive approach was more likely to result in recurrence of the cancer and death, researchers found, in the first study that rigorously tested the two methods. The results, published on Wednesday in The New England Journal of Medicine, had been circulating among cancer specialists in recent months and are already changing medical practices. Minimally invasive surgery for cervical cancer had been regarded as an advance that would help women: It lets patients recover faster, and since it had proved safe for other cancers, it was expected to be safe for cervical cancer, too. (Grady, 10/31)

USA Today Network: Cervical Cancer: Less-Invasive Hysterectomy Doesn't Raise Chances Of Survival, Study Shows
The study says more research is needed about the seemingly counterintuitive conclusion. But the results could change how cervical cancer is treated in the United States. “What’s interesting is that in no other study for any other cancer or any other benign condition have we ever found worse overall survival rates for minimally invasive surgical options,” said Dr. Daniel Margul of the University of Cincinnati Medical Center, the study’s co-author. (Saker, 10/31)

CNN: In Cervical Cancer Surgery, Minimally Invasive Is Worse Than Open, Study Says
Radical hysterectomy, or removal of the uterus, cervix and other parts of the female reproductive system, is a recommended treatment for many patients with early-stage cervical cancer. Introduced in 1992, minimally invasive radical hysterectomy -- in which smaller incisions are made with either a laparoscopic or a robot-assisted procedure -- increased in popularity over time. Today, about 40% of cervical cancer hysterectomies are minimally invasive, according to Brigham and Women's Hospital. (Scutti, 10/31)

In other surgical treatment news —

The Associated Press: Appendix Removal Is Linked To Lower Risk Of Parkinson's
Scientists have found a new clue that Parkinson’s disease may get its start not in the brain but in the gut — maybe in the appendix. People who had their appendix removed early in life had a lower risk of getting the tremor-inducing brain disease decades later, researchers reported Wednesday. (Neergaard, 10/31)

The New York Times: Being Fit May Be As Good For You As Not Smoking
Being in shape may be as important to a long life as not smoking, according to an interesting new study of the links between fitness and mortality. The study also explores whether there is any ceiling to the benefits of fitness — whether, in essence, you can exercise too much. The answer, it found, is a reassuring no. (Reynolds, 10/31)

Atlanta Journal-Constitution: Diabetes Medication May Protect Against Common Cause Of Blindness
While common diabetes medication can help lower blood sugar levels, it may also be able to protect against blindness, according to a new report. Researchers from health institutions in Taiwan conducted a study, recently presented at an American Academy of Ophthalmology conference, to determine the relationship between metformin, a common diabetes medication, and age-related macular degeneration (AMD), an eye disease that can cause vision loss. (Parker, 10/31)

The Wall Street Journal: More U.S. Veterans Are Off The Streets
The number of homeless veterans declined in 2018 in response to long-established federal efforts and a push by dozens of local communities, according to the departments of Housing and Urban Development and Veterans Affairs. Nationwide, the number of homeless veterans fell to approximately 38,000, according to an overall count of the homeless taken in January. That represented a 5.3% decline since last year and about half the 73,367 veterans tallied in 2009. Dozens of towns, cities and states have declared an end to vet homelessness in their communities. (Kesling, 11/1)

NPR: Millions Excluded By Language Barrier From Clinical Trials
According to interviews with doctors, government officials and pharmaceutical companies, few Alzheimer's studies include medical interpreters to help patients complete the specialized neuropsychological testing component required. One of the challenges is that clinicians and researchers have strongly cautioned against using interpreters to facilitate neuropsychological testing based on clinical experiences, observations and anecdotal evidence that they affect outcomes, according to a study published in Clinical Neuropsychology. (Eibelman, 10/31)

The New York Times: Training The Next Generation Of Doctors And Nurses
For decades, medical education has followed a timeworn path — heaps of book learning and lectures, then clinical rotations exposing students to patients. But as technology explodes into patient care (surgeons can preview operations using virtual 3-D images built from a patient’s scans), the gap between medical education and real-world care has “become a chasm,” said Marc Triola, director of N.Y.U. Langone’s Institute for Innovations in Medical Education, created in 2013 to address the issue. (Pappano, 10/31)

The New York Times: Once Paralyzed, Three Men Take Steps Again With Spinal Implant
Mr. Mzee, now 33, is one of three men who lost the use of their legs years ago after severe spinal injuries, but who now are able to walk without any supports, if briefly and awkwardly, with the help of a pacemaker-like implant, scientists reported on Wednesday. The breakthrough is the latest achievement in the scientific effort to understand and treat such life-changing injuries. Several recent studies have restored motion to paralyzed or partially paralyzed patients by applying continuous electrical stimulation to the spinal cord. (Carey, 10/31)

NPR: Why Are Premature Birth Rates On The Rise Again?
The rate of premature birth across the United States rose for the third year in a row, according to the annual premature birth report card from March of Dimes, a nonprofit organization that works to improve maternal and infant health. This comes after nearly a decade of decline from 2007 to 2015. In 2017, the premature birth rate was 9.93 percent of births, up slightly from 2016, when it was 9.85 percent. The report card draws from the latest Centers for Disease Control and Prevention data. (Chatterjee, 11/1)

Cleveland Plain Dealer: March Of Dimes Report Shows Ongoing Preterm Birth Struggle In City, County And State
The high percentage of babies born premature in Cleveland placed the city second to last of big cities in the nation, according to the March of Dimes annual report released today. The city’s rate of 14.4 percent is an improvement over the previous year, when the city ranked last, but is still more than two-and-a-half times that of the best ranked city, Irvine, California, at 5.5 percent. (Zeltner, 11/1)

The Wall Street Journal: EPA Allows Farmers To Keep Using Bayer’s Controversial Weedkiller
The Environmental Protection Agency will continue to allow farmers to spray crops with a controversial weedkiller, while tightening restrictions, the agency said. The EPA extended by two years its approval of XtendiMax, a version of the herbicide dicamba made by Bayer, which some farmers and researchers have blamed for damaging millions of acres of crops over the past two years. (Bunge, 10/31)

The Associated Press: Families Take Step Toward Suing EPA For Toxic Paint Stripper
The mothers of two men killed by a toxic paint stripper took a step toward suing the Environmental Protection Agency on Wednesday for failing to take quick action to remove the product from the market. The EPA had pledged in May, after then-Administrator Scott Pruitt met with families of two victims, to wrap up action “shortly” on proposed Obama-era regulations that would eliminate most allowable uses of the paint-stripping solvent methylene chloride. (Knickmeyer, 10/31)

NPR: Groundskeeper Accepts Reduced $78 Million Award In Monsanto Cancer Suit
The groundskeeper who won a massive civil suit against Bayer's Monsanto claiming that the weedkiller Roundup caused his cancer has agreed to accept $78 million, after a judge substantially reduced the jury's original $289 million award. Dewayne "Lee" Johnson, a Northern Californian groundskeeper and pest-control manager, was 42 when he developed a strange rash that would lead to a diagnosis of non-Hodgkin's lymphoma in August 2014. (Sullivan, 10/31)

Los Angeles Times: L.A. County Department Of Public Works Takes Over Long-Criticized Compton Water District
State officials on Wednesday removed the elected board and general manager of a water district that for years has been accused of serving brown, smelly water to its customers in Compton. With a 22-page decree, the State Water Resources Control Board abolished Sativa Los Angeles County Water District’s five-member board of directors and ousted its manager. In their place, the state appointed the county’s Department of Public Works to temporarily run the district while officials seek to merge the small district, which delivers water to about 1,600 homes, with a larger provider. (Jennings, 10/31)

ProPublica: Chicago Lakeshore Hospital Is Under Fire Over Reports Alleging Abuse of Children
A Chicago psychiatric hospital that treats hundreds of children in state care is under federal and state investigation over safety concerns and alleged sexual assaults, and it may be forced to close if it can’t correct deficiencies. The Illinois Department of Children and Family Services has investigated 16 allegations of abuse and neglect this year at the Aurora Chicago Lakeshore Hospital in the city’s Uptown community, including allegations that children were raped and sexually abused by staff and other patients, physically assaulted and inadequately supervised, a ProPublica Illinois investigation found. (Eldeib, 10/31)

ProPublica and Houston Chronicle: Federal Inspectors Cite St. Luke’s In Houston For Problems In A Heart Transplant
The federal government has cited Baylor St. Luke’s Medical Center in Houston for not having working defibrillator paddles in the operating room during a January heart transplant. The transplant ultimately failed, and the patient died two months later. During a review this month, the federal Centers for Medicare and Medicaid Services found that “there were not sufficient quantities of emergency equipment (internal defibrillator paddles) immediately available during cardiac (open chest) surgery,” according to a copy of the report provided by the agency at the request of ProPublica and the Houston Chronicle. (Ornstein and Hixenbaugh, 10/31)

The Associated Press: Rural Virginia County Hopes, After Years, To Reopen Hospital
There was nowhere local to go for care because Lee County's only hospital, about a mile down the road from where McElyea fell ill, abruptly shut its doors in 2013. In the five years since, local community leaders have been fighting to reopen the facility, and after a series of fits and starts, it looked for much of this year like that might happen thanks to a deal with a startup company. But financial challenges the company acknowledges it's been working through have thrown the plan into question at the last minute, officials say. It's a story that illustrates the herculean task of trying to revive a shuttered rural hospital and the harsh realities of disparate access to health care in many parts of America. (Rankin, 10/31)

Arizona Republic: Banner Health Opening Hospital Tower As Part Of $417 Million Project
Banner Health recently invested more than $1 billion into academic medicine construction projects in Arizona and the biggest of those undertakings — a 16-story hospital tower in Phoenix — opens Tuesday. The 372,476 square-foot tower is part of a $417.9 million upgrade at Banner-University Medical Center Phoenix, 1111 E. McDowell Road. (Innes, 10/31)

Atlanta Journal-Constitution: Piedmont Healthcare Reaches Surgical Milestone
Piedmont Healthcare’s Minimally Invasive & Robotic Surgery Program recently celebrated its 15,000th robotic surgery, according to a press release. That’s a milestone for the program that is one of only a handful of large volume robotic programs in the country and that also ranks in the top 20 percent globally in the number of robotic procedures it performs, according to the release. (Miller, 10/31)

USA Today Network: Adenovirus Outbreak At New Jersey Pediatric Center: 10th Child Dies
A 10th child died Wednesday night from adenovirus after an outbreak at a New Jersey long-term care center that has infected 27 medically fragile children, the state Health Department said. The death came as the outbreak entered its sixth week at the Wanaque Center for Nursing and Rehabilitation. (Washburn, 11/1)

The Associated Press: 2nd Pediatric Facility In New Jersey Hit By Viral Outbreak
Patients at a second New Jersey pediatric facility have been found to have a respiratory virus, but authorities say it’s a different strain from the one linked to nine deaths. The state health department says there are four confirmed adenovirus cases among pediatric patients at Voorhees Pediatric Facility. But preliminary tests have ruled out Type 7, the strain linked to nine deaths at the Wanaque Center for Nursing and Rehabilitation. (11/1)

New Hampshire Public Radio: Study Highlights Child Food Insecurity In New Hampshire
A new report out from UNH's Carsey School of Public Policy highlights the issue of child food insecurity in New Hampshire.To be food insecure means that a child's household goes without access to healthy meals for a portion of the year. It points to data which show that in 2016, Coos County had the state's highest rate of child food insecurity at almost 18 percent. (Garrova, 10/31)

The Associated Press: Whistleblower Says California Prison Officials Misled Judge
Top California corrections officials are misleading a federal judge and attorneys representing inmates about the quality of mental health care behind bars, according to a report released Wednesday that cites a case where a woman received care so poor she plucked out her eye and ate it. The whistleblower report by chief corrections psychiatrist Dr. Michael Golding that was made public by U.S. District Judge Kimberly Mueller says prison officials overruled psychiatrists and misrepresented how often inmates were receiving proper care. (Thompson, 10/31)

Texas Tribune: How Texas Fails To Serve Parents Who Qualify For Subsidized Child Care
In Texas, the demand for subsidized child care has swamped the supply — Texas has more than a million children under 13 who could potentially qualify for subsidized child care, but the state helps just over 9 percent of them, according to Children at Risk, a nonprofit that specializes in policy research related to child care, education and health. According to the federal Office of Child Care and the Annie E. Casey Foundation's Kids Count Data Center, Texas ranked 41st nationally in fiscal year 2015 in providing monthly child care assistance to children under 13 who qualified for it, behind both southern states like Georgia, which ranks 25th, and northern states like New York, which ranks 9th. (Waller, 10/31)

Cleveland Plain Dealer: As Ohio Gun Deaths Continue To Increase, Action In Local Communities Is Limited By A 2006 State Law
In 2006, the state's rural legislators rewrote the laws for urban areas where most of the gun murders occur. In doing so, they wiped away dozens of municipal ordinances enacted by cities like Cleveland. Since then gun homicides are up 60 percent in Ohio's six big urban counties, and 39 percent in throughout the rest of the state. (Exner, 11/1)

Milwaukee Journal Sentinel: Find-A-Ride Will Bring Ridesharing To Seniors And Those With Disabilities
After the rise of transportation apps like Lyft and Uber, a new local service wants to broaden ridesharing’s inclusivity. Seniors and those with disabilities are the focus of the Find-a-Ride Network, which will start a pilot phase in Menomonee Falls on Dec. 3. The network then plans to expand service to all of Waukesha County. (Wickman, 10/31)

New England Journal of Medicine: What We Can Do About Maternal Mortality — And How To Do It Quickly 
Most Americans take for granted that giving birth in a U.S. hospital will be a safe experience resulting in a healthy mother and baby. However, recent reports in the lay media — an NPR special series called “Lost Mothers: Maternal Mortality in the U.S.”; a New York Times article on closures of rural maternal services; and a USA Today series, “Deadly Deliveries” — discuss increasing maternal mortality in the United States and the significant concern it presents for childbearing women and their families. Women in the United States are more likely to die from childbirth- or pregnancy-related causes than women in any other high-income country, and black women die at a rate three to four times that of white women. Increasing maternal mortality is a tragedy, and though multiple factors contribute to the risk of maternal death, national and state reviews have identified the most preventable contributors. (Susan Mann, Lisa M. Hollier, Kimberlee McKay and Haywood Brown, 11/1)

New England Journal of Medicine: Postpartum Care In The United States — New Policies For A New Paradigm
In April 2018, the American College of Obstetricians and Gynecologists (ACOG) called for a new paradigm for postpartum care in the United States. According to the ACOG committee opinion, postpartum care should be an ongoing, individualized, and woman-centered process, rather than being limited to the “arbitrary 6-week check” that constitutes care for most women today. We believe that such a shift is critical to improving postpartum care and outcomes. More than half of pregnancy-related deaths occur during the year after delivery, and many women have postpartum complications such as pain and bleeding, high blood pressure, lactation difficulties, and pelvic-floor dysfunction. (Mara E. Murray Horwitz, Rose L. Molina and Jonathan M. Snowden, 11/1)

The New York Times: The Neuroscience Of Hate Speech
You don’t need to be a psychiatrist to understand that the kind of hate and fear-mongering that is the stock-in-trade of Mr. Trump and his enablers can goad deranged people to action. But psychology and neuroscience can give us some important insights into the power of powerful people’s words. We know that repeated exposure to hate speech can increase prejudice, as a series of Polish studies confirmed last year. It can also desensitize individuals to verbal aggression, in part because it normalizes what is usually socially condemned behavior. (Richard A. Friedman, 10/31)

The Hill: Violence Against Women Act Diminishes The Seriousness Of Domestic Violence 
Domestic Violence (DV) will be redefined if the Violence Against Women Act (VAWA) (H.R. 6545)  is reauthorized in its revised form. VAWA is the federal touchstone for how DV is addressed nationwide. Passed in 1994, the act has been reauthorized in 2000, 2005 and 2013, with additions attached each time. The 2018 reauthorization is no exception. The pending bill would expand the definition of DV in a way that could harm abused women and other innocent people. (Wendy McElroy, 10/31)

Stat: Medicine Must Make Resilience Part Of The Curriculum 
During a recent run-in with burnout, my co-resident at a large teaching hospital in Boston proposed several small but tangible changes that would significantly improve her life as a physician, things like getting help with retrieving outside hospital records, securing prior authorizations for certain medications, and scheduling follow-up appointments at discharge. She was instead reminded that “these things are a part of our job, and we need to explore why everyone else is doing them fine and you are getting burned out because of them. For any line of work, you have to learn to cope with the negatives.”She would feel better, she was told, if she could “be more resilient in difficult situations.” (Rich Joseph, 11/1)

Bloomberg: Save The Climate, Eat Less Red Meat 
Ultimately, if people worldwide who heavily rely on meat switch to a more plant-based diet, they could potentially decrease food-related greenhouse-gas emissions by almost half by 2050. People reluctant to cut back might find it persuasive to learn that eating less meat, especially less red meat, could help them live longer. Red and processed meat-heavy diets are associated with certain kinds of cancer and with health problems such as obesity, diabetes and high blood pressure. Consider the findings from one of Springmann’s earlier studies: If everyone in world became vegetarian, annual deaths would fall by 7.3 million. (Jessica Fanzo and Shreya Das, 10/31)

New England Journal of Medicine: Health Regulation For The Digital Age — Correcting The Mismatch 
Does it make sense that Alexa can remind me when I need to purchase more cereal but not when I need to take my insulin? Rather than applying ill-fitting old laws to new digital medicine interventions, we could tailor a new regulatory regime to new technologies. (Barak Richman, 11/1)

Bloomberg: Want Lower Health-Care Costs? Seduce The Providers. 
Health-policy experts have long debated whether better outcomes and lower costs are achieved by putting more consumer “skin in the game” or by changing how providers such as hospitals and doctors are paid. It doesn’t have to be one or the other, but it’s becoming increasingly clear that if forced to choose, we should focus mostly on the incentives for providers. (Peter R. Orszag, 10/31)

The New York Times: A Voter’s Guide To Health Care
Health care is routinely cited by voters as their top issue as they head to the polls next Tuesday, and rightly so — the midterms could help decide whether many Americans will have access to care and how much it will cost. Mr. Hawley is only one of many candidates on both sides of the aisle eager to convince them that he’s in their corner. Given that interest, it’s worth clarifying the record on these issues so voters are informed heading into the polls. Will Republicans try to repeal the Affordable Care Act again? Will Democrats push hard toward a single-payer system — and, if so, what will that mean for employer-based insurance and Medicare as we know it? And which party will be more likely to protect Americans with pre-existing medical conditions from insurance discrimination? (10/31)

The Washington Post: The Big Secret About The Affordable Care Act: It’s Working Just Fine 
On Thursday, the Affordable Care Act health-insurance exchanges open for the sixth year. A well-kept secret about them is hiding in plain sight: Despite the Trump administration’s best sabotage efforts, the exchanges are succeeding. Indeed, by almost every metric, the exchanges are now stable and even thriving. Just days before an election in which health care is a top issue, this important point has been almost totally ignored. (Ezekiel Emanuel, 10/31)

Bloomberg: Big Pharma's Price Freezes Aren't Fooling Anybody 
Earnings are now in at most of the biggest pharmaceutical firms, and one thing is clear from their results: One of President Donald Trump's most visible efforts to strong-arm them on prices hasn't caused much pain. (Max Nisen, 10/31)

The Hill: Addressing The Dual Crises Of Pain And Opioids — A Case For Patient-Centeredness
To be truly effective, our pain treatment programs and our policies should be evidence-based. They should be patient-centered. And, as one component of patient-centeredness, they should be accessible to those who need them. Three examples of ways to increase patient access to pain care include integrating foundational pain education into the trainings of all health-care clinicians, preserving access to physician-prescribed medication (including opioids when appropriate) and providing digital behavioral pain medicine to patients who cannot easily access in-person treatment. (Beth Darnall, 10/31)

USA Today: As Opioid Crisis Persists, US Must Adopt Overdose Prevention Sites
Today, 200 Americans likely will die from a drug overdose. Most of them will die alone. The government's modern-day response to our nation's overdose epidemic has been woefully inadequate. Rather than relying on medical science, our leaders have been influenced by the same misguided approaches that undergirded the “war on drugs” in the 1980s — fear, stigma and racism. We need a smarter strategy that reduces harm and saves lives. This starts with prosecutors ending the criminal crackdown on drug users — pushing for treatment instead of pressing charges; encouraging law enforcement to change street approaches; and, most of all, calling for the development of overdose prevention sites where people can consume substances under supervision, get clean needles, and get access to treatment and counseling. (Miriam Aroni Krinsky and Dan Satterberg, 11/1)

The Washington Post: The Bad Science Behind The Trump Administration’s Anti-Trans Policy
In short, the Trump administration is relying upon a historical falsehood in saying that the definition of sex is old and well established, and it moreover relies upon specific historical interpretations of sex that no longer reflect scientific consensus. Historically speaking, biological sex has never had a stable definition. (Tom Butcher, 10/31)

St. Louis Post-Dispatch: Missouri Could Benefit From Illinois' Experience With Legalized Medical Marijuana
Illinois’ experience with tightly controlled medical marijuana production and sales is worth deeper study by Missouri. If medical marijuana is legalized here after Tuesday, Missouri officials should consider a visit to Springfield, armed with that big question: Having done this, what would you have done differently? (10/31)

USA Today: Going To Pot: On Election Day, Will More States Legalize Marijuana?
As voters in Michigan and North Dakota head to the polls Tuesday to weigh whether marijuana should be legal for recreational use, they don’t have much definitive data to help make this difficult choice.Although marijuana has been sold legally in Colorado and Washington state since 2014, conclusions about its effect on public health and safety are either limited or mixed. ...While legalizing sales remains a tough choice, some changes in the nation’s policies are clearly needed: Harsh criminal penalties for personal use should be abandoned. And medicinal use — already legal in 31 states and up for a vote in Missouri and Utah on Tuesday — makes sense, as long as laws are not so loose that anyone can get a prescription. (10/31)