Axios

The city of Detroit yesterday joined a torrent of an estimated 400 cities, counties and states suing opioid makers. Their main allegation: the companies are complicit in an addiction crisis that has killed about 37,000 people in the U.S. in just the 12-month period ending in May, or 103 per day.

• Read this statistic: When you add in heroin, to which opioid addicts often turn because it's cheaper and often easier to obtain, the 12-month number of opioid deaths through May exceeds 53,000, meaning 145 people per day.

More suits will be filed this week in Illinois, and Paul Hanly, one of the leading lawyers for the plaintiffs, tells Axios that the number of cases will rise to almost 1,000 by this time next year, a deliberate strategy of driving the opioid-makers to the negotiating table. The suits, first filed in 2014, have vastly accelerated pace this year. In a settlement, Hanly said, "we're talking tens of billions if not hundreds of billions for a nationwide resolution." The lawyers' model is 1990s litigation that led to a $246 billion settlement with Big Tobacco under similar allegations.

There's been a lot of focus on how repealing the individual mandate affects the individual market (it raises premiums and decreases competition). But, as my colleague Caitlin Owens notes, repealing the mandate is also likely to decrease the number of people with employer-based coverage, too.

The big difference: While decreasing coverage on the individual market is likely to destabilize the market itself, the effect on the employer market is probably negligible.

There were plenty of reasons to think the individual mandate was here to stay. It was a linchpin of Republicans' failed effort to defeat the Affordable Care Act in 2010. They couldn't persuade the Supreme Court to strike it down in 2012, or muster enough votes in that year's elections to do it themselves. They failed to repeal it once again in July. This July. Not even five months ago. And yet, here we are.

The bottom line: As important as the passage of Republicans' tax overhaul is for tax policy, and for President Trump's legislative agenda and Paul Ryan's legacy and everything else, this is at least as big a moment in the life of the ACA. After years upon years of dire warnings about what would happen to the ACA without an individual mandate, we're about to find out in a live experiment.

Aledade, a health technology startup that works with doctors to analyze patient data and coordinate care, has raised $23 million in a new funding round, according to a securities filing. It's part of a $28 million offering. Venrock, Biomatics Capital and other existing investors were part of the latest round.

Why it matters: Farzad Mostashari, the former top health care technology official in the Obama administration, co-founded Aledade in 2014 and has raised $97.5 million to date. The company clearly has attracted interest from doctors who want to create so-called accountable care organizations and structure new payment contracts with Medicare and private health insurers.

Research that involves modifying certain diseases to make them more deadly will again be funded by the US government, writes Sara Reardon for Nature. Scientists can use these so called gain-of-function studies to understand what mutations a virus might need to become more deadly, or understand how a disease interacts with our immune system. But concerns about safety protocols and potential pandemics led the White House to ban funding such research in 2014.

Why it matters: If something goes wrong, such research could have deadly consequences. But proponents argue the knowledge gained can save lives. When the ban was first enacted, it applied to the flu, SARS, and MERS, but some scientists said it was too broad. It initially halted 21 projects — some of which were related to vaccine research, reports Reardon. The moratorium gave the government time to develop a regulatory framework and added layers of security.

Envision Healthcare is paying $31 million to sweep away allegations that its emergency room staffing subsidiary, EmCare, was in cahoots with the former Health Management Associates hospital chain to maximize profits by admitting patients from the ER "without regard to whether the admissions are medically necessary."

In addition to the settlement with the Department of Justice, Envision entered into a five-year "corporate integrity agreement" in which the federal government will closely monitor Envision's compliance.

Tenet Healthcare, a for-profit hospital chain that has struggled with debt and investor unhappiness, may sell Conifer Health Solutions, its profitable medical billing and debt collection company. Tenet has hired Goldman Sachs to shop Conifer around.

Looking ahead: Private equity has shown interest in medical billing companies. Pamplona Capital Management bought out MedAssets in 2015 for $2.7 billion. Based on Conifer's profitability, Tenet could fetch at least $2.5 billion from a sale.

Go deeper: Bloomberg recently explored how hospitals are reaping profits from Conifer and other debt collectors, but the practice surprises patients and threatens their credit.