���ϳԹ���

More than 8 million people have signed up for coverage next year under former President Barack Obama's health care law, the government said Friday, a sign of continued demand for the program amid persistent uncertainty over its future. Preliminary numbers from the Centers for Medicare and Medicaid Services showed that 8.3 million people enrolled from Nov. 1-Dec. 17, about 2 percent fewer than last year. The final number will be higher after states that run their own sign-up drives report their results. National totals are usually released in March. (Alonso-Zaldivar, 12/20)

“We are reporting that for the third year in a row enrollment in the Federal Exchange remained stable,” said Centers for Medicare and Medicaid Services Administrator Seema Verma. “Far from undermining the Affordable Care Act – as some hysterical and inaccurate claims would have it – the Trump Administration is making the very best of what remains a failed experiment.” (Sullivan, 12/20)

The enrollment snapshot shows a marginal increase in newcomers buying insurance through the federal marketplace — now just over 2 million. The Trump administration has been trying to dismantle the law yet has vowed to run a smooth enrollment system as long as the statute exists. On Friday, a top administration health official said the enrollment tally shows the insurance exchange is stable. (Goldstein, 12/20)

These numbers are preliminary and do not represent final 2020 Exchange Open Enrollment figures, the Centers for Medicare & Medicaid Services (CMS) said. On Monday, the CMS extended the deadline for enrollment via the website by three days to Dec. 18 after people faced technical issues during the final hours of the enrollment deadline. (12/20)

For 2020, the average premium for the benchmark plan dropped 4% -- the second year in a row of lower rates -- while 20 more insurers are offering policies, bringing the total to 175. While the Trump administration is claiming credit for stabilizing the exchanges, industry experts say insurers have raised rates high enough in recent years to make selling plans on the exchanges a profitable business. A dozen states have also instituted "reinsurance" plans, which help reduce premiums because they shield insurers from high-cost patients. (Luhby, 12/20)

In recent years, the Trump administration also slashed the open enrollment budget for advertising and in-person assistance, while cutting the sign-up period in half. Pervasive confusion among Americans about the status of the healthcare exchanges amid repeated challenges to the ACA have also likely contributed to decreased enrollment. (Livingston, 12/20)

This year, 44,496 New Hampshire residents enrolled in a health insurance plan on Healthcare.gov during the open enrollment period, just slightly lower than the 44,581 who bought insurance in the individual marketplace last year. Nationally, 8.3 million people got coverage in the insurance marketplace this year: 2.1 million people signed up for the first time, and 6.2 million renewed their plans. (12/22)

Meanwhile, in other news regarding the health law —

Less than an hour after an appeals court invalidated part of the Affordable Care Act and pushed off a decision on the rest of it, congressional Democrats began punching, accusing President Trump and his party of imperiling Americans’ insurance and consumer health protections. But on a debate stage Thursday night, Democrats vying for their party’s nomination for president did not mention the major court decision. (Goldstein and Sullivan, 12/20)

The federal government finalized a rule on Friday that requires health insurers selling plans on the Affordable Care Act exchanges to send enrollees a separate bill for the portion of premiums that go toward abortion coverage. Additionally, the rule ramps up oversight of the federal and state-run health exchanges to ensure patients receiving federal subsidies are eligible. The CMS said the rule is meant to save taxpayer dollars and better inform individuals about their coverage. But experts have argued—and the CMS has acknowledged—that the changes would impose significant burdens on insurers and their customers. (Livingston, 12/20)

Homelessness in the United States continued to rise this year, driven by soaring rates of homelessness in California, according to a new federal report that could prompt long-promised action for people living in the streets of Los Angeles and San Francisco. Homelessness rose 2.7 percent from 2018 to 2019, according to the annual assessment by the Department of Housing and Urban Development. (Fadulu, 12/20)

A decline in homelessness in 29 states, as well as the District of Columbia, was offset by a spike in California of 21,000 people, or 16.4 percent, the Department of Housing and Urban Development announced Friday — evidence that homelessness in the nation’s most populous state is “at a crisis level and needs to be addressed by local and state leaders with crisis-like urgency,” HUD Secretary Ben Carson said in a statement. California leaders and advocacy groups share federal officials’ alarm over the state’s outsize role in that trend. But there’s significant disagreement over how to tackle the issue as the president singles out cities like San Francisco and Los Angeles as problems, clashing with a liberal state that often fights his policies. (Knowles, 12/21)

Homelessness among veterans fell 2.1 percent and homelessness among children fell 4.8 percent. "As we look across our nation, we see great progress, but we're also seeing a continued increase in street homelessness along our West Coast where the cost of housing is extremely high,"  HUD Secretary Ben Carson said in the statement. (Frazin, 12/21)

California Gov. Gavin Newsom has said homelessness and housing are among his foremost agenda items. In September, a Public Policy Institute of California survey of likely voters found that homelessness and the economy were their top statewide issues. Responding to Friday's HUD data, Newsom said by email that the federal government "must step up" with more funding. "Without federal leadership, California is making historic investments," he said. "But we have work to do and we need the federal government to do its part.” (Romero, 12/20)

The data comes after the Trump administration sent a team of officials on a "fact finding" trip to California in September to learn more about homelessness in Los Angeles. The homeless population in Los Angeles County increased to almost 60,000 people in 2019, despite major investment in combating the crisis, the Los Angeles Homeless Services Authority said in a June report. (Holcombe, 12/21)

Homelessness is Los Angeles’s defining crisis. Income inequality, a shortage of housing, failing mental health services and drug addiction all contribute to growing scenes of squalor across America’s second-largest city. The federal government recently estimated that a nearly 3 percent rise in homelessness nationwide this year was driven mostly by California. Yet it does not affect everyone equally. The historic displacement and fracturing of black communities in South Los Angeles have pushed black Angelenos like Mr. Wynn onto the streets at more than eight times the rate of other groups. In interviews with more than a dozen black men who are homeless in Los Angeles, the bitter inheritance of racism came up again and again. (Patel, Arango, Singhvi and Huang, 12/22)

More than 25,000 Texans are experiencing homelessness. Their struggles to live without homes have received increased attention amid several recent debates over how best to address homelessness — and help people experiencing it. Gov. Greg Abbott and Austin Mayor Steve Adler have feuded over that city’s response to homelessness, and city officials are dealing with how to address homeless populations in their own regions. Meanwhile, President Donald Trump tapped the founding president of a shelter in San Antonio to lead the entity that coordinates with federal and local agencies to address homelessness on a national level. (Menchaca, 12/23)

A nonprofit advocacy group says the number of people experiencing homelessness in New Hampshire has dropped in the last two years, though homelessness among students and in some counties is on the rise. The New Hampshire Coalition to End Homelessness bases some of their calculations on counts taken every January across the state. These suggest overall homelessness has decreased by five percent, but Coalition director Cathy Kuhn says the homelessness count from January 2019 doesn't reflect the increasing demand on shelters. (Gibson, 12/19)

When Alice Carter died Wednesday after collapsing on a Northwest Washington street, there was no immediate outcry. She had slept on 17th Street north of Q Street for at least 15 years, an advocate said, a transgender woman struggling with addiction and mental-health issues. She recently secured housing through an assistance program, but it wasn’t enough to save her after a life led on the margins. (Moyer, 12/20)

On Friday, Miami will honor the lives of homeless people lost died this year due to violence, drug use, and health complications at the National Homeless Persons’ Memorial Day. Homelessness remains a critical issue across South Florida, and the holidays are often seen as an opportunity for individuals to support those most in need. According to a 2018 report by the U.S. Department of Housing and Urban Development (HUD), more than 30,000 people experience homelessness on any given day in Florida. These include the elderly, veterans and children. For the homeless, the holidays present tough challenges: finding a place to sleep, food and clothes. (Martinez, 12/20)

It doesn’t take long to give away 1,000 peanut butter and jelly sandwiches in San Francisco. “Thank you, thank you, thank you,” said a man in a wheelchair on Turk Street, who got one of them, along with a toothbrush, a pair of gloves and some cookies. A woman in a green tent got one, and the woman in the red tent next door got one, and a man with a shopping cart full of dismantled bicycles got two, because he said he was very hungry. (Rubenstein, 12/22)

The children and parents awoke Sunday in homeless shelters around Greater Boston and boarded school buses, some with no idea where they were going other than to a Christmas event. As they entered the Boston Convention and Exhibition Center, solemn faces broke into wide smiles and dropped jaws as they stepped onto a red carpet toward people waving and applauding them, along with extravagantly costumed characters — Disney princesses and Superman, Star Wars storm troopers and the Incredibles — all there to welcome them. Snowflake confetti fluttered. Lights sparkled. Parents dance-walked to the upbeat Christmas tunes, filming their children’s faces on phones, some with tears in their eyes. (Martin, 12/22)

Patrick Lupien and Mariah LeMieux-Lupien knew they were going to be evicted, because they hadn’t paid rent on their apartment in Biddeford, Maine, for two months. The lapse was a matter of basic math: As Mariah put it, when you don’t have it, you don’t have it. They had four special-needs children, so it was important to stick to routine as much as possible. Patrick, who had a full-time IT job that paid about $40,000 a year, kept going to work. Every morning, Mariah set out the same cereal bowls and 4-year-old Laya’s favorite pink spoon. (Greenberg and Clark, 12/21)

Vilified by lawmakers from both parties for months, the health-care industry this year appeared to face an existential threat to its business model. But this week, pharmaceutical companies, hospitals, insurance companies and medical device manufacturers practically ran the table in Congress, winning hundreds of billions of dollars in tax breaks and other gifts through old-fashioned lobbying, re-exerting their political prowess. “It’s the ‘no special interest left behind bill’ of 2019. That’s what it feels like this is,” said Andy Slavitt, a former health administrator who served in the Obama administration. “There’s no other explanation.” (Stein and Abutaleb, 12/20)

Other news from Capitol Hill focuses on surprise medical bills and toxins —

Four congressional leaders who negotiated surprise billing legislation that was left out of Congress' year-end spending deal have expanded an investigation of balance billing practices to include insurers and physician staffing companies. Senate health committee Chair Lamar Alexander (R-Tenn.), health committee ranking Democrat Patty Murray of Washington, House Energy & Commerce Chair Frank Pallone (D-N.J.) and Energy & Commerce ranking Republican Greg Walden of Oregon on Thursday said they will home in on whether insurance companies refuse to negotiate reasonable reimbursement rates with some providers and on physician staffing companies' policies on sending patients surprise medical bills. (Cohrs, 12/20)

Lawmakers must largely start anew after a major attempt to regulate a cancer-linked chemical that is spreading into the water supply across the United States was stripped from legislation this week, striking the best bet in years to address the problem. The class of chemicals abbreviated as PFAS is used in products ranging from raincoats to nonstick cookware to firefighting foam. It’s been deemed a “forever chemical” due to its lingering persistence in the environment and in the human body. (Beitsch, 12/22)

At 2:04 p.m. on Oct. 15, a guard at the Richwood Correctional Center noticed an odd smell coming from one of the isolation cells. He opened the door, stepped inside and found the lifeless body of Roylan Hernandez-Diaz hanging from a bedsheet. The 43-year-old Cuban man had spent five months in immigration detention waiting for a judge to hear his asylum claim. As his time at Richwood dragged on, he barely answered questions from security or medical staff, who noted his “withdrawn emotional state.” He refused to eat for four days. The day after his death, 20 other detainees carried out what they say was a peaceful protest. They wrote “Justice for Roylan” on their white T-shirts, sat down in the cafeteria and refused to eat. Guards swooped in and attacked, beating one of them so severely he was taken to a hospital, according to letters written by 10 detainees that were obtained by the USA TODAY Network and interviews with two detainees’ relatives. (12/20)

The Department of Homeland Security's internal watchdog found no wrongdoing or misconduct by immigration officials in the deaths of two migrant children last December. The Inspector General for the Department of Homeland Security released two brief statements Friday evening on the deaths of Jakelin Amei Rosmery Caal Maquin, who died Dec. 8 at age 7, and Felipe Gómez Alonzo, who died Dec. 24 at age 8. (12/20)

Each report concluded that the “investigation found no misconduct or malfeasance by DHS personnel.” Officials have said they were the first children to die in Border Patrol custody in a decade. Three other Guatemalan children, ranging in age from 2 to 16, died after being taken into Border Patrol custody in April and May. DHS officials have not released results of internal investigations into those deaths. (Moore, 12/20)

And in other news on the immigration crisis —

The federal agency in charge of immigrant detention has awarded multiyear contracts for private companies to run facilities in California just over a week before a new state law forbidding them goes into effect. Lawmakers in Sacramento passed a bill in September—signed the next month by Democratic Gov. Gavin Newsom —that bans new contracts for for-profit prison facilities beginning Jan. 1. As the legislation was being drafted, the definition was expanded to include immigrant detention, as the Trump administration’s border policies and the conditions in which it held migrants drew increasing criticism. (Lazo, 12/20)

The White House sought this month to embed immigration enforcement agents within the U.S. refugee agency that cares for unaccompanied migrant children, part of a long-standing effort to use information from their parents and relatives to target them for deportation, according to six current and former administration officials. Though senior officials at the Department of Health and Human Services rejected the attempt, they agreed to allow Immigration and Customs Enforcement agents to collect fingerprints and other biometric information from adults seeking to claim migrant children at government shelters. (Miroff, 12/20)

Under a canopy on the edge of a squalid encampment, a young physician named Dairon Elisondo Rojas holds office hours every day from 10 to 4. On a recent afternoon, he saw children with diarrhea, colds and asthma, among other ailments. Some he examined, treated and sent on their way with cough or cold medicine. For those who required special care, like a boy with a broken leg, Dr. Elisondo arranged a transfer to the local Mexican hospital. (Jordan and Ferman, 12/22)

The number of migrant children living in Texas shelters has fallen to its lowest point in two years, a dramatic change after a hardline but short-lived federal immigration policy last year overwhelmed the state’s shelter network and led thousands of children to linger for extended periods in temporary shelters. These shelters are where some unaccompanied minors go after leaving temporary U.S. Customs and Border Protection facilities if officials cannot find U.S.-based sponsors to take them in. (Walters, Murphy and Cameron, 12/20)

Lawmakers of all stripes made an agreement the day following the midterm elections last November: While they might not agree on much, they would work together to lower prescription drug prices. The message came from Nancy Pelosi, the House speaker-in-waiting; Mitch McConnell, the Senate’s Republican majority leader; and from President Trump. All agreed: Even in a deeply polarized Washington, drug pricing would top the 2019 agenda. (Facher and Florko, 12/20)

Doctors who receive money from drugmakers related to a specific drug prescribe that drug more heavily than doctors without such financial ties, a new ProPublica analysis found. The pattern is consistent for almost all of the most widely prescribed brand-name drugs in Medicare, including drugs that treat diabetes, asthma and more. The financial interactions include payments for delivering promotional talks, consulting and receiving sponsored meals and travel. (Fresques, 12/20)

Next year will mark the 10th anniversary of ProPublica’s Dollars for Docs, our ambitious effort to track pharmaceutical company payments to doctors. When we started, we were thrilled to gain access to what seven drug companies paid physicians for speaking and consulting and to collect payment information in a first-of-its-kind database that allowed everyone to search for their doctors in one place. Now, federal law requires every drug and medical device maker, about 1,700 companies, to release information on their payments. (Ornstein, 12/20)

Novartis AG has secured Medicaid coverage for a pricey new sickle cell disease therapy in two U.S. states just weeks after winning U.S. approval, following an early campaign to convince local officials of its value, according to a company executive and a Reuters review of public filings. The approvals from the Florida and Alabama Medicaid health programs for the poor and disabled mark exceptionally fast acceptance for the treatment, which can cost up to $113,000 annually for an individual patient, excluding discounts, said Ameet Mallik, who heads the Swiss drugmaker's U.S. oncology division. (12/20)

Merck & Co said on Friday it expects to make licensed doses of its recently approved Ebola vaccine available in the third quarter of 2020 and price the single-dose injection at the lowest possible access price for poor and middle-income countries. The vaccine, Ervebo, was approved by the U.S. Food and Drug Administration on Thursday, a month after Europe gave its nod to the vaccine, a move that has been hailed by the World Health Organization. (12/20)

Drugmakers are trying to win drug approvals by parsing vast data sets of electronic medical records, shifting away from lengthy, and costly, clinical trials in patients. Pfizer Inc., Johnson & Johnson and Amgen Inc. are among the drugmakers that have submitted the data-mining analyses to the U.S. Food and Drug Administration in seeking approval to sell new medicines or for new uses for older ones. The FDA has approved new uses for breast cancer, bladder cancer and leukemia drugs in part based on the data. (Loftus, 12/23)

Sutter Health, the large hospital system in Northern California, said Friday that it had agreed to pay $575 million to settle claims of anti-competitive behavior brought by the California state attorney general as well as unions and employers. In addition to the settlement amount — which will go to compensate employers, unions and the state and federal governments — Sutter will also be prohibited from engaging in several practices that the state attorney general and others said the hospital system used to ensure its dominance. (Thomas, 12/20)

Becerra called it “one of the largest actions against anti-competitive conduct in the health care marketplace across the country, with unprecedented levels of injunctive relief to restore competition in the market.” It is larger than recent similar settlements with other providers in North Carolina and Washington state, his office said. The settlement immediately set off a debate between hospitals and consumer advocates over whether it will limit or increase health care costs. (Thompson, 12/20)

Under terms of the agreement, Sutter will continue to operate as an integrated system. But it has agreed to end a host of practices that Becerra alleged unfairly stifled competition, including all-or-nothing contracting deals demanding that an insurer that wanted to include any one of the Sutter hospitals or clinics in its network must include all of them — even if some of those facilities were more expensive than a competitor. The agreement includes the appointment of a jointly approved special monitor who will be charged with ensuring that Sutter is following the terms of the agreement for at least the next 10 years. (Gold, 12/20)

Becerra selected Jesse Caplan, managing director of corporate oversight with Affiliated Monitors in Boston, as the monitor. Caplan will investigate Sutter's compliance with the injunctive relief for 10 years, with the possibility of a one-time renewal for another three years, according to the agreement. He did not return a request for comment. (Bannow, 12/20)

Sacramento-based Sutter’s legal counsel said the company was happy to resolve the matter in a way that allowed it to maintain its integrated network and quality care. “Together with the Attorney General, the parties selected an experienced monitor who will oversee the agreement, which specifies parameters for contracting between Sutter Health and insurance companies going forward,” said Flo Di Benedetto, a Sutter senior vice president and general counsel. “There were no claims that Sutter’s contracting practices with insurance companies affected patient care or quality.” (Anderson, 12/20)

Becerra sued Sutter in 2018, alleging that the system — which operates 24 hospitals and 35 outpatient clinics in Northern California — abused its market power to raise prices, harming its subscribers. The case was combined with a similar lawsuit filed in 2014 by the United Food and Commercial Workers and Employers Benefit Trust, a union trust that pays for its workers’ insurance. That was classified as a class-action suit on behalf of 1,500 self-insured employers and trusts in California. The two cases were combined for purposes of a trial, which had been scheduled to begin in San Francisco Superior Court in October. (Li and Ho, 12/20)

Northern California health system Sutter Health has developed a free tool for patients to receive cost estimates on outpatient services. Health care providers will contact patients’ insurance companies to determine estimates for more than 200 ambulatory services, or services outside of hospital procedures. These estimates factor in patients’ benefits and annual health care plan. (Ingalls, 12/23)

Johnson & Johnson isn’t responsible for a Missouri woman’s cancer that she blamed on asbestos-tainted talc, a jury decided in the company’s latest win in the nationwide litigation over its iconic baby powder. Jurors in state court in St. Louis concluded Friday J&J’s talc-based product didn’t contribute to the development of Vickie Forrest’s ovarian cancer and didn’t fail to properly warn her about its health risks. Its the company’s first win in the St. Louis courts since last year. Jurors in that same court hit the world’s largest maker of health-care products with a $4.7 billion verdict for more than 20 women who said their use of asbestos-laced baby powder caused their cancers. (Feeley, 12/20)

Johnson & Johnson said on Friday it would acquire the remaining stake in Verb Surgical Inc, from Verily, Alphabet Inc's life sciences division. Bolstering its Ethicon unit, which makes surgical equipment, J&J in 2015 formed an independent company called Verb Surgical with Verily to create smaller, smarter and less costly robotic-assisted systems for surgery. (12/20)

Cigna Corp.'s Express Scripts and Prime Therapeutics solidified the terms of a three-year collaboration as the pharmacy benefit managers look to leverage the scale of the more than 100 million individuals that their clients cover. Express Scripts, the nation's largest PBM that merged with Cigna last year, said Thursday that it will offer retail pharmacy and drug manufacturer contract services to Prime, which is owned by 18 Blue Cross and Blue Shield plans that stand to benefit from Express Scripts' purchasing power. Prime said it will continue to supply full-service pharmacy benefit management offerings for its clients. (Kacik, 12/20)

The Mayo Clinic has named health-care technology veteran John Halamka as the head of its digital health-care businesses. One of his focus areas will be looking at how neural networks, machine learning and artificial intelligence can improve health care. Dr. Halamka, also a practicing emergency medicine physician, will be president of the Mayo Clinic Platform, a newly created position, when he joins on Jan. 1. The Mayo Clinic Platform is a strategic initiative to improve health care through insights and knowledge derived from data. It is a part of Mayo charged with developing clinical innovations and transforming health care. (McCormick, 12/23)

Baltimore-based insurer CareFirst Blue Cross and Blue Shield is entering the Medicaid managed-care market with acquisitions of two small Medicaid plans in Maryland and Washington, D.C. CareFirst said it reached separate agreements to buy Trusted Health Plan in D.C. and University of Maryland Health Partners in Baltimore. Health Partners is owned by the University of Maryland Medical System. Combined, the Medicaid managed-care organizations serve about 81,000 people. (Livingston, 12/20)

CareFirst BlueCross BlueShield said Friday it plans to acquire Medicaid plans in Maryland and Washington. The state’s largest health insurer will acquire University of Maryland Health Partners in Baltimore, health insurance plans for Medicare and Medicaid members run by the University of Maryland Medical System. The nonprofit also will acquire Trusted Health Plan in Washington, a Medicaid managed-care organization in Washington. (Mirabella, 12/20)

For his role in fomenting the opioid crisis, federal officials want to sentence Insys Therapeutics founder John Kapoor to 15 years in prison. His lawyers, however, argue the former high-flying executive should be locked away for just one year and a day, then confined to his home and perform community service. The contrasting views toward his fate were explained in detail in sentencing documents filed this week in federal court, where Kapoor and several other former Insys executives earlier this year were convicted of wire and mail fraud in connection with a scheme to illegally boost prescriptions for the Subsys painkiller, which contains fentanyl, a powerful and addictive opioid. (Silverman, 12/20)

The last time Nicole Olmstead saw her daughter Rachel, they ate grilled cheese sandwiches and tomato soup together, and then went for a walk around Manchester. ...Two days later, Rachel Ribecca was found dead from an accidental fentanyl overdose, not at home or on the street, but in a residential drug treatment facility in Canterbury. “She was only there less than a day,” Olmstead said. Rachel had just turned 21. Olmstead has filed a wrongful death lawsuit against Granite Recovery Centers (GRC), alleging that negligent supervision, hiring and training at its New Freedom Academy treatment center caused her daughter’s death. (Wickham, 12/22)

Ten former colleagues of an Ohio hospital doctor who pleaded not guilty to murder in 25 patients' deaths are coming to his defense in a new lawsuit. The action was brought Thursday in Franklin County Common Pleas Court by nine nurses and a pharmacist once employed by Mount Carmel Health System in Columbus, NBC News reported. In it, the former employees argue that the hospital wrongfully terminated and defamed Dr. William Husel. (12/20)

Health officials now blame vitamin E acetate for the “vast majority” of cases in the U.S. outbreak of vaping illnesses and they say doctors should monitor patients more closely after they go home from the hospital. The Centers for Disease Control and Prevention announced the updated advice Friday. And, in a related move Friday, authorities investigating how patients obtained possibly tainted vape products said they have shut down 44 websites advertising the sale of illicit vaping cartridges containing THC. (Johnson, 12/20)

The vast majority used products containing THC, the psychoactive ingredient in marijuana. By comparison, no vitamin E acetate was found in the lung fluids of any of 99 healthy individuals in a comparison group. Those people either vaped nicotine exclusively, smoked only cigarettes or said they never smoked. Researchers also found no evidence of other potential toxins in the healthy comparison group. (Sun, 12/20)

"That doesn't mean that there aren't other chemicals that can or are causing lung injury," Schuchat said during a telephone news conference. But backed with additional data about vitamin E acetate found in lung samples from people who were injured after vaping, she attributes the bulk of the outbreak to that additive. (Harris, 12/20)

Vaping-related lung injuries peaked in September and are on the decline, federal officials said Friday, and the link to the additive vitamin E acetate in marijuana-based THC is growing stronger. The Centers for Disease Control and Prevention reported 2,506 people have been hospitalized in 50 states and 54 died as of Tuesday. The CDC found an alarming new trend among lung injury patients after leaving hospitals – 31 returned to the hospital and seven died. (O'Donnell and Alltucker, 12/20)

Health officials are warning doctors to more closely monitor patients with severe lung damage caused by vaping, because some have relapsed or died shortly after being sent home from the hospital. The recommendations are part of four new reports about the nationwide outbreak of severe illnesses from vaping, which has hospitalized 2,506 people and killed 54 as of Dec. 17. The reports were published on Friday, two by the Centers for Disease Control and Prevention, and two by The New England Journal of Medicine. (Grady, 12/20)

In other news on the vaping crisis —

Gail Moody had her first e-cigarette inhale of the day moments after waking up one recent morning. She took more puffs while showering. Aerosolized nicotine filled her lungs again during a break in her morning run, between mouthfuls of lunch, and as she worked at a tobacco shop near the University of Georgia, where she is a sophomore. “Wow,” said Ms. Moody, 19, glancing at the sleek black stick in her right hand that evening. “I’m more addicted to this than I thought.” (Levin, 12/22)

A Montana vape store chain has announced plans to offer customers do-it-yourself vaping kits to combat the state's new temporary ban on the sale of flavored vaping products. Montana Public Radio reported Thursday that Freedom Vapes stores in the cities of Bozeman and Hamilton and the town of Belgrade are offering the workaround to help maintain business. (12/20)

New evidence strengthens the suspected link between a substance known as vitamin E acetate and the outbreak of serious lung illnesses tied to vaping and e-cigarette use, U.S. health officials said Friday. Researchers tested lung fluid samples from 51 patients with vaping-related illness, dubbed EVALI. They found vitamin E acetate — a sticky substance used as an additive or thickening agent in some vaping products — in 48 of the samples. They didn’t find any vitamin E acetate in lung fluid taken from healthy patients, suggesting the chemical played a role in making people sick. (Thielking, 12/20)

State lawmakers are considering a bill that would ban all flavored vaping products except for menthol in New Hampshire stores. The move follows work by a bipartisan group of lawmakers this year that raised the age for vaping and smoking to 19 and made it illegal to vape indoors. (Gibson, 12/20)

Not long ago, the only way to know if someone had Alzheimer’s disease was to examine the brain in an autopsy. That is changing — and fast — with brain scans and spinal taps that can detect beta amyloid, the telltale Alzheimer’s protein. There is a blood test on the horizon that can detect beta amyloid, and researchers are experimenting with scans to look for another protein, called tau, also characteristic of Alzheimer’s. (Kolata, 12/20)

She had been waiting more than a week for the black ice to melt and the farm roads to clear, but Marlene Kennedy, 84, was unwilling to wait any longer. She changed into snow boots, tucked her heart medication into her purse, and stepped out to the porch. She held onto a railing with one hand and to her daughter with the other, inching down the frozen walkway toward her garage, trying not to think about her husband’s slip and fall, which had shattered his hip and eventually forced him into a nursing home located more than an hour away. (Saslow, 12/21)

The company GEDmatch, the DNA database that facilitated an arrest in the Golden State Killer case and in dozens of other cases since, emerged from a desire to connect people to their relatives. For the past decade, the site’s co-founder Curtis Rogers has been running the company out of a small yellow house in Lake Worth, Fla. When Mr. Rogers first learned that the DNA of GEDmatch users had played a critical role in identifying a suspected serial killer, he was upset. (Murphy, 12/22)

For many Americans, hallucinogens still evoke the psychedelic '60s, bringing to mind the sex-and-drugs lifestyle of the hippie counterculture. But that stereotype lags behind reality, by several decades. Today, psychedelic experimentation is more likely to refer to dozens of clinical trials taking place at universities and research facilities. (O'Neill, 12/22)

The Department of Labor's workplace safety agency is getting ready to take new action to reduce workers' exposure to dangerous silica dust that can irreparably damage the lungs. But the agency's new program doesn't give special attention to the kitchen and bathroom countertop industry, which has recently seen cases of severe lung damage that have alarmed public health officials. (Greenfieldboyce, 12/21)

Would you put down that bag of chips if you saw it had 170 calories? What if the label said it would take 16 minutes of running to burn off those calories? Health experts for years have pushed for clearer food labeling to empower people to make better choices. In the U.S., a recent regulation requires calorie counts on packages to be bigger. Red, yellow and green labels signal the healthfulness of some foods in the United Kingdom. (12/20)

These cold, dark winter days make me want to curl up with a book, perhaps while munching on holiday cookies. One could describe my conduct this way: sedentary behavior combined with snacking on sugary treats. A regular practice of these things may well lead to weight gain. (Adams, 12/22)

In the background of a powerful photo of 15 black medical students from Tulane University is a slave cabin. In the foreground stand the students, wearing the white lab coats that tell observers they're members of a highly trained and prestigious profession. “We are our ancestors’ wildest dreams," tweeted Russell Joseph Ledet, who conceived of the photo. (12/20)

As more states legalize marijuana, more women are talking to their doctors about pot use during pregnancy — and obstetricians are grappling with the best way to have that conversation. ...Obstetricians say it’s critical that providers start asking women explicitly about marijuana use in pregnancy, because many women don’t consider marijuana a drug and won’t disclose using it when a provider asks broadly about drug use or smoking. (Thielking, 12/23)

Mayo Clinic researchers are poised this spring to test a remote cardiac procedure that could be a major breakthrough for rural hospital care — a procedure in which a patient’s clogged artery is propped open by robotic tools controlled by an off-site doctor. In the initial test, the Mayo doctor will only be in the next room, able to step in as needed. A successful test, however, would pave the way for a future in which doctors could perform the procedure from miles away. (Olson, 12/21)

Public spaces are packed with vivid color palettes, from the explosive shades of modern art to the covers of library books. But for people with colorblindness, the experience can be muted by an inability to take in the full spectrum of color. Now, museums and libraries are starting to take note — and stock special glasses designed to improve color vision. Institutions such as the Georgia O’Keeffe Museum, the California Academy of Sciences and the St. Johns Public County Library System in St. Augustine, Fla., have partnered with a company that produces eyewear for people with colorblindness. (Blakemore, 12/21)

For as long as he can remember, Steven Knapp never felt well. “That was pretty much true from early childhood,” said Knapp, a self-described “Army brat” who was born in Germany and grew up in Turkey and a half-dozen states, including Georgia where he has lived since high school. (Boodman, 12/21)

The nation’s oldest anti-vaccine advocacy group often emphasizes that it is supported primarily by small donations and concerned parents, describing its founder as the leader of a “national, grass roots movement.” But over the past decade a single donor has contributed more than $2.9 million to the National Vaccine Information Center, accounting for about 40 percent of the organization’s funding, according to the most recent available tax records. That donor, osteopathic physician Joseph Mercola, has amassed a fortune selling natural health products, court records show, including vitamin supplements, some of which he claims are alternatives to vaccines. (Satija and Sun, 12/20)

International health officials are expanding their efforts to prevent a potential spread of measles to more Pacific islands during the holiday travel period, following a large and deadly outbreak in Samoa. Tonga, Fiji and American Samoa, a U.S. territory, have all reported outbreaks or cases of measles in recent weeks. But Samoa, an independent country that is an eight-hour ferry ride from American Samoa, has suffered the largest outbreak by far. As of Saturday, measles had killed 79 people in the island nation and sickened more than 5,400 since September, out of a population of around 200,000. More than 60 of those who died were under the age of 4. (Cherney and McKay, 12/22)

Virginia health officials are mounting an effort to identify people who may have recently been exposed to a person with measles. The Virginia Department of Health said in a news release Saturday that the person visited the Richmond International Airport Tuesday night and a doctor’s office in suburban Richmond on Thursday afternoon. (12/22)

As lawmakers prepare to release the first draft of a highly anticipated bill that would eliminate Connecticut’s religious exemption from vaccines, one sticking point in the debate is what to do about children already enrolled in school who have claimed the exemption. Legislators in a bipartisan working group are mulling whether to make an exception for those children and allow them to remain in school. That means only new children entering the state’s public and private schools would be barred from choosing the religious exemption. (Carlesso, 12/23)

Thanksgiving leftovers are a distant memory, and December's extra travel, shopping and family commitments are already straining nerves, budgets and immune systems. It's officially "the holidays" — which also means we're well into a new flu season. It's never too late to benefit from a flu shot, even into December and January, says Dr. William Schaffner, an infectious disease specialist at Vanderbilt School of Medicine in Nashville. (Haelle, 12/20)

Republican-controlled state legislatures are gearing up to try to tighten abortion laws across the country, while some states controlled by Democrats are looking to enshrine the right to choose into law. It’s one of a handful of deeply polarizing issues that could dominate state legislatures in 2020, a potential sign of the partisan gridlock that’s to come — and the efforts to rally supporters during a hyperpartisan presidential election year. With about 38 state legislatures set to reconvene in January, according to the National Conference of State Legislatures, lawmakers are preparing to debate issues that affect life’s most intimate decisions. (Craig and Wax-Thibodeaux, 12/22)

State lawmakers seeking to rein in health care costs are facing formidable pushback from hospitals, foreshadowing the obstacles a Democratic president and Congress would also face if they try to follow through on bold promises for health reform. As Democratic presidential candidates argue about the merits of “Medicare for All” versus a public option, states are pursuing the latter and getting hammered by hospitals and insurance companies that would stand to lose money under those changes. (Hellmann, 12/21)

Kaiser Health News: Texas Law Highlights Dilemma Over Care For Patients With No Hope Of Survival
Critically ill Tinslee Lewis ― a Fort Worth baby embroiled in a dispute between her family and a hospital over whether to continue life-sustaining treatment ― is the most recent public face of the heartbreaking and intractable dilemmas often confronted quietly in intensive care units. But her circumstances are complicated by a rare law that Texas enacted two decades ago, which critics say gives hospitals the upper hand on whether to stop treatment. Just 15 to 20 years ago, disputes between doctors and families over the futility of further medical care flared once or twice each year, said Dr. Robert Truog, a pediatric intensive care physician at Boston Children’s Hospital. (Huff, 12/23)

Meanwhile, in Virginia —

Gun control. Civil rights. A minimum-wage increase. Virginia Democrats have a long list of goals for the legislative session that starts next month, and with their newfound power they are confident they can achieve many of them. “I’m excited for January to get here, because we’re going to do some good things for Virginia and really respond to what Virginians have asked for for many years,” Democratic Gov. Ralph Northam said in an interview. (Kamp and Calvert, 12/22)

In a hallway inside Indiana’s Capitol, the young man walks up to a state senator and gives her a quick hug. “Hey, it’s Josh Christian,” he tells Sen. Erin Houchin, a member of the Senate’s child welfare committee. “I went to Capitol Hill and I got published. It was crazy!” The encounter would have seemed more than unlikely just a few years ago, when Christian was one of the thousands of kids in Indiana’s foster care system. In about 18 years, he was moved to 18 different places. The experiences were so deflating he had given up on ever finding his forever family. (Bauer and Thomas, 12/22)

He still has the last name of a woman who adopted him in grade school — then gave him back. From the time he was 3 until he turned 14, Dominic Williamson was bounced to 80 different foster homes. When he turned 18, he found himself alone and homeless, and resorting to a life of crime. Now, at 20, he has a home more permanent than any he’s ever known. The Hutchinson Correctional Facility in Kansas. (Bauer and Thomas, 12/15)

Decades into a burgeoning public safety crisis, with a stubbornly high rate of sexual violence, Alaska finally may have arrived at a moment of change. The state board that regulates police officers is now, for the first time, working to identify and train officers who work for remote villages and ensure they meet basic hiring standards. A legislative task force is examining the failing village public safety officer program that was intended to support state troopers by training village residents to become certified, state-funded first responders. (Hopkins, 12/21)

When Rhode Island lawmakers ousted two state Health Department officials from the board that helps oversee its emergency medical services system, Gov. Gina Raimondo replaced them with a city mayor and this man: Albert F. Peterson III. “His decades of experience as a first responder coupled with his recent experience operating a company that trains EMTs made him well qualified to serve on this board,” the governor’s spokeswoman, Jennifer Bogdan, said of Peterson in an email. (Arditi, 12/23)

A Los Angeles church is paying off $5.3 million worth of medical debt for nearly 6,000 households in Southern California, according to one of the church's pastors. Christian Assembly purchased the debt for $53,000 and is working with a nonprofit organization to pay the outstanding bills for 5,555 families in 28 neighborhoods, co-lead pastor Tom Hughes said in a video posted online Thursday. “We are able to give a Christmas gift to the people of Los Angeles, no strings attached,” he said. (12/22)

In about five minutes, users can complete a anonymous five-part questionnaire with questions like whether you want to see an in-person or an online therapist and what you wish to discuss and work on. Then, you can select what approach of therapy you want to try, what cultural areas you want to look at or select from and how much you would be willing to pay so that you can find someone that you can forward. (Many therapists operate on a sliding scale, based on what clients can pay.) At the end of their questionnaire, users can see providers that have been matched up with them, complete with their pictures and a detailed profile of what they focus on and offer. All information on the website is completely anonymous, and the service for users is free. (The providers pay to be on the site.) At the end of the selection process, users do enter their email so that a therapist can contact them. (Maness, 12/20)

An update is expected at the start of 2020 regarding a criminal investigation into the Flint water crisis that was one of the worst man-made environmental disasters in U.S. history, Michigan Gov. Gretchen Whitmer said. Whitmer told MLive.com on Tuesday that she trusts Michigan's Attorney General Dana Nessel “to do the right thing” in the probe of Flint's water crisis. (12/22)

Patrick Hoyt ended up in the Sacramento County Main Jail on Dec. 1, 2015, after being picked up on a misdemeanor domestic violence warrant. Within hours, he said, he was escorted by two deputies into an area of the jail without camera coverage, where one of them twisted his arm and shoved his face into a brick wall so hard he ended up with a swollen black eye. Hoyt said he later complained of excessive force and, after his release, was interviewed by internal affairs investigators who asked, “What would make this right again?” (Stanton and Sullivan, 12/22)

Hospital giant Mercy has ended plans to provide midwifery services in Ferguson in response to claims by the founder of a black midwife-led clinic that Mercy was violating an agreement and copying her model. Brittany “Tru” Kellman, who opened Jamaa Birth Village in 2016, said in a written statement that Mercy’s decision was a victory for addressing health inequities with community-driven approaches. (Benchaabane, 12/21)

A Pinellas County doctor and two Pasco County marketing company executives were sentenced this week to federal prison for their roles in a conspiracy to profit from prescriptions for pain creams billed to the U.S. military’s Tricare health service. On Tuesday, Dr. Anthony Baldizzi, 56, of Treasure Island was sentenced to a year and a day in federal prison. Baldizzi, who had pleaded guilty to conspiracy to commit health care fraud and one count of receiving kickbacks, also was ordered to forfeit $100,000, including a BMW that he had received. Prosecutors said he will give up his medical license in January. (Danielson, 12/20)

Jesus Manuel Gomez quit his restaurant dishwashing job when he saw the effect his long work days had on his 10-year-old son with special needs. Although he was scheduled to work from 11 a.m. to 10 p.m., the Honduran native said through a Spanish-speaking interpreter that he would get out between midnight and 1 a.m. and then still be asleep when his son left for school the next morning. “He takes medication so he can concentrate and gets treatment at school,” Gomez said of his son. “But when I saw what was happening with my schedule, that it was impacting his ability to focus even though he was getting treatment, I only worked there a couple of weeks.” (Backus, 12/22)

Three U.S. House members from Florida want to close a “loophole” used by a Saudi national to buy a handgun before he killed three people and injured eight others this month at a Pensacola naval base. A bill spearheaded in the House by Democrats Charlie Crist of St. Petersburg and Val Demings of Orlando and Republican John Rutherford of Jacksonville would address foreign nationals who meet current requirements to buy handguns in the United States. It would require them to petition the U.S. attorney general before being able to buy guns and would lead to more-rigorous background checks. (Turner, 12/20)

A 19-year-old St. Paul man is dead and seven other people were hurt following a shootout in the parking lot of a Spring Lake Park restaurant and event center overnight Saturday. (Nelson, 12/22)

Outbreaks of influenza in Minnesota schools are expected to ease as students head for winter break. The bad news: sick kids will likely spread the virus at holiday gatherings over the next two weeks. “Kids may share pop cans and may not have the best respiratory etiquette with covering their coughs and sneezes and doing a lot of hand washing,” said Noreen Kleinfehn-Wald, a public health supervisor for Scott County Public Health. (Wurzer and Dunbar, 12/20)

A mobile application developed by a small startup company in Madison has shown strong results in treating one of the most common and costly medical conditions: lower back pain. The company is Kiio, and two pilot projects have found the company’s app effective in helping people with lower back pain while significantly reducing medical costs. The pilot projects were done by Quartz Health Solutions, based in Sauk City, and WEA Trust, based in Madison. (Boulton, 12/20)

Some steadied themselves with walkers as they entered the familiar dining hall. Others were wheeled in by aides. Their eyes, blank or restless, surveyed the colorful array of drums and fruit-shaped sound shakers set up in front of them. A mesmerizing rhythm enveloped them as they formed a circle around David Currier, a visitor bearing the gift of music for older folks grappling with illness and memory loss. He was beating softly on a Korean hourglass drum hanging from a shoulder strap. (Weisman, 12/22)

Kaiser Health News: Government-Funded Day Care Helps Keep Seniors Out Of Nursing Homes And Hospitals
Two mornings a week, a van arrives at the Escondido, Calif., home of Mario Perez and takes him to a new senior center in this northern San Diego County town, where he eats a hot lunch, plays cards and gets physical therapy to help restore the balance he lost after breaking both legs in a fall. If he wants, he can shower, get his hair cut or have his teeth cleaned. Those twice-weekly visits are the highlights of the week for Perez, a 65-year-old retired mechanic who has diabetes and is legally blind. (Basheda, 12/23)

A state pilot program that uses GPS to track therapists who serve children on the autism spectrum is so fraught with problems that providers say they are having a hard time going to appointments and getting paid. The program is one of many changes that state officials made after discovering Medicaid fraud among providers in the applied behavior analysis, or ABA, therapy field two years ago. (12/19)

A new report shows Florida's health ranking has dropped from 29th to 33rd, making it the second-largest drop nationally, especially in terms of terms of health behaviors, the environment, public health policies and clinical care. The annual America’s Health Rankings report, sponsored by the United Health Foundation, says there has been a significant rise statewide in the rates of obesity, physical inactivity, diabetes and drug deaths. (12/20)

A bright greenish-yellow liquid gushed onto the side of a Michigan highway Friday, prompting a multiagency investigation that discovered the mystery substance was probably a chemical that is known to cause cancer. The hexavalent chromium-contaminated water that rushed from a retaining wall onto Interstate 696 in the Detroit suburb of Madison Heights appeared to come from a shuttered electroplating business, said Jill Greenberg, a spokesperson for the Michigan Department of Environment, Great Lakes and Energy. (Iati, 12/22)

On a recent Sunday night, Paul Quinn College president Michael Sorrell kicked off an hourlong, unstructured group discussion during his problem-solving course with a question. “What’s on your mind?” he asked the class composed of the school’s top 18 students. Sophomore LaMontria Edwards promptly asked a question about Sun Tzu’s “The Art of War,” the ancient and seminal Chinese text about war and strategy assigned to the class. (Tatum, 12/19)

Facing financial pressure and increasing capital needs, the Brooklyn Hospital Center wants to redevelop its downtown Brooklyn campus and sell large parcels of its site to finance the project. The hospital plans in the coming weeks to submit initial paperwork to seek rezoning for the entire square-block site in a bid to encourage residential development. That is the start of a multiyear effort to gain technical approvals for the development. (West, 12/22)

Even as Democratic presidential candidacies implode over Medicare for All, Republican state attorneys general and the Trump Administration are handing the left a political lifeline with an overbroad attack on ObamaCare in the courts. On Wednesday the Fifth Circuit Court of Appeals ensured this will drag on as it struck down the individual mandate and asked a district-court judge to determine if other parts of the law have to go too. The finding that the mandate is unconstitutional is straightforward though it should have little impact. Chief Justice John Roberts in 2012 upheld the Affordable Care Act’s (ACA) command that everyone purchase insurance on grounds that it was a “tax” on failing to buy insurance. In 2017 the GOP Congress set the penalty for failing to buy insurance at $0. If it doesn’t collect revenue, the Fifth Circuit now says, it can’t be a tax. (12/20)

Gov. Gavin Newsom, who praised the “Medicare for All” concept last year on the campaign trail, is thankfully offering a more nuanced view now. In announcing the creation of the Healthy California For All Commission, Newsom shrewdly said it would look at ways to expand health care that includes a single-payer government model but also the “hybrid” health systems used around the world. It’s not a given that single-payer is best, yet at Thursday night’s Democratic presidential debate, it was the center of attention. (12/20)

Health care is stuck in a bad place. It’s complicated, expensive, and fraught with disparities. Built to deliver acute care in a different era, health care services doesn’t work well enough at addressing the chronic diseases that account for more than 70 percent of US health care spending. This isn’t an indictment of the millions of dedicated professionals who provide care. It’s an indictment of a broken system that urgently needs transformation. Health care needs a new normal. (Elizabeth Teisberg and Scott Wallace, 12/23)

For all of the talk about our healthy economy, reflected in booming job creation numbers and a surge in new construction, one metric suggests a sickliness under the surface: the growing number of young children without basic health care coverage. A distressing report this month showed Texas has nearly 200,000 children under age 6 who lack health insurance, with a rate of uninsured youngsters (8.3%) that’s nearly twice the national average. Worse, the ranks of uninsured kids under age 6, once on the decline, have been growing over the past couple of years. In 2016, 1 in 14 young children in Texas didn’t have health insurance.Last year, it was 1 in 12, according to a report by Georgetown University’s Health Policy Institute. The report’s authors note this is a particularly troubling trend “during a time of economic growth when more children should be gaining health care coverage” (emphasis added). In our view, these numbers are the entirely predictable outcome of Texas’ stubborn refusal to expand Medicaid, the state’s harmful practice of kicking some kids off Medicaid midyear, and the cuts in federal grants and state outreach efforts that previously helped families obtain coverage. (12/22)

Imagine if sleeping were to get you thrown in jail. Or sitting and lying down in public. Or camping. Or snoozing in your car. In cities across the country, that is exactly what is happening to homeless people who engage in these activities. In an effort to clean up their cities and make residents and visitors more comfortable, lawmakers have taken an inhumane approach to homelessness and made all these actions illegal. (12/23)

The plea came across my Brentwood Nextdoor site on a cold December night: “Will someone please go to the Ralphs at Wilshire and Bundy and provide some help to the homeless woman and her dog? It is raining and cold, and they are both wet and cold.” The writer continued: “I would help but I don’t have any money or resources…Please let’s act like we actually care and help this person out so she and her dog don’t succumb to exposure.” (Carla Hall, 12/22)

As we come together to celebrate this holiday season and take stock of what we are thankful for, let us keep the thousands of San Diegans living on the streets in our hearts and minds. ...Salt Lake City all but ended homelessness, and what they did was simple. They created housing that people living on the street actually wanted to live in, provided the new residents with plenty of on-site counseling and services to help them with any substance abuse, unemployment or mental health issues, and lastly, they created a position charged with coordinating government and nonprofit agencies’ efforts. Similarly, Houston decreased its homeless population by 54% since 2011 by focusing on housing. It is time we learn from other cities and fully embrace and implement this proven successful model here in San Diego. (Chris Olsen, 12/22)

There were times when all Blanca Ahumada could do was cry herself to sleep — her mind racing with anxiety over where her family would find a good night’s rest the next day. She’s a mother of seven kids, ranging from a 2-month-old to a 14-year-old son with autism. She lost her job in retail, and her husband only gets occasional work as a day laborer. After a while, their landlord raised the rent — and they simply couldn’t afford to pay it. (LA Mayor Eric Garcetti, 12/19)

As part of the government spending deal approved this week by Congress, the Centers for Disease Control and Prevention and the National Institutes of Health will receive $25 million to study gun violence. This ends an effective ban that has existed since 1996 to prevent federal agencies from identifying trends and preventing firearm injuries and deaths. The National Rifle Association and others have portrayed the measure as a potential attempt to weaken Second Amendment protections and confiscate guns from law-abiding owners. Some activists on the other side have heralded it as a step toward “gun control” to address the rising gun deaths in the United States. (Leana S. Wen, 12/20)

California has some of the nation’s most stringent gun restrictions, including a law requiring people who build their own firearms from parts to apply for a serial number so the weapons can be traced. It’s a reasonable law, but like many state gun regulations, it can be hard to enforce. The fact is, anyone in California can legally order untraceable parts from out of state and, with a little machine work, assemble a gun. It’s pretty easy at that point to ignore the state registration law if you’re inclined to (as well as the requirement that homemade guns include safety devices).The result: Federal officials say that nearly 1 in 3 guns that police recover at Los Angeles-area crime scenes are just such untraceable built-at-home “ghost guns.” The attacker at Saugus High School in Santa Clarita used a ghost gun to kill two students and himself in November. (12/22)

When a whistleblower revealed the details of Project Nightingale, a collaboration between Google and the Ascension health system, he or she also surfaced critical flaws in the ways that health care and tech work together. As part of the deal, Ascension, a nonprofit Catholic hospital system that operates in 21 states, gave Google access to millions of patient records, including names and birth dates. The goal of Project Nightingale was to build new tools that help doctors extract key information from patients’ medical records and deliver more targeted medical treatments. It would also make it possible for doctors to spend more time with patients and less time combing through endless layers of electronic health data. The problem was that the hospital system gave Google access to this mountain of data without the knowledge of doctors or patients. (Thomas M. Maddox and Simon Macgibbon, 12/23)

Eleven years ago, in the earliest hours of December 22, 2008, at the Tennessee Valley Authority’s Kingston Fossil Plant in Kingston, Tennessee, a dam holding back coal ash slurry — a toxic soup of factory wastewater and burnt coal — broke. The broken dam released over a billion gallons of ash slurry into the Clinch and Emory Rivers and buried about 300 acres of land several feet deep under a poisonous sludge of lead, arsenic, mercury and other heavy metals. The spill was three times larger than the TVA’s initial estimate — in fact, it was more than what the TVA said was in the pond to begin with. Cleaning up the spill took years; a process that was beset by further environmental crimes. The waste was mainly carted away to Uniontown, Alabama, where it was dumped into an uncovered landfill outside of a predominantly black community. Moreover, the company contracted by the TVA to clean up the site, Jacobs Engineering Group, did not provide adequate protective equipment, according to a lawsuit filed by workers, who sat atop piles of toxic waste to eat their lunches. (Tatiana Schlossberg, 12/22)

California is arguably the nation’s most politically “progressive” state. That’s our reputation. Left coast and all that. But on one issue, no state is more regressive. We’re extremely backward on allowing reasonable jury awards for victims of severe medical malpractice. It’s looking like there’ll be a fiercely fought ballot initiative next November to bring California’s malpractice payouts into the 21st century. (George Skelton, 12/23)

The potential for egg freezing to allow women to pause their biological clocks is one of the most astonishing developments of recent fertility science. The promise was thrilling: Women could enjoy more time to find the right partners, break up with the wrong ones and become emotionally and financially ready to become mothers. Enthusiasts even fantasized the technology would promote gender equality by giving women control over their fertility so that they wouldn’t have to scale back their career ambitions during their 20s and 30s. “Freeze Your Eggs. Free Your Career” blared a 2014 cover of Bloomberg Businessweek. (Sarah Elizabeth Richards, 12/21)