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Summaries Of The News:

Health Law Issues And Implementation

For Millions, Paying Penalty For Not Having Coverage Is Lesser Of Two Evils

Many Americans are choosing to pay the fine, which is low in relation to what their premiums would be. One key adviser thinks that making the penalty higher would help fix some of the health law's troubles.

The New York Times: Health Law Tax Penalty? I’ll Take It, Millions Say
The architects of the Affordable Care Act thought they had a blunt instrument to force people — even young and healthy ones — to buy insurance through the law’s online marketplaces: a tax penalty for those who remain uninsured. It has not worked all that well, and that is at least partly to blame for soaring premiums next year on some of the health law’s insurance exchanges. (Pear, 10/26)

The Hill: ObamaCare Architect: ‘I Wish The Mandate Penalty Was Stronger’ 
A key adviser who helped design President Obama’s signature healthcare law is calling for stricter penalties for people who choose not to pay for health insurance. “I think probably the most important thing experts would agree is we need a larger mandate penalty,” Jonathan Gruber said in an interview with CNN on Wednesday.  “That’s something I think, ideally, we would fix,” he added.  When asked later about the one adjustment he would have made to the law before it was passed, he said, "I wish the mandate penalty was stronger."  For 2016, the penalty for being uninsured is 2.5 percent of taxable income or $695, whichever is greater. (Ferris, 10/26)

Meanwhile, in related health law news —

The Washington Post: ACA’s Big Price Hike Reflects Challenges Of Expanding Coverage Amid Political Static
Soaring insurance prices for the coming year under the Affordable Care Act place intense pressure on the next president to follow through with campaign promises for a new round of changes to the nation’s health-care system after years of bitter stalemate. The revelation this week by the Obama administration that premiums will increase by 25 percent, on average, for a popular group of plans sold through immediately became tinder for GOP presidential candidate Donald Trump and congressional Republicans. The lashing was nothing new. (Goldstein, 10/26)

Kaiser Health News: Video: How Obamacare Premium Hikes Affect Politics And Your Wallet
The new enrollment period for the Affordable Care Act opens next Tuesday, and consumers in many areas could see double-digit percentage increases for premiums on average and fewer choices. PBS NewsHour’s Judy Woodruff talks to Mary Agnes Carey of Kaiser Health News and Reid Wilson of The Hill as they consider some of the options that individuals around the country are weighing. (10/26)

The Washington Post: Confused By Obamacare? Here Are Answers To Key Questions.
Four years ago, when President Obama predicted that the Affordable Care Act would result in lower health-insurance premiums, we gave him Three Pinocchios. The “Obamacare” law had not been fully implemented yet, but we reviewed nearly 10 reports from states across the country on the potential impact of the law and concluded the law’s provisions “will almost certainly increase premiums, though tax subsidies will help mitigate the impact for a little over half of the people in the exchanges.” (Kessler, 10/27)

Modern Healthcare: Copycat Enrollment Websites Hamper ACA Sign-Up Efforts
Even in optimal circumstances, many consumers find it hard to understand their choices and pick a plan that best meets their needs on price, out-of-pocket costs, and provider network. Experts say widespread assistance from well-trained navigators and assisters could prove critical in determining whether more younger, healthier Americans sign up for coverage, thus stabilizing the ACA exchanges in 2017. Complicating the navigators' job, however, is the proliferation of insurance shopping websites with URLs similar to the federal government's official enrollment site, such as After visiting such sites, consumers sometimes get flooded with sales pitches from brokers. Some of these pitches are for products that are not ACA-compliant or are not even insurance plans. (Meyer, 10/25)

Morning Consult: HHS Partnering With Tech Companies To Support Enrollment
The Department of Health and Human Services on Tuesday announced partnerships with 17 companies that will use their networks to share information about open enrollment this year. The companies, which range from driving services such as Uber and Lyft to websites such as, said they are committed to sharing information so that people can better understand their coverage options. Their businesses represent more than 15 million professionals and reach 8.5 million through their products and services, they said in a joint statement. (McIntire, 10/25)

And congressional Republicans continue to pursue their fight against insurer bailouts —

Morning Consult: House GOP Shifts Focus To DOJ In ‘Insurer Bailout’ Fight
House Republicans this week sent a letter to Attorney General Loretta Lynch seeking details on the administration’s potential talks with health insurers about settlements in lawsuits related to the Affordable Care Act. Members of the Energy and Commerce Committee sent the letter, following up on previous letters sent to the Department of Health and Human Services about the issue. The lawmakers are against the administration using taxpayer money to settle lawsuits with insurers over an Affordable Care Act program under which insurers say they are due payments. (McIntire, 10/26)

Premium Spikes Reverberate Through The States

Media outlets in Maryland, Tennessee, Minnesota, Washington, Georgia and Illinois report on developments regarding the health law's sharp rise in premiums costs.

The Baltimore Sun: Advocates Suggest Ways To Cut Health Insurance Costs 
State lawmakers heard from consumer advocates Wednesday on how to slow premium increases for those buying health insurance on the state exchange, proposals that might also moderate costs for the majority getting coverage through an employer. Nearly 163,000 Marylanders got their insurance this year through the online health exchange created under the Affordable Care Act, and the majority get federal subsidies to help pay for it. But some must pay the full freight of increases ranging from 20 percent to 30 percent next year, and lawmakers were concerned about the long-term sustainability of the insurance program and the affordability of health care generally. (Cohn, 10/26)

Nashville Tennessean: Dems: State Needs To Help Iron Out Individual Health Insurance Kinks
State government needs to take a leadership role in tackling the problems in the individual health insurance market, which leaves patients in a persistent state of uncertainty, according to state Democrats and patient advocates. Sen. Jeff Yarbro and Rep. John Ray Clemmons, both Nashville Democrats, convened a forum Wednesday to look at why the state's individual health insurance premiums have grown and how to mitigate the impact of insurers' exit from metropolitan markets on consumers who have a dwindling number of options, particularly in three metro areas where some health systems are excluded from benefits. (Fletcher, 10/26)

Nashville Tennessean: Tennessee, Insurer Officials: Network, Preparation Key For 2017 Open Enrollment
The next calendar year is going to be uncharted territory for many people in individual health insurance, and they should be ready to spend time comparing networks to see if their providers are covered. People shopping for individual health insurance for 2017 need to study the networks and plan design for the policies they are considering, particularly in the greater Nashville area, because they will be entering networks with different parameters, state and insurer officials said at the Tennessee Department of Commerce and Insurance. The state's three major metro areas are losing BlueCross BlueShield of Tennessee, which covered the lion's share of individual insurance buyers. (Fletcher, 10/26)

Nashville Tennessean: Saint Thomas Health Jockeys For 2017 Exchange Presence
Saint Thomas Health has launched eleventh hour conversations with insurers on the Obamacare exchange to expand networks around Nashville in the final days before enrollment begins. Saint Thomas Health, which is not covered in 2017 exchange-sold policies because of BlueCross BlueShield of Tennessee and UnitedHealthcare decisions, is trying to make sure its providers are covered by at least one of the remaining insurers. Both Cigna and Humana have contracted only with TriStar Health in previous years, and if no changes are made for 2017 then Saint Thomas and Vanderbilt University Medical Center would not be sold in plans that are eligible to subsidized by tax credits. (Fletcher, 10/26)

The Star Tribune: MNsure Remains The Best Way To Find Affordable Health Care And Tax Credits
There’s no use sugarcoating it. The 5 percent of Minnesotans who buy insurance on their own, rather than getting it through employers or public programs, are in a difficult position. Minnesota’s insurance companies are dramatically increasing their premiums. While policymakers work to fix this broken portion of the health-insurance market, MNsure can help these consumers survive this challenging time. (O'Toole, 10/26)

Pioneer Press: Daudt: Gov. Dayton Should Resign If Not Fixing Health Insurance
The Republican leader of the Minnesota House said Wednesday that the state’s health insurance is a “full-blown crisis” and that if Democratic Gov. Mark Dayton isn’t working toward a solution, he should resign. “If I find out (state officials) aren’t working 24/7 to find a solution to help these people get health insurance on January 1, I’m going to call for Dayton’s resignation myself, personally,” House Speaker Kurt Daudt, R-Crown, said in an impassioned 40-minute news conference. (Stassen-Berger, 10/26)

Seattle Times: Health-Insurance Premiums Rise In Washington, But Not As Much As Elsewhere 
Premiums for individual health-insurance plans in Washington will rise by an average 13.6 percent next year, though rates within the state health exchange are expected to jump about 8 percent for midlevel plans, far lower than national hikes of 25 percent. Thirteen health insurers have been approved to sell 154 individual and family plans in Washington for 2017, including nine insurers that will sell 98 plans through the Washington Healthplanfinder. (Aleccia, 10/26)

Georgia Health News: Employer Plans’ Premiums Much More Stable Than ACA Exchange Plans
The combined cost of premiums and deductibles for a Georgia family with employer-based insurance, on average, took up 11.6 percent of their income last year, a new report released Wednesday shows. Those family expenditures were higher than the national average of 10.1 percent, said the Commonwealth Fund report. The study also showed that nationally, the Affordable Care Act did not have a significant impact on health insurance costs borne by employer plans, which cover more than 150 million Americans. (Miller, 10/26)

Chicago Tribune: State's Online Obamacare Exchange May Have Some Info Wrong, Incomplete
Health insurance shoppers beware: Not all of the information on the state's Obamacare exchange is accurate or complete. Details about health plans offered on the exchange for next year were posted online Monday, giving shoppers a chance to study their options ahead of Nov. 1, when they can start to buy plans. But at least a couple of problems have surfaced since then. In Chicago and the greater Chicago area, many of Advocate Health Care's hospitals were incorrectly appearing as out-of-network in Blue Cross and Blue Shield of Illinois' BlueCare Direct and Blue Precision plans as of Wednesday. Also, farther south, insurer Health Alliance Medical Plans' offerings weren't showing up at all. (Schencker, 10/26)

Campaign 2016

GOP Senate Candidates Capitalize On Premium Spikes In Hopes Of Holding On To Majority

Double-digit increases on Affordable Care Act plan premiums become a campaign issue in states with competitive Senate races, including Pennsylvania and North Carolina.

The Associated Press: Health Premium News Gives Attacks To GOP Senate Candidates
Republican Senate candidates are jumping on news of sharply rising premiums under President Barack Obama's health care law as they seek advantage in the closing days of the election. The unpopular law was already an issue in some key Senate races, a recurring attack line for GOP candidates and in some cases another way to tie Democrats to Hillary Clinton. (Werner, 10/26)

The Associated Press: A Look At Hikes In Health Care Premiums In Senate Races
The cost of health care premiums are going up under President Barack Obama's 2010 law — and the hike looms as an issue in competitive Senate races. Here's a look at the average increase for the typical 27-year-old buying a midlevel plan. The percentage increase is before subsidies to purchase health care coverage, which are determined by income. (10/26)

Morning Consult: Experts Seek Obamacare Fixes As GOP Attacks
Leading health experts are calling for fixes to strengthen Obamacare’s marketplace after the administration acknowledged big premium hikes next year, but such changes would require Republicans to move away from its attacks on the law. Some Republicans have shown a willingness to engage in a conversation about improving Obamacare, but it’s a divisive issue because the attacks have been politically successful for them. (McIntire, 10/26)

Politico: Politico-Harvard Poll: Obamacare Wars Outlast Obama
As Obamacare opponents intensify attacks on soaring rate hikes and shrinking insurance options, a majority of voters believe the health care law is failing and there’s no consensus on what to do about it — findings that bode badly for hopes of Obamacare becoming any less toxic politically when its namesake president leaves office. A new poll conducted for POLITICO and the Harvard T.H. Chan School of Public Health finds that 54 percent of likely voters think Obamacare is working poorly. (Norman, 10/26)

In other news from the 2016 elections —

Politico: Politico-Harvard Poll: Clinton Voters Eager To Scrap Hyde Amendment
Most voters oppose Hillary Clinton’s proposal to allow federal tax dollars to cover abortion — but her most ardent supporters love it. A new poll conducted for POLITICO by the Harvard T.H. Chan School of Public Health found that only 36 percent of likely voters want to overturn the long-standing ban on Medicaid paying for abortion with federal funds. But among self-described Clinton voters, 57 percent support scrapping the current rules. (Haberkorn, 10/26)

Kaiser Health News: Clinton Took More Conciliatory Tone With Health Care Industry In Paid Speeches
On the campaign trail, Democratic presidential candidate Hillary Clinton has sharply criticized the health care industry, accusing pharmaceutical companies of profiteering and vowing to control skyrocketing costs. But Clinton’s tone was often more conciliatory before her presidential campaign when she addressed medical companies and trade groups as part of her brief but lucrative career delivering speeches for pay. (Kopp, 10/26)

Kaiser Health News: Drug Prices, Not The Health Law, Top Voters’ Health Priorities For 2017
Until this week, when big increases in insurance premiums were unveiled for next year, the federal health law has not been a major issue in the presidential election. In fact, fixing what ails the Affordable Care Act isn’t even among voters’ top priorities for health issues for next year, according to a new poll. The monthly October tracking poll from the Kaiser Family Foundation finds that when voters are asked about what the next president and Congress should do about health care, issues relating to prescription drug prices and out-of-pocket spending far outrank proposals to address the shortcomings of the health law. (Rovner, 10/27)


Vermont To Begin All-Payer ACO Project To Cover Medicare, Medicaid And Commercial Plans

The federal government is giving the state nearly $10 million to help start the experiment, which is designed to more directly reward the quality of care. Also, the nation's largest private nursing home company has agreed to pay $145 million to resolve fraud lawsuits, and Kaiser Health News offers some tips about Medicare enrollment.

Modern Healthcare: Vermont's All-Payer ACO Will Begin In January
In January, Vermont will become the first state in the nation to move to a voluntary all-payer accountable care organization model, the CMS announced Wednesday. The Vermont program is modeled after a similar one from Maryland, but the Maryland program covers only hospitals. The Vermont ACO will cover Medicare, Medicaid and commercial payers, requiring those who participate to pay similar rates for all services.The CMS is giving Vermont $9.5 million in start-up funding to support the transition. The demonstration, funded through a 1115 waiver, will last five years. (Muchmore, 10/26)

Reuters: Life Care To Pay Record $145 Mln Over Medicare Fraud Claims
Life Care Centers of America Inc and its owner Forrest Preston agreed to pay $145 million to resolve federal lawsuits accusing one of the largest privately held U.S. nursing home chains of Medicare fraud, the U.S. Department of Justice said on Monday. The accord with the Cleveland, Tennessee-based company is the Justice Department's largest with a skilled nursing facility chain, according to Benjamin Mizer, who heads the department's civil division. As part of the settlement resolving claims under the federal False Claims Act, Life Care also entered a five-year corporate integrity agreement requiring independent annual reviews of its Medicare billings, the department said. (Stempel, 10/24)

Health News Florida: Life Care Will Pay $145M To Settle Medicare Lawsuit
The U.S. Department of Justice has settled a lawsuit with the nation’s largest private nursing home company. Life Care Centers of America will pay $145 million to settle allegations. It will pay a $45 million down payment, and the rest over three years. Life Care Centers of America has more than 60 nursing homes in Florida, from Jacksonville to Orlando to Fort Myers. The Justice Department alleges the company put patients into the highest levels of therapy so it could bill Medicare at the highest rates. (Aboraya, 10/26)

Kaiser Health News: How To Enroll In Medicare And Avoid Costly Mistakes
Your 65th birthday is coming up. Soon, you think, the government will send you a packet explaining how to enroll in Medicare — its vast health program for 46 million seniors. Don’t hold your breath. ... Making a mistake can be costly. If you miss enrollment deadlines or make incorrect assumptions about coverage, you may find yourself without insurance protection for several months or incur substantial penalties. (Graham, 10/27)


EpiPen Is Getting Competition Again -- But It's Unclear Whether That Will Curb Prices

At the time Auvi-Q was pulled from the market in 2015 — after reports that it was not delivering proper doses of epinephrine — it cost more than the EpiPen.

The New York Times: An EpiPen Rival Is About To Return To The Shelves
The EpiPen is about to get some more competition. The makers of the Auvi-Q, an EpiPen alternative taken off the market last year, announced on Wednesday that they would bring it back in 2017. The move is certain to be welcomed by many patients and lawmakers, who have denounced the rising price of EpiPens and the lack of strong competition. (Thomas, 10/26)

Bloomberg: EpiPen Competitor Will Re-Launch After Being Pulled Off Market 
Mylan NV’s dominance of the U.S. allergy-shot market will be challenged next year as drugmaker Kaleo Inc. says it will resume sales of a competing product that was recalled last year. Kaleo’s injector, called Auvi-Q, was recalled from U.S. sales about a year ago over potential malfunctions that could give patients the wrong dose of drug. Closely-held Kaleo said in a statement Wednesday that the shot will return to the market in the first half of 2017. It hasn’t settled on a price, said Chief Executive Officer Spencer Williamson in a phone interview. (Chen, 10/26)

Stat: An EpiPen Alternative Is About To Return To Your Local Pharmacy
A company that now has the rights to a rival product plans to start marketing its allergic-reaction device in the first half of 2017. However, Kaleo Pharma declined to disclose the pricing for its Auvi-Q, which had previously been sold by Sanofi before being withdrawn late last year over reports that the device delivered inaccurate doses...The move, which had been indicated several weeks ago, comes amid raging controversy over EpiPen and the larger issue of the rising cost of medicines. Mylan Pharmaceuticals raised the price by 548 percent over the past decade to $608 for a two-pack of the device. But as insurers passed along more of the cost, consumers confronted bigger bills. (Silverman, 10/26)

NPR: Auvi-Q Maker Says Epinephrine Injector Will Be Available In 2017
Auvi-Q, one of the only direct competitors to the EpiPen, was pulled from the market by the pharmaceutical giant Sanofi last year. Sanofi said it had received a handful of reports that the device didn't deliver a reliable dose of epinephrine. ... The Auvi-Q is smaller than the EpiPen — about the size of a credit card and as thick as a smartphone — and it has audio instructions that guide a user through the injection process. Kaleo also makes Evzio, a popular auto-injector for naloxone, the opioid antidote used to treat overdoses. (Kodjak, 10/26)

The Wall Street Journal: Mylan Officials Unlikely To Lose Pay Over EpiPen Settlement
Executives of EpiPen maker Mylan NV are unlikely to suffer a reduction in their pay from the company’s recent $465 million settlement of allegations that it improperly overcharged Medicaid for the lifesaving drug. That is because Mylan historically has calculated executive pay using a nonstandard measure called “adjusted diluted” earnings, which excludes the costs of such litigation settlements, the company’s regulatory filings show. (Maremont and Francis, 10/27)

Bloomberg: Grassley Sets Judiciary Committee Hearing On EpiPen Settlement 
Senator Chuck Grassley will hold a hearing to examine Mylan NV’s reported $465 million settlement with the U.S. Justice Department regarding the drugmaker’s pricing of its EpiPen allergy shot for federal health programs. The hearing also will look at whether government programs are effectively preventing drugmakers from misrepresenting their products in ways that lead to higher costs for taxpayers, Grassley, an Iowa Republican who’s chairman of the Senate Judiciary Committee, said Wednesday in an e-mailed statement. (Lauerman, 10/26)

As Lawmakers Eye Drug Price Measures, Drugmakers And Insurers Point Blame At Each Other For Rising Costs

Meanwhile, in California, Bernie Sanders rallies for Proposition 61, a ballot initiative that would place some limits on prescription drug prices. And pharmacy benefit manager Express Scripts' dealings with pharmaceutical companies are under scrutiny by federal investigators.

Bloomberg: In Washington’s Drug Price Fight, Plenty Of Blame To Go Around 
Whether Hillary Clinton or Donald Trump wins on Nov. 8, most of the players are betting that something will get done on the cost of prescription drugs. They’re laying defensive and offensive groundwork for when new laws are drawn up by a Congress that has spent the last year holding hearings on the issue. A prime example is a new ad out Wednesday from the Biotechnology Innovation Organization, the Washington lobby group, making the case that high list prices don’t represent what drugmakers really get and that middlemen take a big cut. (Edney and Langreth, 10/27)

The Fiscal Times: Bernie Sanders Takes On Big Pharma As California Eyes Drug Price Limits
The California Drug Price Relief Act, or Proposition 61, would limit the price that any state agency or health care program pays for prescription drugs to what the U.S. Department of Veterans’ Affairs pays for the same pharmaceuticals. Congress prohibits Medicare and most other agencies from negotiating prescription drug prices, with the notable exception of the VA, a behemoth of an agency which purchases drugs for an estimated 6.6 million patients. Federal law insures that VA medical facilities across the country obtain a discount of at least 24 percent off prescription drugs list prices, and in many cases officials obtain much larger rebates. If Proposition 61 were approved, the VA price list would apply when the state directly purchases drugs, as it does for its prison system, or when it is deemed the “ultimate payer” for drugs provided to certain state health care programs, including Medicaid.The stakes couldn’t be higher for the two sides. (Pianin, 10/26)

Modern Healthcare: Feds Probing Express Scripts' Relationships With Drugmakers, Specialty Pharmacies
Federal investigators are looking into Express Scripts' dealings with pharma companies, charitable foundations and specialty pharmacies. The nation's largest pharmacy benefit manager on Tuesday revealed it received a civil investigative demand in August from the U.S. Attorney's Office for the Southern District of New York asking for information about the firm's relationships with drug makers and prescription drug plan clients and how payments to and from both work. (Livingston, 10/26)

And in other pharmaceutical news —

Stat: FDA Issues Guidelines For Female Libido Pills After Learning Some Hard Lessons
After a two-year wait, the US Food and Drug Administration finally issued new guidance for companies that want to develop drugs to bolster female libidos. But the details suggest the agency has belatedly learned some hard-fought lessons following complaints that the controversial Addyi pill did not warrant approval last year. The 15-page draft guidance, which was released Tuesday, offers a typical how-to for companies, but also points to certain steps that Sprout Pharmaceuticals did not follow as part of its Addyi marketing application to the FDA. (Silverman, 10/26)

Stat: Pfizer Fined Again For Violating Environmental Law At Puerto Rico Plant
For the second time in recent years, Pfizer has been fined by federal authorities for violating the Clean Air Act at a manufacturing plant in Barceloneta, Puerto Rico. In this latest instance, the Environmental Protection Agency on Tuesday fined the drug maker $190,000 failing to disclose information about hazardous chemicals that were used at the plant, which makes various pharmaceutical ingredients and finished medicines. (Silverman, 10/26)


Patients Terrified, Powerless As Doctors Flee Puerto Rico By The Hundreds

Up to 700 doctors are expected to leave Puerto Rico this year alone, double the number from two years ago.

The Associated Press: Patients Left In Limbo As More Doctors Flee Puerto Rico
Doctors have gradually left Puerto Rico during a decade-long recession that has gripped the island and driven more than 200,000 people to the U.S. mainland seeking better opportunities. Now, the steady departure of pediatricians, surgeons, orthopedists, neurologists and others has become a stampede as the economy shows no sign of improving and financial problems in the territorial health insurance program make it nearly impossible for doctors to stay in business. (Coto, 10/27)

In other news on physician shortages —

Stateline: How Teletherapy Addresses Mental Health Needs
An acute need for more and easier access to mental health treatment and improvements in communications technology have set off a boom in remote therapy, but strict licensing rules and varying state laws are hampering its growth. Like telehealth in general, using videoconferencing, smartphones and other technology to treat mental illness has long been recognized as an invaluable tool for getting care to people in rural areas, where shortages of psychiatrists, psychologists and other providers are even more acute than in the rest of the nation. (Frandsen, 10/26)

Milwaukee Journal Sentinel: Wisconsin Addresses Shortage Of Rural Doctors
As the state's rural population ages, increasing its need for health care, Wisconsin is facing a shortage of physicians in rural areas that is projected to get much worse in coming decades. To address it, the University of Wisconsin School of Medicine and Public Health, the Medical College of Wisconsin and the state’s health systems are developing residency programs in rural areas — knowing that doctors are more likely to practice where they do their training. Residencies are the typically three to five years of training that follow medical school. (Boulton, 10/26)

The Philadelphia Inquirer: Pa. Joins Pact To Help Doctors Practice Across State Lines
Gov. Wolf on Wednesday signed legislation making Pennsylvania part of an interstate pact intended to streamline physician licensing, improve health-care access, and expand telemedicine, according to his spokesman, Jeffrey Sheridan. Under the Interstate Medical Licensure Compact, doctors get licensed in their home state, which does the usual credential and background checks. Then they can select states in the compact for licenses that are essentially automatic. (McCullough, 10/26)

Veterans' Health Care

The One Controversial Scientist Behind VA's Refusal To Cover Agent Orange-Related Sickness

Alvin Young's nickname is Dr. Orange and he thinks veterans who complain about sickness that they think is related to a toxic herbicide used in the Vietnam War are simply “freeloaders,” making up ailments to “cash in” on the VA’s compensation system. And he's also the one expert the military relies on to decide whether to compensate veterans.

ProPublica: Dr. Orange: The Secret Nemesis Of Sick Vets
Anyone who set foot in Vietnam during the war is eligible for compensation if they become ill with one of 14 cancers or other ailments linked to Agent Orange. But vets with an array of other illnesses where the connection is less well established continue to push for benefits. And those vets who believe they were exposed while serving elsewhere must prove it — often finding themselves stymied.It’s not just the vets. Some of their children now contend their parents’ exposure has led to their own health problems, and they, too, are filing claims. (Ornstein and Hixenbaugh, 10/26)

Public Health And Education

VA's Shift In Tactics On Painkillers Pays Off

Three years after an investigation exposed a dramatic rise in the number of opiate prescriptions at the agency, it has reduced the number by nearly 25 percent.

Reveal: Opiate Prescriptions Down At The VA, Alternatives On The Rise
The Department of Veterans Affairs is doling out narcotics to 160,000 fewer veterans than it was three years ago, a reduction of nearly 25 percent, and alternative treatments are on the rise. Government prescription data also shows that the number of veterans receiving prescriptions for both a narcotic and a tranquilizer, a combination that often leads to overdose, has been cut in half. Although some veterans complain that the alternatives remain sparse, experts say the change – which followed a 2013 investigation by Reveal from The Center for Investigative Reporting – is likely saving lives. (Glantz, 10/26)

Meanwhile, senators demand answer from the Drug Enforcement Administration about its actions on opioids —

The Washington Post: Senators Ask For DEA Data In Wake Of Washington Post Investigation
Two senators asked Attorney General Loretta E. Lynch Wednesday to explain a sharp drop in the number of enforcement actions against large pharmaceutical distributors and others by the Drug Enforcement Administration. Sen. Patrick J. Leahy (D-Vt.) and Sen. Ron Wyden (D-Ore.) requested a wide variety of information about cases brought by DEA’s Diversion Control Division in the wake of a Washington Post investigation published over the weekend. (Higham and Bernstein, 10/26)

HIV's Patient Zero Mythology Debunked

New genomic sequencing research shows that the virus has been in America a lot longer than previously thought.

The New York Times: H.I.V. Arrived In The U.S. Long Before ‘Patient Zero’
In the tortuous mythology of the AIDS epidemic, one legend never seems to die: Patient Zero, a.k.a. Gaétan Dugas, a globe-trotting, sexually insatiable French Canadian flight attendant who supposedly picked up H.I.V. in Haiti or Africa and spread it to dozens, even hundreds, of men before his death in 1984. Mr. Dugas was once blamed for setting off the entire American AIDS epidemic, which traumatized the nation in the 1980s and has since killed more than 500,000 Americans. The New York Post even described him with the headline “The Man Who Gave Us AIDS.” (McNeil, 10/26)

The Washington Post: Mythology Of ‘Patient Zero’ And How AIDS Virus Traveled To The United States Is All Wrong
In a study published Wednesday in the journal Nature, researchers used genomic sequencing of blood samples from that era to go back in time and reconstruct the “family tree” of the virus in unprecedented detail. The findings are stunning, debunking many popular beliefs about the virus's origins and spread and filling in holes about how it made its way to the United States. (Cha, 10/26)

Los Angeles Times: How Scientists Proved The Wrong Man Was Blamed For Bringing HIV To The U.S.
Instead, the researchers report that Dugas was one of thousands of people who were infected with the human immunodeficiency virus by the late 1970s, years before it was officially recognized by the medical community in 1981. The genetic analysis also reveals the path taken by the most common strain of the virus after it traveled from the Caribbean to the United States. Upon arriving in New York City around 1970, it circulated and diversified for about five years before being dispersed across the country. (Netburn, 10/26)

Nonprofit Groups, With U.S. And British Backing, To Test Infecting Mosquitos With Bacteria

The experiment will take place in cities in Brazil and Colombia over two to three years. Also, the head of the Centers for Disease Control and Prevention says the Zika virus is in the U.S. to stay.

Stat: Experiment Plans To Release Bacteria-Bearing Mosquitoes At Large Scale
Two major philanthropic organizations, along with the United States and Britain, announced on Wednesday an ambitious experiment to combat mosquito-borne diseases in cities by infecting the insects with crafty bacteria. Researchers have used the bacteria, known as Wolbachia, in trials in places including Australia and Brazil in recent years. But those efforts were small, reaching areas with tens of thousands of residents. (Joseph, 10/26)

NPR: Zika May Be In The U.S. To Stay
Public health authorities and infectious disease specialists now say we may not be able to rid the U.S. of the Zika virus. Despite months of intense work — including house to house inspections and aggressive mosquito control — federal, state and local officials have not been able to stop the spread of Zika in Miami. In Miami on Tuesday, the head of the Centers for Disease Control and Prevention, Dr. Tom Frieden, delivered what he called the "plain truth" about Zika and the mosquitoes that carry it. "Zika and other diseases spread by Aedes aegypti," he said, "are really not controllable with current technologies." (Allen, 10/26)

Public Health Roundup: Benefit Of Hookworms; Cholesterol Tests For Babies; And Doctors Defend Pelvic Exams

Media outlets also report on cancer-causing heavy metal and tumors that grow on fetuses in the womb.

The Washington Post: Bloodsucking Parasitic Hookworms Could Help Make Millions Of People Healthier
Necator americanus, the New World hookworm, is as long and thin as a vermicelli noodle. It will slip under your skin and travel through the blood to your trachea, where you will swallow it and give it a free ride to your small intestine. Upon arrival, it will open its tiny jaw, dig its teeth into your intestinal wall and begin to drink your blood. And it could be the key to making millions of people healthier. (Kaplan, 10/26)

The Associated Press: Cholesterol Test For 1-Year-Olds? Study Says It Could Help
What if a blood test could reveal that your child is at high risk for early heart disease years in the future, giving you a chance to prevent it now? A big study in England did that — screening thousands of babies for inherited risk — and found it was twice as common as has been thought. The study also revealed parents who had the condition but didn’t know it, and had passed it on to their children. Ninety percent of them started taking preventive medicines after finding out. (Marchione, 10/26)

The Baltimore Sun: Doctors Not Ready To Abandon Annual Pelvic Exams 
When the U.S. Preventive Services Task Force released a statement saying there wasn't enough evidence to determine whether the standard pelvic exam was beneficial for women without symptoms and who are not pregnant, it might have felt like welcome advice for women who dread the annual precautionary look. But that doesn't mean the exams will — or should — be abandoned by everyone, says Dr. Samuel Smith, chairman of the department of obstetrics and gynecology at MedStar Franklin Square Medical Center and a board member of the American College of Obstetricians and Gynecologists' Council on Patient Safety in Women's Health Care. (Cohn, 10/26)

The Washington Post: The Baby Who Was ‘Born’ Twice
Margaret Boemer first sensed something was wrong when her ultrasound technician stayed unusually quiet during a routine 16-week prenatal checkup.It had already been an arduous road to get to that point. Months earlier, Boemer had suffered a miscarriage. When she conceived again, she and her husband were delighted to discover it was with twins — but they lost one of the babies about six weeks into the pregnancy. Soon, doctors would approach Boemer with more grim news: The child she was carrying had sacrococcygeal teratoma, a rare tumor that appeared at the base of baby's tailbone. (Wang, 10/26)

State Watch

Medicaid Health Plan In Massachusetts Stops Taking New Members After Financial Losses

Neighborhood Health Plan, a subsidiary of Partners HealthCare, has lost $241 million since 2014. Meanwhile, a new study in Maryland finds that the Medicaid program spends twice as much on enrollees with diabetes than those who don't have the condition.

Boston Globe: Neighborhood Health Plan Stops Taking MassHealth Members
Neighborhood Health Plan has stopped accepting new Medicaid members after losing $241 million since 2014, a troubling sign of how hard it is to serve low-income residents in a state with some of the highest health care costs in the country. Neighborhood, a subsidiary of Partners HealthCare and the largest Medicaid insurer in Massachusetts, said it temporarily froze enrollment as part of a “corrective action plan” developed with state health officials. The unusual move means low-income families who qualify for Medicaid — a joint federal-state program called MassHealth in Massachusetts — will have fewer insurance options. (Dayal McCluskey, 10/27)

The Baltimore Sun: In Maryland, Diabetics Costs Medicaid Twice As Much, Study Finds 
A study commissioned by the society that represents Maryland's doctors has found that Medicaid, the insurance program for the poor, is spending twice as much money to treat people with diabetes than those who don't have the chronic condition. Results of the study commissioned by MedChi and conducted by the Hilltop Institute at the University of Maryland, Baltimore County are scheduled to be released today. It found that Medicaid spending for a patient with diabetes in 2014 was $24,387, compared to $10,880 for someone without the disease. (McDaniels, 10/27)

State Highlights: Anthem Expected To Confirm Plan To Expand With IT-Hub In Ga.; Pa. Offers Draft Rules On Medical Marijuana

Outlets report on health news from Georgia, Pennsylvania, Vermont, Illinois, Ohio, Massachusetts, Florida, Arizona and California.

Atlanta Business Chronicle: Anthem To Invest $200 Million In 2,000-Job IT Hub In Midtown's Bank Of America Plaza
Georgia Gov. Nathan Deal and Atlanta Mayor Kasim Reed announced the expansion Wednesday. Atlanta Business Chronicle first reported details Oct. 3. Atlanta, which competed with five cities for the project, was chosen because of its talent pool, geographic access and high quality of living, said Tom Miller, Anthem’s senior vice president and Chief Information Officer... Georgia is a burgeoning health-care IT hub, with more than 200 health IT companies. Atlanta’s abundant and relatively inexpensive tech workforce has attracted a slew of Fortune 500 IT hubs and innovation centers. (Karkaria, 10/26)

The Philadelphia Inquirer: Pa. Publishes New Rules For Medical-Marijuana Dispensaries
Pennsylvania’s medical-marijuana program expects to solicit applications from aspiring growers, processors, and dispensaries in early 2017, state Health Department officials said this week after unveiling draft regulations that will govern the outlets that sell cannabis. Since April 17, when Gov. Wolf signed the medical-marijuana bill into law, the Health Department has granted “safe harbor” letters to 103 parents and caregivers, Secretary of Health Karen Murphy  said at a news conference. The letters permit them to obtain out-of-state marijuana products for  children who suffer from any of  17 medical conditions for which the law allows cannabis to be used. (Wood, 10/26)

The Associated Press: New Vermont Health Care System Would Reward Good Health
Vermont health care regulators approved a plan Wednesday that would change the way much of health care is paid for in the state to promote services that keep people healthy as a way to avoid the costs of treating them after they get sick. The Green Mountain Care Board’s approval sets the state on a years-long path in the hopes of both reducing costs and keeping Vermont residents in better health. (Ring, 10/26)

The New York Times: For 22 Unclaimed Bodies In New York, A Grim Path From Death To Burial
Every month or two, the young woman would type her father’s name into an internet search field, hoping for any sign that he was dead or alive. ... In fact, he had died on March 25, 2013, at a hospital in the Bronx, which sent his body to a New York City morgue. While he was hard to find, his ex-wife and daughter would have been easy to locate. But no one contacted them. Instead, the city’s medical examiner’s office “lent” his unclaimed body to the Albert Einstein School of Medicine for use as a cadaver. Long after the last dissection in a medical class, nearly three years after his death, his corpse was one of 22 such “borrowed” cadavers still stranded in cold storage at the school, all of them waiting for the city to provide what the unclaimed dead are owed by law: a decent burial. (Bernstein, 10/27)

The Wall Street Journal: Where The Elderly Die Can Vary By Region, Study Shows
How much time people spend in hospitals or nursing homes in the final months of life, instead of at home, varies widely depending on where they live, new research shows. Across the Rockies and regions of the Gulf Coast, the dying spend more than two additional weeks hospitalized or in other facilities, on average, compared with those at the end of life in the Midwest and Montana, researchers reported Wednesday in the New England Journal of Medicine. In other parts of the country, the picture is more mixed but still differs sharply from one community to another. (Evans, 10/26)

Cleveland Plain Dealer: The Many Schemes Of Four Dentists Accused Of Defrauding MetroHealth
The schemes described in a federal indictment against former MetroHealth executive Edward Hills and three former hospital dentists undertook were complex, intertwined and lasted for years. They also involved about $250,000, much of which was taxpayer money. Meanwhile, Hills was being paid increasingly larger six-figure salaries for his work at the hospital system. (Heisig, 10/26)

Boston Globe: Falmouth Doctor Files Lawsuit Seeking Right To Die
A retired Falmouth physician, terminally ill with metastatic prostate cancer, filed a lawsuit this week in Suffolk Superior Court in Boston asserting he has a constitutional right to obtain a lethal dose of medication from his doctor and choose when he dies to avoid needless suffering. Dr. Roger M. Kligler, a longtime advocate of expanding end-of-life options laws nationwide, asked a judge to affirm his right to die in this way and to prevent prosecution of doctors who assist. His treating doctor, Dr. Alan Steinbach, is also a plaintiff in the lawsuit. (Wen, 10/26)

Miami Herald: Jackson Health Leaders Break Ground On Jose Milton Memorial Hospital In Doral
The 27.3-acre Doral project is expected to take root in what is known as a healthcare desert, an area with limited medical resources where thousands workers commute each day and scores of new residents are moving into new developments. Administrators said they expect the new hospital to serve more than 585,000 people within a five-mile radius. The hospital received a $10 million donation from the José Milton Foundation. The gift was the largest single donation to the Jackson Health Foundation, said foundation CEO Keith Tribble. (Hsieh, 10/26)

Arizona Republic: Purchase Expands Banner Health's Urgent Care Network
Banner Health’s purchase of all 32 Urgent Care Extra facilities in Arizona is the start of an expansion to as many as 50 Banner Urgent Care facilities in the state by the end of 2017. The initial purchase in August is a reflection of the growing national trend aimed at providing patients with a cheaper alternative to emergency room visits. (Rogers, 10/26)

The Associated Press: Man Accused In Hospital Computer Hack Wages Hunger Strike
A man who acknowledges he attacked the computer network at world-renowned Boston Children’s Hospital two years ago, costing it hundreds of thousands of dollars, is waging a hunger strike in prison as he awaits trial. Martin Gottesfeld said his 3-week-old hunger strike was meant to bring attention to the treatment of troubled youths in institutions and the “political prosecutions” by prosecutors he considers overzealous, including U.S. Attorney Carmen Ortiz in Massachusetts. (Lavoie, 10/26)

Arizona Republic: Creighton University Expands Phoenix Health-Education Program
One of Arizona's largest health-care providers announced Wednesday that it is expanding its partnership with Creighton University to help bring more doctors and health professionals to Arizona and keep them. Dignity Health St. Joseph’s Hospital and Medical Center, Maricopa Integrated Health System, District Medical Group Inc. and Creighton University School of Medicine entered into an agreement Wednesday to expand their current health-education programs. (White, 10/26)

Columbus Dispatch: For-Profit Nursing Schools Struggle With Exam Passage Rates
For-profit schools generally are eager to take in new students, but the cost is high: Total tuition to obtain an associate degree in nursing ranges from $29,145 at Hondros College to $50,645 at Chamberlain College of Nursing, according to their websites. By comparison, tuition for that degree is less than $12,000 at Columbus State, but there can be a years-long wait to get in.The results at the for-profits are questionable. All six for-profit registered-nurse programs in the Columbus area had fewer students pass the national nurse-licensure exam last year than the state Board of Nursing considers acceptable. Practical-nursing programs at the same schools have had similar results. (Mogan Edwards, 10/27)

Cleveland Plain Dealer: Cleveland-Area Medical Clinic Named In Workers' Compensation Fraud Indictment
A chain of Cleveland-area medical clinics was indicted on racketeering and other charges that accuse her and a doctor of defrauding Ohio's Bureau of Workers' Compensation by billing the state for medical procedures that never happened. A Cuyahoga County grand jury returned an 170-count criminal indictment against the clinic, and Dr. Stephen Bernie, 77. Former owner Dianne Javier is named in 75 counts of the indictment. The charges include compensation fraud, conspiracy and corruption. The clinic also faces charges of tampering with records and telecommunications fraud. (Harper, 10/26)

Sacramento Bee: Free Medical Clinic At Cal Expo Will Serve Thousands This Weekend In Sacramento
Even as medical and insurance costs rise, free health care will be on hand at Cal Expo this weekend for anyone willing to wait in line. The three-day medical, dental and vision clinic, hosted by volunteer corps California CareForce, will begin registering visitors at 6 a.m. Friday to offer fillings, extractions, eyeglass fittings, diabetes screenings and flu shots to adults and children for no cost. The clinic will also be held Saturday and Sunday, opening at the same time. (Caiola, 10/26)

Weekend Reading

Longer Looks: Dr. Death; The Artificial Pancreas; And 'Election Anxiety'

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

D Magazine: Dr. Death
Lee Passmore can’t feel his feet. His right leg is as stiff as his pressed blue jeans, and when he walks, he appears to use his hips to heave it forward. He also vibrates—his chest shakes, his right hand jitters. But Passmore is one of the lucky ones. He’ll tell you as much. He’s alive. (Matt Goodman, 10/26)

Vox: We Finally Have An “Artificial Pancreas” For Diabetes. But It's A Letdown.
You'd think that a new device called the "artificial pancreas" would be a godsend for someone like [Melinda Wedding]. Designed to make insulin delivery less of a hassle by automating it, the MiniMed 670G by Medtronic was called "revolutionary" and a game changer after the Food and Drug Administration approved it in September. But families like the Weddings say the device, slated to hit the market in spring 2017, has been incredibly overhyped. (Julia Belluz, 10/25)

The New York Times: Talking To Your Therapist About Election Anxiety
The American Psychological Association says that 52 percent of American adults are coping with high levels of stress brought on by the election, according to national Harris Poll survey data released last week. Therapists around the country said in interviews that patients are coming to appointments citing their fears, anger and anxiety about the election. Both poll data and anecdotal reports show that the high levels of election anxiety are affecting both Republicans and Democrats equally. (Lesley Alderman, 10/20)

The Atlantic: Will Winter Kill Zika?
Okay, good news first: Mosquito season in the United States is basically over—even in warmer regions, like Florida and areas along the Gulf Coast. “The risk of mosquito transmission of viruses goes way down by the end of October,” says Peter Hotez, a pediatrician and the dean for the National School of Tropical Medicine at Baylor College. (Adrienne LaFrance, 10/20)

Vox: America’s View Of "Health” Is Very Narrow. The Debates Proved It.
America has an astonishingly narrow view of "health" — and that was reflected in the rhetoric from this season’s presidential candidates, Hillary Clinton and Donald Trump. When the topic of health was broached, which was rare, the focus was mostly on health care — access to doctors, hospitals, and medicines to treat people when they’re sick. There was very little discussion of public health, the goods and regulations that give us clean air and water, safe roads, and mosquito control. Unlike health care providers, public health officials work on preventing illness and injury. They devise plans to prepare for those increasingly frequent pandemic threats, like Ebola and Zika, and regulate tobacco use to give us smoke-free environments. (Julia Belluz, 10/20)

The Huffington Post: How Our New Relationship With Cuba Will Improve Americans’ Health
When Dr. C. William Keck sat down to write an editorial in the New England Journal of Medicine, imploring Congress to end the United States’ Cuba embargo so that Cuban and American researchers could better collaborate, he had no idea that the U.S. Treasury Department’s lift of sanctions was just days away. The embargo isn’t completely gone, but many goods and regulations are now available to Americans. While news of the loosened sanctions has focused on trade policy and travel souvenir rules, Keck sees a clear win for public health and medical research: The government lifted sanctions on joint health research, Cuba pharmaceuticals that earn FDA approval and bank accounts for authorized health-related business, effective October 17. (Erin Schumaker, 10/25)

Editorials And Opinions

Viewpoints: Tweaks To Help Obamacare; Critical Moment For The ACA's Marketplaces

A selection of opinions on the Affordable Care Act from around the country.

Bloomberg: Obamacare Will Survive (With Some Tweaks) 
The most important challenge is to attract more young (and generally healthy) people to the marketplace. Then, the risk to insurers would be spread more widely, making it less expensive to cover people with greater medical costs. People age 25 to 34 remain twice as likely to be uninsured as those age 45 to 64. More young people could be attracted with more generous subsidies, lower caps on deductibles, or a stiffer penalty for going uninsured. (Currently, that penalty is $695 a year or more.) In many cases, it would help to better inform people that they’re eligible for financial help. (10/26)

The Wall Street Journal: Why The Key Indicators To Watch On Health-Care Marketplaces Come In 2017
President Barack Obama said last week that problems in the marketplaces are “growing pains.” Critics on the right have said the ACA is in a “death spiral.” There is a lot to say about this year’s premium increases and no lack of people saying things. What has not been said, however, is that the key moment for the marketplaces is not the start of this open-enrollment season on Nov. 1 or this round of premium increases but next spring and summer, when state regulators begin to see proposed premiums for next year’s open-enrollment season and we learn whether the marketplaces have stabilized. (Drew Altman, 10/26)

Los Angeles Times: Growing Pains For Obamacare — And Its Customers
Starting next week, many Americans who buy individual health insurance policies will see big increases in premiums — 25% on average for those who shop at the federally operated exchanges established by the 2010 Affordable Care Act. That's particularly bad news for those whose incomes aren't low enough to qualify for large premium subsidies. (10/26)

RealClear Health: Strengthen Employer Coverage To Tackle Major ACA Challenges
More than 177 million Americans receive health care benefits through employers and the favorable tax treatment of these benefits in the U.S. tax code helps protect employees and their dependents from the current uncertainties of the Affordable Care Act exchanges. Despite employer-sponsored care’s important role, modifying the tax treatment of employer-provided health benefits has long been a goal of some policymakers and health economists on both sides of the political aisle. (Mark Wilson, 10/26)

The Fiscal Times: Hillary Clinton Hints At A Health Care Takeover To Keep Obamacare Alive
This week, the White House finally admitted what had become obvious for months: premiums within the Affordable Care Act (ACA) exchanges will skyrocket in 2017. Unfortunately, neither the administration nor its intended successor Hillary Clinton demonstrated a grip on the failures that have driven the markets to collapse, or the need for a clear change in direction. Instead, both argued for Band-Aids that will make matters even worse. (Edward Morrissey, 10/27)

The Charlotte Observer: What My Patients Say About Obamacare
As a private practice doctor, I usually try to steer clear of discussing politics with my patients. It’s simply too divisive of a topic, and in order to be effective at my job, I have to build bonds of trust with the people I’m treating. But this rule is getting harder and harder to follow – especially when my patients are the ones who bring political issues up. In recent months, I’ve seen an outpouring of frustration from the men and women who come through my practice’s front doors. (Fritz Butehorn, 10/26)

The Charlotte Observer: 5 Things You Should Know About Obamacare’s Rate Hikes
Obamacare customers and supporters received bad news Monday: Insurers are raising premiums for popular plans on the Obamacare exchanges by an average of 25 percent. As with most everything involving the Affordable Care Act, however, the news was met with a bit of misinformation – and a lot of political spin. Let’s cut through that with five things you should know about the premium hikes. (10/26)

The Columbus Dispatch: Problems Increase In Health Care
Obamacare has succeeded in expanding health-insurance coverage, but the mechanisms the law created to moderate costs and improve affordability simply aren’t working. Increasing federal subsidies for health insurance masks the problem and add to the national debt. Congress and the next president should make fixing this failing program a priority. (10/27)

JAMA: Vital Directions For US Health Care
President Barack Obama took stock of his health care legacy in JAMA this summer. Reflecting on the Affordable Care Act (ACA), the president enumerated evidence to support what he termed “significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care.” Both President Obama and commentators in accompanying Editorials, however, acknowledged that much work remained to be done. To that end, and anticipating the presidential transition following the November election, US National Academy of Medicine (NAM) President Victor Dzau, MD, earlier this year convened 19 working groups to frame a health policy agenda that might gain bipartisan support. (C. David Naylor, 10/25)

JAMA: Improving Health And Health Care In The United States
The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” For too many individuals living in the United States, this state remains well out of reach. Despite spending relatively more on health than any other country and ranking among the wealthiest of nations, the United States is far from the healthiest. Although life expectancy at birth has been gradually increasing, the United States ranks 43rd worldwide on this key measure, with residents demonstrating poorer health (compared with other high-income countries) at each life stage. Furthermore, between the top and bottom 1% of income distribution, life expectancy (at age 40 years) differs about 15 years for men and 10 for women, with further disparities by geography, race/ethnicity, and other dimensions. (Howard K. Koh, 10/25)

Concord Monitor: The Path To Cheaper Drug Prices
Recently, the Monitor’s Ella Nilsen described the plight of Dartmouth-Hitchcock, which was forced to announce the layoff of dozens of employees, in part to make up for losses on the drugs it used. The situation is the same at Concord Hospital, where per-patient drug spending increases by nearly 25 percent per year, and at Franklin and Laconia regional hospitals, where spending on pharmaceuticals has increased by $1 million per month. Nationally, the situation is just as bad. About one in five Americans with one or more prescriptions can’t afford to fill them on schedule. Americans pay far more than citizens of other nations, not because they use more health care or drugs but because they pay so much for them. (10/27)

Stat: Not All There: My Mother's Lobotomy
Growing up, I didn’t know what was wrong with my mother. I was 25, maybe 26, when I learned she had a lobotomy. I am still trying to make sense of it. My mother had two brain tumors. The first one, in July 1945, was operated on in Oklahoma City and she survived, her bright mind intact. The second one, in November 1953, occurred when she was pregnant with me. Shortly after I was born, my mother flew from San Diego, where we lived, to Oklahoma City. This time there was trouble during surgery, and to staunch the trouble they took both her frontal lobes. (Mona Gable, 10/27)

Stat: Students Can Prevent Global Health Groups From Fabricating Success Stories
Sitting in an empty park in the suburbs of New Delhi, India, Rachana (a pseudonym) told me the real story about her work in the sex trade. While shocking, it wasn’t nearly as horrific as the story the organization she worked for urged her to tell when speaking to national media and foreign donors. I’ve learned since then that the prompting she received isn’t unheard of — a famous non-governmental organization (NGO) that helped women who were rescued from sex trafficking in Cambodia was caught in fabrications that resulted in its subsequent closing. ... Exaggerating stories or overselling the impact of an NGO to potential donors isn’t corruption. But it is disappointing at best, and dishonest at worst. The challenges of working in marginalized communities deserve attention and thoughtful improvement, not false appearances of success. (Abraar Karan, 10/26)