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The giant health insurance company UnitedHealth inspired lots of hand-wringing and hyperventilation last year when it announced that it had lost hundreds of millions of dollars on Affordable Care Act exchanges and was considering withdrawing from the market in 2017. Although that news prompted numerous Obamacare critics to declare the impending death of the program, we were skeptical. United, which makes most of its money in the large-group (employer) market, always was a reluctant participant in the individual exchanges, and was largely inept at pricing and managing those products. (Michael Hiltzik, 4/8)

New York is a city with some of the worst income inequality in the country. But when it comes to inequality of life spans, it’s one of the best. Impoverished New Yorkers tend to live far longer than their counterparts in other American cities, according to detailed new research of Social Security and earnings records published Monday in The Journal of the American Medical Association. They still die sooner than their richer neighbors, but the city’s life-expectancy gap was smaller in 2014 than nearly everywhere else, and it has shrunk since 2001 even as gaps grew nationwide. (Margot Sanger-Katz, 4/11)

State Medicaid agencies have launched a wide array of payment and care-delivery reforms, some of which go further than the federal government's efforts. While they hold out the promise of delivering higher-quality care, it's unreasonable to expect they will deliver lower costs, at least in the short run. Why do I say that? Let's start with the basics. Nearly a quarter of Americans, almost 80 million people, now get their healthcare through Medicaid. About a quarter of them are elderly or disabled. (Merrill Goozner, 4/9)

Tasked by policymakers with crafting a way to assist Oklahomans who rely on Medicaid, and aware that simply expanding the program is a political nonstarter, Nico Gomez produced a plan he calls the Medicaid Rebalancing Act of 2020. Lawmakers should give it a close look. ... Gomez proposes creating a new option to Insure Oklahoma, covering adults ages 19 to 64 whose incomes are below 133 percent of the federal poverty level (roughly 175,000 Oklahomans). They would be provided a choice of commercial insurance plans and be made to pay a premium. This program would include potential cost savings for such things as healthy lifestyle choices and preventative screenings. The cost would be about $100 million in state dollars, to be matched by $900 million in federal dollars. (4/10)

Presidential candidate John Kasich delighted Medicaid expansion advocates and infuriated his fellow Republicans in 2013 when he warned expansion foes that failing to help poor people could deny them a place in heaven. He aimed those comments at GOP critics of his decision to do an end-run around the state's Republican-controlled Legislature and expand Medicaid to Ohioans with incomes up to 138% of the federal poverty level as authorized by the Affordable Care Act. About 660,000 people have gained coverage under Kasich's expansion. (Harris Meyer, 4/8)

With the end of the 2016 General Assembly session, Virginians are receiving updates from their legislators about our accomplishments. What Virginians are not hearing about is our failure to expand Medicaid for many of the commonwealth’s 400,000 most vulnerable patients — or what we plan to do to prevent the impending mergers of four of the nation’s largest health insurers from driving up premiums for all Virginians and the cost of doing business in Virginia. (Scott Surovell, 4/10)

One of the peculiarities of American abortion law is that in the days when abortion was illegal, women who had an abortion were not prosecuted for the crime. The criminal law targeted the doctors and unlicensed practitioners who performed the abortions. They were the ones arrested, tried, and sometimes convicted for knowingly procuring or performing an abortion, not the women who had knowingly hired them. Women were subpoenaed to testify as witnesses against their abortionists at trial, but with few exceptions, women didn’t do time. (Carol Sanger, 4/11)

Republican presidential frontrunner Donald Trump horrified both conservatives and progressives recently when he expressed support for banning abortion and instituting “some form of punishment” for women who get the procedure. With his comments, Trump — who backtracked on his position after an immediate uproar — used language that the anti-abortion movement has studiously avoided in their attempt to paint laws restricting women’s access to reproductive healthcare as “protecting” rather than harming women. But what has been largely overlooked in the media storm surrounding Trump’s comments is that women are already being punished by the anti-choice laws being passed in states across the country. (Dorothy Chaney, 4/10)

Missouri GOP senators are playing with fire in their maneuver to force abortion service providers to hand over patients’ private medical records. If senators persist with threats to conduct contempt proceedings, they almost certainly will find themselves in an embarrassing court battle that they are unlikely to win. Federal law is very clear about medical providers’ requirement to protect their patients’ privacy. Senators appear to be trying to compel providers to break federal law. Mary Kogut, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, and James Miller, owner of Brentwood-based Pathology Services Inc., have been issued subpoenas and could face contempt proceedings as early as this week if they do not comply. (4/10)

David Daleiden is not a reporter. His grossly misleading, politically irresponsible videos purporting to implicate Planned Parenthood in illegal behavior make that clear. It's an insult to responsible journalism. The only question Attorney General Kamala Harris needs to answer for her investigators' raid of Daleiden's home Tuesday is: What took her so long? (4/7)

Medicine struggles with a chronic disease: racism. Medical schools try to combat this disease with diversity initiatives and training in unconscious bias and cultural sensitivity. I’m about to graduate from the University of Virginia School of Medicine, so I’ve been through such programs. They’re not enough. (Jennifer Adaeze Anyaegbunam, 4/11)

Time is precious and in short supply in daily primary-care practice. In order to survive financially, primary-care practices have to schedule as many visits as possible each day, because insurers have long paid inadequately for them while overpaying for specialty care. The net result is a daily schedule of rushed visits that are all too often unsatisfying and frustrating, not only for patients but also for their primary-care physicians. In this setting, the annual physical has degenerated into little more than an impersonal checking of a few boxes on the computer, performing a quick perfunctory physical exam, and ordering some screening studies. Little wonder, then, that calls for its elimination have started to emerge. (Allan Goroll, 4/11)

In my addiction medicine practice in central Ohio, I see five to six new heroin addicts a week. My patients are mostly young, under the age of 25, Caucasian and predominantly female. Since there is a volitional component to any addiction, many people, it seems, want to dismiss the heroin addicts among us as "junkies" who have chosen their lifestyle and will get what they deserve. (Peter Rogers, 4/10)

It wasn’t the hardest phone call I’ve ever made, but it was certainly awkward. I was cold-calling the National Rifle Association. Because the NRA is well-known for offering gun safety training, I wanted to know whether the organization had ideas on how to reduce the number of firearm suicides. Half of all suicides in the United States are by firearm, and roughly two-thirds of all firearm deaths are suicides. Given the NRA’s opposition to virtually all gun regulation, I knew this was a touchy area. (Jennifer Stuber, 4/8)

When Congress enacted the Veterans Access, Choice and Accountability Act of 2014 in the wake of revelations about bureaucratic dysfunction at the Veterans Affairs Department, the plan was to reduce wait times at VA hospitals, give veterans access to outside health care and allow the VA to quickly terminate problem employees. How is the VA doing? For starters, government statistics show that hospital wait times are 50% longer than two years ago. (Kyndra Miller Rotunda, 4/10)

The story is a not uncommon one: A person who is injured or undergoes surgery becomes addicted to the prescribed pain pills — and ends up with an even more dangerous medical problem. Officials at the Ohio Bureau of Workers’ Compensation, whose claim fund pays for medication for injured workers, saw dosages so shockingly high that they created a program to spell out a list of permitted drugs and dosages. (4/11)

On the wooden back porch of an Old Louisville home, birds broke the silence with their joy-filled chirps after a downpour of rain. A small replica of Michelangelo’s David towered triumphant in the middle of the manicured yard, like a reminder of old century opulence. Here, in this house of serenity, gay men infected by an unacknowledged plague once came to die. That was the mid-1980s, when those infected by HIV and suffering from AIDS faced a limited future. Abandoned by their families and forgotten by the world, some patients were forced to the streets, homeless, hopeless and alone. (Amanda Beam, 4/10)

Next year, San Francisco will become the first U.S. city to guarantee fully paid family leave to almost everyone who works there. May it also be the last. Or rather, may it be the last that makes employers pay so much of the cost. The way San Francisco has designed its program risks undermining support for the policy -- and there's little doubt that more generous and accessible family-leave policies benefit both workers and the overall economy. Workers who get paid parental leave are more likely to stay in their jobs and have healthier children, which can lower government social spending in the long run. (4/9)

Now that deaths from opioid overdose exceed those from car crashes, the medical community has come to recognize an error of historic proportions. In 2014, U.S. doctors wrote 245 million prescriptions for Vicodin, OxyContin and other painkillers in the highly addictive family of opium derivatives known as opioids. That practice spares many patients from pain following accidents or surgery, but the cost is more than 20,000 deaths a year. (Faye Flam, 4/8)

Once a decade, the United Nations organizes a meeting where every country in the world comes together to figure out what to do about drugs — and up to now, they've always pledged to wage a relentless war, to fight until the planet is “drug-free.” They've consistently affirmed U.N. treaties written in the 1960s and 1970s, mainly by the United States, which require every country to arrest and imprison their way out of drug-related problems. But at this year's meeting in New York City later this month, several countries are going to declare: This approach has been a disaster. We can't do this anymore. Enough. (Johann Hari, 4/10)

Lily Parra is 4 months old and needs a heart. But she has been told she can’t have one. Not because she’s too sick but because of deep-seated discrimination against those who have — or might have — a developmental disability. An operation that could give Lily a shot at life, and hope to her family, is being denied apparently not because of Lily’s medical condition but because of who she may become. (Timothy P. Shriver, 4/8)