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The Republican health care bill remained in shambles Thursday as House leaders threw up their hands and sent lawmakers home for a two-week recess. GOP chiefs announced a modest amendment to curb premium increases, but internal divisions still blocked their promised repeal of former President Barack Obama's law. (Fram and Alonso-Zaldivar, 4/6)

Under intense pressure from President Trump, House Republicans took a small step Thursday to revive legislation to dismantle the Affordable Care Act, adding a $15 billion fund to help insurers pay claims for their sickest customers. Speaker Paul D. Ryan orchestrated a broad show of Republican support for the proposal, conceived as an amendment to the repeal bill that collapsed on the House floor two weeks ago. (Pear, 4/6)

The new provision would create a fund of $15 billion over the next decade to reimburse insurers for patients with costly pre-existing conditions. House leaders had planned to add it to legislation to replace the ACA, which they pulled just hours before a planned vote last month due to a lack of support. ... The amendment’s co-sponsor, Rep. David Schweikert (R., Ariz.), believes it can pull in “every member who was concerned that we weren’t seeing enough premium efficiency.” It was unclear whether the provision persuaded any Republicans who opposed the overhaul plan to change their minds. (Hackman and Andrews, 4/6)

Called the Federal Invisible Risk Sharing Program, the Republican proposal would give health insurers $15 billion over nine years to subsidize the care of high-cost patients. It’s similar, though less generous, than Obamacare’s three-year-long reinsurance program, which gave insurers $7.9 billion for 2014 and $7.8 billion for 2015, according to data from the Kaiser Family Foundation, and is intended to pay out $4 billion for 2016. (House, Tracer and Edney, 4/6)

The idea, modeled after a program in Maine, appears similar to the “reinsurance” idea from the first three years of ObamaCare. That program gave insurers $7.9 billion for 2014 and $7.8 billion for 2015. But experts say $15 billion is not enough to bring down premiums. "$15 billion over 9 years is definitely not enough to make a meaningful difference in premiums or market stability," tweeted Larry Levitt, senior vice president of the Kaiser Family Foundation. (Hellmann, 4/6)

House Majority Leader Kevin McCarthy (R-Calif.) told Republicans as they departed Washington on Thursday that their recesses could be cut short if a deal is reached on legislation to repeal and replace ObamaCare. Such a compromise between the centrist and conservative factions of the House GOP remains a long way off. But McCarthy warned lawmakers they might have to return early if negotiations prove fruitful in the next two weeks. (Marcos, 4/6)

Tempers are flaring at the White House over House Republicans’ failure to repeal Obamacare. But that hasn’t changed the reality on the ground: As Congress skips town for a two-week recess, Speaker Paul Ryan and his team are no closer to approving legislation. In fact, some Ryan allies worry that the White House involvement has only set GOP leaders back further. (Bade and Haberkorn, 4/7)

A number of states are readying blueprints for substantial changes under an ObamaCare waiver program, but a renewed push to repeal the law is complicating their plans. The Affordable Care Act’s 1332 State Innovation Waiver lets states skip some of the law’s regulations if their healthcare plan covers a comparable number of people without increasing the federal deficit. States can apply for the waivers starting this year. But a revived attempt to repeal the health law is throwing a wrench in those plans, since states don’t know what a new bill will entail. (Clason, 4/6)

The majority of the House Freedom Caucus would vote for a healthcare bill that gets rid of three of ObamaCare's insurer regulations, the group’s chairman, Rep. Mark Meadows (R-N.C.), said Thursday. The caucus has withheld its support from the GOP's ObamaCare repeal bill last month, saying it does nothing to drive down insurance premiums. (Hellmann, 4/6)

Meadows said the group wants to make sure that people with pre-existing conditions will still be able to get insurance, and insurance premiums will be reduced. "If we don't do that, we will have failed," said Meadows. (Eaton, 4/6)

Two insurers announced this week that they would pull out of Iowa's Affordable Care Act exchanges next year, raising worries that the decisions could be the leading edge of a trend. Insurers face approaching deadlines and major uncertainties about the short-term viability of the exchanges, and beyond, because of politicians' inability thus far to move a specific repeal and replace plan forward. (Johnson, 4/6)

Aetna Inc will exit Iowa's Obamacare-compliant individual insurance market in 2018, a year surrounded by uncertainty over which insurers will sell plans and at what price as Republicans seek to dismantle the 2010 Affordable Care Act. (4/6)

Aetna said its move in Iowa came “as a result of financial risk and an uncertain outlook for the marketplace” and it was “still evaluating Aetna’s 2018 individual product presence in our remaining states.” Aetna currently offers exchange plans in four states -- Iowa, Delaware, Nebraska and Virginia -- a sharp reduction from its presence last year. It has more than 30,000 enrollees in Iowa. (Wilde Mathews,, 4/6)

Aetna’s brief statement didn’t detail its reasons. But the national carrier already had stopped selling such policies in 11 other states for 2017, citing turmoil in the wake of the Affordable Care Act. Wellmark cited similar reasons, plus the inability of Republicans controlling Congress to replace the Affordable Care Act with a plan that could provide more stability for the market. (Leys, 4/6)

The decision follows on the heels of Wellmark Blue Cross and Blue Shield's announcement that it will exit Iowa's individual market in 2018. Now thousands of Iowans will be forced to switch health insurers—if they can find one. (Livingston, 4/6)

Anthem said steps to stabilize the marketplaces, including eligibility verification, more rigid special enrollment periods, and shortening of premium grace periods are steps in the right direction, but not enough. The insurer has a deadline of July 1 to make up its mind whether to continue to sell policies on Access Health. (Radelat, 4/6)

In the absence of Aetna and Wellmark, Iowa has only two insurers providing individual policies. Minnesota-based Medica and Wisconsin based-Gundersen both have until this summer to decide if they'll continue participation in Iowa's individual insurance exchange. (Boden, 4/6)

For the first time, the Food and Drug Administration said it would allow a company to sell genetic tests for disease risk directly to consumers, providing people with information about the likelihood that they could develop various conditions, including Parkinson’s and Alzheimer’s. The move on Thursday is a turnaround for the agency, which had imposed a moratorium in 2013 on disease tests sold by the company, 23andMe, which is based in Mountain View, Calif. (Kolata, 4/6)

The product is offered by the closely held Silicon Valley genetics-testing company 23andMe Inc., which was initially stymied by the FDA in 2013 when it sought to offer such saliva-analysis tests to the general public. But the company began making more headway by 2015, when it offered consumers a test to tell them if they carried a genetic variant for one of 36 diseases that could be inherited by their children. Those hereditary tests evaluated people for their likelihood of passing on conditions like cystic fibrosis, sickle cell anemia and a disease known as Bloom syndrome. (Burton, 4/6)

Maryland has become the first state to enact legislation to mitigate any federal cuts to Planned Parenthood. The measure was enacted Thursday after Gov. Larry Hogan decided not to veto the bill. Like 14 other bills, it went into effect after a midnight deadline without the Republican governor's signature. The Democrat-led General Assembly passed the bill with enough votes to override a veto. (Witte, 4/6)

California has joined 15 other state attorneys general in filing a friend-of-the-court brief in support of a lawsuit by Planned Parenthood of Greater Ohio challenging a law in that state that excludes healthcare providers that offer abortion services from participating in other publicly funded health programs, officials said Thursday. The lawsuit challenges the exclusion of such providers from breast and cervical cancer prevention programs, according to California Atty. Gen. Xavier Becerra. (Patrick McGreevy, 4/6)

Shonda Rhimes, one of Hollywood’s most popular and powerful women, has joined the national board of Planned Parenthood. Rhimes, creator and producer of prime-time television shows “Grey’s Anatomy” and “Scandal”, assumes a formal role in the organization at a time when antiabortion activists and some Republican lawmakers have set their sights on defunding Planned Parenthood. (Williams, 4/6)

Tennessee's attorney general has questioned the constitutionality of current legislative proposals that would ban most abortions after 20 weeks. The opinion from Attorney General Herbert H. Slatery III, the top law enforcement official in a conservative Republican state, is the second this year to raise concerns over whether an abortion ban bill is constitutional. Last month, Slatery wrote that a push to outlaw most abortions after a fetal heartbeat is detectable, as early as six weeks, may not be able to withstand a court challenge. (Mattise, 4/6)

After more than six hours of sometimes bitter debate extending over two days the Iowa House last night approved a bill which, if it becomes law, would include the most extensive abortion restrictions ever approved in Iowa. The bill bans abortion after the 20th week of pregnancy, and enacts a 72 hour waiting period for all abortions. (Russell, 4/6)

What does a human cell look like? That is somewhat of a mystery because most current cellular models are static and based on limited data, according to scientists from the Allen Institute for Cell Science in Seattle. Until recently researchers lacked the tools to assess cells and their tiny internal structures, known as organelles, in real time on a large scale, they say. (Hernandez, 4/6)

Viruses are supposed to be tiny and simple — so tiny and simple that it's debatable whether they're even alive. They're minimalist packets of genetic information, relying entirely on the cells the infect in order to survive and reproduce. But in 2003, researchers identified a new kind of virus that that turned scientific understanding of viruses upside down, and tested the boundary of what can be considered life. (Bichell, 4/6)

It is one of the great mysteries in recent American pop culture: the death of Prince almost one year ago and the circumstances that led him to be found crumpled on the floor of an elevator at his sprawling residence Paisley Park outside of Minneapolis. How did he come into possession of the powerful opioid fentanyl, which killed him in what the coroner ruled was an accidental overdose? How did he so expertly conceal what appears to have been his addiction to pain medicines? And who, if anyone, bears some responsibility for his demise at 57? (Eldred, Kovaleski and Sisario, 4/7)

The U.S. military can only intercept a quarter of known drug shipments in the Caribbean and Latin America because U.S. Southern Command has only about a quarter of the ships it needs, the regional commander testified Thursday. With drug-related deaths soaring in the United States, the need to combat the supply side of the problem could drive up congressional calls for more military procurement. Adm. Kurt Tidd, the Southern Command’s top officer, told Senate Armed Services he has a longstanding requirement for 23 ships and associated aircraft but only has “on any given day probably about six ships.” Because of the shortages, Tidd says he can only intercept 25 percent of the drugs known to be transiting through the region. (Donnelly, 4/6)

There’s a clear culprit in the rising drug overdose death count in Massachusetts — the synthetic opioid fentanyl. More powerful and more deadly than heroin, fentanyl has sparked a new set of survival rules among people who abuse opioids. About 75 percent of the state’s men and women who died after an unintentional overdose last year had fentanyl in their system, up from 57 percent in 2015. It’s a pattern cities and towns are seeing across the state and country, particularly in New England and some Rust Belt states. (Bebinger, 4/7)

As headlines scream about the ravages of the nation's growing opioid epidemic, employers are waking up to the notion that substance abuse may be wreaking havoc in a nearby cubicle — and a new tool aims to help them see just how costly that can be. The Substance Use Cost Calculator lets employers enter their industry, location and organization size to determine how much substance abuse might be costing the company. ... For example, in Illinois, a 150-worker construction company — an industry with twice the national average when it comes to the number of employees with substance use disorders — could face $57,387 in annual costs from substance abuse because of lost time, turnover and health care expenses. (Elejalde-Ruiz, 4/6)

New Mexico on Thursday became the first U.S. state to require all local and state law enforcement agencies to provide officers with antidote kits as the state works to curb deaths from opioid and heroin overdoses. Surrounded by advocates and parents who had lost children to overdoses, Gov. Susana Martinez signed legislation that was approved unanimously by lawmakers during their recent session. (4/6)

A dearth of beds at state psychiatric hospitals in many parts of the country and shortages of mental health resources mean that mentally ill people who commit minor crimes often end up languishing in jails, which are poorly equipped to handle their illnesses. It’s a difficult problem that, without intervention, creates a grim cyclical pattern: Untreated mentally ill people get carted off to jail, where their illnesses go unaddressed, which increases the odds that they will commit crimes after their release. But cities, counties and states across the U.S. are attempting to break that pattern, using law enforcement and criminal justice tools to direct those with mental illness toward treatment services that could help them control behaviors that got them into trouble. (Ollove, 4/7)

A federal judge in Brooklyn has accused state officials of secretly trying to subvert a landmark court order to improve care for thousands of mentally ill residents of New York City. Three years ago, U.S. District Judge Nicholas Garaufis ended a prolonged lawsuit against New York state by ordering the Department of Health to begin moving as many as 4,000 mentally ill residents housed in group homes to less restrictive environments where they could live more independently. (Sapien, 4/6)

Palo Alto teens and families looking for mental health services that fall between occasional therapy and hospitalization soon will have that option. With the help of an anonymous donor interested in reducing the number of teen suicides, the nonprofit Children’s Health Council has launched a 12-week Intensive Outpatient Program at its Palo Alto campus at 650 Clark Way. (Lee, 4/6)

It took a few years, but dental hygienists finally may have gotten the ability to provide basic dental care to thousands of poor children and elderly Georgians without a dentist present. That’s a big deal because most counties in Georgia don’t have enough dentists to meet the need and emergency-room visits for dental care cost taxpayer-funded health programs big money, supporters of the legislation said. (Salzer, 4/6)

Assemblywoman Autumn Burke says she just wants to help children whose unidentified vision problems may be holding them back academically. But her bill encouraging more comprehensive eye exams when students enroll in school has divided eye doctors – the latest skirmish in a long political history of medical groups squaring off over their scope of practice. (Koseff, 4/6)

Six months after health insurer Land of Lincoln went under, the state is telling former members how to get reimbursed for money they lost due to the insurer's midyear collapse. It's uncertain, however, how much money consumers might actually see. Meanwhile, the Illinois Life and Health Insurance Guaranty Association has already been paying health care providers for their Land of Lincoln claims. As of March 15, the association had paid about $33.5 million to providers for 80,000 claims, said Michael Batkins, a spokesman for the Illinois Department of Insurance. More claims from providers are expected. (Schencker, 4/6)

At the end of the legislative session last week, the Georgia House passed a resolution to create a study committee on Georgians’ Barriers to Access to Adequate Health Care. The state’s HIV criminal laws are among the health care topics the committee is tasked with examining. Besides punishing spitting, the current laws can also be used against HIV-positive people who do not disclose their status before having sex, sharing needles, performing paid sex work or donating blood, or who assault a law enforcement officer through spitting, biting, or throwing bodily fluids. (Knight, 4/6)

Legislators are continuing to battle families with relatives in state-supported living centers about the facilities’ future. In 2014, a state commission found that Texas could “no longer afford” operating costs for the state-supported living centers. Despite the centers' low enrollment and high operating costs, legislators have expressed reluctance over the years to completely do away with them. (Evans, 4/6)

Massachusetts lawmakers appear increasingly likely to raise the minimum legal age for sale of tobacco to 21, a move that would make the state just the third in the nation to enact that requirement statewide. The tobacco measure could be included in the overhaul of Massachusetts’ marijuana legalization law that state lawmakers expect to pass by the end of June. (Miller, 4/6)

Nearly half of all sixth-graders in Richmond missed class this school year because they didn’t get the right shots. But the Richmond City Health District blames poverty rather than a growing anti-vaccination movement, and it is making an effort to help residents overcome barriers. Last year, 760 Richmond Public School students had not received their Tdap — tetanus, diphtheria and pertussis — vaccine on the first day of school, representing 44 percent of the sixth-grade population, according to data from RPS. (Demeria, 4/7)

Iowa organizations that provide services to victims of sexual violence say they face potential funding cuts at the state and federal levels. A cut to state funding for victim services is being discussed as a way to help make up for a budget deficit. (Sostaric, 4/6)

New England Baptist Hospital, which specializes in orthopedic care, aims to join a proposed merger between Lahey Health and Beth Israel Deaconess Medical Center... Combining all three hospitals would bring the new network closer in size to Partners HealthCare, the state's dominant health care system. (Bebinger, 4/6)

San Francisco began working with Pestec, a pest control company, to treat more than 23,000 storm drains in the city for mosquitoes. Its eight-member San Francisco Mosquito Abatement Courier Team (SF MAC Team) completes most treatment by hand, getting around on bike or foot. (Placzek, 4/6)

Legacy Community Health, the largest system of community-based health care in Texas, will open three new facilities in the Houston area in coming weeks to keep up with growing need, the company said Thursday. The new additions to the network of health care clinics brings the total to 25 in the region. Legacy served 125,000 patients last year. (Deam, 4/6)

Bexar County and the city of San Antonio have made clear their opposition to the transportation of spent nuclear fuel through the San Antonio region to a potential “interim” site in West Texas. The Waste Control Specialists site in sparsely populated Andrews County could potentially begin accepting high-level waste in 2021, storing up to 40,000 metric tons for 40 to 100 years. (Brodesky, 4/6)

For the past three years, the owner of Whirlygigs Toy Shop in downtown Exeter has donated hundreds of teddy bears to Exeter Hospital’s emergency department to help ease the fears of its youngest patients. Since starting the bear drive, [Geoffrey] Pendexter has heard stories shared by parents whose kids found the emergency room wasn’t such a scary place after they were handed a teddy bear. He recalled one time when a child showed up at the hospital for a CT scan and calmed down as soon as she received a bear. (Schreiber, 4/6)

Insurance transitions—sometimes referred to as “churn”—before and after childbirth can adversely affect the continuity and quality of care. ... Using nationally representative survey data for the period 2005–13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100–185 percent of the poverty level. (Daw et al., 4/3)

More than eight million children risk having their health insurance coverage disrupted if federal funding for the Children’s Health Insurance Program (CHIP) is not extended beyond 2017. In this study we explored two current policy alternatives: extending federal funding for CHIP or enrolling children in the existing health insurance Marketplace plans. ... If CHIP funding is not renewed and children with chronic conditions shift to coverage under Marketplace plans, their families face increased annual out-of-pocket expenses ranging from $233 at the lowest income levels to $2,472 at the highest income level of 251–400 percent of poverty. Families with children who have epilepsy, diabetes, or mood disorders may face the highest costs. Cost sharing for prescription drugs (25 percent) and hospitalizations (23 percent) account for much of the difference. (Peltz et al., 4/3)

This study estimates the effects of the ACA on hospital finances in 2015 and how they differ between hospitals in states that expanded Medicaid and hospitals in states that did not expand Medicaid. ... it expands upon a 2016 study .... this new analysis finds that the Medicaid expansion under the ACA increased Medicaid revenue by $5.0 million per hospital, reduced costs of uncompensated care by $3.2 million per hospital, and improved average operating margins by 2.5 percentage points. This study also finds that the financial benefits of the Medicaid expansion on hospitals’ profit margins were strongest for small hospitals, for-profit and non-federal-government-operated hospitals, and hospitals located in nonmetropolitan areas. (Blavin, 4/3)

[T]he average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies. Established by the health law to reimburse insurers for the cost of reducing out-of-pocket costs for lower-income people buying marketplace plans (with incomes from 100% to 250% of the poverty level), the subsidies have been challenged in a lawsuit from the U.S. House. ... The analysis ... finds that the estimated premium increase for silver plans would be higher (21%) in states that did not expand Medicaid under the ACA than in states that expanded Medicaid (15%). ... Estimated premium changes vary for the 38 states that used healthcare.gov in 2016, ranging from 9 percent in North Dakota to 27 percent in Mississippi. (4/6)

Medicaid has been the subject of debate recently—with issues raised about eligibility, financing, and potential work requirements for beneficiaries. More fundamentally, there have been questions about who Medicaid covers and how well it helps them. According to data from the Commonwealth Fund’s Survey of High Need Patients, nearly half of adults with Medicaid are 50 or older; many have multiple chronic conditions, behavioral health problems, or physical limitations or disabilities. Any changes to the Medicaid program could disproportionately affect many of our neediest, sickest Americans. (Ryan and Abrams, 4/6)

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)