The New York Times: Warren Draws Fire From All Sides, Reflecting A Shift In Fortunes In Race
Senator Elizabeth Warren of Massachusetts faced a sustained barrage of criticism from her Democratic rivals at a presidential debate in Ohio on Tuesday, tangling with a group of underdog moderates who assailed her liberal economic proposals, while former Vice President Joseph R. Biden Jr. appeared to fade from the fray after parrying President Trump’s attacks on his family. The debate confirmed that the primary race had entered a new phase, defined by Ms. Warren’s apparent strength and the increasing willingness of other Democrats to challenge her. (Burns and Martin, 10/15)

Politico: Warren's Charmed Campaign Just Entered A Brutal New Phase
Warren’s biggest gains have come since the last debate, so Tuesday's debate was the natural point for a more full-throated engagement from the other candidates. Until now, three elements central to Warren’s candidacy have received relatively little pressure from her opponents as she has slowly ticked up in the polls. (Lizza, 10/16)

The New York Times: 6 Takeaways From The October Democratic Debate
For a candidate who has risen in the polls based on her policy acumen and specifics, Ms. Warren’s unwillingness to address the question of whether her “Medicare for all” plan would require higher taxes on the middle class was striking. And her opponents put her on the defensive. (Goldmacher and Epstein, 10/16)

The Washington Post: Warren Faces First Sustained Attack In Debate That Begins With Unified Condemnation Of Trump
Warren fought back against the attacks, casting her challengers as too small-minded or timid for the moment, or as part of an entrenched political system that is dominated by corporations and the wealthy. “Look, I understand that this is hard, but I think as Democrats, we are going to succeed when we dream big and fight hard, not when we dream small and quit before we get started,” Warren said. (Olorunnipa, Janes and Viser, 10/16)

The New York Times: ‘Medicare For All’: Elizabeth Warren And Pete Buttigieg Clash At Debate
Pete Buttigieg directly criticized Elizabeth Warren over health care at Tuesday night’s debate, saying that she had not been forthcoming about whether she would raise taxes on the middle class to help finance “Medicare for all.” Ms. Warren, the Massachusetts senator, was asked if she would raise taxes on the middle class, and she responded by focusing on the costs that middle-class families would face. “I will not sign a bill into law that does not lower costs for middle-class families,” she said. (Kaplan, 10/15)

CNN: Ideological Divide In Democratic Primary Exposed As Moderates Gang Up On Elizabeth Warren
"I don't understand why you believe the only way to deliver affordable coverage is to obliterate private plans," Buttigieg said to Warren. "We're competing to be president for the day after Trump. Our country will be polarized, more than now. After everything we have been through, after everything we are about to go through, this country will be more divided. Why divide this country over health care when there's a better way to deliver coverage for all?" (Reston, 10/16)

Los Angeles Times: Elizabeth Warren Faces Debate Attacks Over Healthcare
“This is why people here in the Midwest are so frustrated with Washington in general, and Capitol Hill in particular. Your signature, Senator, is to have a plan for everything — except this,” South Bend, Ind., Mayor Pete Buttigieg said to Warren. “No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare for all plan that Sen. Warren is putting forward is expected to get filled in.” (Mehta, 10/15)

Kaiser Health News: Health Care Stayed Front And Center At Democratic Debate
While the debate began on the topic of impeaching President Donald Trump, Sen. Bernie Sanders of Vermont soon steered the discussion back to kitchen-table issues. “I think what would be a disaster, if the American people believe that all we were doing is taking on Trump,” he said. “We’re forgetting that 87 million Americans are uninsured or underinsured.” (Huetteman, 10/16)

The New York Times: Amy Klobuchar Goes After Elizabeth Warren Over Health Care Plan In Debate
Bernie Sanders, the Vermont senator who has championed a single-payer system, said taxes would go up for “virtually everybody.” But he added that the tax increase would be substantially less than what people currently pay for premiums and out-of-pocket health care expenses. “At least Bernie is being honest here, and saying how he’s going to pay for this and that taxes are going to go up,” Ms. Klobuchar, of Minnesota, said after his comments. “And I’m sorry, Elizabeth, but you have not said that and I think we owe the American people to tell them where we will send the invoice.” (Zraick, 10/15)

Politico: Klobuchar Charges At Warren
“I want to give a reality check here to Elizabeth because no one on this stage wants to protect billionaires — not even the billionaire wants to protect billionaires,” Klobuchar said, referencing Tom Steyer, the environmental activist and former hedge fund manager participating in the debate. “We just have different approaches. Your idea is not the only idea.” Warren responded in part that “the rich are not like you and me,” asserting that “the really, really billionaires are making their money off their accumulated wealth, and it just keeps growing.” She added: “Look, I understand that this is hard, but I think, as Democrats, we are going to succeed when we dream big and fight hard, not when we dream small and quit before we get started.” (Forgey, 10/15)

The Wall Street Journal: Warren Pressed On Health-Care Plan At Democratic Debate
Former Rep. Beto O’Rourke of Texas joined in the critique of Ms. Warren, saying “sometimes, I think that Senator Warren is more focused on being punitive or pitting some part of the country against the other, instead of lifting people up and making sure that this country comes together around the solutions.” Ms. Warren appeared puzzled, telling Mr. O’Rourke, “I’m really shocked at the notion that anyone thinks I’m punitive.” (Thomas, Siddiqui and McCormick, 10/16)

Reuters: Warren Comes Under Attack On Healthcare, Taxes At U.S. Democratic Presidential Debate
"I have made clear what my principles are here, and that is that costs will go up for the wealthy and for big corporations and, for hard-working middle-class families, costs will go down," [Warren] said. The expansive Medicare for All proposal, based on the government-run healthcare plan for Americans over age 65, has sharply divided Democratic presidential contenders. Some analysts have said it would cost $32 trillion over a decade. Many other Democratic candidates back a Medicare-based plan as just one option for Americans seeking healthcare coverage. (Hunnicutt and Renshaw, 10/16)

NPR: 6 Takeaways From The 4th Democratic Presidential Primary Debate
But while a similar line from Warren at an earlier debate got thunderous applause, it didn't land the same way this time, and Klobuchar was ready with a response, going after Warren for, in her view, dismissing others' plans because they weren't hers. "You know, I think simply because you have different ideas doesn't mean you're [not] fighting for regular people," Klobuchar said. (Montanaro, 10/16)

Bloomberg: Is Elizabeth Warren The Frontrunner? 2020 Dems Critique Senator
In the middle of the debate, O’Rourke’s campaign took another swipe at Warren. “Beto has been very clear that he will not raise taxes on those who make less than $250,000 a year. Senator Warren has not provided the same level of clarity,” said O’Rourke campaign spokeswoman Lauren Hitt. “Warren needs to be straight with middle-class people about the taxes they would face under her plans.” (Kapur, 10/15)

Politico: Dems Go After Warren, And Other Big Moments From Tuesday’s Debate
Sanders, noting (again) that he “wrote the damn bill” on Medicare for all, said that “deductibles are gone. All out-of-pocket expenses are gone ... At the end of the day, the overwhelming majority of people will save money on their health care bills. I do think it is appropriate to acknowledge that taxes will go up. They will go up significantly for the wealthy and for virtually everybody, the tax increase will be substantially less -- substantially less than what they were paying for premiums and out-of-pocket expansions.” (Caputo and McCaskill, 10/15)

And news outlets fact check the candidates' health care claims —

Kaiser Health News and Politifact HealthCheck: Biden Gets Too Specific On ‘Medicare For All’ Tax Hikes
Sparring over “Medicare for All” and universal health care, former Vice President Joe Biden leaned on a new variation of his attack line, highlighting potential costs to middle-class Americans. “For people making between $50,000 and $75,000 a year, their taxes are going up about $5,000 because the fact is, they will pay more in new taxes,” Biden said. (Luthra, 10/16)

Kaiser Health News and Politifact HealthCheck: Warren Trots Out Her Own Harvard Law Research
In a back-and-forth about “Medicare for All” and the cost of health care, Sen. Elizabeth Warren (D-Mass.) directed the discussion back to medical debt and bankruptcy — citing her own work from Harvard Law School. “Back when I was studying it, two out of three families that ended up in bankruptcy after a serious medical problem had health insurance,” Warren said. This is a new emphasis in the ongoing debate over health care costs, and the debate over what role health care plays in American finances. Instead of focusing on uninsurance, Warren stepped into whether the insurance people currently have is sufficient. (Luthra, 10/16)

The New York Times: Fact-Checking The Democratic Debate
What Mr. Sanders said: “I do think it is appropriate to acknowledge that taxes will go up. They’re going to go up significantly for the wealthy and for virtually everybody, the tax increase they pay will be substantially less than what they were paying for premiums and out-of-pocket expenses.” This lacks evidence. Mr. Sanders’s health care plan would substantially increase the amount that the federal government spends. Estimates of its precise cost vary, but according to an estimate from the conservative Mercatus Center, which Mr. Sanders has mentioned approvingly, federal spending would need to increase by about 10 percent of the country’s gross domestic product, triple what the government spends on the military. (10/15)

The Washington Post: Transcript Of The Fourth Democratic Debate
A field of 12 candidates for the 2020 Democratic presidential nomination met onstage in Westerville, Ohio, for a fourth primary debate, this one hosted by CNN and the New York Times. Below is a transcript of the debate; we’ll update it as the text becomes available. (10/16)

The New York Times: Kamala Harris Calls For Attention On Reproductive Rights At Debate
Senator Kamala Harris of California made an impassioned plea on Tuesday for her fellow presidential candidates to focus on women’s access to reproductive health care, generating applause. “This is the sixth debate we have had in this presidential cycle,” she said at the night’s debate in Ohio. “And not nearly one word, with all of these discussions about health care, on women’s access to reproductive health care, which is under full-on attack in America today. And it’s outrageous.” (Murphy, 10/15)

Los Angeles Times: Kamala Harris Slams Republicans On Abortion, Says They're Killing Poor Women Of Color
“There are states that have passed laws that will virtually prevent women from having access to reproductive healthcare,” she said at the CNN/New York Times debate in Westerville, Ohio. “And it is not an exaggeration to say women will die. Poor women, women of color will die because these Republican legislatures in these various states who are out of touch with America are telling women what to do with their bodies.” Harris hadn’t been asked about abortion. But when her turn came to respond to comments by other candidates on healthcare, she raised her voice in protest. The crowd cheered Harris several times. (Finnegan, 10/15)

Time: October Democratic Debate Recap: Top 11 Biggest Takeaways
Harris said she’d have the Department of Justice review state legislature’s laws before they can take effect; Indiana Mayor Pete Buttigieg said he’d consider adding judges to the Supreme Court to preserve Roe v. Wade; and former Housing Secretary Julián Castro lobbied for term limits for appellate court justices. Others suggested codifying Roe v. Wade. (Vesoulis, 10/16)

Vox: Democratic Debate Highlights: Best And Most Substantive Answers Of The Night
Harris’s response was echoed by Sen. Cory Booker soon after, noting that two Planned Parenthood clinics had recently closed in Ohio, where the debate was being held. “We are seeing all over this country women’s reproductive rights under attack,” he said. “God bless Kamala. Women should not be the only ones taking up this cause and this fight.” (Stewart, North, Golshan, Samuel and Kirby, 10/15)

HuffPost: 4 Debates In, Democrats Finally Got The Chance To Talk Abortion Rights
Gabbard, Klobuchar and Warren agreed that Roe v. Wade, the historic 1973 Supreme Court ruling that legalized abortions in the U.S., should be codified. Both Buttigieg and Castro supported enforcing term limits for Supreme Court justices and de-politicizing the court as much as possible.  Booker said that if he were voted in as president he would create an office of reproductive freedom that would oversee reproductive protections. The senator from New Jersey also pointed out that the attack on reproductive rights is about privilege as much as it is about sexism. (Vagianos, 10/15)

Vox: Democratic Debate: Kamala Harris Brought Up Abortion Rights
Back in 2016, reproductive justice activist Renee Bracey Sherman started the hashtag #AskAboutAbortion because the issue wasn’t getting enough attention in debates at the time. Three years and one presidential election cycle later, the issue still isn’t getting much airtime on the stage. Reproductive rights did get a substantive discussion in a debate in June, when Gov. Jay Inslee and Sen. Amy Klobuchar sparred over who had done more to expand access. But at subsequent debates, the issue got less and less attention, and in the third debate in September, reproductive rights weren’t mentioned at all. After the debate, Harris voiced her displeasure, tweeting that the debate “was three hours long and not one question about abortion or reproductive rights.” (North, 10/15)

The Hill: Booker On Reproductive Rights: 'Women Should Not Be The Only Ones Taking Up This Cause And This Fight' 
Sen. Cory Booker (D-N.J.) said during Tuesday night's Democratic presidential debate that more men need to be standing up for women's reproductive rights, which he said are under attack in America. "Women should not be the only ones taking up this cause and this fight," Booker said during the event in Ohio. "It's not just because women are our daughters and our friends and our wives. It's because women are people," he added. (Klar, 10/15)

The New York Times: Bernie Sanders, Joe Biden And Elizabeth Warren Discuss Age At Debate
Loath as the candidates have been to talk about it, age is an inescapable subject in this Democratic primary: The three highest-polling candidates are all in their 70s, and one of them just had a heart attack. So it was perhaps not surprising that, about two hours into the debate on Tuesday, the moderators bluntly asked how Senator Bernie Sanders, 78, Joseph R. Biden Jr., 76, and Senator Elizabeth Warren, 70, could assure voters that they were up to the rigors of the presidency. (Astor, 10/15)

The Associated Press: Takeaways: Warren Under Fire, 70s Club Ignores Age Issue
Biden promised to release his medical records before the Iowa caucuses next year and said he was running because the country needs an elder statesman in the White House after Trump. Warren, whose campaign has highlighted her hours-long sessions posing for selfies with supporters, promised to "out-organize and outlast" any other candidate — including Trump. Then she pivoted to her campaign argument that Democrats need to put forth big ideas rather than return to the past, a dig at Biden. (10/15)

Los Angeles Times: 7 Takeaways From The Democrats' October Debate
At 76, with a penchant for wandering answers and cultural references that can seem cringe-inducingly dated, some say the vice president’s time has come and gone. Obviously, it’s impossible to turn back the clock. Instead, Biden sought to make his longevity an asset. “One of the reasons I’m running is because of my age and experience,” he said, citing his decades in public life and, especially, eight years as vice president. “I know what has to be done and I will not need any on-the-job training the day I take office.” (Barabak, 10/15)

Los Angeles Times: Sanders, Biden And Warren Talk Age At Democratic Debate
Sen. Bernie Sanders, in his first major public appearance since suffering a heart attack this month, raised the issue as he tried to insert himself into a debate question about the opioid epidemic. “I’m healthy, I’m feeling great,” the Vermont Democrat said, leading moderator Erin Burnett to ask the 78-year-old how he would reassure the American people after his health scare. (Seema Mehta, 10/15)

Politico: What Heart Attack? Bernie Bounces Back At Debate
The inevitable question Sanders received from moderators about his age was relatively brief and painless. Asked how he would reassure Democratic voters that he has the energy to be president after his heart attack, he urged them to come to his rally in New York City this weekend, which drew laughter from some in the crowd. “We are going to be mounting a vigorous campaign all over this country,” he said. “That is how I think I can reassure the American people.” (Otterbein, 10/15)

USA Today: Democratic Debate: What We Learned From The 2020 Ohio Democratic Debate
While the debate was still underway, news broke that Sanders had won the endorsement of Rep. Alexandria Ocasio-Cortez, who last year became the youngest woman elected to Congress and is a leading voice in the progressive movement. (Madhani, 10/16)

The Wall Street Journal: Democratic Debate: The Moments That Mattered
Mr. O’Rourke and Mr. Buttigieg had a heated exchange over whether to implement a mandatory government buyback of assault weapons, which devolved into the two bickering over who was more courageous. Mr. O’Rourke has become a vocal advocate for tougher gun-control measures after 22 people were killed in a mass shooting in his hometown of El Paso, Texas, in August, and he supports a mandatory buyback program. He said he expected Americans would follow the law and turn in their weapons voluntarily, but guns would be confiscated if people refused and then used their guns for intimidation. (Parti and Collins, 10/16)

Dayton Daily News: Oregon District Shooting, Guns Topic Of Democratic Debate In Ohio
With Daytonians in the audience of the Democratic presidential debate, candidates advocated for assault weapons bans and buybacks, universal background checks and other measures to reduce the gun violence that has claimed more than 16,000 Ohioans since 2007. “The public is with us on this in a big way. The majority of Trump voters want to see universal background checks right now. The majority of gun owners want to see us move forward with gun safety legislation,” said U.S. Sen. Amy Klobuchar of Minnesota, who said she met with an Oregon District shooting survivor. “I just don’t want to screw this up.” (Bischoff and Robinson, 10/15)

Los Angeles Times: Democratic Debate: Candidates Sharpen Attacks
O’Rourke denied he would send law enforcement door-to-door to retrieve guns but struggled to explain how he would otherwise enforce the proposal beyond relying on voluntary compliance from gun owners. “Look, Congressman, you just made it clear that you don’t know how this is actually going to take weapons off the streets. If you can develop the plan further, I think we can have a debate about it,” Buttigieg said. (Mason, Bierman and Halper, 10/15)

Los Angeles Times: Pete Buttigieg And Beto O'Rourke Clash Over Gun Control
“We cannot wait for purity tests; we just have to get something done,” Buttigieg said. “This is not a purity test,” O’Rourke replied, saying that if the government was going to ban the sale of assault rifles for being too dangerous, then logically it followed that those guns should be taken off the streets. O’Rourke also implied that Buttigieg’s caution on confiscations was the result of poll testing and focus groups. Buttigieg replied: “I don’t need lessons from you on courage. We are this close to an assault weapons ban” — for sales, that is. (Pearce, 10/15)

CBS News: Beto O'Rourke And Pete Buttigieg Spar Over Gun Buyback Proposal At Fourth Democratic Debate
Immediately after the exchange between O'Rourke and Buttigieg, Senator Cory Booker of New Jersey, in a more conciliatory tone, urged the rest of the candidates to dial down the rhetoric. "I worry about how we talk to each other and about each other," he told the audience.  (Montoya-Galvez, 10/15)

The Associated Press Fact Check: Dems Debate On Guns, Syria, Health Care
PETE BUTTIGIEG: "On guns, we are this close to an assault weapons ban. That would be huge." AMY KLOCHUBAR: "I just keep thinking of how close we are to finally getting something done on this." THE FACTS: No, the U.S. is not close to enacting an assault-weapons ban, as Buttigieg claimed, nor close on any significant gun control, as Klobuchar had it. Congress is not on the verge of such legislation. Prospects for an assault-weapons ban, in particular, are bound to remain slim until the next election at least. (Yen and Woodward, 10/15)

Vox: Democratic Debate Candidates: We Should Lock Up Opioid Executives
At Tuesday’s Democratic debate, several presidential candidates agreed on one point: The pharmaceutical executives who helped create the opioid epidemic should go to prison. Asked directly whether opioid executives should be locked up, Sen. Kamala Harris (D-CA) said: "I am. And I will tell you as a former prosecutor, I do think of this as being a matter of justice and accountability because they are nothing more than some high-level dope dealers. They should be held accountable. This is a matter of justice." (Lopez, 10/15)

Cincinnati Enquirer: Democratic Debate: Fact-Checking What The Candidates Said About Ohio.
Minnesota Sen. Amy Klobuchar talked about Ohio’s opioid crisis: “The state of Ohio has been hit by the opioid epidemic. We need to take on these pharmaceutical companies and make them pay.” Ohio has one of the highest rates of fatal drug overdoses in the nation. Opioids, heroin and fentanyl have ravaged the state for years. (Balmert and Borchardt, 10/15)

The Atlantic: Beto Promotes Legalized Marijuana During Democratic Debate
During a discussion about solutions to the opioid crisis during last night’s Democratic primary debate, Beto O’Rourke suggested that when pharmaceutical companies go low, we should get high. The former congressman from El Paso said a veteran he once met wouldn’t have gotten addicted to heroin if the veteran had been prescribed marijuana instead of opioids for his health condition. “Now imagine that veteran, instead of being prescribed an opioid, had been prescribed marijuana, because we made that legal in America [and] ensured the VA could prescribe it,” O’Rourke said. (Khazan ,10/16)

In other health news from the debate, Sanders addressed the homeless crisis —

The Washington Post: Fact Check Of The 4th Democratic Debate
“You have half a million people sleeping out on the street today.” –Sen. Bernie Sanders (I-Vt.) The way Sanders frames this is exaggerated. Sanders’s number come from a single-night survey done by the Department of Housing and Urban Development to measure the number of homeless people. For a single night in January 2018, the estimate was 553,000 people are homeless. But the report also says that two-thirds — nearly 360,000 — were in emergency shelters or transitional housing programs; the other 195,000 were “unsheltered” — i.e., on the street, as Sanders put it. The number has also been trending down over the past decade; it was 650,000 in 2007. (Kessler, Rizzo and Kelly, 10/15)

Time: Fact-Checking The October Democratic Debate
However, Sanders’s language exaggerated the survey’s findings. The report found that about two-thirds of homeless people in the U.S. were staying in sheltered locations like emergency shelters or transitional housing programs. About one-third were actually sleeping on the street. (Carlisle, Abrams and Vesoulis, 10/16)

The Associated Press: Study: 'Medicare For All' Not Only Way To Universal Coverage
Health care memo to Democrats: there's more than one way to get to coverage for all. A study out Wednesday finds that an approach similar to the plan from former Vice President Joe Bide n can deliver about the same level of coverage as the government-run "Medicare for All" plan from presidential rival Bernie Sanders. The study from the Commonwealth Fund and the Urban Institute think tanks concludes that the U.S. can achieve a goal that has eluded Democrats since Harry Truman by building on former President Barack Obama's health care law. (Alonso-Zaldivar, 10/16)

FierceHealthcare: A Look At Policy Pathways For Health Insurance Reform: 3 Takeaways
David Blumenthal, M.D., president of the Commonwealth Fund, said on a call with reporters that it’s crucial for both policymakers and the public to understand the directions health reform could take in the coming years. “We believe it is important to evaluate the impact of all proposals from those that build on the Affordable Care Act to wholesale health system overhauls,” Blumenthal said.  (Minemyer, 10/16)

The Hill: New Study: Full-Scale 'Medicare For All' Costs $32 Trillion Over 10 Years 
A new study finds that a full-scale single-payer health insurance program, also called "Medicare for All," would cost about $32 trillion over 10 years. The study from the Urban Institute and the Commonwealth Fund found $32.01 trillion in new federal revenue would be needed to pay for the plan, highlighting the immense cost of a proposal at the center of the health care debate raging in the presidential race. (Sullivan, 10/16)

The Washington Post: State AGs Dangle $18B Potential Settlement, But Fail To Delay Federal Opioid Trial
An 11th-hour bid to delay a landmark federal opioid trial failed after a group of state attorneys general tried to persuade U.S. District Court Judge Dan Aaron Polster to give them more time to craft a settlement in their own cases, according to people with familiar with the events. They told Polster they were trying to reach an $18 billion settlement with the nation’s three largest drug distributors, McKesson Corp., Cardinal Health and AmerisourceBergen, according to the people familiar with the events who spoke on the condition of anonymity because of the sensitivity of the negotiations. (Bernstein, Higham, Horwitz and Davis, 10/15)

The Wall Street Journal: Drug Distributors In Talks To Settle Opioid Litigation For $18 Billion
The three distributors— McKesson Corp. , AmerisourceBergen Corp. , and Cardinal Health Inc. —would collectively pay $18 billion over 18 years under the deal currently on the table, the people said. Johnson & Johnson is also involved in the discussions to contribute additional money, some of the people said. Players up and down the pharmaceutical supply chain, including drugmakers, distributors and pharmacies, have been sued by virtually every state and thousands of city and county governments. Over 2,000 lawsuits allege the industry’s overly aggressive marketing of prescription painkillers and lax oversight over drug distribution contributed to widespread opioid addiction. (Randazzo, 10/15)

CNBC: Top Drug Distributors In Talks To Settle Opioid Litigation For $18 Billion, Report Says
AmerisourceBergen declined to comment. McKesson and Cardinal Health didn’t immediately respond to requests for comment. “As previously stated, we remain open to viable options to resolve these cases, including through settlement,” J&J spokesman Jake Sargent said when asked about the potential settlement. (10/15)

The Hill: Three Drug Distributors In Talks For $18 Billion Opioid Settlement: Report 
Pressure is mounting for McKesson, AmerisourceBergen and Cardinal Health, as all three are set to begin trial in a Cleveland federal court on Monday, according to the Journal. By the end of it, the deal could include other drug companies, such as Johnson & Johnson, as well as the donation of opioid addiction treatment medicine. (Johnson, 10/15)

Bloomberg: J&J Pitches $4 Billion For Opioids As Distributors Seek Deal 
Johnson & Johnson has offered to pay $4 billion to settle all claims accusing the company of helping fuel the U.S. opioid epidemic as part of a potentially larger deal involving drugmakers and distributors that could top $20 billion. J&J’s overture came on the heels of a proposal by distributors McKesson Corp., Cardinal Health Inc. and AmerisourceBergen Corp. to pay $18 billion to wipe out all opioid suits against those companies, according to people familiar with the pitch. The Wall Street Journal first reported the distributors’ offer Tuesday. The money would be paid out in annual $1 billion increments, according to the people, who asked not to be identified because the negotiations are private. (Feeley and Griffin, 10/15)

The Washington Post: Landmark Opioid Trial Against Giant Drug Companies Begins In Ohio
The U.S. opioids epidemic has claimed more than 400,000 lives and left millions of people addicted, strained health care, law enforcement and social service systems, cost governments billions, and bankrupted the best-known manufacturer of narcotic painkillers. Now, 12 ordinary people will decide whether drug companies should be held responsible for the worst drug crisis in U.S. history and forced to pay billions of dollars to help clean it up. That effort begins Wednesday in U.S. District Judge Dan Aaron Polster’s courtroom on the 18th floor of the federal building here, where attorneys will start picking a jury for the landmark trial. (Bernstein, 10/15)

And in other news on the opioid crisis —

CNN: Oklahoma Judge Miscalculated How Much Johnson & Johnson Would Pay For The State's Opioid Crisis
The Oklahoma judge who recently ordered pharmaceutical giant Johnson & Johnson to pay $572 million for its role in the state's opioid crisis says he made a mathematical error when calculating the judgment. As part of the landmark verdict in August, Judge Thad Balkman set aside $107,683,000 to help combat neonatal abstinence syndrome, or NAS. The problem -- he added three too many zeroes and meant to award $107,683. (Becker and Smith, 10/16)

NPR: Opioid Crisis: A Guide To The Massive (And Massively Complex) Litigation
In less than a week, a landmark battle over who bears responsibility for the U.S. opioid crisis will begin in federal court. The case involves thousands of plaintiffs at virtually every level of government and defendants from every link in the chain of opioid drug production — from major multinational corporations such as Johnson & Johnson and CVS, right down to individual doctors. And on Oct. 21, the first trial is set to kick off before a judge in the Northern District of Ohio. (Dwyer, 10/15)

The Associated Press: New Study: Opioid Crisis Cost US Economy $631B Over 4 Years
The opioid crisis cost the U.S. economy $631 billion from 2015 through last year — and it may keep getting more expensive, according to a study released Tuesday by the Society of Actuaries. The biggest driver of the cost over the four-year period is unrealized lifetime earnings of those who died from the drugs, followed by health care costs. (10/15)

The New York Times: Fed Up With Deaths, Native Americans Want To Run Their Own Health Care
When 6-month-old James Ladeaux got his second upper respiratory infection in a month, the doctor at the Sioux San Indian Health Service Hospital reassured his mother, Robyn Black Lance, that it was only a cold. But 12 hours later James was struggling to breathe. Ms. Black Lance rushed her son back to the hospital in western South Dakota, where the doctors said they did not have the capacity to treat him and transferred him to a private hospital in Rapid City. There he was given a diagnosis of a life-threatening case of respiratory syncytial virus. “They told me if I hadn’t brought him back in, he would have died,” Ms. Black Lance said, choking back tears. (Walker, 10/15)

In other news from the administration —

The Associated Press: Judge In Chicago Latest To Block Trump Green Cards Policy
A federal judge in Chicago had joined three others nationwide in temporarily blocking President Donald Trump's policy to deny green cards to many immigrants who use Medicaid, food stamps and other government benefits. Judge Gary Feinerman granted a temporary injunction Monday night blocking the new rules hours before they would have taken effect. It followed rulings by federal judges Friday in California, New York and Washington. (10/15)

ProPublica: Welcome To Coffeyville, Kansas, Where The Judge Has No Law Degree, Debt Collectors Get A Cut Of The Bail, And Americans Are Watching Their Lives — And Liberty — Disappear In The Pursuit Of Medical Debt Collection.
On the last Tuesday of July, Tres Biggs stepped into the courthouse in Coffeyville, Kansas, for medical debt collection day, a monthly ritual in this quiet city of 9,000, just over the Oklahoma border. He was one of 90 people who had been summoned, sued by the local hospital, or doctors, or an ambulance service over unpaid bills. Some wore eye patches and bandages; others limped to their seats by the wood-paneled walls. Biggs, who is 41, had to take a day off from work to be there. He knew from experience that if he didn’t show up, he could be put in jail. Before the morning’s hearing, he listened as defendants traded stories. One woman recalled how, at four months pregnant, she had reported a money order scam to her local sheriff’s office only to discover that she had a warrant; she was arrested on the spot. (Presser, 10/16)

Related KHN Coverage: ‘UVA Has Ruined Us’: Health System Sues Thousands Of Patients, Seizing Paychecks And Claiming Homes

The Star Tribune: UnitedHealth Group Shares Jump 8% On Strong Earnings, Guidance 
Shares of UnitedHealth Group soared on Tuesday after the company reported third-quarter results that beat expectations for profit and revenue while putting a focus on the Minnetonka-based company’s expanding business running outpatient medical centers. David Wichmann, the UnitedHealth Group chief executive, told investors during a conference call that the company is trying to develop a “next-generation” health care system, an ambition furthered in June by the purchase of DaVita Medical Group, which added more than 200 clinics across five states. (Snowbeck, 10/15)

Bloomberg: Health Insurers May Have Bottomed As Investors Tire Of Politics 
The worst may be past for managed-care stocks this year, barring any major surprises, as investors are growing fed up with the political rhetoric in Washington, according to Wall Street analysts. UnitedHealth Group Inc.’s solid third-quarter earnings on Tuesday sparked the sector’s biggest rally in a decade as it helped ease concerns about rising medical costs. While expectations were low heading into the report, the magnitude of the move illustrates just how negative sentiment has gotten. Also roiled by fears of a single-payer system, health insurers appear to have found their footing as investors turned more optimistic about the industry’s business outlook, according to BMO analyst Matthew Borsch. (Darie, 10/15)

Modern Healthcare: Amazon, City Of Hope Partnership Gives Workers Access To Cancer Support
Amazon is the latest employer to contract with Duarte, Calif.-based cancer treatment center City of Hope to offer its workers an array of cancer support services. The partnership allows Amazon employees to request a review of their diagnosis and treatment plan from City of Hope specialists, who may recommend improvements to the plan if appropriate. Amazon employees may also travel to City of Hope for an in-person evaluation, according to the cancer center's announcement Tuesday. (Livingston, 10/15)

Modern Healthcare: Oscar Will Appeal Dismissal Of Florida Blue Antitrust Challenge
Insurance company Oscar Health said it will appeal a federal court's decision to dismiss its antitrust lawsuit against Blue Cross and Blue Shield of Florida. Oscar challenged Florida Blue's policy of prohibiting its brokers from selling other insurers' plans. Though New York-based Oscar had support from the U.S. Justice Department, U.S. District Judge Paul Byron in Orlando dismissed the case in September, ruling that the dominant Florida health insurer's exclusive agreements with brokers are exempt from federal antitrust law. (Livingston, 10/15)

Modern Healthcare: Hackensack Meridian Health To Merge With Englewood Health
Hackensack Meridian Health and Englewood Health have signed a definitive agreement to merge, the not-for-profit New Jersey health system and hospital announced Tuesday. Hackensack pledged a $400 million capital investment in Englewood, which executives hope will further Englewood's position as a tertiary academic hub in northern New Jersey. Those investments include new operating rooms, additional ambulatory care facilities and expanded cardiac catheterization labs, among others. (Kacik, 10/15)

Modern Healthcare: Lower Reimbursements Lead Sinai Health System To Close Subacute Unit
Sinai Health System plans to close the subacute services unit at its North Lawndale rehabilitation hospital in Chicago due to changes in Medicare's skilled-nursing payment system. The 21-bed unit within 102-bed Schwab Rehabilitation Hospital serves as a bridge between acute care and home health. It stopped accepting new patients Oct. 1 and will close upon approval from the state, Sinai said in a statement today. (Goldberg, 10/15)

CQ: Judge Strikes Part Of Obama-Era Nondiscrimination Health Rule
A federal judge on Tuesday vacated an Obama-era health care rule banning discrimination, including against transgender individuals. The rule also prohibits medical providers and insurers from discriminating against people seeking abortions. The ruling comes as the Supreme Court is considering three other cases on gender identity and sexual orientation discrimination this term. (Raman, 10/15)

Politico Pro: Judge Overturns Civil Rights Protections For Transgender, Abortion Patients
The ruling is the latest turn in the long-running legal battle over the ACA’s nondiscrimination protections, Section 1557 of the law. The Obama administration extended those protections to transgender and abortion patients, prompting a lawsuit from eight conservative-leaning states and a Catholic health system. At the tail end of the Obama administration, O’Connor blocked the anti-discrimination provision specifically for gender identity and patients who have had an abortion. The Trump administration agreed with that ruling and had asked to O’Connor to delay a decision on the merits until it was able to write new regulations. HHS proposed new nondiscrimination rules in May that excluded protections for transgender patients. (Luthi, 10/15)

The Hill: Federal Judge Overturns ObamaCare Transgender Protections
O’Connor, the same judge who last year ruled that the entire Affordable Care Act is unconstitutional, said the rule violates the Religious Freedom Restoration Act. His ruling is likely to be appealed. The ObamaCare rule was initially challenged in court in 2016 by a group of Christian providers called the Franciscan Alliance as well as five conservative states. (Weixel, 10/15)

The New York Times: A Young Man Nearly Lost His Life To Vaping
Gregory Rodriguez thought he had the flu when he went to the emergency room on Sept. 18, feeling feverish, nauseated and short of breath. He woke up four days later in a different hospital, with a tube down his throat connecting him to a ventilator, and two more tubes in his neck and groin, running his blood through a device that pumped in oxygen and took out carbon dioxide. The machines were doing the job of his lungs, which had stopped working. (Grady, 10/15)

Bloomberg: Vaping Sales Grow At Slowest Rate In A Year As Illnesses Mount 
E-cigarette sales in recent weeks grew by the slowest rate in more than a year and a half amid public health warnings over vaping, while cigarette sales declines eased slightly in the past month, according to industry data. Sales of e-cigarettes grew by 25.5% in the four weeks ended Oct. 5 compared with the same period a year ago, Cowen analyst Vivien Azer wrote, citing data from Nielsen. It’s a significant slowdown from the monthly growth rates of more than 50% that the e-cigarette category has seen since at least August 2018. (Sircar, 10/15)

The Associated Press: Judge Blocks Michigan's Ban On Flavored E-Cigarettes
A Michigan judge temporarily blocked the state's weeks-old ban on flavored e-cigarettes Tuesday, saying it may force adults to return to smoking more harmful tobacco products and has irreparably hurt vaping businesses. Court of Claims Judge Cynthia Stephens put the prohibition on hold until "further order of this court." The preliminary injunction will be appealed by Gov. Gretchen Whitmer, who ordered the creation of the emergency rules in a bid to combat the epidemic of teen vaping. (10/15)

The Oregonian: Oregon Flavored Vape Ban Hits Tobacco Shops Hard 
The restrictions bar retailers from selling nicotine liquids that taste like anything but tobacco as well as cannabis liquids that taste like anything but marijuana or that contain any chemicals not derived from marijuana. Flavored liquids with CBD for vaping also are banned. The ban began Tuesday and follows a growing epidemic of severe lung illnesses connected to vaping. On the same day, the state announced another two vaping-related illness in Oregon, bringing the total to 11. Federal investigators have tallied nearly 1,300 cases in 49 states and 26 deaths, including two in Oregon, linked to vaping. (Zarkhin, 10/15)

Cincinnati Enquirer: Are You 21? If Not, Ohio Will Make It Harder To Vape, Smoke Thursday
Getting cigarettes and vaping products is about to get harder for young Ohioans.The state's "Tobacco 21" law goes into effect on Thursday. That means the age in Ohio to purchase any tobacco products or nicotine products such as electronic cigarettes will rise to 21. (DeMio, 10/15)

St. Louis Public Radio: To Discourage Vaping Among Youth, Missouri Gov. Parson Mandates Education Campaign
Calling vaping-related illnesses among Missouri’s youth “an epidemic,” Missouri Gov. Mike Parson on Tuesday signed an executive order mandating education to discourage usage. Thousands have been sickened across the country due to vaping-related illnesses. In Missouri, there have been 22 reported illnesses and one death as of Oct. 4. The majority of those cases involve people between the ages of 15 and 24. (Driscoll, 10/15)

The New York Times: What Are The Benefits Of CBD?
The CBD industry is flourishing, conservatively projected to hit $16 billion in the United States by 2025. Already, the plant extract is being added to cheeseburgers, toothpicks and breath sprays. More than 60 percent of CBD users have taken it for anxiety, according to a survey of 5,000 people, conducted by the Brightfield Group, a cannabis market research firm. Chronic pain, insomnia and depression follow behind. Kim Kardashian West, for example, turned to the product when “freaking out” over the birth of her fourth baby. The professional golfer Bubba Watson drifts off to sleep with it. And Martha Stewart’s French bulldog partakes, too. (MacKeen, 10/16)

The New York Times: What Are The Benefits Of Turmeric?
Have you noticed lattes, ice cream and smoothies with a tawny hue? That could be a sign of a not-so-secret ingredient: turmeric. The botanical is omnipresent in health food aisles, in the form of pills and powders. Turmeric, native to South Asia, is one of the fastest-growing dietary supplements. In 2018 products racked up an estimated $328 million in sales in the United States, a more than sevenfold increase from a decade earlier, according to a report from Nutrition Business Journal. (MacKeen, 10/16)

The New York Times: Is Celery Juice A Sham?
Celery juice has been seemingly everywhere: The murky green potion looks like water from an algae-filled pond, yet its disciples have been downing it by the glassful.  Yes, that staid crunchy workhorse usually smeared with peanut butter has gone to the top of the vegetable cart. (MacKeen, 10/16)

The New York Times: Are There Benefits To Drinking Kombucha?
Kombucha is a fermented food, much like cultured yogurt, cheese, kefir, kimchi and sauerkraut. Traditionally a carbonated drink with live micro-organisms, kombucha is made by brewing together sugar, black or green tea, liquid from a previous batch and the Scoby, short for symbiotic culture of bacteria and yeast (though its more popular nickname is “mother,” since it reproduces during fermentation). (MacKeen, 10/16)

NPR: How Magic Mushrooms Can Help Smokers Kick The Habit
Carine Chen-McLaughlin smoked for more than 40 years. She didn't want to be a smoker. She'd tried to stop dozens of times over the decades. But she always came back. Smoking was "one of my oldest, dearest friends," she said of her habit. "To not have that relationship was very, very scary." (Sofia and Brumfiel, 10/15)

Stat: Ancestry Launches Consumer Genetics Tests For Health
Ancestry, the consumer genetics company that has until now focused on helping people understand their family history, on Tuesday revealed new products that will allow consumers to get health information based on their DNA results — putting it in direct competition with 23andMe. Ancestry has chosen a very different strategy than its rival. Unlike 23andMe tests, which are ordered by consumers, AncestryHealth products will be ordered by a physician who works for PWNHealth, a New York-based national network of doctors that says on its website that its mission is “to enable safe and easy access to diagnostic testing.” Access to professional genetic counselors, also from PWNHealth, will be included in the purchase price, which will be as low as $49. (Herper, 10/15)

Boston Globe: Harvard Study Spotlights Growing Inequality Among Older Americans
A new Harvard study shows the inequality of wealth and opportunity that has become a stubborn feature of American life is being entrenched in the oldest segment of society. Recent income gains — from investments, property appreciation, and retirement income — have gone disproportionately to the highest earners in the 65-and-older age group, while the number of older households burdened by housing costs has reached an all-time high, according to the report by Harvard’s Joint Center for Housing Studies. (Weisman, 10/16)

NPR: DNA Sequencing And Rare Disease Cold Cases
When Alex Yiu was born 14 years ago, he seemed like a typical healthy kid. But when he turned 2, his mother Caroline Cheung-Yiu started noticing things that were amiss — first little problems, then much bigger ones. As Alex's health slowly deteriorated, Caroline and her husband, Bandy Yiu, set off on what's become known among families like theirs as a "diagnostic odyssey." This ended up being a 12-year quest that ended after a lucky accident. (Harris, 10/16)

The New York Times: Exercise Advice For Surviving Cancer, And Maybe Avoiding It
Even a little exercise may help people avoid and survive many types of cancer, according to new exercise guidelines released today that focus on how exercise affects cancer outcomes. The guidelines, issued jointly by the American College of Sports Medicine, the American Cancer Society and 15 other international organizations, update almost decade-old recommendations with new science and specific advice about how much and what types of exercise may be the most needed, helpful and tolerable for anyone facing a cancer diagnosis. (Reynolds, 10/16)

The Associated Press: Panel: Florida Should Tighten School Shooter Drills
Florida's public schools should have realistic active-shooter drills and any armed school employees must be trained by a sheriff's office and not a private company, the commission investigating last year's high school massacre recommended Tuesday to the Legislature. The Marjory Stoneman Douglas High School Public Safety Commission, meeting in Orlando, recommended that each school have four active-shooter drills per year and that each be unique so teachers and students have to react to the situation presented. (10/15)

The Associated Press: Missouri Appeals Court Overturns $110 Million Talc Verdict
A Missouri appeals court has overturned a $110 million verdict in a case alleging that Johnson & Johnson products containing talcum powder caused a Virginia woman’s ovarian cancer. The appeals court ruling Tuesday reversed a 2017 judgment on behalf of Lois Slemp. She is among many women whose lawsuits have claimed that Johnson & Johnson’s talcum powder contributed to their cancer. Johnson & Johnson says its Baby Powder is safe and does not cause cancer. (10/15)

The Baltimore Sun: ‘More Must Be Done’: STD Cases In Maryland Mostly Outpacing Those Nationally 
There were 29 babies born in Maryland last year with the sexually transmitted disease syphilis. The rate of infant infection was the country’s ninth worst. The “tragic” figures were among a host of data about STDs alarming experts at the U.S. Centers for Disease Control and Prevention, which recently released the numbers. There were record numbers of cases recorded in all of the three most common STDs: syphilis, gonorrhea and chlamydia. (Cohn, 10/16)

Georgia Health News: Georgia Declines In Health Ranking For Women And Children
A recent report ranks Georgia 40th among states on the health of women and children, down three spots from its 2018 ranking.The 2019 United Health Foundation report said among Georgia’s challenges are its high percentage of uninsured women, its low rate of prenatal care before the third trimester, and its low percentage of high school graduation. The state also has high rates of infant mortality and low-birthweight babies. (Miller, 10/15)

MPR: Some Calling For Better Access To HIV Prevention Drugs In Minnesota
A new law in California allows HIV prevention drugs to be prescribed by pharmacists instead of doctors. Gov. Gavin Newsom signed the law last week. Some in Minnesota, including JustUs Health, are calling for similar availability here. (Crann, 10/15)

The Philadelphia Inquirer: Pa.’s Largest Community College Eliminates Campus Mental Health Counseling For 17,000 Students
Pennsylvania’s largest community college system has eliminated all on-campus mental health counseling for its students, Spotlight PA has learned, a move college health experts called short-sighted and risky at a time of growing need. The Harrisburg Area Community College (HACC) told counselors across its five campuses to stop individual and group counseling as of mid-September, according to an internal memo obtained by Spotlight PA. Instead, students with mental health needs will be sent to a dean of student affairs who will refer them to an off-campus provider. (Pattani, 10/16)

Reveal: The Fourth Trimester: Postpartum Takes On A New Meaning For New Moms With History Of Opioid Abuse
In states that have not expanded Medicaid, coverage for pregnant women expires 60 days after childbirth. Missouri almost became the exception last year when it passed a bipartisan law, House Bill 2280, to extend coverage for women with a history of substance abuse to one year after childbirth. The law was to go into effect in August 2018, but more than a year later, implementation is at a standstill as the Missouri Department of Health and Senior Services and the Centers for Medicare & Medicaid Services evaluate a waiver that would allow the federal government to grant Missouri flexibility with its Medicaid program. (Giraldo, 10/15)

The Associated Press: Toxic PCBs Linger In Schools; EPA, Lawmakers Fail To Act
At first, teachers at Sky Valley Education Center simply evacuated students and used fans to clear the air when the fluorescent lights caught fire or smoked with noxious fumes. When black oil dripped onto desks and floors, they caught leaks with a bucket and duct-taped oil-stained carpets. Then came the tests that confirmed their suspicions about the light ballasts. (10/16)

St. Louis Public Radio: After Years Collecting Dust, Missouri's Untested Rape Kits Are Getting Sorted Out
Missouri has more than 10,000 untested rape kits sitting on shelves in police departments and hospital — some have been there for decades — but the state is finally set to have a full inventory of those kits by the end of the month. Once the inventory is complete, Attorney General Eric Schmitt’s office can move forward with creating an electronic database to not only keep track of the untested kits, but to help prosecute rapists and provide justice for victims. (Driscoll, 10/16)

Sacramento Bee: CA Gov Gavin Newsom Signs Slate Of Marijuana Bills Into Law
California Gov. Gavin Newsom handed a win to the cannabis industry over the weekend when he signed a law allowing marijuana businesses to claim state tax deductions. It’s one of eight laws he signed in the closing weeks of the legislative year aimed at fine-tuning the 2016 ballot initiative voters passed to legalize cannabis and at helping state-registered marijuana companies compete with black market dealers. (Sheeler , 0/15)

California Healthline: No More Tater Tots? California Schools Put Healthier Lunches To The Test
When Miguel Villarreal addresses a crowded education conference, a group of school district administrators or a room full of curious parents, he often holds aloft a foil-wrapped package of Pop-Tarts — the heavily processed, high-sugar snack routinely sold on school campuses. Villarreal, who oversees nutrition for the San Ramon Valley Unified School District in Northern California, then speaks clearly and loudly as he unloads the news: “School food services are completely broken.” (Kreidler, 10/15)

Sacramento Bee: CA Prison Whistleblower Blasts State Over Inmate Health Care
The whistleblower who accused California prison leaders last year of providing false and misleading data to a federal court on how the state handles inmate psychiatric care made his first public appearance Tuesday, standing behind his claims and saying corrections officials concocted “utter statistical rubbish” in some cases. Dr. Michael Golding, the chief psychiatrist at the California Department of Corrections and Rehabilitation headquarters, testified in Sacramento federal court Tuesday about what he said were repeated instances to gin up phony data the state needed to present to U.S. District Judge Kimberly J. Mueller to prove they were making progress on improving psychiatric care in the prisons. (Stanton, 10/15)

WBUR: One California County Combats Homelessness Crisis With New, Sometimes Controversial Methods
There is a radical approach on the table to fight the homeless crisis in Kern County, where Bakersfield sits. The sheriff there is proposing locking up some homeless people for drug and other misdemeanor offenses. The approach has largely been out of favor for decades now. (Mosley, 10/15)

Stat: Most Americans Back Various Ideas To Lower Drug Costs, But Some Fear Impeachment Will Get In The Way
As Congress debates how to lower prescription drug costs, a large majority of Americans want the federal government to negotiate with drug makers to reduce prices paid by Medicare, according to a new poll by the Kaiser Family Foundation. Specifically, 88% of those queried support negotiations to lower Medicare Part D costs, and 85% believe this approach should be pursued for both Medicare and private insurers. (Silverman, 10/15)

Stat: House Progressives Plot Overhaul Of Pelosi Drug Pricing Bill
In the eyes of progressive lawmakers, House Speaker Nancy Pelosi’s drug pricing legislation is less a finished masterpiece than a rough sketch. For the past two weeks, left-wing legislators have plotted a top-to-bottom overhaul of the legislation, aided by outside advocacy groups who have compiled lists of a half-dozen or more changes to the sweeping Lower Drug Costs Now Act, Democrats’ signature drug pricing bill. (Facher and Florko, 10/15)

CQ: Patients Raise Questions About Democrats' Drug Pricing Bill
Democrats are betting their legislation to lower drug prices will be a political winner — but some patients learning the details are skeptical it will help them. Speaker Nancy Pelosi of California said in late September that her signature drug pricing bill (HR 3) received "rave reviews from everyone but the pharmaceutical industry." And lawmakers tried to tout the bill during the October recess. Two House committees, Energy and Commerce and Education and Labor, will markup the measure on Thursday. (Kopp and Siddons, 10/16)

Vox: Pelosi’s Plan To Lower Drug Prices: The Good And Bad For Health Care
The centerpiece of House Speaker Nancy Pelosi’s plan to lower prescription drug prices — more direct Medicare negotiations with drug makers, with a hard cap on prices as a backstop — would save the federal government hundreds of billions of dollars, but fewer new drugs would come onto the market, according to a new analysis from the Congressional Budget Office. The CBO report makes clear the tradeoff for more government intervention in the drug market: Cost savings for the government would equal less spending on research and development by drug companies, which will mean fewer new treatments. What we don’t know is how harmful, if at all, that would actually be. (Scott, 10/14)

Roll Call: Scope Of Drug Pricing Bill Could Thwart Democrats’ Hope For Political Win
Democrats are betting their legislation to lower drug prices will be a political winner — but some patients learning the details are skeptical it will help them. Speaker Nancy Pelosi of California said in late September that her signature drug pricing bill received “rave reviews from everyone but the pharmaceutical industry.” And lawmakers tried to tout the bill during the October recess. Two House committees will markup the measure on Thursday. (Kopp and Siddons, 10/16)

Stat: A Murky Approach To Tracking 340B Drugs May Yield Duplicate Rebates
Amid ongoing controversy over a federal drug discount program for safety-net hospitals, a new survey finds a dozen state Medicaid programs rely on an arguably inadequate method to avoid receiving duplicate rebates, which could provide a boost for taxpayers but hurt the pharmaceutical industry’s bottom line. At issue is the interplay between Medicaid and the so-called 340B program, which was created in 1992 and requires drug makers to offer discounts of up to 50% on all outpatient drugs — for everything from AIDS to diabetes — to hospitals and clinics that serve indigent populations. (Silverman, 10/15)

The Guardian: DIY Drugs: Should Hospitals Make Their Own Medicine?
When a pharmaceutical company raised the price of an essential medicine to unacceptable levels, there was only one thing for pharmacist Marleen Kemper to do: start making it herself. When Kemper was in primary school, she had watched two of her classmates get ill. One had a brain tumour, the other contracted an infection in his gut. Both of them died. Kemper was about 10 at the time, and knew she did not want to see another friend perish. She told her parents she wanted to do something that would prevent others dying. She wanted to be a doctor. (Stokel-Walker, 10/15)

FiercePharma: State Laws Trying To Force Drug Price Transparency Come Up Short, Study Says
Transparency in drug pricing sounds like a great idea, but a new study from the University of Southern California (USC) found almost none of the laws passed in an attempt to force transparency will do much good. In fact, fewer than 5% of the drug pricing laws passed by states in the past few years would result in new information about drug pricing, according to the study by Neeraj Sood and Martha Ryan at USC’s Shaeffer Center for Health Policy & Economics, published in JAMA. (Bulik, 10/15)

California Healthline: California’s New Transparency Law Reveals Steep Rise In Wholesale Drug Prices
Drugmakers fought hard against California’s groundbreaking drug price transparency law, passed in 2017. Now, state health officials have released their first report on the price hikes those drug companies sought to shield. Pharmaceutical companies raised the “wholesale acquisition cost” of their drugs — the list price for wholesalers without discounts or rebates — by a median of 25.8% from 2017 through the first quarter of 2019, according to the Office of Statewide Health Planning and Development. (Feder Ostrov and Rowan, 10/11)

CBS News: Doctors Without Borders Asks Johnson & Johnson To Halve Price Of Tuberculosis Drug
Doctors Without Borders is calling on Johnson & Johnson to halve the price of a lifesaving tuberculosis drug, called bedaquline, to make it more accessible to patients around the world. Currently, a six-month supply of the drug for a single person costs $400 in countries around the world that participate in the Global Drug Facility, a United Nations-linked organization that is the world's largest provider of tuberculosis medication. A 20-month supply is slightly cheaper at $1,200, or $2 a day, though the drug is pricier in more developed countries. (Cerullo, 10/14)

Stat: Doctors Without Borders Urges Drug Makers To Lower Price For TB Medicine
At the same time, Doctors Without Borders wants Otsuka Pharmaceutical to slash the $1,700 price tag for Deltyba, which Mylan also licensed and now sells for $940 in South Africa. The nonprofit cited estimates from University of Liverpool researchers who calculated the drug could be made and sold at a profit for $5 to $16 a month if enough countries are able to purchase large quantities. (Silverman, 10/10)

CBS News: Humira, Cialis And Other Drug Prices Have Jumped. Are The Increases Justified?
Drug prices are rising far faster than inflation, causing financial pain for many Americans. Even worse, some of those prices may not be justified by clinical improvements to the drugs themselves, a new report claims. A watchdog group says the prices for seven widely used medications — including Humira, Cialis and Lyrica — rose at more than twice the medical consumer price index from the start of 2017 through the end of 2018, yet failed "to support a claim of additional clinical benefit." (Picchi, 10/9)

The Wall Street Journal: New Gilead Sciences CFO Expected To Pursue More Deals To Expand Portfolio
Biopharmaceutical giant Gilead Sciences Inc. selected an internal candidate to become its next finance chief, filling a key position on its leadership team as the company looks to further expand its portfolio beyond its core HIV treatments. The Foster City, Calif.-based company Tuesday said it appointed Andrew Dickinson as chief financial officer, effective Nov. 1. Mr. Dickinson, currently executive vice president for corporate development and strategy, joined Gilead in 2016 following a nine-year tenure in investment banking. He will succeed Robin Washington, who is set to retire from the CFO role but will remain in an advisory capacity until early next year. Ms. Washington’s planned retirement was announced in April. (Trentmann, 10/15)

Stat: PhRMA's Talking Points Shouldn't Derail The Pelosi Drug Pricing Bill
Two of the most innovative pharmaceutical corporations in the world have their headquarters on opposite banks of the Rhine as it flows through Basel, Switzerland. Ranked No. 2 and 4 in total worldwide sales, Roche (RHHBY) makes Herceptin and other important cancer treatments while Novartis (NVS) recently brought to market the immune therapy Kymriah and the gene therapy Zolgensma. Sanofi (SNY) (7) is in Paris, Glaxo Smith Kline (6) and AstraZeneca (AZN) (14) are in London, and Takeda (TAK) (20) is based in Osaka. (Peter B. Bach, 10/11)

The Hill: Caution For Democrats: Voters Care More About Drug Pricing Than Impeaching Trump
As House Democrats press on with their impeachment inquiry into President Donald Trump, it is essential that their party remains mindful of the promises and policies they campaigned on in 2018. Though the impeachment inquiry will continue to dominate the media cycle and Washington politics for months to come, congressional Democrats would be wise to remain focused on legislative priorities and accomplishments because, simply put, these will be the issues that Americans take to the ballot box in 2020. (Douglas Schoen, 10/13)

Stat: Wanted: Better Policies And Incentives To Revitalize R&D For New Antimicrobial Drugs
In the not-too-distant future that we could be facing — one with rampant, uncontrollable, multidrug-resistant microbes — a seemingly inconsequential infection could have the power to kill. Being admitted to a hospital may do more harm than good, as hospital-acquired infections become incurable. Modern medical procedures, such as organ transplants, chemotherapy, and even surgery, might no longer be possible. For many patients and physicians, this future is already a reality.If an individual in the U.S. is infected with a drug-resistant strain of Acinetobacter — a species of bacteria my company is working on that is widely found in hospitals and that has one of the highest rates of resistance to antibiotics — there is a 50% chance he or she will die. (Manos Perros, 10/15)

Bloomberg: J&J And UnitedHealth Earnings Are Good For Now
Being an enormously profitable industry leader doesn't mean what it used to. Johnson & Johnson and UnitedHealthGroup Inc., the world’s biggest health-care company and health insurer, respectively, reported third-quarter earnings results Tuesday morning that should thrill investors. Both managed to beat Wall Street earnings estimates and boosted full-year profit guidance above expectations as they generated a combined $80 billion in sales. (Max Nisen, 10/15)

Boston Globe: Drug Price Transparency: Round 2
Next week is expected to kick off yet another round in Massachusetts’ continuing battle to control health care costs, a prime driver of the state budget and family budgets alike. This time, health regulators are taking a hard look at drug costs — an overdue target for scrutiny if there ever was one — but already Big Pharma and the local biotech industry are pushing back. Total health care spending in Massachusetts rose 3.1 percent to $60.9 billion in 2018, outpacing inflation (2.9 percent) and wage growth (2.8 percent), according to the latest report of the Center for Health Information and Analysis (CHIA) released last week. That was $2.1 billion more than the previous year. (10/16)

The Hill: Congress Should Set Fair Rules That Force Drug Corporations To Negotiate Prices
Today in our country, nearly one in four Americans either go without their prescriptions or skip doses because they cannot afford prescriptions medicines. The drug corporations are bringing in record profits — making billions while collecting huge tax breaks under President Trump’s 2017 tax law. Eli Lilly, one of the largest manufacturers of insulin, for instance, paid no federal taxes last year despite raking in $598 million. Meanwhile, families are being forced to choose between paying for rent or food and filling their child’s prescription. (Jennifer Butler, 10/14)

Stat: FDA Is Smashing The Status Quo For Regulatory Science 
A recent press release from the Food and Drug Administration titled “Reorganization of the Office of New Drugs with Corresponding Changes to the Office of Translational Sciences and the Office of Pharmaceutical Quality,” may have sounded like another bland and boring exercise in regulatory rhetoric. But it actually signals a revolutionary shift in regulatory velocity. Changes in the FDA’s Office of New Drugs (OND) will create enhanced review zones that cross disease areas and divisions to maximize access to more focused and innovative areas of regulatory expertise. ...The rationale is to make the FDA more efficient and help it better understand the diseases that are the aim of treatment by the drugs being evaluated for approval. (Peter J. Pitts, 10/14)

Stat: Mean Survival Gain Is A Better Metric For Pricing New Cancer Drugs
Outrage about the rising prices of prescription drugs has put cancer drugs in the spotlight. But there’s an important question that needs to be asked: What is the best pricing metric to use for them? Economists like us spend a lot of time worrying about this in a more general context. When the government computes its consumer price index, for example, it thinks about the quality of the goods that households purchase. (Alice Chen and Dana Goldman, 10/14)

The New York Times: It Was The Best Of Warren. It Was The Worst Of Warren
Pete Buttigieg went after Elizabeth Warren, wondering why she was so intent on abolishing private health insurance and suggesting that her stance would dangerously intensify political polarization in America. Amy Klobuchar went after Warren, describing her Medicare for All plan as one big fat Republican talking point and Warren as a fantasist peddling “a pipe dream.” Bernie Sanders went after her — well, sort of — by correctly noting her repeated refusal to admit what he already had, which is that Medicare for All would require a tax increase not just for affluent Americans but also for the middle class. (Frank Bruni, 10/16)

The Hill: Promising Lower Health Care Costs Doesn't Fly With Women — Who Will Vote 
Can you afford to buy a new economy car each year? And if you do not drive it, would you just junk it and buy another new one, repeating this cycle every year? Of course not, no matter how much money you have. But that is the equivalent of what we do each year on health care costs, according to a recent Kaiser Foundation report. The average premium for family coverage now tops $20,717 for those covered by a large employer. The average for high-deductible plans with savings options is $21,683. That premium for large firms was only $5,845 in 1999. And these costs do not include copays and deductibles. (Sarah Chamberlain, 10/14)

The New York Times: This Is The Most Realistic Path To Medicare For All
Much to the dismay of single-payer advocates, our current health insurance system is likely to end with a whimper, not a bang. The average person simply prefers what we know versus the bureaucracy we fear. But for entirely practical reasons, we might yet end up with a form of Medicare for All. Private health insurance is failing in slow motion, and all signs are that it will continue. It was for similar reasons that we got Medicare in 1965. Private insurance, under the crushing weight of chronic conditions and technologic breakthroughs (especially genetics), will increasingly be a losing proposition. (J.B. Silvers, 10/15)

Boston Globe: Drug Price Transparency: Round 2
Next week is expected to kick off yet another round in Massachusetts’ continuing battle to control health care costs, a prime driver of the state budget and family budgets alike. This time, health regulators are taking a hard look at drug costs — an overdue target for scrutiny if there ever was one — but already Big Pharma and the local biotech industry are pushing back. (10/16)

Nashville Tennessean: Lower Health Care Costs Act Will Backfire In Rural Areas Of Tennessee
No one likes to receive a surprise bill for medical services that you assumed were covered by your health plan. Congress wants this to end, and there are several proposals on the table now that they’ll consider in the weeks ahead. (Byron F. Stephens II, 10/16)

Stat: It's Time To Eliminate All Flavored Cigarettes, Not Just Electronic Ones 
The unprecedented rise in youth vaping is a pressing public health challenge. More than one-quarter of all high school students now use e-cigarettes. Reducing e-cigarette use among youths is critical to preventing another generation of kids from becoming addicted to nicotine. We applaud efforts to prohibit the sale of menthol-, mint-, candy-, and fruit-flavored e-cigarettes. But government and public health leaders must not repeat the same mistake they made a decade ago when they allowed combustible menthol cigarettes to remain on the market. (Derek Carr and Pratima Musburger, 10/16)

Seattle Times: Vaping response should be science-based, not prohibition
It’s frightening when people are dying and doctors don’t know why. Over the past few months, 26 deaths and some 1,300 injuries have been attributed to vaping. We shake our heads in disbelief at X-ray images of lung damage and findings of vape-borne chemicals that turn to cyanide when heated. Doctors and public health officials are appropriately sounding alarms. Lawmakers are responding predictably, and unfortunately, with calls for outright bans on vaping and vape products. (Susan Collins, 10/14)

The Washington Post: STDs Are On The Rise. They Must Be Combated. 
In 2000 and 2001, the national rate of reported primary and secondary syphilis cases in the United States reached the lowest since reporting began in 1941. In 2009, the rate of gonorrhea cases reached a historic low. Now this progress has unraveled. Sexually transmitted infections — syphilis, gonorrhea and a third illness, chlamydia — hit an all-time high in the United States last year. This is a surge of illness that did not have to happen and must be addressed. (10/15)

Los Angeles Times: What The Gun Lobby Gets Wrong About The 2nd Amendment
The case involves a New York City regulation on transporting handguns that was repealed in July. Although that original rule is no longer in effect, for now the court has not determined the matter to be moot, so the case will move forward. In this dispute and others, opposition to gun regulations is often grounded on the premise that once an individual interest is identified as a “fundamental” right, that interest prevails over all countervailing public concerns. That premise is profoundly mistaken. (Vikram D. Amar and Alan E. Brownstein, 10/16)

The Hill: Genetic Counselors Save Health Care Dollars When Involved In The Testing Process
As a cardiovascular genetic counselor with more than 15 years of experience, I know firsthand the critical importance of identifying genetic risk in a timely manner. Genetic counselors are in a unique position to help patients and their providers navigate medically complex genetic risk factors. (Amy Sturm, 10/15)

The Washington Post: We’re Launching The Nation’s First Safe-Injection Site. We Hope It Will Be One Of Many.
This month, a federal judge in Philadelphia ruled that a supervised injection site that we co-founded is not illegal, opening the door for the first one to be established in the United States. We hope it will be one of many across the country.In a well-reasoned 56-page opinion, U.S. District Judge Gerald A. McHugh ruled that a supervised injection site, designed to combat the staggering death toll of opioid overdoses by allowing people to inject drugs under medical supervision, does not violate the “crack-house” section of the Controlled Substances Act because the site would be operated not “‘for the purpose of’ unlawful drug use” but to "save lives.” (Ed Rendell, Jose A. Benitez and Ronda B. Goldfein, 10/15)

The Oregonian: Oregon’s Addiction Crisis Needs Governor’s Action Now
Each day, five Oregonians die as a consequence of alcohol and one or two die from drug overdoses – over 2,100 lives lost each year to substance addiction. Comparatively, in 1994 alone, Oregon lost 362 people to the AIDS epidemic. Yet untreated addiction gets little of the attention that an epidemic of its size demands. Moreover, untreated addiction is a leading contributor to our overwhelmed foster care system, our homelessness crisis, and our packed prisons. (Se-ah-dom Edmo and Tony Vezina, 10/14)