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President Trump’s plan to lower prescription drug prices hit two major obstacles this week. He killed a proposal on Thursday that would have reduced out-of-pocket costs for older consumers out of concern that it would raise premiums heading into his re-election campaign. And a federal judge threw out a new requirement that drug companies disclose their prices in television ads. Administration officials rushed to assure the public that the double setback did not reflect failure on one of the president’s signature issues, one that has fueled public outrage and drawn the attention of both parties. (Thomas and Goodnough, 7/11)

The proposed HHS rule, first unveiled in January, would have excluded the rebates drugmakers pay to pharmacy benefit managers from protections from anti-kickback laws. Instead, the agency would have created new safe harbor protections to protect certain PBM service fees and another protection for certain price reductions made at the point of sale. (7/11)

Right now, if you're a Medicare Part D beneficiary, and you need to pick up a drug that has a $120 list price, you might have to pay that full price, even if the middleman that negotiates on behalf of your insurer only pays a net price of $100 for it, after rebates. The idea of this proposal was that the consumer would only have to pay the discounted price. (Simmons-Duffin, 7/11)

The rebate plan was crafted by Health and Human Services Secretary Alex Azar but ran into opposition from White House budget officials. That pushback stiffened after the nonpartisan Congressional Budget Office estimated that the plan would have little effect on manufacturer prices and would cost Medicare $177 billion over 10 years by leading to higher premiums subsidized by taxpayers. Trump's reversal on rebates was a win for insurers and middlemen called "pharmacy benefit managers" who administer prescription drug plans for large blocks of insured patients. (Alonso-Zaldivar, 7/11)

While the White House had argued eliminating rebates would result in drug manufacturers charging lower list prices, the proposal has been controversial since its unveiling in January. Drug manufacturers had largely supported it, while middlemen known as pharmacy benefit managers and insurers were vocally opposed. (Facher, 7/11)

The withdrawal of the plan is expected to put pressure on administration officials to pursue more populist proposals, from importing lower-cost drugs from other countries to basing the prices of some Medicare drugs on the lower prices paid by other countries — ideas favored by the president but reviled by the drug industry and many Republicans. It also demonstrates the internal conflicts within the administration on drug policy and the president’s tendency to flip-flop — the plan was part of his drug pricing blueprint released with fanfare a year ago. (Abutaleb, Goldstein and Parker, 7/11)

The potential impact on Medicare beneficiaries is why the administration withdrew the proposal, Health Secretary Alex Azar told reporters later on Thursday "At the end of the day, while we support getting rid of rebates, we won't put seniors at risk for premiums going up," he said. Still, he said Congress may end up addressing rebates, which have long been a controversial part of the US drug industry and are blamed for incentivizing many players to keep list prices high. "I think you will see the days of rebates are over," Azar said. (Luhby, 7/11)

The administration is also open to a controversial proposal being discussed in the Senate that would limit how much drug companies can increase their prices within Medicare's drug benefit. (Owens, 7/11)

Azar sought to pass on responsibility for addressing those issues to Congress. He said lawmakers have more tools than HHS to protect seniors from rising premiums while dealing with rebates. “I think we’re going to continue to see the days of rebates are over,” he said. “We’ve changed the debate.” Senator Chuck Grassley, an Iowa Republican, said in a statement that the issue was far from dead. “The withdrawal puts even more pressure on Congress to step up to the plate,” he said. (Edney, 7/11)

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) said Thursday that he plans to advance a bipartisan deal to lower drug prices “very soon.” “While the final details are still being negotiated, we’re on track to report a bill out of committee very soon,” Grassley said in a statement. (Sullivan, 7/11)

Donald Trump’s ambitious agenda for lowering drug prices has shrunk drastically, leaving the White House dependent on Congress and an idea championed by Sen. Bernie Sanders to salvage one of his signature health care promises. ... What’s left of the biggest proposals among dozens unveiled by Trump last year is a plan to tie certain drug payments in Medicare Part B to cheaper international prices, and elsewhere, a plan to let states import medicine that is fast gaining traction. Versions of such ideas have been championed by progressives like Sanders but are loathed in the conservative movement. (Owermohle, Cancryn and Diamond, 7/11)

The proposal had split the administration, with Health and Human Services Secretary Alex Azar championing it but other White House officials pushing back and worrying about estimates that showed it could increase Medicare spending by almost $200 billion. (7/11)

Baird analyst Eric Coldwell said Trump was likely refocusing his reform efforts on the pharmaceutical companies themselves. "There are still many headwinds for the supply chain, but... pharma and biotech seem to have drawn the ire of the administration more recently," said Coldwell, noting the industry's successful legal challenge of a rule that would have required drugmakers to include list prices in TV ads for their medicines. (Humer and Pietsch, 7/11)

Just two days after the future of the Affordable Care Act was once again called into question, health insurers scored a big win. Investors should expect the risk of adverse regulation to shift, rather than vanish altogether. The Trump administration is withdrawing its plan to curb billions of dollars in annual rebates that drugmakers give middlemen in Medicare. Investors had worried the rule, which was to go into effect as soon as next year, would eat into the drug supply chain’s profit margins. Share prices had languished as a result. (Grant, 7/11)

CVS in a statement said it is “pleased” with the administration’s move and that “any solution should start with addressing drug prices.” (LaVito, 7/11)

Health care remains a top concern of U.S. voters headed into the 2020 election. Taken together, the recent setbacks could leave Mr. Trump vulnerable to Democrats’ attacks that he isn’t following through on his promises to lower drug prices. Seeking to regain momentum, the Republican president sought to shift the focus last week, promising an executive order on drug pricing. He has also pledged to deliver a new GOP health plan and issued an executive order to require hospitals and doctors to better disclose pricing to patients. (Armour, 7/11)

The Trump administration is certainly facing difficulties in its drug price push, but it’s not a “full-on” roadblock, said Tricia Neuman, director of the Kaiser Family Foundation’s Medicare policy program. “It’s a bit too early to write the obituary,” Neuman added. “There is bipartisan support for government action in this area. Our polls show Democrats and Republicans are looking to take action.” (Lovelace, 7/11)

When the Trump administration rolled out its drug pricing blueprint in May 2018, framing it as its plan to make good on one of the president’s signature campaign promises, it promised to shake up how Americans pay for prescription drugs. But in May, the administration abandoned a proposal to allow private Medicare plans to refuse to pay for certain drugs in so-called “protected classes” if they spiked in price. (Joseph and Garde, 7/11)

A rally in health-care stocks pushed the Dow Jones Industrial Average over 27000 for the first time after the Trump administration abandoned a plan to curb drug rebates. The decision canceled a proposal that would have eliminated rebates from government drug plans, easing concerns of a massive disruption to the U.S. pharmaceutical industry. Shares of UnitedHealth jumped 5.5%, leading the Dow industrials 227.88 points, or 0.8%, higher to 27088.08—its best close ever. (Wursthorn and Allen, 7/11)

A federal appeals court says it intends to quickly consider whether the Trump administration can impose new abortion-related restrictions on federally funded family planning clinics. The 9th U.S. Circuit Court of Appeals on Thursday issued an order in lawsuits brought by more than 20 states and health care organizations challenging the new rules. The rules include a ban on taxpayer-funded clinics making abortion referrals. (7/11)

The 9th U.S. Circuit Court of Appeals ruled against emergency petitions that sought to block the rule from taking effect while the changes are being challenged in court. That means the administration can enforce the rules, which block abortion providers like Planned Parenthood from the Title X program and bans providers in that program from referring women for abortions. (Hellmann, 7/11)

The court, which Trump has regularly criticized for its rulings on immigration and other issues, has 16 judges appointed by Democratic presidents and 12 by Republicans — including seven by Trump — and one vacancy. Thursday’s panel, chosen by random draw, had seven judges appointed by Republicans and four by Democrats. (Egelko, 7/11)

Planned Parenthood Federation of America President Leana Wen called Thursday's ruling "devastating news for the millions of people who rely on Title X" for a slew of reproductive health services. "While we are incredibly concerned the panel did not recognize the harm of the Trump-Pence administration's gag rule, we will not stop fighting for the millions across the country in need for care," Wen added in a statement. (Kelly, 7/11)

Under the rule, recipients of federal funds may give women a list of providers that includes doctors who perform abortions but may not direct them to those physicians. The rule also requires providers to encourage patients to discuss their situation with their families and to tell single women about the benefits of abstinence. Julie Rabinovitz, president and CEO of Essential Access Health, one of the challengers in the case, called the 9th Circuit decision “a setback.” (Dolan, 7/11)

Elizabeth Warren on Thursday unveiled her plan to reform the nation’s immigration system amid a deepening crisis over detention at the southern border and a fraught debate across the country and within the Democratic Party on the way forward. Among other things, the proposal calls for allowing more immigrants to come into the country legally, lifting the refugee cap from 30,000 under the Trump administration to 125,000 and then 175,000; a revamp of the immigration court system to establish independence from Justice Department leaders; and the creation of an "Office of New Americans" tasked with facilitating integration, including teaching English. (Thompson, 7/11)

The rollout comes as Warren and other national Democrats have accused the Trump administration in recent weeks of exacerbating a humanitarian crisis along the southern border by failing to provide basic necessities and sanitary conditions for migrants held in detention centers. “But while Trump may have taken the system to its most punitive extreme,” Warren wrote, “his racist policies build on a broken immigration system and an enforcement infrastructure already primed for abuse.” (Forgey, 7/11)

Ms. Warren also said she would create a task force in the Justice Department to investigate allegations of abuses of migrants detained by the Trump administration, including “medical neglect and physical and sexual assaults.”“If you are violating the basic rights of immigrants, now or in the future, a Warren administration will hold you accountable,” she wrote. (Stevens, 7/11)

In response to a swirl of recent reports alleging overcrowding and squalid conditions at similar facilities, Warren is pledging to hold the current administration accountable, saying she will "designate a Justice Department task force to investigate accusations of serious violations -- including medical neglect and physical and sexual assaults of detained immigrants." It would be granted "independent authority to pursue any substantiated criminal allegations." (Diaz, 7/11)

Immigrant rights activists and Democratic Latino political leaders called her plan one of the most comprehensive yet in the campaign. Many of them have criticized their party’s presidential candidates for failing to prioritize immigration even as the issue has risen to the top tier of voter concerns and is expected to be central to Trump’s reelection campaign. “The thing her platform says the most to me is that she has done what the movement has asked: she has stepped away from the old framework,” said Ana Maria Archila, co-executive director of the Center for Popular Democracy, a progressive advocacy organization. (Ulloa, 7/11)

The plan puts Warren, a Massachusetts Democrat running for president, firmly on the liberal side of the immigration debate. Her announcement comes as many Democratic voters are angered by reports of squalid conditions in U.S. border facilities, the separation of children from parents and President Trump’s threats to deport “millions.” (Linskey, 7/11)

Warren’s plan comes amid heightened tensions over immigration this week. The proposal’s release coincides with a report in the New York Times that mass arrests of thousands of undocumented people are expected to begin Sunday. In addition, an administration official said Trump would seek a new way to obtain data on citizenship after the president backed down from his effort to require the U.S. Census to include a question in the decennial population count. (Kapur, 7/11)

Sen. Kamala Harris said Thursday that if she wins the White House she’ll push Congress to spend hundreds of millions of dollars in her first term to help state law enforcement agencies process tens of thousands of untested rape kits that could help police identify perpetrators of sexual assaults. The rape kit backlog has long been a stain on American law enforcement agencies. By some estimates, the nationwide backlog includes more than 225,000 cases in which evidence from reported sexual assaults has gone untested. (Madhani and Tuchscherer, 7/11)

According to End the Backlog, a project sponsored by the Joyful Heart Foundation, which seeks to assist crime victims, hundreds of thousands of rape kits collected from victims are sitting untested in evidence storage or crime labs nationwide. As advances in DNA testing placed strain on crime labs, there are no national standards for keeping and testing the evidence. (Janes, 7/11)

Harris said she would spend $1 billion to encourage states to clear rape kit backlogs and invest in reforms, including requiring rape kits to be tested within narrow time frames, counting and reporting untested rape kits, and giving victims information about the status of their rape kits. (Hensley-Clancy, 7/11)

Harris touted her efforts as California attorney general to close the state's backlog of DNA analysis and more than 1,000 untested rape kits in state-run labs. “The federal government can and should prioritize justice for survivors of sex abuse, assault and rape,” Harris said in a press release. “As California’s Attorney General, I committed resources and attention to clearing a backlog of 1,300 untested rape kits at state-run labs, and we got it done within my first year in office. We need the same focus at the national level to pursue justice and help hold predators accountable.” (Axelrod, 7/11)

Harris, who sponsors the Survivors’ Access to Supportive Care Act in the U.S. Senate, is also calling on states to enact four reforms which includes counting and reporting the number of untested rape kits, putting shorter turn-around times for the testing of new kits, allow for the tracking of kits which will be available to victims, and increasing the availability of the kits. (Christian, 7/11)

Meanwhile, KHN looks at the cost of getting such a kit —

Kaiser Health News: Despite Federal Protections, Rape Victims Still Get Billed For Forensic Exams
Six years ago, Erin was a newly minted graduate of the School of the Art Institute of Chicago, working three part-time jobs and adjusting to life as a non-student. She stopped in for a drink one night at a restaurant in Chicago’s Bucktown neighborhood, where she got into a conversation with a guy. The next thing she remembers clearly was awakening at home the next morning, aching, covered in bruises, with a swollen lip. She believed she had been raped and went to the local police station to file a report. (Andrews, 7/12)

Sen. Bernie Sanders (I-Vt.) announced Thursday he will accompany patients with diabetes on a bus trip to Canada to buy insulin that's available at cheaper prices than in the U.S. The move comes as Sanders seeks to burnish his progressive bona fides as he vows to lower drug costs if elected president. He will make the trip with members of Insulin4All on July 28. (Axelrod, 7/11)

The trip, which will leave from Detroit, is scheduled for two days before CNN's presidential primary debates in the city on July 30 and 31. Sanders has so far set the pace for the 2020 health care debate, with the other candidates either signing on to his "Medicare for All" single payer plan or talking about how their vision differs. And throughout much of his political career, Sanders has targeted pharmaceutical companies over the cost of prescription drugs. He often lists the industry among the powerful few whose interests are at odds with the American public, alongside Wall Street and the wider health care system. (Grayer and Nobles, 7/11)

Meanwhile, Sen. Kirsten Gillibrand has released a new drug plan —

Presidential candidate Sen. Kirsten Gillibrand (D-N.Y.) on Thursday unveiled a plan to lower drug prices and increase scrutiny of pharmaceutical companies. Gillibrand said in a campaign statement that she would work to penalize and prosecute pharmaceutical companies when necessary, allow safe importation and negotiation of drug prices and create the position of "pharmaceutical czar" to lead audits of the industry's business practices. (Frazin, 7/11)

Sen. Amy Klobuchar on Friday released a multifaceted plan to improve care for seniors — including lowering prescription drug costs, strengthening retirement funds and Social Security benefits, and investing in long-term treatments. Building on her leadership in the Senate, according to a statement outlining the plan, Klobuchar would “continue to stand up for our seniors and the 10,000 Americans who turn 65 each day.” (Dugyala, 7/12)

Klobuchar’s proposal, which is also designed to invest in research for a cure for Alzheimer’s disease and improving the stability of Social Security, would allow the government to negotiate Medicare Part D costs, which cover prescriptions for seniors. Klobuchar, a U.S. senator from Minnesota, would also allow people to order prescription drugs from countries like Canada, a proposal proponents say would lower costs. (Gibson, 7/12)

Klobuchar's plan calls for "expanding resources" and financial support to the caregivers of those living with Alzheimer's disease -- the most common form of dementia -- as well as an expansion of the Medicare-covered-services for the disease. The plan would also "fully implement" legislation that helps families locate missing people with Alzheimer's or developmental disabilities and promises "reliable and consistent" funding for dementia research. "Senator Klobuchar will commit to preventing, treating and facilitating a cure for Alzheimer's disease, with the goal of putting us on a path toward developing a cure and treatment by 2025," the news release states. (LeBlanc, 7/12)

Along with three other presidential candidates, Klobuchar will appear at an AARP/Des Moines Register forum in Des Moines to address issues of importance to older voters. Klobuchar, a Democrat from Minnesota, has a history of Alzheimer's disease in her family and has championed various bills related to the ailment, or its symptoms. In 2017, she co-sponsored a bill with U.S. Sen. Chuck Grassley, R-Iowa, designed to boost training to help people who may wander from safety as part of their condition. (Coltrain, 7/12)

House Speaker Nancy Pelosi on Thursday warned her caucus about President Donald Trump’s planned immigration raids this weekend, urging members to spread information about undocumented immigrants' legal rights. Speaking to a closed-door whips meeting, Pelosi urged members to spread the party’s “know your rights” campaign, according to two people in the room. (Ferris and Hesson, 7/11)

If the Trump administration follows through on its threat to deport thousands of immigrants living in the country illegally, it will start with migrants who are under removal orders signed by an immigration judge. A Stateline analysis of immigration court data suggests that of the 1.1 million removal orders on file last month, 60% were issued to migrants residing in California, New York, Texas, Florida and Arizona. Miami, Brooklyn, Los Angeles, Houston and Florence, Arizona, have the most removal orders, based on addresses listed in court documents, which can easily change. Many immigrants use the addresses of temporary detention centers, like the one in Florence, or homes of friends. (Henderson, 7/11)

Weeks ago, as President Donald Trump warned that ICE agents were preparing raids across the country, a 41-year-old housekeeper and babysitter in Miami headed to the grocery store with her daughter. They knew they'd be staying inside and needed to stock up on supplies. "I felt that day like it was a hurricane coming," the undocumented immigrant from Nicaragua told CNN. (Schoichet, 7/12)

In other news on the immigration crisis —

More than a year after the Trump administration ended a controversial policy that led to hundreds of family separations, as many as five migrant children per day continue to be separated from their parents at the U.S.-Mexico border, according to federal data gathered by an immigrant advocacy group. The data, which the American Immigration Council and other immigrant advocacy groups requested from the U.S. Department of Health and Human Services, shows that almost 400 children were separated from their parents between June 2018 — when the Trump administration ended its controversial zero tolerance policy — and March 2019. (Roldan, 7/12)

Lawmakers in the U.S. House of Representatives said on Thursday they have sent letters seeking documents and information from three companies responsible for detaining illegal immigrants arrested by U.S. immigration agents. The House Oversight Committee and its House Subcommittee on Civil Rights and Civil Liberties sent letters to CoreCivic Inc, Geo Group Inc and DC Capital Partners LLC seeking information about the facilities they operate under contract from the U.S. government. (7/11)

Four Democratic freshmen who reported squalid conditions at migrant detention stations at the southern border are taking the spotlight at a House committee hearing, even as partisan and internal Democratic tensions near a boil over President Donald Trump's immigration policies. Friday's House Oversight and Reform Committee session comes as surging numbers of families, children and other migrants entering the U.S. from Mexico have overwhelmed the government's capacity to house them adequately. (Fram, 7/12)

There were water balloons at Byron Xol's birthday party — bunches of them, filled a dozen at a time. He squeezed them with both hands, until the water burst on his face and chest. "Super good!" the 9-year-old yelled, again and again. It's a new catchphrase — but then, Byron spoke no English at all 15 months ago. (Merchant, 7/11)

On June 12, Gerardo, a 41-year-old indigenous bricklayer from Guatemala, appeared before a U.S. immigration judge in El Paso, Texas. Since crossing the U.S.-Mexico border illegally two months earlier with his 14-year-old son, he had been separated from the boy and forced to wait in Mexico for his hearing. Now, he had only one question for the judge: “Can you help me get my son back?” (Cooke, 7/11)

In May, 24-year-old Crystal City resident Barton Lynch checked into MedStar Georgetown University Hospital to donate one of his kidneys—not to a friend or relative, but simply because he knew someone out there needed it more than he did. It was an extraordinary act of generosity, done out of a deep sense of frustration. For years, Lynch regularly gave blood as a way to honor his father, who was diagnosed with cancer during Lynch’s freshman year of college. However, recently Lynch, who works for a consulting firm, started dating both men and women and per FDA policy, all men who have sex with other men cannot donate their blood unless they refrain from same-sex intimacy for a year. (Newman, 7/11)

"Not that long ago I started dating guys, which now eliminates me from being able to donate blood. This frustrates me to no end, because I think it’s based on outdated science and outdated [HIV] scares," Lynch told the magazine. "So I needed to find a way to give back that wasn’t giving blood. I know the need is there for kidney donations, so it seemed like a no-brainer—how could I not?" he added. (Bowden, 7/11)

The Ohio hospital system where excessive painkiller doses were given to dozens of patients who died fired 23 nurses, pharmacists and managers Thursday and said it is changing leadership, a sign that professional fallout from the scandal has expanded far beyond the intensive care doctor accused of ordering the drugs. The announcement by the Columbus-area Mount Carmel Health System comes five weeks after that doctor, William Husel, pleaded not guilty to murder charges in 25 of the deaths, marking one of the biggest cases of its kind against an American health care professional. (Franko, 7/11)

The chief executive of an Ohio health care system announced his resignation and the termination of 23 employees on Thursday, one month after a doctor who worked for the hospital was charged in one of the largest murder cases in the state’s history. Ed Lamb, the chief executive of Mount Carmel Health System, said in a statement that his resignation would take effect on July 25. He added that the hospital’s executive vice president, Richard Streck, would be retiring at the end of September. The employees’ terminations were effective immediately. (Padilla, 7/12)

The patient deaths have exposed a stunning case of medical oversight and alleged medical malpractice, and called into question how repeated failures potentially involving 30 or more employees could have gone unchecked for so long. Husel pleaded not guilty and was released on bond following his arrest June 5. He faces 15 years to life in prison per count if convicted. Husel's attorney has denied that the doctor was trying to kill any of his patients, most of whom were older and already in poor health, and said he never attempted to euthanize them. (Ortiz, 7/11)

Facing pressure from federal agencies, Mount Carmel has undertaken a series of reforms since firing Husel. The federal Centers for Medicare and Medicaid, with the Ohio Department of Health, launched a separate investigation into Mount Carmel in January. Both Mount Carmel West and Mount Carmel St. Ann's were found in violation of federal regulations surrounding pharmaceutical practices and building safety. (Rosenberg and Pfleger, 7/11)

Ahead of a 2020 race already focused on health care, President Trump is boasting that his administration played a huge role in achieving the first annual drop in overdose deaths in three decades. The drop, he crowed recently, is “tremendous.” But behind the scenes, his administration’s efforts to address the opioid crisis are increasingly contentious. Two federal agencies are feuding over how to classify certain drugs too dangerous for public consumption. And in the two-plus years since his inauguration, his White House has yet to nominate a leader for the Drug Enforcement Administration. (Facher, 7/12)

Authorities from seven states, the District of Columbia and some major U.S. cities are backing a Philadelphia effort to open a supervised drug-injection site, which the federal government is trying to stop in court. Safehouse, a nonprofit in Philadelphia, seeks to open a site where people can use drugs in a safe and sanitary environment with help to avoid overdose fatalities. Federal prosecutors sued the nonprofit in February, arguing it would violate federal law by creating a place for people to use illegal drugs such as heroin and bootleg fentanyl. (Kamp, 7/11)

Top officials from 13 states are joining Philadelphia in urging a federal court to allow a site to open where people can inject illegal opioids under medical supervision, the latest escalation in a legal battle with the Justice Department that may determine whether such facilities, known as supervised injection sites, can start to operate in America. In Philadelphia, where drug overdoses — most involving opioids — kill three times as many people as homicides, a nonprofit called Safehouse has been working to launch an injection site as a way of combating the city's opioid crisis. (Allyn, 7/11)

And in other news on the epidemic —

As the U.S. grapples with an ongoing opioid crisis, a new federal government report finds that efforts to rethink physician prescribing practices and provide treatments for people who have abused opioids appear to be working. In 2018, nearly 3 in 10 beneficiaries received at least one prescription opioid through Medicare Part D. Specifically, 29% of beneficiaries, or 13.4 million of the 46.8 million people enrolled in the program, received opioids. (Silverman, 7/11)

Lawmakers on the U.S. Senate Judiciary Committee have urged the Trump administration to conduct a scientific review of a Justice Department-backed bill to classify all illicit chemical knockoffs of the potent painkiller fentanyl in the same legal category as heroin. The sweeping legislation may "deter valid, critical medical research aimed at responses to the opioid crisis," the senators said in a July 10 letter to Department of Health and Human Services (HHS) Secretary Alex Azar seen by Reuters on Thursday. (Lynch, 7/11)

The number of opioid overdoses in the county have continued to decrease with a 25% decline in comparison to 2018. Since the start of 2019 until June 25, 433 overdoses — with 71 fatalities — have occurred with majority of the incidents taking place in the northern part of the county, according to a report by the Anne Arundel Police and the county health department. (Harris, 7/12)

The number of drug-related deaths in Florida, including those caused by opioids, declined in the first six months of 2018, compared to the first half of 2017, according to an interim report released by the state Medical Examiners Commission. There were 107,570 deaths in Florida during the first six months of 2018. Of the cases reviewed by the state’s medical examiners, toxicology results determined that 5,922 cases involved drugs. (Sexton, 7/11)

A Happy Valley man who distributed counterfeit oxycodone pills laced with fentanyl was sentenced Thursday to four years and nine months in federal prison. Johnell Lee Cleveland, 37, pleaded guilty to conspiracy to possess with intent to distribute and distribution of controlled substance, possession of an unregistered firearm and two counts of money laundering. (Bernstein, 7/11)

A bill that would give Puerto Rico a substantial boost in federal Medicaid funding advanced out of a U.S. House subcommittee on Thursday after lawmakers agreed to work on stricter safeguards for the money in the wake of a government corruption scandal in the island territory. The Health Subcommittee sent the legislation, which would give the bankrupt U.S. commonwealth an additional $12 billion over four years, to the full House Committee on Energy and Commerce. (7/11)

A corruption scandal in Puerto Rico is prompting fresh calls from Republican lawmakers to impose tighter constraints on federal spending for the island, intensifying a long-running political conflict in Washington over how to help it recover from a 2017 hurricane. (Stein and Dawsey, 6/11)

The CMS wants to lower states' requirements for showing that their Medicaid fee-for-service payment rates are adequate to enlist enough providers to offer beneficiaries satisfactory access to care. The rule proposed Thursday would rescind a 2015 Obama administration rule requiring states to file an access monitoring review plan and update it at least every three years. (Meyer, 7/11)

Iowa Medicaid Director Mike Randol's belief in privatization is undaunted. Randol agreed the state and federal governments should pay $386 million more to national insurers who are managing Iowa's Medicaid program. But, he told reporters Thursday, he's still confident taxpayers are saving money by having the work done by private companies instead of state employees. “I’m a firm believer in managed care,” Randol said in a news conference. (Leys, 7/11)

Kaiser Health News: Listen: Young Undocumented Californians Cheer Promise Of Health Benefits
Medicaid provides health care to low-income people. And California is set to be the first state to offer it to immigrants younger than 26 living there without legal permission. Starting in January, California will expand eligibility to include undocumented people ages 19 through 25. The change allows them to apply for full health coverage under Medi-Cal, the state’s version of Medicaid. It’s part of a bigger plan to eventually get everyone in the state covered. California is making the move at a time when other states and the Trump administration are trying to restrict who gets health benefits. (Caiola, 7/12)

Premera Blue Cross, the largest health insurer in the Pacific Northwest, has agreed to pay $10 million to 30 states following an investigation into a data breach that exposed confidential information on more than 10 million people across the country. The settlement, negotiated with the Washington attorney general's office and filed in state court Thursday, comes several weeks after Premera said it would spend $74 million to settle a federal class-action lawsuit on behalf of affected customers. (Johnson, 7/11)

As part of the settlement, insurer Premera Blue Cross Blue Shield agreed to implement data security measures, including hiring a chief information security officer, ensuring data is safeguarded in line with laws and provide data security reports to state attorneys general, officials said in an announcement. (Cohen, 7/11)

[Oregon] state officials said auditors had alerted Premera to the vulnerabilities in its system, including that it was slow to install software updates and security patches, but the company failed to fix them. They accused Premera, also known as LifeWise Health Plan of Oregon, of failing to meet its obligations to protect the data under the federal Health Insurance Portability and Accountability Act, known as HIPAA, and Washington's Consumer Protection Act. (7/11)

The student from Birmingham, Ala., came because she wants to “stir up tough conversations” about gun control in a deep-red state. The teenager from Los Angeles was there because she is sick of learning how to prepare for a school shooting instead of how to prevent one. The boy from Baltimore came because he is tired of bullets ripping through his neighborhood as he tries to sleep. (Richman, 7/11)

Nearly half of all deaths worldwide in children under the age of 5 is from malnutrition. And those who manage to survive suffer long-term consequences, such as stunted growth and delays in neurodevelopment. From nutrition bars to energy supplements, the current standards for addressing the nutrition gap focus on providing the recommended amount of calories as well as individual nutrients. (Chakradhar, 7/11)

Not enough breastfeeding costs the global economy almost $1 billion each day due to lost productivity and healthcare costs, researchers said on Friday, as health experts urged more support for nursing mothers. A new website developed by researchers in Canada and Asia showed that the world could have saved $341 billion each year if mothers breastfeed their children for longer, helping prevent early deaths and various diseases. Known as the “Cost of Not Breastfeeding”, the online tool used data from a six-year study supported by the U.S.-based maternal and child nutrition initiative, Alive & Thrive. (Yi, 7/12)

Johnson & Johnson deserves a new trial after a jury ordered the world’s largest maker of healthcare products to pay $417 million to a woman who blamed the company’s iconic baby powder for causing her cancer, an appeals court concluded. Although there was sufficient evidence to uphold the jury’s finding that a J&J unit improperly failed to warn Eva Echeverria about the health risks of talc-based powder, conflicting evidence about the product’s cancer links warrants another trial, the Los Angeles court said Tuesday. (Feeley and Pettersson, 7/10)

Over the course of two decades, 53-year-old Guillermo Argueta’s diabetes developed into cataracts and later resulted in kidney failure. That was when his sister, Ana Argueta, realized that his care was more than she could take on. So Guillermo’s daughter Lorena stepped up. At just 26 years old, she became her father’s primary caregiver this May. “His health issues were in decline,” says the Houston medical scheduler. “Two months ago, he was at stage 2 kidney disease, and now he’s at stage 5.” (Trevino, 7/10)

When pregnancies last for 40 weeks or longer, there is an increase in the risk of stillbirth and neonatal death, a large review of studies has found. The meta-analysis also found that prolonging pregnancy beyond 40 weeks did not reduce the risk for death in the baby’s first month of life. Current practice in the United States is to induce labor at 41 weeks. (Bakalar, 7/11)

Even without a psychology degree, Bella’s natural talents made her an excellent therapist: She is calm and accommodating of a range of personalities, with the patience to listen to endless problems without so much as a judgmental moo. From a lush, secluded pasture on the Mountain Horse Farm, a 33-acre bed-and-breakfast in the Finger Lakes region of New York, 3-year-old Bella and 2-year-old Bonnie are the highlander-angus crossbred cows that provide animal-based therapy. (Mala, 7/12)

Cutting just 300 calories from your daily diet could significantly benefit your cardiovascular health, even if you're already at a healthy weight, according to a new study. Such caloric restriction can be achieved through techniques such as intermittent fasting, or by skipping that slice of cheesecake for dessert. (Howard, 7/11)

Heading into another wildfire season, California’s political leaders have moved with unusual speed to help the state’s utilities erect a backstop against huge liability claims. The State Legislature gave final approval on Thursday to a measure that would set up a fund to help compensate victims for losses from fires started by the utilities’ equipment. (Penn and Eavis, 7/11)

The bill’s passage was a political victory for the governor, but some questioned whether California leaders were just making a down payment for wildfire costs that will skyrocket if more isn’t done to prevent ever-larger blazes. The administration says the bill will provide investor-owned utilities with at least $21 billion to pay for damage from blazes linked to their equipment beginning this summer. Utility customers will be required to pay $10.5 billion to the so-called wildfire fund through a 15-year extension of an existing charge on monthly bills, one that was originally expected to expire by 2021. (Luna, 7/11)

In a 63-8 vote the Assembly sent AB 1054 to the governor's desk, three days after the Senate approved it. Newsom is expected to sign the bill on Friday, which would create a fund of up to $21 billion to pay for damages linked to fires caused by utility equipment. (Pickoff-White and Orr, 7/11)

Assemblymen Phil Ting and David Chiu, D-San Francisco, were among the few votes against the measure, as was state Sen. Scott Wiener, D-San Francisco, when the Senate passed the bill earlier in the week. San Francisco’s representatives have objected to a provision that would make it harder for the city to buy Pacific Gas and Electric Co.’s local power lines, a step they are considering. (Morris, 7/11)

In a statement, Newsom praised lawmakers for moving the bill onto his desk. “I want to thank the Legislature for taking thoughtful and decisive action to move our state toward a safer, affordable and reliable energy future, provide certainty for wildfire victims and continue California’s progress toward meeting our clean energy goals,” Newsom wrote. “The rise in catastrophic wildfires fueled by climate change is a direct threat to Californians. Strengthening our state’s wildfire prevention, preparedness and mitigation efforts will continue to be a top priority for my administration and our work with the Legislature.” (Anderson, 7/11)

New figures released by California Gov. Gavin Newsom show the town of Paradise has lost over 90% of its population since a wildfire killed 85 people last year. A door-to-door survey in April counted 2,034 residents, down from previously released state figures that showed the population had declined to nearly 4,600 as of Jan. 1. (7/11)

The Camp Fire killed 85 people as it burned across 153,000 acres for more than two weeks last November. About 14,000 residences were destroyed, but some have started rebuilding. Officials issued the first permits to rebuild two homes in March. Although some wildfire survivors welcomed the legislation's provisions they say will allow them to fight for greater compensation, several lawmakers raised concerns that utility customers will be footing the bill for fires ignited by PG&E. (Lam, 7/11)

Not enough people are covered by an oversight system meant to safeguard residents of a New York housing program for people with mental illness, a federal judge found this week, after reviewing a report commissioned in response to a ProPublica and Frontline investigation. Since January 2014, more than 750 people with severe mental illness have moved out of troubled New York City adult group homes and into subsidized apartments under a federal court order. The idea was to give them a chance to live outside institutions, with services coming to them as needed through a program called supported housing. (Sapien, 7/12)

The National Union of Healthcare Workers announced Thursday that 4,000 members of the union had soundly rejected Kaiser Permanente’s contract offer, saying the proposal failed to remedy the long wait times for California patients seeking mental health treatment.Kaiser’s “proposals didn’t offer clinicians meaningful solutions to provide timely, adequate care for patients,” said Clement Papazian, a licensed clinical social worker in Oakland. (Anderson, 7/11)

A controversial ballot measure that would give San Franciscans universal mental health care is being pushed from the November 2019 ballot to the March 2020 ballot to give lawmakers more time to come to an agreement as to how it should be implemented. The measure, dubbed “Mental Health SF”, was announced in May. After the announcement, Mayor London Breed and the San Francisco Department of Public Health, which would be in charge of implementing the program, expressed concern about the high costs of implementation and a lack of input from the city’s health experts. (Wolffe, 7/110

A federal judge in California has already found in favor of the plaintiffs accusations that UnitedHealth's coverage for behavioral health care is substandard. Now, lawyers expect, the judge will schedule oral arguments before making a final decision about proposed remedies. (Roth, 7/11)

A 31-year-old woman with mental health issues who allegedly stabbed a Boston EMT seven times inside an ambulance on Wednesday was questioned by law enforcement the day before the attack regarding a hoax bomb threat at multiple airports, an official said. State Police spokesman David Procopio confirmed on Thursday that investigators spoke to Julie Tejeda on Tuesday as part of an ongoing probe into the threat made to airports, including one on Martha’s Vineyard. (Sweeney, Anderson and McDonald, 7/11)

When a top St. Louis County police commander on April 22 took over management of the county jail where three inmates had died, he said he planned to evaluate the jail and make improvements. Lt. Col. Troy Doyle, the interim director of justice services, promised to be transparent about what he found. But county officials acknowledged Thursday that nearly three months into his tenure — which included a fourth inmate death — Doyle’s ability to review breakdowns or make changes at the jail has been limited because he does not oversee the nurses and other medical staff. (Kohler, 7/11)

About 50 Massachusetts residents purchased sham insurance coverage through Simple Health Plans LLC, they said. A judge ordered the Florida company to shut down temporarily last fall after a complaint from the Federal Trade Commission. Officials at the Massachusetts Health Connector — where individuals can purchase comprehensive insurance plans — said they will allow those affected by the scam to buy new coverage through the Connector, even though the normal enrollment period is closed. (Dayal McCluskey, 7/11)

Why are tampons taxed when Viagra isn’t? That’s the question at the heart of the push to repeal the so-called tampon tax, a catchy phrase that refers to state sales taxes applied to menstrual products, including pads and cups. Thirty-five states still tax the items, despite momentum to change that. Opponents of the tax argue that tampons and pads should be treated like groceries and medical supplies: they should be tax-exempt because they are necessities. (Zraick, 7/12)

Katie Bennett needed to move. The 34-year-old was staying with a friend in Belle Plaine while she worked a seasonal job after being released from jail in mid-2015. When the job ended, she couldn’t find work in the eastern Iowa town of 2,400. Her criminal record didn't help. “I wasn’t able to provide any source of income,” she said. “I absolutely had to go to a big city just to get work so I could establish myself.” (Richardson, 7/11)

In the wake of Freddie Gray’s death from injuries suffered in police custody and the subsequent protests and rioting in Baltimore in 2015, state lawmakers passed a law mandating police agencies across Maryland report when officers use excessive force or injure someone and cases of officers’ criminal misconduct, among other data. However, dozens of agencies — including the Baltimore Police Department — never did so. That’s resulted in extreme undercounting of such encounters in annual reports mandated by the law and collated by the Maryland Police Training and Standards Commission. (Rector, 7/11)

Los Angeles Police Chief Michel Moore said he is working to eliminate thousands of homeless people's old warrants for minor offenses in the coming weeks as part of a solution to help get people off the streets. "This is a humanitarian crisis of our generation," Moore said Wednesday in a wide-ranging interview with The Associated Press. "This matches any other calamity that this city or this region or this country has seen. It is, I believe, a social emergency." (7/11)

The Florida Department of Health in Orange County has issued a 60-day rabies warning at Walt Disney World Resort in response to reports a rabid cat had been found in the area. The alert, announced Tuesday, covers the two-mile radius of the intersection of Interstate 4 and Epcot Center Drive, which includes Disney's Epcot Center theme park. (Trepany, 7/11)

Two residents of a Virginia assisted living facility have died and 18 more have been hospitalized with respiratory symptoms in the past 11 days, prompting Fairfax County health officials to launch an outbreak investigation at the Springfield facility, officials said Thursday. The Fairfax County Health Department announced the probe of Greenspring after 54 residents out of 263 were reported to be ill with symptoms ranging from coughs to pneumonia, department officials said in a statement. (Williams, 7/11)

With the recent flurry of activity in state legislatures and concerns about the future of Roe vs. Wade, medical students in Colorado are taking note. (Seaman, 7/11)

The state of California is paying off $10.5 million in student loans for 40 dentists who agree to ensure that 30 percent of their patient caseload is made up of Medi-Cal patients – among the state’s poorest and frailest residents. ...Ruiz said the grant will pay off $300,000 of the $307,000 he owes for dental school at the University of California, San Francisco. In exchange, he will commit for five years to ensuring his patient mix is at least 30 percent Medi-Cal beneficiaries. (Anderson, 7/12)

Advisers in the Trump administration are recommending the President veto any defense authorization bill that includes millions for water contaminated from PFOA and PFOS chemicals, much of which was earmarked for New Hampshire. The Trump administration takes issue with using the EPA drinking-water health advisory to determine unhealthy levels of water used for agriculture purposes. The veto recommendation is included in a 10-page memo issued Tuesday by the Office of Management and Budget. (Hayward, 7/11)

Chalise Scholl’s mother died of heart disease and breast cancer two years ago, and to pay for the burial, Scholl cashed in her own small life insurance policy of $1,000. Scholl, then 35, assumed she had plenty of time to buy a new policy. Sadly, she was wrong. Almost one year later, in November 2018, Scholl, of Peoria, Ill., ended up in the emergency room with abnormal bleeding. (Free, 7/11)

Some of the patients had suffered heart attacks or were in septic shock; others had cancer, pneumonia, or a whole host of other conditions. From 2001 to 2012, more than 46,000 of them passed through the intensive care units at Beth Israel Deaconess Medical Center, a Boston hospital affiliated with Harvard. Their vital signs were monitored and recorded, as were their lab test results, their doctors’ notes, and reams of other data. (Robbins, 7/12)

Starting next year, “X” can mark the gender on New Hampshire driver’s licenses.Gov. Chris Sununu allowed House Bill 669 to become law this week without his signature. It allows driver’s licenses or non-driver identification cards to be marked “M” for male, “F” for female or “X” for other. New Hampshire joins 12 other states and Washington D.C. in providing the third designation for “non-binary” people who do not identify as male or female. HB 669, which passed both the House and the Senate on voice votes earlier this year, takes effect Jan. 1, 2020. (Feely, 7/11)

Los Angeles County caseworkers allowed 4-year-old Noah Cuatro to remain in his parents’ home despite a court order in May — weeks before the Palmdale boy died under what authorities say are suspicious circumstances, according to two sources who have reviewed court documents. At the time of his death Saturday, Noah remained under active supervision by the county Department of Children and Family Services after at least 13 calls to the child abuse hotline and police from people who said they suspected that the children in the home were being abused, the sources said. (Therolf and Stamos, 7/11)

Far from being a recent arrival at the southern border, the teen entered the country when he was a 9-month-old infant; he has lived in Houston his whole life, along with his mother, who brought him to the U.S. in 2004. ...Lawyers for teens at the Homestead facility say they’ve represented at least 20 other kids with similar cases: all were apprehended in the United States far from border towns or ports of entries without immigration documents, and while they were not physically with their biological parents. ( Madan, 7/12)

Republican leaders in the Iowa Legislature Thursday denied Democrats’ request to form a special committee to make recommendations for the state’s medical marijuana program. Rep. John Forbes, D-Urbandale, said a study committee would help with crafting a proposal to expand the program. (Sostaric, 7/11)

If you smoke marijuana for medical purposes, it’s time to check in with your doctor.Starting Friday, any doctor’s orders for medical marijuana that contain a recommendation for smokable, whole flower marijuana must be up to date. The system was updated June 28 to include smokable flower as a newly established route of administration for medical patients. (Gross, 7/11)

Dr. Vasso Godiali, a vascular surgeon in Bay City, Mich., was charged with orchestrating a $60 million healthcare fraud. Federal prosecutors charged Godiali with submitting false claims for placing stents in dialysis patients and for treating arterial blood clots, according to a criminal indictment unsealed Wednesday. (Kacik, 7/11)

Mississippi has suspended the medical license of an OB-GYN physician amid several complaints about him, including that he had an affair with one of his married employees starting in 2015 and tried to insert abortion-inducing drugs into her while she was pregnant with his child. The baby was born in 2016. (Pettus, 7/11)

A woman has been accused of having a sexual relationship with a patient while working as a security supervisor at a Nebraska psychiatric hospital. Lancaster County Court records say 36-year-old Chalice Closen is charged with felony sexual abuse of a protected person. County jail records say Closen remained in custody Thursday. The court records don't list the name of an attorney for her. (7/11)

President Trump on Wednesday announced an executive order on a topic rather far afield from his usual concerns: improving care for patients with kidney disease. (Dylan Matthews, 7/10)

In 2015, Travis Rieder, a medical bioethicist with Johns Hopkins University's Berman Institute of Bioethics, was involved in a motorcycle accident that crushed his left foot. In the months that followed, he underwent six different surgeries as doctors struggled first to save his foot and then to reconstruct it. (Terry Gross, 7/8)

The straightforward explanation for measles’ return is that fewer Americans are receiving vaccines. Since the turn of the century, the share of American children under the age of 2 who go unvaccinated has quadrupled. But why are a growing number of American parents refusing vaccines—in the process welcoming back a disease that decades ago killed hundreds of people a year and hospitalized close to 50,000? (Peter Beinart, 7/8)

Heading into the highlands of Tasmania, some 250 miles south of the Australian mainland, narrow black-topped roads meander through a wide river valley bounded by distant mountain bluffs. Two-track paths splinter off into grassy pastures, past skeletal trees bleached by sun and drought. All along the way, small signs dangle from wire fence lines: Danger Prohibited Area Poison. Little else would suggest that these fields represent the nucleus of the global opioid supply chain—the starting point for one of the world's largest drug markets. (Peter Andrey Smith, 7/11)

There is exactly one reasonable response to whether you would abolish private insurance, and it isn’t “yes” or “no.” It’s not raising or lowering your hand. It’s: “It depends.” There are a bunch of questions that need to be answered first before you can even make sense of it. (Ezra Klein, 7/8)

Poop transplants work so well against some infections that they’re becoming a first line of defense. But two bad incidents raise questions about what's next. (Maryn McKenna, 7/11)

Even in the complicated ecosystem of drug pricing, one fact stands out: $166 billion in discounts from pharmaceutical companies go directly into the coffers of pharmacy benefit managers. That’s 37% of our nation’s entire expense on drugs. Not a single dollar of that largesse is used to reduce patients’ out-of-pocket costs when they need medicines. So when the White House boldly developed a rule to change the dynamic by banning many rebates drug companies pay to pharmacy benefit managers under Medicare, policy experts applauded. That proposed rule died last night, the victim of intense lobbying and general ignorance. Who loses? Patients. Who wins? The status quo. (Peter J. Pitts, 7/11)

President Donald Trump’s efforts to make good on promises to lower prescription-drug costs suffered a couple of major setbacks this week. With luck, though, these reversals may clear a path for better solutions.  A judge started the week by derailing a Trump administration plan to force drugmakers to disclose the high list prices of their medicines in TV ads. Then, late Wednesday, the White House confirmed it is scrapping an ambitious effort to change how the government pays for drugs. The now-dead plan called for eliminating some of the rebates received by pharmacy benefit managers (PBMs) – the middlemen that negotiate drug costs for health plans. (Max Nisen, 7/11)

Ohio politicians have paid a lot of lip service in the past year to address the damage done to health care by pharmacy benefit managers. But now, 16 months after The Dispatch first reported on CVS Caremark’s abusive pricing strategy, one element of the current Statehouse budget stalemate suggests lawmakers aren’t serious about fixing the problem. The House- and Senate-passed versions of the 2020-21 budget have different language for reforming state contracts with PBMs, and that is one of the differences that must be resolved to pass a budget. A first question to ask is why this thorny, complicated problem is even part of the state budget bill. (7/10)

On a subject as fraught as immigration, there's plenty of room for disagreement about border security, workplace enforcement, paths to citizenship and other policies. But when the topic is the well-being of kids crammed into federal immigration centers on the southern border, there ought to be no room for debate. For young children, toddlers and infants guilty only of being carried or led into the United States, it's unconscionable for federal officials to banish them for days or weeks to squalor. (7/11)

President Trump recently weighed in on the rise in homelessness in cities across the country, including Los Angeles and San Francisco, and warned that the federal government may “do something to get that whole thing cleaned up” — whatever that means. But the federal government already plays a major role in keeping people off the streets by supplying publicly owned, subsidized housing units to some lower income people (albeit in dwindling numbers) and vouchers to others to rent privately owned units.Now, a misguided proposal from the Trump administration could make homelessness even worse here and in other cities by kicking families out of these programs if even one person in the household is living in the country illegally. That is not only counterproductive, it’s cruel. (7/12)

The state of New Jersey has enabled paramedics to offer buprenorphine (Suboxone) to patients after they reverse a near-fatal overdose. In a prepared statement, Dr. Shereef Elnahal, New Jersey’s health commissioner, said that buprenorphine “is a critical medication that doesn’t just bring folks into recovery — it can also dampen the devastating effects of opioid withdrawal.” Dr. Dan Ciccarone, who studies heroin use and the opioid epidemic, told STAT that the New Jersey effort is “a potentially brilliant idea.” (David A. Patterson Silver Wolf, 7/12)

The political stars seem to have aligned to make real progress on medical billing abuse a tantalizing possibility. In Congress last week the Senate Health, Education, Labor and Pensions Committee (HELP) passed the Lower Health Care Costs Act. The act has many important parts, but let’s focus on the long overdue solution it provides for the pernicious problem of surprise medical billing. Possibilities, of course, are not realities and already there is an impressive array of providers and insurers invested in preserving the status quo and determined to prevent real change. The act should become law as soon as possible, and without any further watering-down of its important provisions. Coverage for ground ambulance charges should be added to the bill. (George A. Nation III, 7/10)

The rate at which Americans take their own lives has been climbing for 20 years, prompting policy makers and medical experts to search for novel suicide-prevention practices. But one approach is as old as civilization itself: religious faith. Encouraging the most vulnerable Americans to attend religious services could reduce the suicide rate, and a new type of church growing in the U.S. shows particular promise. (Ericka Andersen, 7/11)

Newborn screening is a complex effort that can continue to improve and thrive only if the federal-state partnership currently in place is allowed to continue. The achievements in newborn screening over the decades have been significant, and with the development of more treatments and cures for heritable disorders that will further save and improve children’s lives, Congress must act to reauthorize the Newborn Screening Saves Lives Act before it expires in September to ensure that this success continues. (R. Rodney Howell, 7/12)

They packed like moms pack — healthy snacks, water, comfortable shoes, tissues in their purses — and wore matching red shirts. They got babysitters, took the day off from work or swapped car pool duties so they could be up at 5:30 a.m. Tuesday for the long drive to Richmond, where the state legislature was finally — finally — going to debate Virginia’s lax gun laws. (Petula Dvorak, 7/11)

Texans with intellectual or developmental disabilities often have a choice: Add their name to a 10-year waitlist for services in their community in places like group homes or get a spot in a more restrictive state-supported institution immediately. Most choose to wait. The state of Texas prioritizes funding for state-supported institutions over community-based services for developmentally disabled citizens. But these institutions are fraught with problems, and few choose them. In order to serve its citizens and use public funds more responsibly, the state needs to reconsider its priorities. (7/12)

Like the miners who work underground in dark and dangerous conditions, black lung disease is, for many, largely out of sight, out of mind. But for folks such as Gary Hairston, who spent more than 27 years in the mines around his Beckley, W.Va., home, the ailment is ever-present. He lives with it. Many have died of it. (Joe Davidson, 7/11)

The Annie E. Casey Foundation has released its 2019 State Trends in Child Well-Being report and Texas ranked 41st. Contrast that with Texas being named as the 2018 top state for business by CNBC. If we were a state that was struggling, 41st might be understandable, albeit terrible. But, because we are a thriving state by so many other metrics and often recognized for our generosity, this stat — which illuminates deeper issues — should bring us to our knees. (Michelle Kinder, 7/11)

Juul’s initiative would repeal anti-smoking laws that were enacted to keep e-cigarettes out of the mouths of children. It would also gut city officials’ authority to regulate e-cigarettes in the future. (Lousie Renne, 7/10)