The Associated Press: Dialysis Companies Spend $111 Million To Kill Ballot Measure
Dialysis companies have contributed an extraordinary $111 million and counting to defeat a California ballot initiative that would cap their profits, the most any one side has spent on a U.S. ballot issue since at least 2002. A $5 million donation from this week from dialysis provider Fresenius Medical Care pushed the anti-Proposition 8 campaign's total past the $109 million pharmaceutical companies spent two years ago to defeat a measure limiting prescription drug costs. More than $70 million has been spent on television and radio ads as well as consulting services in the last two months. (Bollag, 10/26)

On the national elections stage, preexisting conditions protections emerge as flashpoint —

The New York Times: To Rally Voters, Democrats Focus On Health Care As Their Closing Argument
Senator Claire McCaskill isn’t subtle in reminding voters what her campaign is all about. She’s rechristened it the “Your Health Care, Your Vote” tour. The turnaround could not be more startling. After years of running as far as they could from President Barack Obama’s health care law, Ms. McCaskill and vulnerable Senate Democrats in Florida, West Virginia and other political battlegrounds have increasingly focused their closing argument on a single issue: saving the Affordable Care Act. Now, with Republicans desperate to reposition themselves and come up with their own health care pitch, and with the elections roiled by gale-force winds on immigration and Justice Brett M. Kavanaugh’s confirmation hearings, the question is whether health care will be enough to save her and Democrats in other key Senate races. (Gabriel, 10/28)

The Wall Street Journal: Pre-Existing Condition Discord Shows Health Care Still A Hot-Button Issue
As President Trump pushes ahead with efforts to chip away at the Affordable Care Act, Democrats are seizing on his moves to attack Republicans’ claims that they will protect people with pre-existing medical conditions. Republicans are hitting back, saying Mr. Trump’s actions will increase consumer choice and that they strongly favor covering pre-existing conditions. In either case, the back-and-forth shows the continuing potency of health care as an issue less than two weeks before the midterm elections. (Armour, 10/28)

The Washington Post: These Republicans Are Misleading Voters About Our Obamacare Fact Checks
Somewhere, somehow, a memo must have gone out to Republican lawmakers who voted for the American Health Care Act (AHCA), the Republican bill to repeal and replace Obamacare: If you are attacked for undermining protections for people with existing health problems, jab back by saying the claim got Four Pinocchios from The Washington Post. That’s not true. Republicans are twisting an unrelated fact check and are misleading voters. We have found at least seven politicians who have done this. (Kessler, 10/29)

KQED: California Escalates Battle With Trump EPA Over 'Clean Car' Rules
Gov. Jerry Brown, flanked by his attorney general and air quality chief, issued another demand on Friday that the Trump administration abandon its plan to freeze auto emission standards and revoke California's right to set its own rules. ... State officials, along with attorneys general from 20 other states, also released their 415 pages of comments on the proposal, which Trump appointees have dubbed the SAFE Rule, for Safer Affordable Fuel-Efficient Vehicles, calling it "riddled with errors and based on faulty assumptions, incorrect modeling, cherry-picked data and a fundamental misunderstanding of consumer behavior." (Miller, 10/26)

Capital Public Radio: California To Trump Administration: 'Protect Clean Car Rules'
Top California officials urged the federal government on Friday to preserve the nation’s clean car standards rather than weakening them. In August, the Trump Administration proposed halting future mile-per-gallon goals for cars and trucks, saying they are too expensive for automakers. (Nichols, 10/26)

CALmatters: Analysis: Lung Cancer Deaths Decline In California 
California’s low rate of lung cancer deaths saved nearly 5,000 lives in 2014 — and saved Californians at least $500 million just in that year, according to a CALmatters analysis in consultation with public health researchers. Those savings will likely grow into the billions of dollars in the decades ahead, experts say. Earlier this month, a study from the UC San Diego School of Medicine found California’s rate of lung cancer mortality was 28 percent lower than the rest of the country in 2014, the most recent year of available data. The study’s authors attributed California’s low number of lung cancer deaths to the state’s early and aggressive anti-smoking initiatives. (Levin, 10/28)

San Francisco Chronicle: California Immigrants Worried About Health Care Under Trump Green Card Plan
Patients at La Clinica de la Raza have caught wind of a recent Trump administration proposal that could make it harder for legal immigrants to get a green card if federal immigration officials think they’re likely to use Medicaid or other public benefits in the future. And they’ve been asking [clinic employee Laura] Plasencia if they should drop their Medicaid coverage, or not apply, for fear that receiving the benefit could imperil their chances at permanent residency. (Ho, 10/28)

In other health news around the state —

Sacramento Bee: With STD Rates Skyrocketing In Sacramento, County Funds Treatment At Community Colleges
A pilot program beginning in November at two campuses of the Los Rios Community College system hopes to curb some of that alarming growth in STDs by providing free access to treatment and education. The Sacramento County Board of Supervisors recently approved a $25,000 grant to pay for a nurse to work twice a week at the health centers at Cosumnes River College and Sacramento City College to offer free screenings and treatments for sexually transmitted infections, including chlamydia, syphilis, gonorrhea and HIV. (Yoon-Hendricks, 10/28)

Los Angeles Times: Here’s What Happened After California Got Rid Of Personal Belief Exemptions For Childhood Vaccines 
Health authorities in California have more power to insist that a dog is vaccinated against rabies than to ensure that a child enrolled in public school is vaccinated against measles. That’s just one of the frustrations faced by health officials in the first year after California did away with “personal belief exemptions” that allowed parents to send their kids to school unvaccinated, according to a study published Monday in the journal Pediatrics. (Kaplan, 10/29)

The California Health Report: People Of Color Face Higher Rates Of Hep C, More Deadly Cases Of Liver Cancer 
In California, liver cancer incidence and death rates have also declined among APIs since 2000. Yet rates among Latinos and African-Americans have increased over that same period, according to data from the California Cancer Registry. Just over half of liver cancer cases arise from well-established risk factors, like viral hepatitis, cirrhosis, and non-alcoholic fatty liver disease, according to Salma Shariff-Marco, a UCSF professor who works on the Greater Bay Area Cancer Registry. Researchers, health care professionals and advocates are doing their best to screen, prevent and treat for those risk factors. (Matthews, 10/25)

San Francisco Chronicle: SF Way Ahead Of Goal In Registering Homeless In New Tracking System
By the end of this month, San Francisco officials had hoped to have at least 2,000 homeless people enrolled in the city’s new system to monitor and document their interactions with city aid agencies, with the goal of improving the care they receive. On Friday, with six days to go before the end of October, the Department of Homelessness and Supportive Housing said it had already reached its goal — and then some. (Fracassa, 10/26)

Modesto Bee: Homeless Community Takes Root At Modesto’s Beard Brook Park
Since the city of Modesto sanctioned Beard Brook Park as a campground for the homeless over a month ago, it has taken on a life of its own. The 250-plus people who live in the park along Dry Creek that has become known as Beard Brook Village participate in weekly potlucks, have taken part in events with face painting and rock gardens for the children and are planning a Thanksgiving dinner. (Tracy, 10/26)

Los Angeles Times: Homelessness, Mental Health Top Glendale Health Concerns, Summit Reveals
Homelessness, substance abuse and mental health remain some of Glendale’s most salient health concerns, according to community leaders who came together Thursday for an annual summit to identify and address the city’s health needs. The Glendale Community Health Summit — which stretched for six hours and brought together representatives from the city, school district, police department and area hospitals — was the first leg in a process that will ultimately result in a public report slated for completion in June. (Seidman, 10/26)

Sacramento Bee: Health Care Workers Claim Win In 3-Day Strike; UC Leaders Say No Deal
Roughly 39,000 unionized employees wrapped up a three-day strike Thursday at five University of California teaching hospitals, including UC Davis Medical Center, a job action that UC leaders said moved them no closer to a contract agreement. ... Union leaders, however, said that they received reports from colleagues working on the UCD hospital floor, saying that the hospital had to postpone services for patients in the gastrointestinal clinic, physical therapy and elective surgery. (Anderson, 10/26)

Fresno Bee: One Valley Hospital Gets A Star For Reducing Infections; Another Needs State Help
Hospitals in the central San Joaquin Valley are among the best and the worst at reducing health care associated infections, according to California public health officials. Mercy Medical Center in Merced is among 16 hospitals in California to have achieved 2020 goals for reducing all types of infections, according to the California Department of Public Health’s 2018 report. (Anderson, 10/26)

The Bakersfield Californian: More Than A Thousand Tour New Adventist Health Tehachapi Valley Hospital
Eager and joyful expressions were on the faces of more than a thousand Tehachapi residents who took tours Sunday afternoon of the soon-to-open, new Adventist Health Tehachapi Valley hospital. Many people have waited years for the facility to become a reality. ...The new hospital, slated to open in November, is located on a 20-acre campus in the Capital Hills area, north of Highway 58 on Magellan Drive. It will replace the current downtown facility, which was built in 1954. The groundbreaking for the new hospital was in 2013, although planning and various bond measures have been passed to fund the hospital since 2003. (Jackson, 10/28)

The Associated Press: Shoppers May Face Hard Choices Again On Health Marketplaces
Insurance shoppers likely will have several choices for individual health coverage this fall. The bad news? There’s no guarantee they will cover certain doctors or prescriptions. Health insurers have stopped fleeing the Affordable Care Act’s marketplaces and they’ve toned down premium hikes that gouged consumers in recent years. Some are even dropping prices for 2019. But the market will still be far from ideal for many customers when open enrollment starts Thursday. (Murphy, 10/28)

The New York Times: Shopping For Insurance? Don’t Expect Much Help Navigating Plans
When the annual open enrollment period begins in a few days, consumers across the country will have more choices under the Affordable Care Act, but fewer sources of unbiased advice and assistance to guide them through the labyrinth of health insurance. The Trump administration has opened the door to aggressive marketing of short-term insurance plans, which are not required to cover pre-existing medical conditions. Insurers are entering or returning to the Affordable Care Act marketplace, expanding their service areas and offering new products. But the budget for the insurance counselors known as navigators has been cut more than 80 percent, and in nearly one-third of the 2,400 counties served by HealthCare.gov, no navigators have been funded by the federal government. (Pear, 10/27)

USA Today: Insurance Open Enrollment 2019: How To Choose The Right Plan, Benefits
Every fall, open enrollment season means complicated forms to read and big decisions to make about insurance and other benefits offered at your job. You may find the process a headache, but taking the time to evaluate your choices could save you thousands of dollars. Three out of five (60 percent) workers say their employer offers an open enrollment period for benefits, according to a recent Nationwide Financial consumer survey. Workers typically can switch health care plans, add disability or life insurance, or sign up for other benefits. (Herron, 10/29)

And the troubles people over 65 can face if they miss the first window to sign up for Medicare Part B —

The New York Times: Why You Shouldn’t Wait To Sign Up For Medicare Part B
[George Zeppenfeldt-Cestero] should have signed up for Medicare Part B three years earlier when he turned 65. By delaying, he had missed the best window — the so-called Initial Enrollment Period — to apply for Part B, which covers much of what we consider health care: doctor visits, tests, injectable drugs (including chemotherapy), ambulances, physical therapy and other non-hospital services. As a result, he has to pay permanently higher premiums, and he had to endure an unsettlingly long period — from December to July — before the coverage actually kicked in. (Span, 10/26)

Stat: A New Drug Lowers Cholesterol. Can It Spoil A Multibillion-Dollar Market?
A small biotech company has a shot at shaking up a market roosted by giants, moving toward approval with a pill it believes can lower bad cholesterol at a discount to other medicines. On Sunday, Esperion Therapeutics said a combination of its once-a-day treatment and a maximum dose of statin lowered LDL cholesterol 18 percent more than statins alone after 12 weeks. The results come from the last of five successful trials on Esperion’s drug, called bempedoic acid. The company plans to submit all of its data to the Food and Drug Administration in the early months of 2019. (Garde, 10/28)

Stat: Pfizer, Novartis Pair Up On Fatty Liver Drug Trials As Rivals Near Finish Line
Pfizer (PFE) and Novartis (NVS) are pairing up on new clinical trials of combination therapies to treat the fatty liver disease known as NASH. The collaboration between the pharma giants announced Monday won’t yield significant clinical results for quite some time, but scientists working at both companies say attacking NASH with two or more drugs that act in the liver differently will ultimately bring the most benefit to patients. (Feuerstein, 10/29)

The New York Times: Why Private Equity Is Furious Over A Paper In A Dermatology Journal
Early this month, a respected medical journal published a research paper on its website that analyzed the effects of a business trend roiling the field of dermatology: the rapid entrance of private equity firms into the specialty by buying and running practices around the country. Eight days later, after an outcry from private equity executives and dermatologists associated with private equity firms, the editor of the publication removed the paper from the site. No reason was given. Furor over the publication and subsequent removal of the article has deepened a rift in the field over what some see as the “corporatization” of dermatology and other areas of medicine. (Hafner, 10/26)

The Wall Street Journal: Caregivers Do Double Duty To Make Ends Meet
Demand for these workers, who provide the majority of hands-on non-medical care to older adults, is strong now and for the foreseeable future because of the aging baby-boom generation, longer life expectancies and growing rates of chronic conditions. In the next decade, home-care work is expected to add more jobs than any other occupation, with an additional 1.2 million needed by 2026, according to the Bureau of Labor Statistics. ... Yet even with high demand and tight supply, wages remain stubbornly low. Between 2007 and 2017, inflation-adjusted median hourly wages for direct-care workers—including home-health aides, personal-care aides and nursing assistants—fell 2% to $11.83 from $12.08, according to PHI, an organization that works with the direct-care industry. A 40-hour work week at that rate yields an annual income of around $24,600. (Ansberry, 10/27)

In other public health news stories: strategies for avoiding the flu, rare childhood cancers, Alzheimer's, and conflicting nutrition research —

The Washington Post: Want To Avoid The Flu? Wash Hands, Clean Counters, Crack A Window, Consider A Surgical Mask.
Influenza viruses cause about 200,000 hospitalizations every year in the United States. Annual seasonal vaccination is our best line of defense, but in recent years, mismatches in the vaccine can clearly limit its effectiveness. We study how the flu virus spreads between people. While we strongly encourage everyone to get the flu vaccine, the findings from our study on the stability of flu viruses in the air can provide useful information for parents, teachers and health-care officials to limit the spread of the flu in the community. By employing simple strategies to reduce the amount of the flu virus in our environment, we can decrease the number of infections every year. (Lakdawala and Marr, 10/27)

NPR: Scientists And Parents Band Together To Research Cures For Rare Childhood Cancer
Epithelioid sarcoma is exceedingly rare — estimates vary but at most, no more than around 100 cases per year. Of those, 10 percent occur in children and adolescents. For this and many other rare cancers that kids get, it takes a long time to find enough patients to test new therapies. Even worse, small patient numbers mean there's less motivation to allocate resources to study the diseases and develop potential drugs. Dozens of childhood cancers fall in this category, some so rare that few pediatric oncologists hear about them. (Landhuis, 10/26)

Stat: How An Outsider Bucked Prevailing Alzheimer's Theory, Clawed For Validation
Dating to the 1980s, the amyloid hypothesis holds that the disease is caused by sticky agglomerations, or plaques, of the peptide beta-amyloid, which destroy synapses and trigger the formation of neuron-killing “tau tangles.” Eliminating plaques was supposed to reverse the disease, or at least keep it from getting inexorably worse. It hasn’t. The reason, more and more scientists suspect, is that “a lot of the old paradigms, from the most cited papers in the field going back decades, are wrong,” said MGH’s Rudolph Tanzi, a leading expert on the genetics of Alzheimer’s. (Begley, 10/29)

The New York Times: Confused By Nutrition Research? Sloppy Science May Be To Blame
Confused about what to eat and drink to protect your health? I’m not surprised. For example, after decades of research-supported dietary advice to reduce saturated fats to minimize the risk of heart disease and stroke, along comes a new observational study of 136,384 people in 21 countries linking consumption of full-fat (read saturated) dairy foods to a lower risk of death from cardiovascular disease. ... Caution is in order, especially since another new study, this one a randomly assigned clinical trial, found that three weeks on a diet rich in saturated fat caused liver fat and insulin resistance to rise far higher than diets high in sugar or unsaturated fat. (Brody, 10/29)

Politico: Verdict On Trump Drug Plan: A Tough Sale Ahead
The Trump administration faces a lengthy battle to make its plan to lower Medicare drug costs a reality, with resistance coming from its own party, Democrats and large segments of the health care industry. Conservatives and the drug industry say it’s tantamount to government price controls and socialized medicine. Democrats are beating up the president for not going far enough and doctors are worried their patients could lose access to critical medicines. (Karlin-Smith, 10/26)

Bloomberg: Trump Springs Globalist Surprise With Medicare Drug-Pricing Plan
The Trump administration’s drug-pricing plan puts the U.S. on a path toward policies like those in Europe, where governments use tight cost controls. Under the new proposal unveiled at an event at the Department of Health and Human Services on Thursday, President Donald Trump and health secretary Alex Azar said that the administration would create a reference price for high-cost medicines paid for by Medicare, based on comparable prices from other countries. (Lauerman and Edney, 10/26)

And in other national health care news —

The New York Times: Republicans Look To Safety Net Programs As Deficit Balloons
With the federal deficit growing and President Trump suddenly talking about another tax cut, the conversation in Washington has turned to the inevitable question of how — or whether — Congress will engage in any type of fiscal discipline. Senator Mitch McConnell, the majority leader and Kentucky Republican, got people in Washington talking — and generated some new campaign ads from Democrats — when he suggested this month that changes to Medicare, Social Security and Medicaid were needed to tame the deficit. So what does that presage should Republicans maintain control of Congress? (Steinhauer, 10/26)

Modern Healthcare: Will Trump's Push For Flexibility Help Revamp Insurance Markets?
States and employers are getting a lot more leeway in the types of health insurance they can offer residents and workers, ensuring the likelihood that differences in access and affordability of coverage will continue to widen in the name of expanding consumer choice and reducing regulatory burden. But observers are divided over whether the Trump administration's moves last week to allow states to sidestep certain aspects of the Affordable Care Act through new 1332 waiver guidance and allowing employers to pay for workers' individual market premiums through health reimbursement arrangements will ultimately harm the marketplace and its enrollees. (Livingston, 10/27)

CQ: Federal Judge Skeptical Of Legal Challenge To Short-Term Plans
A federal judge in a Friday hearing appeared skeptical of a push by advocacy groups to stop the implementation of short-term insurance plans as designed by the Trump administration. U.S. District Court Judge Richard Leon of the D.C. Circuit didn't seem impressed by the groups' arguments that Trump administration actions were undermining the individual insurance markets. He indicated he would not rule for several weeks on their request for a preliminary injunction to stop the plans, which only last up to 12 months and cover less than the full plans under the Affordable Care Act. (McIntire, 10/26)