San Francisco Chronicle: Obamacare Small-Business Exchange Insurance Premiums To Rise 4.6 Percent
Health insurance premiums for 5,700 small businesses in California — which employ roughly 47,000 workers — will go up 4.6 percent in 2019, Covered California announced Thursday. The increase applies to the small slice of California companies and workers that get their health insurance from Covered California for Small Business, the exchange created under the Affordable Care Act where companies with 100 or fewer workers can buy health plans for their employees. (Ho, 9/13)

Capital Public Radio: How Suicide Trainings, Community Connections Could Patch Holes In Amador’s Mental Health Safety Net 
Rural counties are more likely to have trouble using the funds if they lack the staff support to execute new programs. That’s part of the reason why lawmakers are trying to change the rules to make it easier for counties to spend the money. (Caiola, 9/13)

In other public health news —

San Diego Union-Tribune: Infant Mortality Rate Flat In San Diego County But Disparities Remain For Some 
San Diego County’s infant mortality rate was flat in 2016, but significant disparities continue for African American babies, according to newly-released data from the county Health and Human Services Agency. There were 3.7 infant deaths per 1,000 live births in 2016, the most recent year for which numbers are publicly available, compared to a rate of 3.7 in 2015 and 3.8 in 2014, records show. While tragic, infant deaths are rare. In 2016, the county recorded 159 deaths in the first year of life, totaling 0.37 percent of the 42,654 live births tallied that year. (Sisson, 9/13)

San Francisco Chronicle: Court Throws Out California Law Raising Money For Hazardous Cleanup
Rejecting a 2015 state law, a federal appeals court ruled Thursday that California cannot charge railroads a $45-per-car fee for carrying crude oil, gasoline and other hazardous materials into the state to help pay for cleanup costs resulting from environmental accidents. The fee, part of a companion bill to the state budget, was intended to raise up to $10 million a year to pay for state and local emergency-response programs for spills of hazardous substances. (Egelko, 9/13)

In other news from the courts —

San Francisco Chronicle: Daly City Family Sues Police In Death Of Man Held Down, Tased By Police In His Home 
Family members of a 34-year-old man who died after getting tased by a police officer inside his home filed a civil suit Thursday against the Daly City Police Department, months after officers were cleared of wrongdoing, according to court records. Warren Ragudo, of Daly City, died in January from cardiopulmonary arrest roughly an hour after Officer Bruce Perdomo deployed his Taser to Ragudo’s lower back as two officers pressed him down with their weight, making it difficult for the already-handcuffed Ragudo to breathe, his family said in the suit. (Hernandez, 9/13)

Sacramento Bee: Wyoming Teen In Recovery For Rare Illness Visits Sacramento
It started with just a fever, sending Trinity Shores to the nurse at her high school in Cheyenne, Wyoming. “It didn’t feel like a normal cold,” Trinity said. Two days later, on Jan. 10, Trinity was rushed to the ER, becoming unconscious before she arrived, she said. Trinity, 15, spent the next eight months hospitalized at the Children’s Hospital Colorado in Aurora. What started as influenza B turned to pneumonia, then sepsis. Then Trinity contracted MRSA – a severe staph infection – in her lungs. (Darden, 9/12)

In other news from across the state —

Reuters: U.S. Reports Mild Bird Flu Virus At California Farm: OIE
The United States has reported an outbreak of the low pathogenic H7N3 bird flu virus at a turkey farm in California, the World Organisation for Animal Health (OIE) said on Friday. The outbreak at a farm in Stanislaus County led to all 26,258 birds of the flock exposed to the virus being killed and disposed of, the Paris-based OIE said in a note on its website, citing a report from the U.S. Department of Agriculture. (9/14)

The New York Times Fact Checker: Trump’s False Claims Rejecting Puerto Rico’s Death Toll From Hurricane Maria
In a pair of tweets casting doubt on the official estimate of nearly 3,000 deaths, the president clung to an outdated estimate, wrongly suggested that doubt over the figure emerged “a long time later” and inaccurately characterized the new figure as including all deaths on the island. (Qiu, 9/13)

Bloomberg: Trump Defies Science With Rejection Of Puerto Rico Death Toll
“I’m flabbergasted,” said Irwin Redlener, director of Columbia University’s National Center for Disaster Preparedness, a think tank. “People need to understand we’re not just counting immediate fatalities. We have to understand what happens long-term with ongoing conditions.” (Shields, 9/13)

The Associated Press: Trump Disputes Estimate Of Puerto Rico Storm Deaths
Public health experts have estimated that nearly 3,000 perished because of the effects of Maria. But Trump, whose efforts to help the island territory recover have been persistently criticized, was having none of that. He said just six to 18 people had been reported dead when he visited two weeks after the storm and suggested that many had been added later "if a person died for any reason, like old age." Trump's jarring comments, coming as the East Coast braced for a massive storm, offered fresh evidence of his resistance to criticism and his insistence on viewing large and small events through the prism of his own success or failure. (9/14)

The Wall Street Journal: Trump Denies Heavy Death Toll In Puerto Rico From Hurricane Maria
The researchers estimated the number of excess deaths by analyzing death certificates and other mortality data, and comparing the number of deaths during the designated period with past mortality patterns. They calculated the total number of deaths in the period was 22% higher than the number of fatalities that would have been expected, the researchers said. In analyzing Puerto Rico’s death-certification process, the study found that listed causes of death included cardiac arrest, respiratory failure and septicemia. But researchers concluded that such causes were sometimes misassigned, with physicians failing to link the deaths to the hurricane. (Ballhaus, 9/13)

The Washington Post: Trump Creates Political Storm With False Claim On Puerto Rico Hurricane Death Toll
Trump’s charge about the Puerto Rico storm — a humanitarian crisis that continues to affect life on the island a year later — baffled his advisers as well as officials at the Federal Emergency Management Agency, who have been working to prepare the Carolinas for Hurricane Florence, the potentially deadly storm forecast to make landfall Friday. Trump’s aides said they have tried to focus the president’s attention on Florence, noting that he has been engaged in daily disaster briefings and called governors, senators and other officials representing North Carolina and South Carolina. Officials have brought large, colored charts and graphs into the Oval Office to illustrate Florence’s dangerous path for Trump, who is a visual learner. And the president made a rare trip outside, to visit the staff of the National Security Council’s resilience office housed across the street in the Eisenhower Executive Office Building. (Rucker, Costa and Dawsey, 9/13)

The New York Times: As A New Hurricane Roars In, Trump Quarrels Over The Last One
Ever since the storm, Mr. Trump has pushed back against criticism that his administration was slow to respond to Puerto Rico, where the distribution of supplies, gas and food lagged and power outages lasted for months, particularly compared with a swift and efficient response to an earlier hurricane that hit Texas. It was six days after Hurricane Maria hit the island before Mr. Trump pledged to go there, even as he traveled to Texas four days after Hurricane Harvey made landfall. Full power was restored to homes only in August, nearly a year after the storm. Former Gov. Chris Christie of New Jersey, a Republican ally of Mr. Trump’s who was praised for his own leadership during Hurricane Sandy in 2012, said that Puerto Rico was an “extraordinary challenge” in part because the island’s infrastructure was in poor shape to begin with and that Mr. Trump resented being blamed for factors beyond his control. (Baker, 9/13)

Politico: First Responder Emails Appear To Undermine Trump's Narrative On Hurricane Maria
Emails released Thursday by congressional Democrats show correspondence between first responders that appears to undermine the Trump administration’s public reporting of the human toll from Hurricane Maria last year. In one email, dated Sept. 29, 2017, a first responder — whose name has been redacted — describes “finding mass graves in mud slide areas,” and requests counseling support for federal first responders in the area. An unnamed Army National Guard general is included in the correspondence. (Wilhelm, 9/13)

Meanwhile, Hurricane Florence has made landfall on the East Coast —

The New York Times: When You’re Elderly And Ill And A Storm Is Coming
When mandatory evacuation orders are issued for natural disasters like hurricanes, it poses a special challenge for those who are frail and in poor health. Patients with disabilities or who are in hospice care may be too ill to sit in cars inching along evacuation routes for hours, and their families must face the wrenching decision of whether it is better to stay or go. For people with dementia, evacuations can be especially disorienting and overwhelming. (Rabin, 9/14)

The New York Times: Florence’s Path Is Strewn With Toxic Hazards
While people can move out of harm’s way as Hurricane Florence advances on North and South Carolina, their structures remain behind to face the storm’s full force. In the Carolinas this means not only homes, schools and towns but ponds of coal ash, Superfund sites, chemical plants — and thousands of industrial hog farms with lagoons filled with pig waste. Here is where the danger lies, and why. (Pierre-Louis, Popovich and Tabuchi, 9/13)

The Associated Press: How Hurricanes Unleash Lethal Storm Surges
Behold the awesome power of water. Already the ocean is swallowing beaches, roads and anything else in the way of Hurricane Florence's monstrous storm surge. Storm surges aren't walls of water, like a tsunami, as commonly thought. Caused by a hurricane's winds pushing relentlessly on the shore, they are more like domes of high water that form as the ocean spreads inland. The high water has destructive waves on top, and it comes in addition to normal tides. (9/14)

The Washington Post: Bitter Senate Fight To Confirm Kavanaugh Plunges Deeper Into Chaos Over Letter
The bitter Senate fight to confirm Brett M. Kavanaugh to the Supreme Court plunged into deeper chaos Thursday as a top Democrat disclosed she had referred “information” about President Trump’s nominee to the FBI. Sen. Dianne Feinstein (D-Calif.) issued a brief, cryptic statement about the referral, but the absence of any details only raised questions. The information came in a letter that describes an alleged episode of sexual misconduct involving the 53-year-old Kavanaugh when he was in high school, according to a person familiar with the matter. (Kim and Viebeck, 9/13)

Los Angeles Times: Feinstein Asks FBI To Review Letter Involving Supreme Court Nominee Brett Kavanaugh
Several Democrats on the committee declined to talk about the contents of the letter on Thursday after a hearing in which a vote on Kavanaugh’s nomination was slated for Sept. 20. It was unclear whether they had seen it. Anyone can make a referral to the FBI and it does not mean Kavanaugh is under federal investigation. Kavanaugh’s nomination is under intense scrutiny by Democrats who argue he would be the fifth solid conservative justice on the Supreme Court, a lock for Republican priorities such as scaling back abortion rights. (Haberkorn, 9/13)

The Washington Post: Senate Committee Delays Vote On Kavanaugh Nomination Until Next Week
The Senate Judiciary Committee delayed its vote on Supreme Court nominee Brett M. Kavanaugh until next week, as the deeply bitter fight over his confirmation intensified and a handful of moderate senators continued to deliberate privately over whether to support him. (Kim, 9/13)

In other national health care news —

Stat: Trump Wants Drug Prices In TV Ads. The Latest Roadblock? Republicans 
President Trump’s splashiest idea for lowering the cost of prescription drug prices was to force pharmaceutical companies to include the prices of their products in TV and other advertisements. But when Capitol Hill had a chance Thursday to help him achieve that goal, lawmakers failed. And counterintuitively, it was House members in the president’s own party who ultimately nixed the provision. In fact, it was a Democrat, Sen. Dick Durbin of Illinois, pushing the measure hardest. (Florko, 9/13)

The New York Times/ProPublica: Top Sloan Kettering Cancer Doctor Resigns After Failing To Disclose Industry Ties
Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, resigned on Thursday amid reports that he had failed to disclose millions of dollars in payments from health care companies in dozens of research articles. The revelations about Dr. Baselga’s disclosure lapses, reported by The New York Times and ProPublica last weekend, have rocked Memorial Sloan Kettering, one of the nation’s leading cancer centers, in recent days. Its top executives scrambled to contain the fallout, including urgent meetings of physician leaders and the executive committee of its board of directors. (Thomas and Ornstein, 9/13)

The New York Times: Cuban Experts Insist No Proof Exists Of Attack On Diplomats
Some of Cuba’s top scientists and medical specialists denounced on Thursday claims that two dozen American diplomats in Havana had been the targets of mysterious attacks over the last two years. The experts were careful not to offer a definitive explanation for the episodes, in which the diplomats reported hearing strange noises that led to symptoms similar to those after a minor traumatic brain injury or a concussion. (Harris, 9/13)

Stat: Here’s The Data Behind The New Apple Watch EKG App 
When the new Apple Watch heart monitoring app can get a reading, it can accurately detect that a person has an irregular heart rhythm known as atrial fibrillation 99 percent of the time, according to a study of the new device that Apple submitted to the Food and Drug Administration. ...In one study, Apple tested the watch in more than 580 people, half of whom had atrial fibrillation. The app couldn’t read about 10 percent of the heart rhythm recordings in the study. When it looked at the rest, though, the app was very accurate: It caught more than 98 percent of people with atrial fibrillation, and correctly told people that they didn’t have the condition 99.6 percent of the time. (Sheridan, 9/13)

Reuters: Amazon's Jeff Bezos Commits $2 Billion To Help Homeless, Pre-Schools
Jeff Bezos, Amazon.com Inc's founder and the world's richest person, said on Thursday he will commit $2 billion (1.5 billion pounds) to helping homeless families and starting pre-schools for low-income communities. The announcement marks a deeper foray into philanthropy for Bezos, whose fortune has soared to more than $160 billion thanks to his stake in Amazon. Dominance in e-commerce and the nascent field of cloud computing has made Amazon the world's second-most valuable public company. (9/13)

Los Angeles Times: Gov. Brown, Don't Let The Feds Scare You Into Vetoing Safe Injection Site
Last month, the Legislature gave its blessing to a proposal under which San Francisco would be allowed to open one safe injection facility on a three-year trial basis. ... The narrower bill is now on the desk of Gov. Jerry Brown. He should sign it, despite the threat leveled by Deputy U.S. Atty. Gen. Rod Rosenstein in an op-ed in the New York Times in August, the day after the Legislature approved the bill. (9/12)

Sacramento Bee: On Propositions 8 And 11, Vote To Protect Patient Safety
Proposition 8, which would limit revenues at nearly 600 outpatient dialysis clinics, is another power play by SEIU-United Healthcare Workers West, which is trying to organize clinic workers and force more hiring. ... If we were confident that Proposition 8 would lead to better care for patients and lower bills, we would be inclined to support it. But because this measure is so complex – as is healthcare financing in general – it’s also possible that the measure could backfire and lead to less care. ... Proposition 11 would allow the companies to continue their longstanding practice of requiring their paramedics and EMTs to stay on duty during meal and rest breaks in case of 911 calls. ... We generally support workers and their rights on the job. On these ballot measures, however, patients have to come first. (9/12)

Sacramento Bee: California Needs To Catch Up On Gun Safety
Generally, when it comes to gun safety, California leads the nation. We require criminal background checks on every gun sale, and we were one of the first states to adopt a strong “red flag” law that allows family members and police to seek a court order temporarily blocking someone from having guns if they show signs of violence. But when it comes to concealed carry permits, we’ve fallen behind. Under current state law, it is legal for a person who has never fired a gun to carry a concealed, loaded handgun in public. (David Brame, 9/7)

Los Angeles Times: We Can't Make Economically Rational Choices On Healthcare. Our Brains Won't Let Us
Standing under a sign reading “pain relief,” I scanned the shelves, my legs throbbing after a 10K race that morning. I spotted a familiar red box: Tylenol Extra Strength, 100 pills for $7. Right next to it was the drug store’s generic version, offering 100 pills for $5. This should have been a no-brainer. I’m a physician, and I know the active ingredient, acetaminophen, is the same in both. It’s a simple molecule — a six-carbon hexagonal ring at the center with two side chains poking out — something any biochem major could manufacture in an afternoon. The U.S. Food and Drug Administration also makes certain that generic and brand-named drugs are identical. There were only two differences here: the packaging and the price. (Robert Pearl, 9/10)

Los Angeles Times: One-Third Of American Schools Still Contain Asbestos. That's Unconscionable
As we send our kids back to school, we do our best to prepare them for the new academic year. We buy their school supplies, make their lunches, sort out secure routes to and from campus and attempt to curb bullying. But there is a truly lethal threat that we scarcely discuss: asbestos poisoning. Roughly one-third of American schools contain asbestos, the dangerous mineral once heralded for its fire-resistant properties, but which we now know causes cancer and a host of other diseases, even at very low levels of exposure. (Linda Reinstein, 9/13)

Fresno Bee: Quality Health Care In The Valley 
As an emergency room doctor, I saw the vital need for all families to have access to quality care. The 31st Assembly District, which covers much of Fresno County and which I represent in the Legislature, includes some of the state’s most disadvantaged and impoverished communities. (Dr. Joaquin Arambula, 9/13)

Fresno Bee: Wellness Elusive In Fresno County
Wellness is that ability to recognize, and capacity to achieve, the maximum of our genetic makeup, and it is something that many of us casually take for granted. ... The keystone to this is our educational system. (Dr. Ken Bird, 9/11)

Los Angeles Times: California Is Sitting On Hundreds Of Millions Of Dollars For Mental Health Programs. Let's Put It To Use
Like much of the rest of the nation, California went only halfway toward keeping its promise to improve mental health care. ... A bipartisan proposal from state Sens. Scott Wiener (D-San Francisco) and John Moorlach (R-Costa Mesa) would provide the appropriate spending guidelines and promote some uniformity in treatment around the state while leaving counties the flexibility to spend on different priorities if they can make a persuasive case for them. The measure (Senate Bill 1004) cleared the Legislature and is now on Gov. Jerry Brown's desk. (9/10)

Sacramento Bee: Trump Is Unikely To Be The First President Removed With The 25th Amendment
The anonymous op-ed in the New York Times said that senior staff officials have considered invoking the 25th Amendment to have President Donald Trump declared incapable of performing the duties of office. This would be unprecedented in American history. At this point, it is highly unlikely to be used, but it is stunning that it has been discussed in the White House at all. (Erwin Chemerinsky, 9/10)