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The Trump administration said on Thursday that it had reunified all the migrant children under the age of 5 it determined were eligible to be returned to their parents, part of a court order to reunite the children who were separated from their families at the border. Officials said that 57 of the 103 children had been reunited with their families as of Thursday morning. An additional 46 children remain in government custody because they have been found ineligible to be returned to their families for various reasons. (Nixon and Jordan, 7/12)

“As of this morning, the initial reunifications were completed. Throughout the reunification process our goal has been the well-being of the children and returning them to a safe environment,” HHS Secretary Alex Azar, Homeland Security Secretary Kirstjen Nielsen, and Attorney General Jeff Sessions said in a joint statement. (Weixel, 7/12)

Attorneys seeking to reunify migrant children separated from their parents at the southern border said Thursday that they were not able to verify the Trump administration’s claim that nearly five dozen children had been returned to their parents. (Kullgren, 7/12)

The U.S. officials said 46 of the children were not eligible to be reunited with their parents; a dozen parents had already been deported and were being contacted by the administration. Nine were in custody of the U.S. Marshals Service for other offenses. One adult’s location was unknown, they said. Of the deported parents, officials said they had chosen to leave their children behind. One deported father, however, told the Los Angeles Times earlier this week that he didn’t realize what he was doing when he signed the paperwork to leave his child behind. It wasn’t clear if he was one of the dozen; no names have been made public. (Long, 7/12)

Court records show that 22 children were not returned because of safety concerns posed by the adults with whom they had been traveling. Eleven of the adults had serious criminal histories, such as kidnapping and murder, said Chris Meekins, chief of staff for the Office of the Assistant Secretary for Preparedness and Response, which is aiding in the reunification effort. One adult was convicted of child cruelty and narcotics charges. For the others, the case outcomes remain unclear: Meekins said one adult has been charged with human smuggling, another faces domestic violence charges, one father has an outstanding drunken driving charge in Florida, and another adult is wanted for murder in Guatemala. Others have similar convictions or charges filed against them, officials said. (Sacchetti, 7/12)

Authorities will now move to reunite the more than 2,000 older minors who remain apart from their relatives, a process a judge has said must be completed by the end of the month. The government will take steps to screen parents to determine whether they are eligible for reunification, so it isn’t clear how many children will be reconnected with their families. (Gurman and Campo-Flores, 7/12)

Public outrage over the separations led President Donald Trump to retreat last month from his "zero-tolerance" policy toward unlawful border crossings. Under the approach, parents and other caregivers apprehended after traversing the border were arrested and jailed, and the government placed their children with HHS. U.S. District Judge Dana Sabraw had ordered the administration to reunite all children under age 5 from their parents by July 10. The court has also required the administration to reunite the much larger group of older children by July 26. (Sink, 7/12)

Detaining immigrant children has morphed into a surging industry in the U.S. that now reaps $1 billion annually — a tenfold increase over the past decade, an Associated Press analysis finds. Health and Human Services grants for shelters, foster care and other child welfare services for detained unaccompanied and separated children soared from $74.5 million in 2007 to $958 million in 2017. The agency is also reviewing a new round of proposals amid a growing effort by the White House to keep immigrant children in government custody. (Mendoza and Fenn, 7/12)

A defense contractor admitted it occasionally held separated migrant children overnight at an unlicensed Phoenix facility, apparently contradicting earlier claims that it had used the office building only for short stopovers while transporting children, according to a report from Reveal from the Center for Investigative Reporting. (Philip, 7/12)

Anticipating renewed fights over abortion, some governors and state lawmakers already are looking for ways to enhance or dismantle the right in their own constitutions and laws. President Donald Trump's nomination of Judge Brett Kavanaugh to the U.S. Supreme Court has raised both fears and hopes that a conservative court majority could weaken or overturn the 1973 Roe v. Wade ruling that created a nationwide right to abortion. That could fan an already raging battle in states over what should and should not be legal. (7/12)

Four states — Louisiana, Mississippi, North Dakota and South Dakota — already have laws designed to prohibit most abortions if the Roe ruling were overturned. Several other states have laws adopted before the Roe ruling that ban many abortions and that have not been removed from their statutes. It's unclear whether those laws automatically would take effect if the Roe precedent were overturned. Some state courts also have ruled that abortion rights are protected under their state's constitution. Here's a look at some states with old abortion laws still on the books or with newer laws that could be triggered if Roe were reversed. (7/12)

Democratic Sen. Tammy Baldwin (Wis.) announced Thursday that she will oppose Brett Kavanaugh's nomination to the Supreme Court over concerns that he would undercut the Affordable Care Act and a landmark abortion case. “The President vowed to appoint judges to the Supreme Court who would overturn Roe v. Wade, and I cannot support a nominee for a lifetime appointment who would turn back the clock on a woman’s constitutional right and freedom to make her own health care choices, including access to birth control," Baldwin said in a statement. (Carney, 7/12)

Nearly two-thirds of Americans support Roe v. Wade, the landmark Supreme Court case that legalized abortion, according to a new Gallup poll. Sixty-four percent of Americans stand by Roe v. Wade while 28 percent would like to see it overturned, pollsters found. The poll found a wide partisan split, with 81 percent of Democrats supporting the ruling, compared to 41 percent of Republicans. Thirteen percent of Democrats opposed Roe v. Wade, meanwhile, as did 51 percent of Republicans. (Birnbaum, 7/12)

On an infernal afternoon this week, hundreds of women gathered in Union Square in the name of protecting reproductive rights and in protest, implicitly, of a flimflam progressivism that allows New York to market itself to the country as a polestar of liberal sanctity. The immediate impetus for the rally was the nomination of Judge Brett M. Kavanaugh to fill Justice Anthony M. Kennedy’s seat on the Supreme Court, a move that could bring the reversal of Roe v. Wade closer to reality. But the real news for anyone who might have wandered into the event, exiting from Whole Foods with locally grown strawberries and little knowledge of the state’s legal code, is that New York’s own abortion laws place it nearer to the sentiments of the “Handmaid’s Tale” than many would imagine. (Bellafante, 7/13)

Chuck Schumer says he’s going to fight Brett Kavanaugh’s nomination to the Supreme Court with “everything I’ve got.” To do so, he’ll need to get centrist Democrats to hold the line. The minority leader’s problem? Those Democrats say he can’t tell them what to do. “I’ll be 71 years old in August, you’re going to whip me? Kiss my you know what,” said Sen. Joe Manchin (D-W.Va.) when asked if Schumer can influence his vote. (Everett and Schor, 7/13)

Judge Kavanaugh has written two dissenting opinions in the legal challenges to the Affordable Care Act while serving on the United States Court of Appeals for the District of Columbia Circuit. In both cases, he refrained from making broad pronouncements about the constitutionality of the Affordable Care Act, said Wendy Parmet, a professor of health law at Northeastern University. (Qiu, 7/12)

Senate Democrats and their allies are casting Judge Brett M. Kavanaugh as a grave danger to Americans’ ability to afford health care as a central theme of their high-decibel campaign to block his ascension to the Supreme Court. But after a half-dozen years in which the high court has repeatedly upheld the essence of the Affordable Care Act, Kavanaugh, if confirmed, would be less likely to help decide cases threatening the law’s survival than a mosaic of narrower issues, often arising from the Trump administration’s eagerness to chip away at parts of the law. (Goldstein, 7/12)

The Trump administration is bound by a federal court decision to suspend billions of dollars in ObamaCare payments, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said Thursday. “We really are in a tough spot,” Verma told reporters. “I think that there’s been a lot of discussion about whether the Trump administration is making a decision. We’re not making a decision. The court has told us what to do here … at the end of the day, we have to abide by the court’s ruling.” (Weixel, 7/12)

In other health law news —

The House Ways and Means Committee on Thursday approved legislation that would chip away at ObamaCare, including a measure that would temporarily repeal the law's employer mandate. The bill sponsored by GOP Reps. Devin Nunes (Calif.) and Mike Kelly (R-Pa.) would suspend penalties for the employer mandate for 2015 through 2019 and delay implementation of the tax on high-cost employer-sponsored health plans for another year, pushing it back to 2022. (Hellmann, 7/12)

Startup insurer Bright Health is doubling the number of states where the Minneapolis-­based health plan competes — an expansion plan that fits with a broader trend of carriers seeing a shot at growth in the individual market. Bright Health, which already competes in parts of Alabama, Arizona and Colorado, announced plans Wednesday to expand into portions of New York, Ohio and Tennessee. (Snowbeck, 7/11)

Federal prosecutors in eight states with high drug overdose death rates will pursue even seemingly small synthetic opioid cases under a program announced Thursday by Attorney General Jeff Sessions. Sessions announced Operation Synthetic Opioid Surge in New Hampshire, which Republican President Donald Trump has called a "drug-infested den." The program is modeled after a successful effort in Manatee County, Florida, and will involve prosecutors each choosing one county in which to pursue every "readily provable" case involving the sale of fentanyl and other synthetic opioids, regardless of the quantity involved. (Ramer, 7/12)

Sessions said he will add an additional prosecutor to the office of U.S. Attorney in New Hampshire as part of the nationwide effort, labeled Operation Synthetic Opioid Surge. “When it comes to fentanyl dealers, there is really no such thing as a small case,” Sessions said. Sessions announced Operation SOS after meeting the federal law enforcement officers and prosecutors at the U.S. District Court offices in Concord, followed by a similar meeting with state and local officers. Other prosecutors will be provided to areas of Ohio, Tennessee, Kenucky, West Virginia, Maine, California, and Pennsylvania. All have some of the highest overdose death rates in the country, Sessions said, ranking New Hampshire and Ohio second behind only West Virginia. (Hayward, 7/12)

More news on the epidemic comes out of Maryland, North Carolina, New York, Pennsylvania, Texas and Massachusetts, as well—

CVS is putting containers in its retail stores where people can dispose of unused prescription drugs as a way to fight an opioid epidemic that has killed thousands of people across the country. The containers are designed to get unused opioids out of people’s houses, CVS officials said in announcing the initiative Thursday. People addicted to opioids sometimes get the drugs from the medicine cabinets of families and friends without their knowledge. (McDaniels, 7/12)

Debbie Dalton was sitting at her kitchen table in Cornelius writing Christmas cards the week after Thanksgiving 2016 when she received a devastating phone call. The caller ID said “Hunter,” the name of her then-23-year-old son who recently graduated college and moved to Raleigh to work at Citrix. (Knopf, 7/12)

At an unassuming storefront on a busy Brooklyn street, people sign up to use a bathroom outfitted to try to curb an overdose crisis. Waiting his turn, a man named Robert is frank about why he’s there, instead of one of the stairwells, parks, rooftops or porches where he has used heroin in the past. “It keeps us safe. It keeps us from getting arrested. You feel secure here,” says Robert, who discussed his drug use on condition that his last name not be used because he fears arrest and damage to family relationships. “You know that someone’s paying attention if you fall out in there. ... You know they’re not going to let nothing happen to you.” (Peltz, 7/13)

Blue Cross Blue Shield members are being prescribed fewer opioids at lower doses, the insurance giant said in a report released Thursday. Officials said they’re “making headway” in a crisis that killed tens of thousands in 2016. In the Philadelphia region — which includes parts of Pennsylvania, Maryland, New Jersey, and Delaware, and where Independence Blue Cross is the largest private insurer — opioid prescriptions among BCBS members dropped by 32 percent between 2013 and 2017. (Whelan, 7/13)

All Travis County sheriff’s patrol deputies will now carry the life-saving drug naloxone, which can reverse the effects of an opioid overdose. The Texas Overdose Naloxone Initiative, which works to get the drug into the hands of law enforcement, first responders and addicts, gifted the department with the medication, also known by the brand name Narcan. (Huber, 7/12)

The House voted unanimously late Wednesday to adopt its own version of Governor Charlie Baker’s legislation to address the opioid crisis, adding an amendment from Worcester Representative James J. O’Day that goes partway toward meeting the entreaties of advocates for addicted inmates. ... Currently most jails and all prisons in Massachusetts deny inmates access to the main medications used to treat opioid addiction — methadone and buprenorphine (often known by a trade name, Suboxone). (Freyer, 7/12)

In parts of the country hit hard by addiction, some public health officials are considering running sites where people can use heroin and other illegal drugs under medical supervision. Advocates say these facilities, known as supervised injection sites, save lives that would otherwise be lost to overdoses and provide a bridge to treatment. (Allyn, 7/12)

Health officials in Illinois and Iowa are investigating an increase in people becoming sick from a parasite that causes intestinal illness. The Illinois Department of Public Health said in a news release Thursday that it has received confirmation of about 90 cases of cyclosporiasis, which is caused by the Cyclospora parasite. The Iowa Department of Public Health, in its own release, said it has identified 15 cases linked to the same illness and parasite. Both departments say there appears to be a link to consumption of McDonald's salads. (7/13)

Symptoms can begin a week or more after consuming the parasite. They include diarrhea and frequent, sometimes explosive bowel movements, according to the US Centers for Disease Control and Prevention. Those who are infected might also experience loss of appetite, weight loss, stomach cramps or pain, nausea, gas and fatigue. ...The illness can last from a few days to a few months and patients might feel better, then get worse again. Patients can be treated with antibiotics. (Goldschmidt, 7/12)

A salmonella outbreak linked to a popular Kellogg's cereal has infected 100 people, the Centers for Disease Control and Prevention announced Thursday. The agency is urging consumers to avoid Honey Smacks, a sugary puffed wheat cereal which has been the subject of a recall by the company since mid-June. At least 30 of the 100 have been hospitalized, while no deaths have been reported, the CDC said. (Rosenberg, 7/12)

Symptoms of salmonella infection include diarrhea, fever and abdominal cramps and typically present 12 to 72 hours after exposure to the bacteria. The first cases of illness in this outbreak began with symptoms on March 3, and the most recent individuals began feeling ill on July 2. ...Florida and Colorado are the latest states to report illnesses as part of the outbreak, bringing the total number of states affected to 33. (Moulite, 7/12)

Mock-shooting drills. Metal detectors. Bulletproof classroom shelters. As deadly school shootings continue to be a fixture in headlines and an everyday fear for districts and students, schools across the country have resorted to “hardening” their campuses. But a federal report released Thursday backs another model that school safety experts have for years supported as a way to save lives: the formation of “threat assessment teams” that employ mental health, law enforcement and education professionals to help identify and support troubled youths. (Yoon-Hendricks, 7/12)

One day, she thought, the three kids would come back and find her. They would return to Houston and reunite with the woman who fought to keep their family together. Priscilla Celestine held on to that dream for years, long after the state of Texas took the children — all younger than 6 at the time — and sent them 1,300 miles away to live in a Minnesota town she didn’t know, in a home she didn’t know with a family she didn’t know. The interstate adoption, finalized in 2009, was in Devonte, Jeremiah and Ciera’s best interest, the state determined. They would be safe and cared for.The state was wrong. (Heim and Tate, 7/12)

Researchers have found flaws in some of the data that track and field officials used to formulate regulations for the complicated cases of Caster Semenya of South Africa, the two-time Olympic champion at 800 meters, and other female athletes with naturally elevated testosterone levels. Three independent researchers said they believed the mistakes called into question the validity of a 2017 study commissioned by track and field’s world governing body, the International Federation of Athletics Associations, or I.A.A.F., according to interviews and a paper written by the researchers and provided to The New York Times. (Longman, 7/12)

Could the tick that just bit you carry a pathogen that causes Lyme disease or another ailment? If you're worried, you could ship the offending bug to a private testing service to find out. But between August 2016 and January 2017, you could have gotten a free analysis by sending it to Nathan Nieto's lab at Northern Arizona University. You'd get back info on the critter that bit you and, if applicable, a pathology report. (Blakemore, 7/12)

Suppose that, seeking a fun evening out, you pay $175 for a ticket to a new Broadway musical. Seated in the balcony, you quickly realize that the acting is bad, the sets are ugly and no one, you suspect, will go home humming the melodies. Do you head out the door at the intermission, or stick it out for the duration? Studies of human decision-making suggest that most people will stay put, even though money spent in the past logically should have no bearing on the choice. (Goode, 7/12)

We might be able to blame the heat for our bad decisions: A small study published this week found that college students who lived in dorms without air conditioning during a heat wave did worse on cognitive assessments than students who had air conditioning. "To us, this is a way of saying yes, some of the effects are common sense, but what do you do about them?" said Jose Guillermo Cedeño Laurent, associate director of the Healthy Buildings Program at Harvard T.H. Chan School of Public Health and lead author of the study, which was published Tuesday in the journal PLOS Medicine. "And this is giving more precision to the opportunity of better controlling thermal environments in our buildings." (Moulite, 7/12)

Every night without fail, Paul Blumstein straps on a mask that prevents him from repeatedly waking up, gasping for air. It's been his routine since he was diagnosed with a condition called sleep apnea. While it helps, he doesn't like wearing the mask."It's like an octopus has clung to my face," said Blumstein, 70, of Annandale, Virginia. "I just want to sleep once in a while without that feeling." (Johnson, 7/12)

Juul Labs Inc., the maker of the popular e-cigarette brand that has recently come under fire from health officials over its popularity with young adults, plans to introduce a line of lower-nicotine pods. The company will begin to sell pods with a 3-percent nicotine concentration in its mint and Virginia tobacco flavors later this year, according to a statement Thursday. It currently offers eight flavors -- mango is a top seller -- containing a 5-percent nicotine level, which is about as much nicotine as a pack of traditional cigarettes. (Wolf, 7/12)

Learning a bit of neuroscience may provide some relief from pain. In a randomized clinical trial, researchers assigned 120 men and women with chronic back or neck pain to one of two treatments. The first group received the commonly recommended program of physical therapy and general exercises. (Bakalar, 7/11)

Hospital administrators in Broward County — and around the country — said enhanced security protocols like lockdowns are standard when victims of violence are being treated. ... But hospital administrators recognize the indirect consequences of mass shootings — the far-reaching ripple effects on an entire community — like the distress people experience when they're separated from sick loved ones during a lockdown. (Bakeman, 7/13)

If you were thinking that the ancient Alpine traveler known as Otzi — and often known simply as Iceman — scraped by on a diet of foraged grasses and berries, you’d be very wrong. A comprehensive new study of his stomach contents reveals that Otzi, who perished roughly 5,300 years ago on a mountain in the Eastern Alps of Italy, died with a belly full of fatty meat, some whole seeds from the einkorn wheat plant, and maybe a bit of goat’s milk or cheese — all eaten just a couple of hours before he died. (Healy, 7/12)

Kaiser Health News: Retooled Vaccine Raises Hopes As A Lower-Cost Treatment For Type 1 Diabetes
For Hodalis Gaytan, 20, living with Type 1 diabetes means depending on an assortment of expensive medicines and devices to stay healthy. Test strips. Needles. A glucose meter. Insulin. The increasing cost of Type 1 diabetes, one of the most common serious chronic diseases, has created heavy financial burdens for families and generated controversy, with insulin prices more than doubling in the past decade. Without her parent’s insurance, “I would not be alive,” said Gaytan, a student at the University of Maryland. (Heredia Rodriquez, 7/13)

An outbreak of Legionnaires’ disease has sickened 11 people in Upper Manhattan, 10 of whom have been hospitalized, according to city health officials. Eight people remained in the hospital on Thursday. “This disease is very treatable with antibiotics,” Dr. Mary Bassett, the city’s health commissioner, said in a statement. “I encourage anyone with symptoms of Legionnaires’ disease to seek care early.” (Greenberg, 7/12)

A union says 1,800 nurses at Vermont's largest medical center are on strike following unsuccessful contract negotiations. The Vermont Federation of Nurses and Health Professionals and UVM Medical Center met again Wednesday, but were not able to reach an agreement. Nurses were on picket lines as of 7 a.m. Thursday. The strike is to last through 7 a.m. Saturday. (7/12)

The legal assault on Johnson & Johnson and its signature baby powder reached new heights today, when a state court jury in Missouri found the company responsible for the ovarian cancers of 22 women, and ordered the drug and consumer products giant to pay $4.69 billion in compensatory and punitive damages to the cancer victims or their survivors. The verdict by the jury of six men and six women in St. Louis Circuit Court was by far the largest yet in the mushrooming baby powder litigation. (Levin and Silverstein Fairwarning, 7/13)

The state not only does not punish mental health care providers, it lets the agencies choose their own remedies for breakdowns in treatment. In cases reviewed by the Journal-Constitution, this often involved little more than additional training for the agencies’ staffs. (Judd, 7/12)

Thousands of Minnesota seniors and people with disabilities who require help with daily living activities at home now have a place to go to find caregivers who can meet their needs. After years of preparation, the Minnesota Department of Human Services (DHS) has launched the state's first online job portal that connects people who need assistance with tasks, such as bathing, dressing and preparing meals, with caregivers who are looking for work. State officials will roll out the new online job portal — Direct Support Connect — to the state's 140,000-person direct care workforce this summer and fall, with the hope of getting enough people to register for the website that it will become a reliable place for people to get help in their homes. (Serres, 7/12)

Some of the decades-old language in North Carolina’s state laws sound more like insults from a schoolyard bully rather than precise descriptions of medical conditions. But thanks to the painstaking work of a state commission, at least some of that terminology will change come October. For example, right now, North Carolina guardianship laws refer to people who are “mentally retarded.” Other statutes still refer to people being “lunatic.” (Hoban, 7/11)

The Johns Hopkins University Berman Institute of Bioethics, one of the world’s largest bioethics centers, announced Thursday that it has received one of its biggest financial gifts, $15 million to be used to support education and training. The donation came from Alex Levi and his wife, Vicki, and was made in honor of the institute’s founding director, Ruth R. Faden. Levi, a New York-based clinical psychologist, is a trustee emeritus of the Johns Hopkins University and chair of the Berman Institute’s national advisory board. (Cohn, 7/12)

The agency overseeing Oregon's legal medical marijuana industry conceded in a report Thursday it has not provided effective oversight of growers and others in the industry, creating opportunities for weed to be diverted to the black market. The blunt internal review echoes complaints from federal authorities that Oregon hasn't adequately controlled its marijuana businesses, and that overproduction of pot is feeding a black market in states that haven't legalized it. (7/12)

Advocate Aurora Health and Foxconn Health Technology Business Group plan to work together to develop new services and products for health care. The two organizations — one the 10th largest nonprofit health system in the country, the other one of the world’s largest technology companies — envision collaborating in areas such as managing the health of employees, analytics and artificial intelligence. (Boulton, 7/12)

To date, the state Cannabis Control Commission has granted only five provisional licenses to two companies. ...More are expected to come down the line, but the process has been slow, frustrating marijuana proponents, as well as one legislator who is a key author of the state’s marijuana law. (Brown, 7/12)

The city’s public health director has announced he will retire later this summer after nearly three decades in the department. Manchester Public Health Director Tim Soucy said that after 28 years in the Manchester Health Department he feels “blessed to live, work and raise my family” in the Queen City. (Feely, 7/11)

City Councilor Bob Hamel is facing criticism for his remarks at a Monday night meeting during a prickly exchange with the head of the union that represents city firefighters. It is the height of budget season in Laconia, which has a tax cap in place, and the council and fire department have clashed in recent weeks over the cost of overtime for firefighters. The council had initially considered cutting up to $300,000 from the fire department’s $4.4 million budget but voted Monday to trim $150,000 instead. That money will be used to hire a school resource officer for the middle school and pay for park irrigation. (Lewis, 7/12)

School officials are voicing concern over a recent survey that indicates more than 20 percent of students feel they were bullied at school within the past year. According to the results of the 2017 Youth Risk Behavior Survey, more than 9 percent of students reported that they did not go to school in the last 30 days because they felt unsafe due to bullying, cyberbullying or fighting. In addition, 22 percent of students reported that they were bullied on school property or on the way to or from school in the past 12 months. “We crossed the line where our trend in our community is not where we want it to be,” superintendent Chip McGee said. “We moved from being a little better than state patterns to a little worse.” (Houghton, 7/11)

A Central Florida nonprofit is aiming to feed hungry University of Central Florida students through urban farming. Fleet Farming’s Greg Noonan says sites like the one at the University of Central Florida are offering local, organic produce. (Prieur, 7/12)

Consumers’ responses to mandates may be influenced by nonfinancial factors that are difficult to measure, including a desire to comply with the law, beliefs about enforcement, and inertia in decision-making. Under a range of scenarios that reflect alternative assumptions about responses to these factors, we find that enrollment falls by 2.8 million to 13 million people and premiums for bronze plans increase by 3 percent to 13 percent when the mandate penalty is removed. The impact on the federal budget deficit is more uncertain, with effects ranging from a reduction of $8 billion to an increase of $3.6 billion in 2020. The effect on the deficit depends on how enrollees who are eligible for tax credits and Medicaid — those who have little financial reason to drop coverage — respond to the penalty’s elimination. (Eibner and Nowak, 7/11)

Social determinants of health can be related to health care spending, and they often reflect material hardships people face. However, research on the relationship between specific hardships and medical care utilization across the US adult population is limited. Using 2010–11 data from the Survey of Income and Program Participation (SIPP), we study three specific hardships—food insecurity, housing insecurity, and housing quality—and their relationship to annual medical care utilization and out-of-pocket spending. Adults who faced housing quality hardships had higher utilization and spending (14.9 percent more provider visits and 16.9 percent higher out-of-pocket spending), as did adults who faced housing insecurity (22.1 percent more provider visits and 28.5 percent higher out-of-pocket spending). We find less evidence of a relationship between food insecurity and medical care utilization, especially after accounting for the presence of multiple hardships. (Caswell and Zuckerman, 6/27)

One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015—also known as Medigap—to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries’ access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period. (Boccuti, 7/11)

Although rates of lower extremity amputations among US patients with ESRD who receive dialysis decreased by 51% during a recent 15-year period, mortality rates remained high, with nearly half of patients dying within a year after lower extremity amputation. Our results highlight the need for more research on ways to prevent lower extremity amputation in this extremely high-risk population. (Franz et al, 7/9)

With the nomination of Judge Brett Kavanaugh to the Supreme Court, President Donald Trump has now engaged all three branches of government in his fight to get rid of the Affordable Care Act and protections for people with pre-existing health conditions. Kavanaugh made clear last year in a speech at the Heritage Foundation that he thinks the court was wrong to uphold the ACA's insurance mandate as constitutional. He has also said a president should be allowed to not enforce components of a law if he personally deems it unconstitutional (encouragement this president doesn’t need). There couldn’t be a more in-your-face threat to the ACA than from a Justice Kavanaugh. (Andy Slavitt, 7/13)

As ThinkProgress’s Ian Millhiser explains, last year Kavanaugh gave a speech to the American Enterprise Institute praising William Rehnquist’s dissent in Roe v. Wade and Rehnquist’s insistence that the Constitution does not imply a right to abortion. This is hardly an unusual view — Roe relied on an earlier case finding that the Constitution contains an implied though not explicit right to privacy — but it does remove a good measure of doubt about Kavanaugh’s beliefs. And in the one case concerning abortion he dealt with as an appeals court judge, he charted a path that would have adhered to the letter of Roe (as he had no choice but to do) but would also have circumvented its protections for the plaintiff and likely allowed the government to prevent her from getting the abortion she needed. But this is all a kind of game. We all know that one way or another, Kavanaugh is going to be a vote to take away women’s right to choose. To pretend otherwise is to be willfully obtuse. (Paul Waldman, 7/12)

If Atul Gawande’s first week as CEO of a health care startup was anything like mine, I hope he is able to get away from it all and enjoy a completely relaxing weekend. He will have earned it. After Gawande was named to head the joint venture between Amazon, Berkshire Hathaway, and JPMorgan, some critics said that choosing a physician was a mistake. I disagree — a physician is exactly what this new company needs. Health care in America is at a crossroads. Our success in navigating the many challenges ahead will depend heavily on who is leading the charge. (Alexi Nazem, 7/13)

The federal court decision on Kentucky's Medicaid waiver may be more sweeping than has been recognized — because it shows how any state proposal to impose work requirements, or make other changes that reduce coverage, could be immediately vulnerable to legal challenges. The bottom line: The DC District Court shot down the Kentucky waiver, including its work requirements, because the Health and Human Services secretary did not address the likelihood that it would cause people to lose their health coverage. And whether you are for them or against them, all work requirement programs will cause some coverage losses. (Drew Altman, 7/13)

The text messages that begin arriving on June 28 end my ordinary life. “Where does your husband work?” “What’s happening in Annapolis?” “Have you seen the news?” My husband, John McNamara, is a reporter for the Capital Gazette. I am at my office, a government agency just outside Washington.I Google. Then I close my laptop and run toward the parking lot. (Andrea Chamblee, 7/13)

With all of these different approaches available, why focus on naloxone? Critics note that a number of the people treated with the drug will still die within a year, because the underlying problem isn’t addressed. This is true — but ignores the obvious fact that saving some is better than saving none. (Brenden Layte, 7/13)

When my grandfather was a private practice pediatrician in Queens, making house calls in exchange for eggs and hand-knitted hats, medical communications were often between one doctor and his or her patient (or parent). As a primary care provider to adults with opioid use disorder, I need to communicate with many other clinicians. Privacy rules can thwart me from doing that. (Melissa Stein, 7/13)

Marijuana has since risen into prominence as the new cigarette of choice, as folks refuse to believe that weed is harmful. Sound familiar? Too many people were serving time in prisons who were otherwise not criminals — sad but true. We began seeing casual scenes in motion pictures where kids and adults used pot routinely, much like cigarettes of yore. More and more, celebrities promoted pot as not only harmless; it was useful in the treatment of numerous diseases. (Marshall Frank, 7/12)

On June 8, we lost a rare, great man. Anthony Bourdain was a lightning rod of cultural connectivity. He brought disparate, marginalized people together and made the unknown accessible — some of the many gifts that made Anthony such a valuable presence in our collective lives, whether we knew him or not. An unwavering supporter of women and the #MeToo movement, Bourdain’s loss was a tragedy on so many levels, to so many people who saw him as a beacon of a new way of being. We share that grief and deepest sadness for his family and those closest to him whose pain must be unimaginable. One of the most vocal and unwavering figures in the #MeToo movement has been Asia Argento. At the center of our community, Asia has stood, her fist in the air, fighting daily not just for justice for those of us she has come to know, but for abused people the world over. Asia has now found herself on the receiving end of vicious cyberbullying and repulsive slander at the hands of internet trolls who hold her responsible for Anthony’s death. She has been accused of everything from causing her boyfriend’s suicide to trying to use her “survivor status” and the #MeToo movement to advance her career. (7/12)

The so-called Goldwater rule, an ethical guideline that prohibits diagnosing public figures without a personal examination, started with an unremarkable history. Based on one lawsuit and already considered outdated by the time it entered the books in 1973, scholars largely ignored it. Many psychiatrists had not even heard of it, and those who pondered it considered changing it to simple etiquette. Then came the turbulent presidency of Donald Trump. We have a president with questionable decisional capacity who attended a summit with North Korea, a hostile nuclear power, unprepared and unaware of his deficiencies. He woke up one morning and decided to launch a trade war. He just threatened to quit NATO. Now he's about to meet with Russian President Vladimir Putin, who attacked our 2016 elections. Nominating a Supreme Court justice, or deciding to hold summits with rivals and enemies, are political decisions that presuppose certain basic mental capacities. Are we certain Trump possesses them? Some of the most renowned psychiatrists in the country have their doubts. (Bandy X. Lee, 7/13)

A thistle to UnitedHealthcare, one of Iowa’s private Medicaid insurers, for its dedication to slashing in-home care for a disabled man — again. (And a jab to Gov. Kim Reynolds for continuing to support the disastrous privatization of this state’s health insurance program for 600,000 low-income and vulnerable Iowans). Jamie Campbell, who is paralyzed after breaking his neck in a high school wrestling accident 29 years ago, lives at home with daily assistance from aides paid by Medicaid. After United tried last year to drastically reduce the amount of in-home care he could receive, Campbell appealed to an administrative law judge who ruled in his favor and ordered the insurer to continue covering the amount of care he had received before. (7/12)

Reasonable Texans can disagree on abortion policy. But generally, we agree that government should be free of waste, incompetence and anything smelling of financial shenanigans.So, the revelation that a statewide elected official helped dole out hundreds of thousands of taxpayer dollars to unqualified consultants is cause for concern. The fact that the elected official is already under indictment for security’s fraud is cause for alarm. (7/12)