The Wall Street Journal: UnitedHealth Raises Doubts About Its Participation In Affordable Care Act
UnitedHealth Group Inc. said it expects major losses on its business through the Affordable Care Act’s exchanges and will consider withdrawing from them, in the most prominent signal so far of health insurers’ struggles with the health law’s marketplaces. The disclosure by the biggest U.S. health insurer, which had just last month sounded optimistic notes about the segment’s prospects, will sharply boost worries about the sustainability of the law’s signature marketplaces, amid signs that many insurers’ losses on the business continue to mount. (Wilde Mathews, 11/19)

Forbes: UnitedHealth Group May Leave Obamacare Exchanges By 2017
The nation’s largest health insurer said it was “evaluating the viability of the insurance exchange product segment,” pulling back on its marketing efforts for individual exchange products for next year and “will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017.” The insurer sells individual plans on public exchanges in 24 states and covers more than a half million Americans in these plans. (Japsen, 11/19)

Bloomberg: UnitedHealth May Leave Obamacare Marketplace; Stock Slides
Insurers have struggled to profit from the government-run marketplace created by Obamacare. Anthem Inc. last month said some rivals were offering premiums too low to provide the coverage patients require and book a profit. “We can expect other participants to guide to the same experience,” Sheryl Skolnick, an analyst at Mizuho Securities, said in a note. The Minnetonka, Minnesota-based company “is insulated in part from the exchange issue because it entered late and in a more limited way than peers, and because it has a more diversified business model. We expect the group to get hit harder.” (Tracer, 11/19)

Minneapolis Star Tribune: UnitedHealth Group Cuts Earnings Outlook On Exchange Woes
Currently, UnitedHealth Group has about 550,000 customers through health insurance exchanges in 23 states. When the exchanges were launched in 2014, UnitedHealth Group offered products in only a few of the marketplaces, but grew the business considerably this year. (Snowbeck, 11/19)

Reuters: Health Insurer UnitedHealth Cuts Full-Year Profit Forecast
"in recent weeks, growth expectations for individual exchange participation have tempered industry wide ... so we are taking this proactive step," UnitedHealth Chief Executive Stephen Hemsley said in a statement on Thursday. ... Other large health insurers including Cigna, Humana, Aetna have said also said that the individual plans they offer could be affected in 2016. (11/19)

In other insurance industry news -

The Wall Street Journal: Shares Of Deal Targets Reflect Regulatory Fear
Shares of some high-profile takeover targets are trading at steep discounts to the prices of deals they signed, showing fissures may lurk in the current deal boom. ... Cigna Corp.’s stock is 22% below the value of Anthem Inc.’s $48 billion offer, while oil-field-services provider Baker Hughes Inc. trades 17% cheaper than the price of its pending $35 billion sale to Halliburton Co.​ ... Meanwhile, there have been signs that regulators take a dim view of some of the big pending deals. They are closely reviewing both Anthem’s deal for Cigna and the $34 billion proposed tie-up of Aetna Inc. and Humana Inc. Together, the two deals would trim the number of big health insurers from five to three. (Hoffman, 11/18)

The Wall Street Journal: Health-Plan Rates Vary Widely, But Most Popular Have Jumped From 2015
For a snapshot of typical insurance prices for 2016 under the health law, The Wall Street Journal examined choices for a midrange “silver” plan through HealthCare.gov for people who currently have coverage with the most popular insurer in their state. Specific premiums vary based on age, locality, the extent of coverage offered and family size, but pricing trends are generally consistent across plans—including those sold directly to people without using HealthCare.gov. (Radnofsky and Overberg, 11/18)

The Wall Street Journal: Rising Rates Pose Challenge To Health Law
Many people signing up for 2016 health policies under the Affordable Care Act face higher premiums, fewer doctors and skimpier coverage, which threatens the appeal of the program for the healthy customers it needs. Insurers have raised premiums steeply for the most popular plans at the same time they have boosted out-of-pocket costs such as deductibles, copays and coinsurance in many of their offerings. The companies attribute the moves in part to the high cost of some customers they are gaining under the law, which doesn’t allow them to bar clients with existing health conditions. (Radnofsky, Overberg and Armour, 11/18)

The New York Times: Shopping For Health Insurance Is New Seasonal Stress For Many
For 2014, the first year she got health coverage through the Affordable Care Act, Gail Galen chose a plan from a new nonprofit insurer, Oregon’s Health CO-OP. But the price jumped for 2015, so Ms. Galen switched to a policy from a different company, LifeWise Health Plan. Now, with open enrollment for 2016 underway, she is preparing to leap to her third insurer in three years — and stocking up on whiskey, she says, only half in jest, as she braces for another round of shopping on the federal insurance marketplace. (Goodnough, 11/18)

The New York Times: Health Care Law Forces Businesses To Consider Growth’s Costs
Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee. Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company’s profit and the five-figure salary she pays herself from it, she said. ... The health care law’s employer mandate, a provision that business groups fought against fiercely, is intended to make affordable health insurance available to more people by requiring employers to bear some of the cost of providing it. (Cowley, 118)

The Chicago Tribune: Blue Cross Premiums Jump More Than 17 Percent In Illinois
Some [Illinois] health care consumers are seeing rate increases of 40 percent or more. Rate increases for the lowest-cost plans in the majority of counties are in the 15 to 20 percent range, according to the Illinois Department of Insurance. Blue Cross is the target of a lot of consumer unhappiness. The state's dominant health insurer raised 2016 premiums an average of 17.8 percent on individual policies sold on or off the exchange, according to HealthCare.gov. (Sachdev, 11/17)

The Chicago Tribune: About 175,000 Eligible But Uninsured In Chicago Area
During the third season of open enrollment under the health care law, the Obama administration has called on Chicago and other cities with large numbers of uninsured to increase their outreach to help people gain coverage. ... In Illinois, more than 300,000 are enrolled in marketplace plans. But that represents only about one-third of those eligible for insurance under Obamacare. In the Chicago area about 175,000 people are uninsured but eligible for insurance. (Sachdev, 11/17)

The Miami Herald: HHS Secretary Burwell Visits Miami To Promote Obamacare Enrollment
With more than a million Floridians signed up for coverage through the Affordable Care Act’s insurance exchange — and nearly as many still uninsured but eligible for some type of plan in 2015 — Health and Human Services Secretary Sylvia Burwell visited Miami on Wednesday to make a hard sell for people to enroll. She toured an enrollment center at Miami Dade College’s Wolfson Campus downtown, met privately with South Florida healthcare leaders and held a press conference where she introduced a Miami small business owner who pays $75 a month for coverage through the exchange. (Chang, 11/118)

The Baltimore Sun: Advocates Find Problems With Lists Of Health Exchange's OB-GYNs
For the second time in a year, consumer advocates have found that the specialists listed as available to those who bought health insurance on the state exchange aren't all that available. When the advocates tried to call the obstetrician-gynecologists in the online directory of insurers' in-network providers, they found the list so outdated that only about 22 percent of the 1,493 practitioners were accepting new patients, performed well-patient visits and had appointments available within four weeks. (Cohn, 11/18)

The Dallas Morning News: Study: Dallas, Collin Shoppers Face Biggest Obamacare Price Hikes If They Don’t Switch
Dallas County is the country’s major metropolitan area with the largest potential premium increase next year for people currently enrolled in the most popular health insurance plan on the Affordable Care Act marketplace, a new report shows. (Garrett, 11/18)

Minnesota Public Radio: Allison O'Toole Chosen As MNsure CEO
MNsure's board of directors has unanimously chosen interim CEO Allison O'Toole to become it's permanent leader. O'Toole took over MNsure last spring and was not a candidate for the permanent CEO job. A search committee had named just one finalist, Minnesotan Mark Nyquist who's worked for UnitedHealth Group and General Mills. (Zdechlik, 11/18)

AL.com: Gov. Robert Bentley's Task Force Recommends Medicaid Expansion
A task force appointed by Gov. Robert Bentley today recommended that the governor and the Legislature find a way to provide health insurance for Alabamians without coverage. The Alabama Health Care Improvement Task Force approved a recommendation that said the biggest obstacle in improving health is the "coverage gap that makes health insurance inaccessible to hundreds of thousands of Alabamians." The majority of that group are working people who earn too much to qualify for Medicaid but don't have private insurance, according to the Task Force statement. (Cason, 11/18)

Montgomery (Ala.) Advertiser: Bentley Task Force Backs Expanded Medicaid
A task force created by Gov. Robert Bentley voted Wednesday to recommend Medicaid expansion, citing the potential public health and economic benefits and the need to keep state hospitals open. Bentley and the Legislature will still have to decide how — and if — to move forward on the proposal, which could extend health insurance to 300,000 people in the state. But the vote by the Alabama Health Care Improvement Task Force, passed without dissent, means one step forward in a difficult process. (Lyman, 11/18)

The Hill: Republican Senator Vows To Block Nominees Over Obamacare Co-Ops
Sen. Ben Sasse (R-Neb.) is ramping up his vow to block all of President Obama’s health-related nominees until he gets answers about the failure of ObamaCare co-op plans. Twelve of the 23 co-ops — nonprofit health insurers set up under ObamaCare and meant to compete with established companies — have failed because of financial problems. Sasse has demanded answers from the Department of Health and Human Services (HHS) about why the co-ops are failing but said he had heard nothing. He now plans to use Robert Califf’s nomination as Food and Drug Administration commissioner as leverage. (Sullivan, 11/18)

The Washington Post: House Panel Ordered To Comply With SEC ‘Political Intelligence’ Probe
A federal investigation into Washington-style insider trading got the green light to continue this week when a judge ruled that congressional staff must provide information to investigators about possible leaks of sensitive information to investors. ... The investigation has focused attention on a relatively new and highly lucrative form of Washington consulting in which “political intelligence” firms leverage their connections on Capitol Hill and inside executive agencies to provide investors with special insights to inform their trading decisions. That Washington-to-Wall Street communication is at the heart of the SEC investigation into the health-insurance stock surge. The episode began after a Washington-based firm, Height Securities, published an alert to clients on April 1, 2013, predicting an imminent change in a rule governing health insurance companies participating in a Medicare program. (Hamburger, 11/18)

CQ Healthbeat: Bipartisan Anger Over Pharmacy Benefit Manager Power At Hearing
Republicans and Democrats showed rare unity in a hearing over competition among pharmacy benefit managers, combining their attacks against companies for contributing to soaring drug prices and trampling independent pharmacies. The House Judiciary Regulatory Reform, Commercial and Antitrust Law Subcommittee, which has maintained a focus on a rapidly consolidating health care industry, turned its attention on Tuesday to these specialized companies that typically negotiate discounts and rebates with drug manufacturers for their clients. (Chamseddine, 11/18)

Reuters: Express Scripts And Other Major PBMs Clamp Down On Specialty Pharmacies
In recent days, the largest managers of private prescription drug benefits in the U.S. have cut off at least eight pharmacies that work closely with drugmakers, intensifying scrutiny of a system that helps inflate drug prices, officials at the benefit managers told Reuters. The terminations come from payers who together manage drug benefits for more than 100 million Americans, and they follow disclosures by Valeant Pharmaceuticals International Inc. in late October that one pharmacy accounted for about 7 percent of its sales. (Humer and Beasley, 11/18)

The Associated Press: Kasich Aides Helped Craft Abortion Restrictions
Believing state legislators were solely responsible for abortion restrictions added to the 2013 budget bill, activists and editorialists across Ohio called on Gov. John Kasich to veto the provisions. What they didn't know at the time was that Kasich's office had a hand in developing some of the language. Among other things, the provisions required abortion clinics to have emergency-transfer agreements with hospitals, prevented public hospitals from joining those agreements and strengthened the state health director's authority to refuse exceptions. The combination contributed to clinic closures or near-closures in several cities. (11/18)

The Wall Street Journal's Washington Wire: Club For Growth, Long An Establishment Gadfly, Takes Aim At Outsider Carly Fiorina
The conservative Club for Growth is casting doubt on another Republican presidential contender with less experience in elected office than many of her rivals. ... The group plans to release a research paper Thursday that questions Mrs. Fiorina’s commitment to the small-government, free-market policies the group advocates. The Club has raised similar doubts about businessman Donald Trump and retired neurosurgeon Ben Carson. The seven-page research document calls attention to Mrs. Fiorina’s past support for tax breaks for specific industries, inconsistent positions on spending issues, and general lack of specificity in how she would reform Medicare and Social Security. (O'Connor, 11/18)

The Wall Street Journal: Clinton And Sanders Escalate Sniping On Health-Care Taxes
Democratic presidential contenders Hillary Clinton and Sen. Bernie Sanders for months have warily circled one another, contrasting their policy ideas in mostly gentle terms. No more. This week, Mrs. Clinton, the front-runner, unloaded on the Vermont senator, charging that Mr. Sanders would raise taxes on the middle class to pay for his single-payer health-care plan that would have the government replace private insurance companies to pay claims. (Meckler, 11/18)

The New York Times: Reviews Reveal Divisions Within The Clinton Health Initiative, Starting At The Top
Its chief executive, Ira C. Magaziner, who is admired as a brilliant, farsighted leader, has long alienated co-workers at the Clinton Foundation. But a harsh new set of complaints about Mr. Magaziner were captured this year in a performance review, with most of the grievances coming from the board of the Clinton Health Access Initiative, or CHAI, of which Chelsea Clinton is a member. The review said Mr. Magaziner had shown “disdain” for the health initiative’s board, exhibited “duplicitousness with management” and displayed a “lack of transparency” and “dismissive behavior” toward Clinton family members. (Haberman, 11/18)

The Washington Post: Top VA Official: Private Doctors Must Be ‘Part Of The Fabric Of VA Care’
A top Veterans Affairs official told lawmakers Wednesday that the government’s network of private doctors available to veterans at taxpayer expense is “too complicated” for veterans, physicians and VA employees. Deputy Secretary Sloan Gibson, laying out an ambitious plan to merge and expand VA’s private health-care system, said reforming what has become an inefficient, unwieldy bureaucracy is crucial to making outside care “part of the fabric of VA care” to meet a growing demand from veterans. (Rein, 11/18)

The Arizona Republic: Ruling: Former Phoenix VA Boss Sharon Helman May Keep Bonus
The Department of Veterans Affairs cannot rescind a bonus paid to former Phoenix VA hospital Director Sharon Helman shortly before she was fired last year for misconduct, according to a ruling by an administrative judge.​ (Wagner, 11/18)

The Orlando Sentinel: Mica's Bill Would Have State Run Lake Baldwin VA Nursing Home
Rep. John Mica wants to transfer the operations of an empty nursing home on the Lake Baldwin campus from the federal Department of Veterans Affairs to Florida VA. He introduced a bill on Wednesday, hoping that the transfer to the state would speed up the re-opening of the 120 empty beds. "These valuable nursing beds cannot remain vacant at Lake Baldwin," said Mica. “The State of Florida can speed up the opening of the nursing care facility, provide staffing, reduce costs to federal taxpayers and operate more efficiently." (Miller, 11/18)

The Associated Press: Heroin Antidote Gets OK
The Food and Drug Administration has approved an easy-to-use version of the life-saving drug that reverses heroin and prescription painkiller overdoses, as communities across the country grapple with a wave of drug abuse. The reformulated drug, sold as Narcan, comes as a nasal spray and should help first responders, police and others deliver the antidote in emergency situations. Known generically as naloxone, the drug reverses the effects of opioids — drugs that include legal painkillers such as oxycodone and illegal narcotics such as heroin. (11/18)

STAT: FDA Approves Nasal Spray That Reverses Opioid Overdose
A critical drug used to reverse opioid overdoses will now be sold as a nasal spray, a development that will likely broaden use of the antidote among family members and friends of addicts caught up in a growing national epidemic of drug abuse. (Armstrong, 11/18)

The Washington Post: NIH Ends Era Of U.S. Medical Research On Chimpanzees
The National Institutes of Health has quietly ended the federal government’s long and controversial history of using chimpanzees for biomedical research. Director Francis Collins announced Wednesday that 50 chimpanzees held by the government for medical research will be sent to sanctuaries. His decision came a little more than two years after NIH decided to release more than 300 chimps at research facilities across the country and resettle them in more-humane conditions. (Fears, 11/18)

The Baltimore Sun: NIH Says It Will Retire All Remaining Research Chimpanzees
The National Institutes of Health will reduce its staff by 50 — chimpanzees. The director of the nation’s biomedical research facility announced late Wednesday that the primates, the closest living relatives to humans, would no longer be needed to test experimental vaccines, drugs or other treatments. As a result, the remaining animals in the NIH’s chimp colony will be sent to sanctuaries to retire. (Kaplan, 11/18)

The Chicago Tribune: AMA Doesn't Want You To See Those Cialis Ads
The American Medical Association on Tuesday called for a ban on consumer advertising for prescription drugs and medical devices, saying such marketing could be driving demand for unnecessary expensive treatments. The Chicago-based association said it adopted a policy supporting an advertising ban and called for greater transparency in prescription drug prices and costs. The policy was adopted by physicians at an AMA meeting in Atlanta. (Russell, 11/18)

The Washington Post: American Medical Association Urges Ban On TV Drug Ads
The resolution, approved by the AMA’s House of Delegates, has no immediate impact as only the Food and Drug Administration or Congress has the power to ban pharmaceutical advertising. ... According to the AMA, as more people seek drugs they may not need from doctors who may not be willing to prescribe them, drug prices and the money spent on selling them is on the rise. The group reported an 30 percent uptick in the money spent on DTC ads in the past two years, now a total of $4.5 billion. (Moyer, 11/19)

Marketplace: Doctors Vote To Stop Drug Ads To Consumers
Julie Donohue, an associate professor at the University of Pittsburgh’s Graduate School of Public Health, has studied direct-to-consumer drug advertising for 15 years. She said even if the federal government were to ban the ads, “it’s very unlikely the ban would stand up to a legal challenge, which would almost certainly be mounted by both the pharmaceutical industry and media.” (Scott, 11/18)

The San Jose Mercury News: Attorney General Kamala Harris Delays Decision On Daughters Of Charity Deal
California Attorney General Kamala Harris on Wednesday said her office will delay for two weeks a decision she was expected to announce Thursday on a proposed deal between the struggling Daughters of Charity Health System and a New York-based hedge fund. (Seipel, 11/19)

The Baltimore Sun: Funding In Jeopardy For 1,000 New Jobs Proposed By Hospitals After The Unrest
A widely supported program to create 1,000 mostly entry-level jobs at Johns Hopkins and other local hospitals was dealt a blow Wednesday when state regulators recommended against letting the facilities raise their prices to fund it. Administrators at Hopkins and other hospitals conceived the program to address the hopelessness expressed by many in Baltimore's toughest neighborhoods during the unrest of April. (Cohn, 11/18)

The Des Moines Register: UnityPoint To Help Launch Health-Insurance Carrier
Iowa’s largest hospital-and-clinic system plans to start selling health insurance. UnityPoint Health announced Tuesday that it is joining forces with a Minnesota-based company, HealthPartners, to sell Medicare Advantage policies, starting in fall 2016. Medicare Advantage policies are private plans that seniors can choose instead of traditional Medicare coverage. (Leys, 11/17)

The Associated Press: Florida Hospitals Say They Spent $1.5B In Charity Care
Florida hospitals paid for $1.5 billion in health costs for uninsured and underinsured patients last year. The Florida Hospital Association released its annual report Wednesday, noting it provided inpatient care for 2.7 million people and treated 9.5 million patients in emergency rooms in 2014. Hospitals contributed a total of $4.2 billion in community benefits, including charity care. Hospitals also spent about $22.4 million to ensure they are prepared to for emergencies, including hurricanes or outbreaks such as Ebola. (11/18)

Minnesota Public Radio: Hospitals Finding Ways To Fight Delirium In Elderly Patients
Delirium is a common and a terrifying experience for elderly hospital patients and their loved ones. But the hallucinations, paranoia and other symptoms can be avoided. More than two dozen Minnesota hospitals have new programs to help. (Benson, 11/19)

WBUR: A Tale Of 2 Hospital Visits: How The Cost Of Care Can Vary Dramatically Depending On Where You’re Treated
The stomach cramp and nausea began one hot Friday evening in August, midway through a vacation on Martha’s Vineyard. The next morning, nearly doubled over in pain, a patient who we’ll call “Nancy” walked gingerly into the emergency room at Martha’s Vineyard Hospital. Nancy is a 55-year-old former nurse who would prefer not to use her real name because she works with the hospitals in this story. Even Nancy, who spends hours every day focused on health care costs, would gasp when she saw the bill for this visit. (Bebinger, 11/18)

Also, Modern Healthcare examines these trends -

Modern Healthcare: How Hospitals Are Prepping For Medicare's Mandatory Bundled-Pay Test
Hospitals in dozens of U.S. markets are now cramming for a compulsory test of Medicare payment reform. The hardest part may be that their success relies on the work of partners they aren't used to collaborating with. Hospitals in 67 metropolitan areas learned this week they have no choice but to accept a single sum for the cost of care during and 90 days after patients visit the hospital for hip and knee replacement surgery, a strategy known as bundled payments. (Evans, 11/18)

Modern Healthcare: Stronger Economy Drives More Nursing Turnover, Higher Wages
A stronger economy is increasing employee turnover rates at hospitals, particularly among nurses, and putting additional pressure on wages that are already straining hospital balance sheets. Hospital operators around the country have been reporting increases in staffing costs, including contract labor, in the third quarter. Nursing positions have been most in demand, and the need is compounded by the increased patient volume that many health systems are seeing under the Affordable Care Act. (Kutscher, 11/17)

The Baltimore Sun: State Agrees To Overhaul Health Care Services At Baltimore Jail
State officials agreed Wednesday to overhaul health care services and make improvements to the Baltimore jail system under the terms of a settlement in a decades-long dispute with advocates for prisoners. Under the agreement, the latest in a federal case that dates to 1971, the state will allow three independent monitors to inspect the facility and report to a federal judge, who will enforce compliance. The previous agreement, made six years ago, was not enforceable by a judge. (Fenton, 11/18)

The Washington Post: Md. Agrees To Expand Medical Care At Baltimore City Detention Center
Maryland has agreed to expand medical care at the state-run Baltimore City Detention Center to settle a class-action lawsuit filed on behalf of pretrial detainees at the sprawling facility. The deal, announced Wednesday, requires the jail to provide accommodations for people with disabilities and to establish guidelines for assessing, treating and independently monitoring detainees’ physical and mental health. (Hicks, 11/18)

The Associated Press: State Of Maryland Settles Over Conditions In Baltimore Jail
The agreement says the state will overhaul its system for distributing medicine to inmates, as well as how detainees are screened and treated for mental illness. ... The case was settled in 1993 but was reopened in June after the plaintiffs argued that jail conditions were still so substandard it brings “shame to this city.” Inmates suffering from serious illnesses such as HIV and diabetes are being denied life-sustaining prescription medication and the state has failed to cure well-documented systemic problems within the jail after entering into a 2007 agreement with the U.S. Department of Justice, the court documents said. (Linderman, 11/18)

And another lawsuit in Washington state -

The Associated Press: Lawsuit: Dept. Of Corrections Denies Medical Care
Four prison inmates have filed a class action lawsuit against the Washington State Department of Corrections claiming prisoners with medical conditions often do not receive adequate care. The lawsuit filed by Columbia Legal Services on Tuesday says hundreds of incarcerated people are regularly denied needed medical care for illnesses such as diabetes or orthopedic issues that involve ongoing pain. The plaintiffs' attorney, Merf Ehman, says the agency's care review committee denies more than 60 percent of requests for treatment and violates the constitutional right of inmates to get adequate medical treatment. (11/18)

The Chicago Tribune: Cook County Picks Medicaid Health Plan Administrator For $72M Contract
Cook County's public health system has selected a new organization to oversee its Medicaid managed care plan, after abruptly firing the administrator earlier this year. Chicago-based Valence Health won the contract to be the "third-party administrator," beating three other bidders, said Steven Glass, executive director of managed care at the Cook County Health and Hospitals System. (Sachdev, 11/18)

Des Moines Register: Iowa Democrats Take Medicaid Concerns To D.C.
Federal officials are heeding the thousands of Iowans who have flooded them with concerns about the state’s plan to privatize its Medicaid program, Democratic legislators said Wednesday. Three leading Iowa Senate Democrats met Wednesday morning in Washington, D.C., with Obama administration officials who will decide whether to approve Gov. Terry Branstad’s plan. ... Senate President Pam Jochum of Dubuque said federal administrators’ primary concern is whether the four managed-care companies would have sufficient networks of health-care providers participating in their plans. She said the administrators also want to ensure that the 560,000 Iowans using Medicaid would have consistent care during the changeover. The senators and other critics say neither condition can be met in the next six weeks. (Leys, 11/18)

Kaiser Health News: California Exchange Offers Dental Coverage To Adults For First Time
Reporting for Kaiser Health News, Barbara Feder Ostrov writes: " Thousands of California adults are signing up for dental insurance offered for the first time by California’s health insurance exchange, Covered California, officials said Wednesday. About 33,000 adults have signed up for the dental plans, including about 6,000 who also are signing up for health insurance on the exchange for the first time, said Peter Lee, Covered California’s executive director." (Feder Ostrov, 11/19)

The Associated Press: SD Gets Over $1.8M To Help Boost Rural Health
The U.S. Department of Agriculture says South Dakota is getting more than $1.8 million in loans and grants to help boost health and public safety in rural areas. The funding announced this week is through USDA Rural Development's Community Facilities program. South Dakota has three projects receiving funding, including a $48,700 grant to the Oglala Sioux Tribe Department of Public Safety to purchase two police vehicles and a $40,800 grant to the Boys and Girls Club of Lower Brule to replace windows, doors and floor covering. Meanwhile, Wilmot Care Center Inc. in the northeast South Dakota community of Wilmot was awarded a $1.77 million loan for the construction of an assisted living facility that will include eight bedrooms and three efficiency units. (11/18)

NPR: In Tennessee, Giving Birth To A Drug-Dependent Baby Can Be A Crime
In the United States, a baby is born dependent on opiates every 30 minutes. In Tennessee, the rate is three times the national average. The drug withdrawal in newborns is called neonatal abstinence syndrome, or NAS, which can occur when women take opiates during their pregnancies. In the spring of 2014, Tennessee passed a controversial law that would allow the mothers of NAS babies to be charged with a crime the state calls "fetal assault." Alabama and Wisconsin have prosecuted new mothers under similar laws, and now other states are also considering legislation. (Shapiro, 11/18)

Los Angeles Times: Medi-Cal Cancer Patients Don't Fare Much Better Than The Uninsured, UC Davis Study Says
As part of a massive coverage expansion under the Affordable Care Act, millions of people have been allowed to sign up for California's health insurance plan for the poor for nearly two years. The program, known as Medi-Cal, now serves more than 12.5 million people, nearly 1 out of every 3 Californians. But there have been persistent concerns about the quality of care, with questions about whether patients can find doctors and get the help they need. (Karlamangla, 11/19)

The San Jose Mercury News: Berkeley: First-In-Nation Soda Tax Begins To Show Results
A year after voters here overwhelmingly approved a tax on the distribution of sodas and other sugary drinks, several academic studies have noted a hike in retail prices, indicating that the tax, or at least part of it, is being passed along to consumers. (Lochner, 11/19)

North Carolina Health News: When Doctors Become Advocates
The medical students sat around a conference table, some in white coats, some with stethoscopes around their necks, as Laura Wenzel explained the goals of her work. The students quietly bit into their burritos and salads, as Wenzel, the manager of Medical Advocates for Healthy Air, launched into it: a whirlwind presentation on particulate matter, smog, climate change, federal law, tailpipe pollution and ozone, not to mention a smattering of health research about air pollutants. (Rivin, 11/19)

The Associated Press: Doctor Sentenced In New Jersey Lab Referral Scheme
A Long Island doctor has been sentenced to prison for his role in a bribery scheme involving a New Jersey lab. A federal judge in Newark sentenced Brett Halper of Glen Head, New York, to 46 months in prison Wednesday. The 41-year-old, who practiced in Rockville Centre, had pleaded guilty to accepting bribes. (11/18)

The Orlando Sentinel: What Does It Mean To Have HIV Today?
Dr. Edwin DeJesus said he felt bad for Charlie Sheen when the well-known actor sat in front of television cameras Tuesday and told the world that he was HIV-positive. But he also saw the upside. "Assuming that this is just the end and there's not more to the story, I think that having a public figure that more young people can relate to in some ways is helpful in a way to bring HIV again to the front line," said DeJesus, medical director of Orlando Immunology Center. (Miller, 11/18)

The Orlando Sentinel: Potentially Deadly Bacteria Infects Highest Number In Florida In Years
A potentially deadly bacteria that occurs naturally in bodies of water and raw shellfish has infected more than 40 residents of Florida in 2015 — the highest number of cases in the state in recent years, Florida Department of Health records show. Vibrio vulnificus, which can cause vomiting, diarrhea, abdominal pain, blistering skin and in extreme cases, gangrene and death, peaked at 42 confirmed cases statewide so far this year. Of those cases, 13 people have died — the first death was reported in May. (Pesantes, 11/18)

The Denver Post: DaVita Subsidiary Under Investigation By Feds For 'Medical Necessity'
DaVita HealthCare Partners Inc. disclosed to investors Wednesday that the U.S. Department of Justice is investigating two of its Florida clinics regarding the medical necessity of certain procedures. The Denver-based operator of a kidney care centers said that this involves RMS Lifeline, its wholly owned subsidiary that operates as Lifeline Vascular Access. The Justice Department notified RMS on Nov. 10 that it is investigating services provided at the two clinics since Jan. 1, 2008. The department has asked for documents and medical records for 10 patients. (Chuang, 11/18)

Bloomberg: Texas Is Making Abortion More Dangerous
Defenders of a Texas law that restricts abortion clinics say its main purpose is to protect women's health. So far, however, it has mainly undermined their safety. Since 2013, when the law began requiring that clinic doctors have admitting privileges at local hospitals, the number of clinics providing abortion services in Texas has fallen by more than half, from 42 to 18. There's no proof that this in any way "elevated" care, as Ken Paxton, the state's attorney general, claims. But many women in the state -- an estimated 100,000 to 240,000 -- have since tried to end a pregnancy on their own, according to research at the University of Texas. (11/18)

Los Angeles Times: Healthcare Shocker: Medicaid Is Very Good For Kids
Medicaid is the healthcare family's poor relation. It's taken for granted. Its quality is widely derided, even as it's typically saddled with the lowest provider reimbursement rates of any government health program. Republican governors and legislatures refused to accept the central role it was given as the insurance plan for their poorest constituents (though that's been changing). So here's a shocker: Children on Medicaid receive very good care — in many respects better than those on private insurance. (Michael Hiltzik, 11/18)

Huffington Post: Hillary Clinton Attacks Bernie Sanders’ Progressive Agenda
While [Vermont Sen. Bernie] Sanders has supported the Affordable Care Act, or Obamacare, he has described the legislation as merely a first step toward guaranteeing that every American has health insurance. He has said that creating a single-payer system, similar to the schemes that now operate in countries such as France and Taiwan, would achieve that goal. Such a large expansion of government programs would inevitably require raising trillions of dollars in new revenue. ... In the past, Sanders has proposed financing a single-payer scheme with a payroll tax that would affect everybody, including the middle class. On Monday, that possibility drew a sharp attack from Brian Fallon, Clinton’s chief campaign spokesman. (Jonathan Cohn, 11/17)

Real Clear Politics: What Washington Should Learn From Obamacare Co-Op Failures
Another of Obamacare’s insurers is going under. This time, it’s Health Republic of New York, an insurer that made waves in 2014 for offering some of the lowest-cost insurance plans on New York’s exchange. The non-profit, which had been hemorrhaging money since year one, will shut down by the end of November, taking $265 million in federally-subsidized loans with it. Health Republic is a textbook example of failure in government management, with lessons that should guide future reforms. (Yevgeniy Feyman, 11/19)

The New York Times' The Upshot: In Many Obamacare Markets, Renewal Is Not An Option
Last year, we encouraged returning Obamacare customers to shop around for a better deal. This year, a lot of people will have no choice. In markets throughout the country, the plan in the most popular category that was least expensive this year will not be offered next year. That means that some people who took our advice and shopped for a bargain will need to shop again, even if they’re happy with their plan. (Amanda Cox and Margot Sanger-Katz, 11/18)

The Richmond Times-Dispatch: Rural Health In Virginia
We face a critical challenge of keeping our rural hospitals open and thriving. The threats to these hospitals are numerous and include sequestration cuts, the constant threat of shrinking reimbursement rates, geographic areas that serve lower patient volumes than their urban counterparts and a population with unique health challenges that can often be more costly. ... To help Virginia’s rural hospitals remain open and continue to serve those in need, Governor McAuliffe and I continue to work to expand access to health care. Expanding access increases the opportunities for citizens across the commonwealth to get needed health insurance, and allows our state system to reimburse hospitals that care for those citizens not currently covered. (Virginia Secretary of Health and Human Services William Hazel, 11/18)

Modern Healthcare: Drop Medicaid 'Best Price' Drug Rules In Favor Of Value-Based Strategies
When is a “best price” anything but?Medicaid regulations require that drug companies charge the state-federal health program for the poor the lowest or “best” price that they negotiate with any other buyer. In theory, the best-price requirement protects taxpayers from price-gouging. With the federal and state governments spending about $20 billion annually on drugs for Medicaid patients, such protection seems valuable. n practice, the Medicaid Drug Rebate Program contributes significantly to a dysfunctional pricing process that undermines competition and inflates drug costs. (Dana Goldman, 11/17)

The New York Times: Protect Doctor-Patient Confidentiality
When should a doctor betray a patient’s confidence? This week the Supreme Court of the State of Washington heard arguments on this question in a case that has profound implications for the doctor-patient relationship. In the case, Volk v. DeMeerleer, a psychiatrist, Howard Ashby, was sued after a patient of his, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before killing himself. (Mr. DeMeerleer also stabbed another son, who survived.) The estate of the victims, Rebecca and Phillip Schiering, took legal action, arguing that Dr. Ashby was liable because he had not warned the Schierings. A lower court ruled in Dr. Ashby’s favor on the grounds that Mr. DeMeerleer, who had occasionally voiced homicidal fantasies, had made no specific threats toward the Schierings during his treatment. (Sandeep Jauhar, 11/19)

The Washington Post: America Needs A National Sugar Tax
The latest results from the National Health and Nutrition Examination Survey, an authoritative federal source, is that the country’s obesity rate hasn’t budged over the course of this decade, despite unprecedented attention and public health campaigns devoted to the issue. The rate stood at nearly 35 percent in 2011 and 2012. The latest figures, for 2013 and 2014, peg the rate at nearly 38 percent. The 3-percentage-point increase from the previous results is not statistically significant — but the 6-point increase from 2003 and 2004 is. (11/18)

Raleigh News & Observer: The ACA, Medicaid Expansion And The Care Our NC Veterans Deserve
Many of our elected leaders beat the drums of patriotism when they send our troops to fight their wars but then refuse to fund vital programs to support them when they return home. Here in North Carolina, Gov. Pat McCrory and the GOP-controlled General Assembly have turned their backs on N.C. veterans who would be eligible for Medicaid expansion funding. In fact, a study by the Robert Wood Johnson Foundation and the Urban Institute concluded that at least 23,300 North Carolina veterans would be eligible for Medicaid if the program were expanded. Refusing to accept those funds, already paid for by N.C. tax dollars, means many veterans in need of vital physical and mental health care services must go without. (Douglas H. Ryder, 11/18)

The Chicago Tribune: Going Home For The Holidays? Look For Signs Older Family Members May Need Help
For many Americans, the holiday season is one of the few times each year they can spend time with their parents and other older relatives. That makes it an ideal time to find out if older loved ones need assistance in any areas of their lives, such as personal care, home maintenance, physical problems, finances and transportation, according to AgeOptions, the Area Agency on Aging of suburban Cook County. Some changes, such as appearance, reflexes and physical or mental health, may be obvious. Others may require looking into the refrigerator, financial records and other aspects of the older person's life. Keep in mind that issues may be connected, such as when physical limitations or lack of transportation make it difficult to shop, cook, clean or visit friends. (11/17)

news@JAMA: When Publicity Preempts Peer Review
About 2 months ago, the media was full of news stories about a study called the Systolic Blood Pressure Intervention Trial (SPRINT). This media attention wasn’t because of the publication of a peer-reviewed article. It was because the National Institutes of Health held a media briefing about ending the trial early. ... Although this was certainly good news and the results would be of interest to many, I was concerned, as were many others, about how the announcement was made. At this point, the trial’s results had not been fully analyzed by the study team. More importantly, their meaning and context had not yet been subject to peer review. We live in an age in which the barriers to information dissemination are disappearing. This does not mean, however, that all information should be disseminated immediately. Peer review exists for a reason. (Aaron Carroll, 11/18)

JAMA: The Pendulum Of Prostate Cancer Screening
[T]here is reason to be concerned about the decline in prostate cancer screening and prostate cancer incidence reported [in JAMA]. Certainly, physicians have been overly aggressive in their approach to prostate cancer screening and treatment during the past 2 decades, but the pendulum may be swinging back the other way. It is time to accept that prostate cancer screening is not an “all-or-none” proposition and to accelerate development of personalized screening strategies that are tailored to a man’s individual risk and preferences. By doing this, it should be possible to reach some consensus around this vexing problem. (David F. Penson, 11/17)