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Failure is a familiar outcome in U.S. health policy. Presidents have long struggled to translate their promises and aspirations into legislative victory. Harry Truman’s national health insurance program never came close to becoming law. Richard Nixon’s universal coverage plan did not pass. Congress rejected Jimmy Carter’s hospital cost-containment bill. Bill Clinton’s campaign to enact universal insurance ended in political disaster. Yet even judged against this dismal history, Republicans’ March 2017 efforts to repeal and replace the Affordable Care Act (ACA) were an epic failure. (Jonathan Oberlander, 4/5)

President Trump has said the Democrats will take the fall politically if and when Obamacare "explodes." But new polling shows that the public will hold Trump and the GOP accountable for failing to address problems in the marketplaces, not the Democrats. That means they'll have to think twice about some of the moves they might make that could make the Affordable Care Act's problems worse. (Drew Altman, 4/7)

What about our kids? As Congress considered changes to the Affordable Care Act, I was increasingly alarmed about the lack of attention and debate on the risks the changes to Medicaid posed to children’s health. ... The fact is that nearly half of our country’s children, 36 million, receive some form of health care coverage through Medicaid and the related Children’s Health Insurance Program. (Peggy Troy, 4/6)

On March 10, 2017, the Accreditation Council for Graduate Medical Education (ACGME) issued revised common program requirements for residents that go into effect this July. The revisions emphasize the importance of teamwork, flexibility, and physician welfare during training, but all the attention has been (and will no doubt remain) focused on the changes in duty hours. The new rules maintain an 80-hour-per-week cap on residents’ work, averaged over 4 weeks, but extend the permissible work shifts for first-year residents from 16 hours to 24 — limits already in place for residents in year 2 and beyond — and permit more within-shift flexibility as long as weekly duty-hour limits are met. What makes this policy change so important is that it seems to reverse direction on the basis of a new approach to developing and using evidence to inform education policy. (David A. Asch, Karl Y. Bilimoria and Sanjay V. Desai, 4/5)

As young doctors in the 1980s, we witnessed the devastation of the AIDS epidemic. In those early years, patients died within months of diagnosis, often in agony, suffering headaches, diarrhea, shortness of breath and even blindness. Yet medical science fought back -- first identifying the virus, then developing a diagnostic test and coming up with treatments. By 1996, highly effective therapy was available. While much work remains, in particular the development of an HIV vaccine, the response to AIDS stands as a success story in the history of medicine. At a time when federal funding for medical research faces deep cuts, it's important to remember especially one key part of this story ... [t]he breakthroughs came in the form of new medicines that grew out of fundamental research carried out decades earlier. (Arturo Casadevall and Ferric C. Fang, 4/6)

Iowa’s largest health insurer, Wellmark Blue Cross Blue Shield of Iowa, recently announced it will no longer sell individual health insurance policies, affecting 21,000 Iowans who purchased policies in the past three years. Wellmark says it cannot continue to sustain the losses incurred in covering this group of individuals. Shortly thereafter, another large Iowa insurer, Aetna, announced it is also dropping out of the individual insurance policy market. (State Rep. John Forbes, 4/6)

Much misinformation has been published about the legislative members’ contributions to the cost of their health insurance. House Republicans have voted 11 times since 2009 to require legislators to pay more for their health insurance. Former Senate Majority Leader Mike Gronstal and Senate Democrats chose to kill the bills. The Iowa Legislature has always followed state law which required members to pay the same premium as full-time, non-contract state employees. A new bill is on its way to the governor that will cause the legislators, and all state employees, to pay higher premiums for health insurance which will be more in line with private sector employees. (State Rep. John Landon, 4/6)

Nearly 80 percent of Iowa adults support state funding for non-abortion services at Planned Parenthood. This includes a healthy majority of Republicans and evangelical Christians, according to a February Des Moines Register/Mediacom Iowa Poll. Such broad support is likely because everyone understands how women get pregnant. They know Planned Parenthood provides birth control and services to prevent unwanted pregnancies. They know fewer unwanted pregnancies mean fewer women seek abortions. Yet a surprising number of elected officials seemingly fail to accept these reproductive basics. (4/6)

What happens when you suddenly offer parents generous family leave benefits, paid at the expense of the government? You can probably think of dozens of outcomes. But here’s one you might not have been expecting: people die. That’s the finding of Benjamin Friedrich and Martin Hackmann, in a new working paper at the National Bureau of Economic Research. The culprit? Nurses, who skew female, provide a lot of vital health care, and made heavy use of Denmark’s new paid family leave benefit when it passed in 1994. Since the supply of nurses was limited, and their skills could not easily be replaced, hospital readmissions went up, and more troublingly, mortality spiked among elderly patients in nursing homes. (Megan McArdle, 4/6)

The opioid epidemic is bigger than all of us. Bigger than the laudable attempts by many in Greater Cleveland to find more treatment options and more family interventions. Bigger than the ability of many families to cope. Some may still believe that jailing users who turn from prescription drugs to dangerous heroin and fentanyl will resolve the issue. It won't. (4/7)

Would you jump out of a plane if there were only 50/50 odds that your backpack contained a parachute? Probably not. Yet that is how a controlled study on the safety and efficiency of parachutes would work. You and several dozen others would be randomly sorted into two groups, handed either a parachute as part of the test group or an empty backpack as part of the control group, then asked to jump. (Rick Barton, 4/7)

Mass incarceration overall hurts the health of Americans, leading to worse outcomes for the families and communities of men in prison. The inmates themselves are at a very large risk of self-harm and violence immediately after their release. But a recent review of the impacts of incarceration on health published Thursday in the Lancet hints at a surprising upshot: Getting out of jail can be miserable, but going to jail can temporarily protect health—at least for some men. (Olga Khazan, 4/7)

“What will really move malaria control forward is going to be the work by the unsung heroes at the community level and in district health facilities. That’s where the battle will be won or lost,” said Robert Newman, the former director of the World Health Organization’s Global Malaria Program. As an African entomologist and malaria researcher, I could not agree more. (Janet Midega, 4/6)

In tandem with the growing visibility and acceptance of transgender people in the United States, we have seen a rapid increase in insurance coverage for health care services related to gender transition. Despite ongoing court battles over federal nondiscrimination protections for transgender people and uncertainty over the future of the Affordable Care Act (ACA), this trend is likely to continue: Medicare, many state-regulated private plans, some state Medicaid programs, and an increasing number of employer-sponsored plans now cover transition-related care for transgender people. (Kellan E. Baker, 4/5)