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The federal government cheered the 2016 open-enrollment period as more than 12.7 million Americans signed up for health insurance, but a closer look at the data reveals that many individual counties recorded precipitous annual declines in plan selections. That's not entirely worrisome news though, because people may have picked up health insurance from Medicaid, employers or other sources. Those numbers also show how closely linked state Medicaid programs and the Affordable Care Act's individual marketplaces are, given that many exchange enrollees are low income. (Herman, 6/2)

Most insurers are not discussing exiting ObamaCare marketplaces and some could in fact could grow their participation, according to a new analysis. The Commonwealth Fund reviewed insurer earnings calls to get a broader picture of experiences on the healthcare marketplaces, after the attention given to United Healthcare dropping out of many states. The analysis found that only one other insurer, Humana, explicitly said it is considering exiting ObamaCare marketplaces in 2017. (Sullivan, 6/2)

Mental health care ranks among the most expensive kinds of health care in American medicine—and having a mental illness or behavioral disorder can drive up costs for other kinds of care. But new research suggests that the Affordable Care Act has helped young people with mental illnesses afford health care—especially young blacks and Latinos. (Mack, 6/2)

Blue Cross and Blue Shield of North Carolina sued the federal government, becoming the latest health insurer to claim it is owed money under the Affordable Care Act. The suit, filed on Thursday in the U.S. Court of Federal Claims in Washington, D.C., says the U.S. failed to live up to obligation to pay the insurer more than $147 million owed under an ACA program known as “risk corridors,” which aimed to limit the financial risks borne by insurers entering the new health-law markets. (Wilde Mathews, 6/2)

Insurance companies participating in Delaware’s health insurance exchange under the Affordable Care Act are seeking average rate increases of about 24 percent or more for next year, state officials revealed Thursday in acknowledging the potential sticker shock for consumers. In a rate filing with the Delaware Department of Insurance, Highmark Blue Cross Blue Shield of Delaware is asking for an average rate increase of 32.5 percent for individual plans. Rate increases would vary by plan and would range from 24.1 percent to 35.8 percent. (Chase, 6/2)

The state Senate on Thursday sent Gov. Jerry Brown a measure that would ask for federal approval to allow immigrants in the country illegally to purchase their own health insurance through the Covered California exchange. State Sen. Ricardo Lara (D-Bell Gardens) said his bill may lead to an estimated 390,000 immigrants who earn an income too high to qualify for Medi-Cal to fully pay for healthcare coverage through the state exchange under the Affordable Care Act. (McGreevy, 6/2)

Illegal immigrants would be allowed to purchase health insurance for themselves and their families through California's state-run marketplace under legislation that passed both houses of the Legislature this week with bipartisan support. (Calefati, 6/2)

The Justice Department announced on Thursday that Donald B. Verrilli Jr., who won historic Supreme Court rulings for the Obama administration on its signature health care law and on same-sex marriage, would be stepping down as the nation’s top appellate lawyer. Mr. Verrilli, 58, has been the solicitor general for five years, arguing the administration’s position before the justices during an unusual wave of contentious cases that drew attention far outside the legal world. (Lichtblau, 6/2)

The top Justice Department official who defended the president's health care law at the Supreme Court is leaving his job. Solicitor General Donald Verrilli Jr. is ending his five-year tenure as the administration's chief lawyer at the high court, President Barack Obama said in a statement Thursday. "Thanks to his efforts, 20 million more Americans now know the security of quality, affordable health care," Obama said. (6/2)

Verrilli, the 46th solicitor general, had served as the country’s top appellate lawyer and advocate before the Supreme Court since 2011. He took over for Elena Kagan after her appointment as a justice. The 58-year-old spearheaded a number of high-profile cases, notably defending the Affordable Care Act in the King v. Burwell case and winning over a majority of the justices in Obergefell v. Hodges that the 14th Amendment required that same-sex marriages be recognized across the country. He had earlier won a case declaring unconstitutional a federal law defining marriage as between a man and a woman. (Zapotosky and Barnes, 6/2)

"Thanks to his efforts, 20 million more Americans now know the security of quality, affordable health care; we’re combatting discrimination so that more women and minorities can own their piece of the American Dream; we’ve reaffirmed our commitment to ensuring that immigrants are treated fairly; and our children will now grow up in a country where everyone has the freedom to marry the person they love," Obama said in the statement. (6/2)

Donald Trump says the Obama administration plans to keep consumers in the dark about premium increases for 2017 under the president's health care law — for political reasons. But the administration says next year's sign-up season is going forward on schedule, and insurers say they've seen no indication of a delay. "The numbers are coming out, right now, the numbers are scheduled to come out on November 1. The increases are going to be so large that everybody is going to vote for Donald Trump. It's a catastrophe," the presumptive Republican nominee for president, said Wednesday at a rally in Sacramento. (6/3)

Rep. Renee Ellmers may become only the second incumbent House member to lose a primary in this election cycle, owing to a rift with social conservatives that traces back to the Republican House member’s one-time opposition to the 20-week abortion ban. (Haberkorn, 6/2)

Prince, the music icon who struggled with debilitating hip pain during his career, died from an accidental overdose of self-administered fentanyl, a type of synthetic opiate, officials in Minnesota said Thursday. The news ended weeks of speculation about the sudden death of the musician, who had a reputation for clean living but who appears to have developed a dependency on medications to treat his pain. Authorities have yet to discuss how he came to be in possession of the fentanyl and whether it had been prescribed by a doctor. (Eligon and Kovaleski, 6/2)

A medical examiner's report released Thursday said Prince Rogers Nelson died of "fentanyl toxicity." The superstar's April death was an accident, the report said; the drug had been self-administered. Fentanyl is an opioid drug used to treat severe pain. It's more powerful than morphine, and often comes in the form of a skin patch or injection. Its role in Prince's death puts the musician's story at the center of an epidemic that has claimed tens of thousands of lives each year in the United States. (Collins, 6/3)

Whether Prince knew he was taking fentanyl is unclear. An attorney who previously represented two of Prince’s siblings has said that the musician had used Percocet and cocaine in the past. “Most of the people we’re seeing are dying unsuspecting that they used fentanyl,” said Traci Green, deputy director of the Boston Medical Center Injury Prevention Center. Because the drug “is extremely fast-acting, [Prince] probably died quickly,” she said. “There’s not a lot of time to intervene to reverse that.” (Maher and Campo-Flores, 6/2)

Kent Bailey, head of the DEA in Minneapolis, said the agency will continue investigating along with Carver County authorities and the U.S. Attorney’s Office. He declined to offer details, but said “rest assured, we will be thorough.” Legal experts say the focus of the investigation will now probably turn to whether the source or sources of the fentanyl were legal or not. Often, such investigations include grand jury subpoenas for records or for testimony from individuals. (Tarm and Forliti, 6/3)

Prince's death earlier this year was the result of an overdose of opioids, the Associated Press reported on Thursday, citing a law enforcement official. Now confirmed by the medical examiner, Prince has just become a key example of a problem that has spiked in recent years — and that has become a key undercurrent in American politics. The most recent annual data on opioid overdoses comes from 2014 by way of the Centers for Disease Control and Prevention. At the end of 2015, the CDC released figures for that year and the trend back to 1999. Sixty-one percent of drug-overdose deaths in 2014 involved some sort of opioid, including heroin. The recent uptick in heroin overdoses is obvious, but the longer-term growth of opioid deaths is also visible. (Bump, 6/2)

Prince's death from an overdose of the powerful opioid fentanyl is another example of the national opioid epidemic driven by prescription painkillers. "This was a man in his 50s who may have been struggling with pain and took a very potent opioid analgesic and died accidentally from an overdose," said Dr. Barbarajean Magnani, pathologist-in-chief at Tufts Medical Center who read a one-page autopsy report released Thursday. "Celebrities bring it to our attention, but we see this every day. We have to re-examine the way we're treating pain." (6/3)

Minnesota officials reported on Thursday that Prince died in April of an overdose of the opiate fentanyl. The authorities have not revealed how the musician obtained the drug or whether a doctor had prescribed it. But it has been reported that he had hip surgery in the mid-2000s and may have still been in pain. Fentanyl has become a source of concern for government agencies and law enforcement officials as death rates from fentanyl-related overdoses and seizures of the drug have risen in several states. Here’s what we know about the drug. (Browich, 6/2)

Fentanyl was first introduced under the name Sublimaze in the 1960s, and was initially administered via an intravenous anesthetic. Nowadays, patients can get a fentanyl dosage via tablets, patches, and injections -- or even lozenges referred to as “lollipops.” The drug is often prescribed for patients dealing with chronic pain from late-stage cancer, and is also used as an anesthetic during heart surgery. (Ng, 6/2)

Prince is the latest victim of the opioid epidemic. The singer accidentally overdosed on the powerful painkiller fentanyl, according to autopsy results released Thursday. (6/2)

Dr. James Gill walked through the morgue in Farmington, Connecticut, recently, past the dock where the bodies come in, past the tissue donations area, and stopped outside the autopsy room. "We kind of have a typical board listing all of the decedents for the day," Gill said, pointing to the list of names on a dry erase board. "Overdose, overdose, overdose, overdose overdose. That's just for today." Gill is the chief medical examiner for the state of Connecticut, and of the nine bodies in his custody that day, four were the remains of the people who likely died from an accidental drug overdose. A fifth was a probable suicide involving drugs. It was a sad, but typical day, he explained, with a practical consequence for the state's morgue: Gill is running out of room to store bodies. (Cohen, 6/3)

Senate Democrats will try to force a vote next week on nearly $2 billion to bolster the national response to the Zika virus. Senate Minority Leader Harry Reid (D-Nev.) said at a press conference Thursday he will dig in on Zika funding as GOP leaders in both chambers work on hammering out a compromise. “We’re going to push forward next week and force the Republicans to vote again against full funding for Zika virus,” Reid said. (Ferris, 6/2)

Scientists raised the possibility that the Zika virus can be transmitted by oral sex — perhaps even by kissing — on Friday in a letter to The New England Journal of Medicine describing one such case in France. A single incident may seem trivial. But until early this year, there was only one known instance of sexual transmission of the Zika virus — a 2008 case in which a mosquito researcher just back from Africa infected his wife in Colorado. (McNeil, 6/2)

Surgeon General Dr. Vivek Murthy is, arguably, the most powerful physician in the United States. The 38-year-old Harvard-trained doctor is a year-and-a-half into a four-year term as the face of public health in the United States. He’s made emotional well-being, walkable communities, and preventive care a priority. Later this fall, he’ll release the first-ever Surgeon General’s Report on substance abuse. (6/3)

American cyclist Tejay van Garderen understands the chances that he might contract the Zika virus at the Rio Olympics are minimal, and that precautions could be taken to further reduce the threat. With a pregnant wife at home, not even the smallest risk was worth it. Van Garderen withdrew his name from consideration for the road cycling team Thursday, making him perhaps the first athlete to back out of the Summer Games because of the mosquito-borne illness blamed for causing birth defects including microcephaly, in which the baby's brain does not develop properly. (6/2)

More rain is coming, and so are more mosquitoes. As parts of South and Southeast Texas enter peak season for Aedes aegypti, the species of mosquito apparently posing the greatest risk for transmitting the Zika virus, state health officials are ramping up a public awareness campaign urging people to protect themselves from insect bites. (Walters, 6/3)

Florida health officials confirmed three new Zika infections on Thursday, including one case in Miami-Dade and two in Broward, raising the statewide total to 165 people who have contracted the virus this year. As summer arrives, and Florida Gov. Rick Scott appealed to President Obama for help combating Zika, federal officials announced a new source of assistance for states: Medicaid dollars are available to prevent, detect and respond to the virus. (Chang, 6/2)

The persistent cough started when Rebecca Hiles was 16. She was an active high school senior, though, at 180 pounds, overweight for her height. She was diagnosed with airway irritation, given medicine, and advised to lose weight. But she was unprepared for how much those extra pounds would dog her over the course of the next seven years — overshadowing her doctors’ visits while a tumor grew undetected in her lung. (Adaeze Okewerekwu, 6/3)

Access to mental health care in the U.S. may vary by race and class because of biases on the part of psychotherapists, a new study suggests. Based on calls to hundreds of therapists, the study found that middle class patients had an easier time than their working class counterparts getting an appointment, but among middle class callers, blacks were less likely to be offered an appointment than whites. (6/2)

Strain on family caregivers is alarming many lawmakers and social-service providers. They are pushing for new ways to assist the vast unpaid workforce of people who are crucial in part because they allow more seniors to age in place and reduce reliance on public subsidies such as Medicaid, a major funder of institutional health care for older Americans. “Families have always been the backbone of our system for caring for people,” said Kathy Greenlee, the assistant secretary for aging at the U.S. Department of Health and Human Services. “Really, if we didn’t have them, we couldn’t afford as a country to monetize their care and we couldn’t replace, frankly, the love they provide to family members.” (Levitz, 6/3)

The latest public health scare involving a Colorado surgical technician has revealed states have more work ahead in trying to prevent needle-stealing hospital workers from getting hired. Authorities say an HIV-positive surgical tech stole syringes with fentanyl and endangered patients at a suburban Denver hospital - the third incident of this type in the state in less than a decade. Colorado lawmakers are trying to tighten regulations but experts say it is a national concern. (6/3)

Although they account for half of all new sexually transmitted infections, most young people between the ages of 15 and 25 have never been tested for those infections, according to a study published in the May issue of the Journal of Adolescent Health. The 2013 survey of 3,953 adolescents and young adults by researchers at the federal Centers for Disease Control and Prevention found that 11.5 percent had been tested for a sexually transmitted infection in the previous year, including 17 percent of females and 6 percent of males. (Andrews, 6/3)

A group of scientists say they want work toward being able to create a synthetic version of the entire human genetic code in the laboratory. Their hope is that a complete set of synthetic human DNA, known as a genome, could someday lead to important medical breakthroughs. "We just had a revolution in our ability to read genomes," says George Church, a geneticist at Harvard University who is part of the group that outlined the plan Thursday in the journal Science. "The same thing is happening now with writing genomes." (Stein, 6/2)

Spectrum Health is one of eight centers in the U.S. participating in the clinical trial, which uses a device called the organ care system that keeps a heart beating after being removed, lengthening the time it can remain outside the body. “It gets put in the device and the device allows it to be infused with warm oxygenated blood and beating, so it's beating almost the entire time it's out of the one body and into the other," said Dr. Theodora Boeve. She is in charge of the team that monitors the heart while enroute for transplant. (Lego, 6/2)

When [Derek] Scott returned to the emergency room two weeks later, again short of breath, he was enrolled in a study assessing the effectiveness of a new home monitoring program overseen by Dr. Mauro Moscucci, medical director of the LifeBridge Health Cardiovascular Institute and chairman of Sinai's department of medicine. Not one of the 15 patients enrolled in the study has returned to the hospital this year, which is a relief to patients and to Sinai, as hospitals are penalized financially by federal and state regulators for unnecessary readmissions. Moscucci said 15 percent to 20 percent usually would be readmitted during that time span. (Cohn, 6/3)

The chairwoman of a special House committee investigating links between abortion clinics and medical researchers is accusing a firm that transfers fetal tissue between the two of violating federal privacy laws and ethics regulations. Rep. Marsha Blackburn (R-Tenn.), who leads the select investigative panel established last year, alleges that California-based StemExpress engaged in “systematic violations” of federal health privacy laws and accuses it of “fraudulently using invalid consent forms” in its dealings with Planned Parenthood abortion clinics. (DeBonis, 6/2)

Lawmakers are considering adding a mental health reform bill to the work of a conference committee focused on opioid legislation, according to congressional aides. The idea is to add a mental health bill from Sens. Bill Cassidy (R-La.) and Chris Murphy (D-Conn.) to the product coming out of the conference committee that is reconciling the differences between House and Senate bills on the opioid crisis. (Sullivan, 6/2)

The Justice Department is siding with a legal argument by a fired Department of Veterans Affairs official at the center of a nationwide scandal over long wait times for veterans seeking medical care and secret lists covering up the delays. Sharon Helman, the former director of the Phoenix VA Health Care System, is suing the VA to win back her old job. Helman argues in court papers that a key portion of a 2014 law passed in response to the wait-time scandal is unconstitutional and denies her an important step to appeal her firing. (6/2)

Lawmakers are fuming over what they describe as a "shameful" decision by the Justice Department that could help the former head of the scandal-scarred Phoenix Veterans Affairs hospital get her job back. Attorney General Loretta Lynch, in a letter sent Tuesday, notified House Majority Leader Kevin McCarthy, R-Calif., that the DOJ would not defend a key provision of the Veteran Affairs reform law, passed in the wake of the scandal over officials covering up long patient wait-times. (6/2)

A proposal to expand nurses' scope of practice at Veterans Affairs facilities will likely draw even more medical professionals to a sector that is already the largest employer of nurses in the country. The rule-making, released last week and meant to address long wait times for veterans seeking healthcare, comes at a time when hospitals and medical groups, including the VA, around the country struggle with a nursing shortage. That's led some to question whether there are enough nurses to actually make a difference. (Dickson, 6/2)

Abortion clinic owners on Thursday filed a challenge to two new Alabama abortion restrictions, one banning clinics near schools and another banning a common second-trimester abortion procedure. The complaint filed by American Civil Liberties Union in Montgomery federal court said the school location restriction would close two abortion clinics that perform more than half of the abortions in the state, and the procedure ban would severely curtail second-trimester abortion access throughout Alabama. (6/2)

Opponents and supporters of abortion rights engaged in heated debate Thursday (June 2) that stretched from the Capitol to the Governor's Mansion over the constitutionality of abortion regulations offered in the legislative session. Supporters of Planned Parenthood and abortion rights warned in a demonstration in front of the governor's residence that Louisiana will be on the hook for millions of dollars in legal fees defending bills passed by legislators. (Litten, 6/2)

A Northern Virginia clinic whose license to perform abortions was suspended in April after a Department of Health inspection that found more than two dozen deficiencies has not sought reinstatement and remains under suspension, officials said Thursday. (Nolan, 6/2)

Some patients and high-ranking officials at the National Institutes of Health are urging Director Francis S. Collins to reconsider his planned demotion of top leaders at the agency’s flagship hospital, contending that blame for safety problems identified by an outside panel has been misplaced. In a letter to Collins on Thursday, an advisory group of hospital patients asked him to rethink his plan to replace the Clinical Center’s current leaders with three new executives and a structure similar to the one at most hospitals. (Bernstein, 6/2)

Pasadena’s Huntington Hospital broke state law by not quickly reporting a suspected deadly outbreak last year, according to a letter by city officials. The hospital released the letter this week, as well as the results of the city’s investigation into the outbreak caused by dirty scopes, which sickened 16 patients, including 11 who died. City health officials did not investigate the cause of the patients’ deaths, many of whom were seriously ill. The officials noted in the report that only one patient’s death certificate listed as a cause the dangerous drug-resistant bacteria that contaminated the scopes and sickened the patients. (Petersen, 6/2)

Terry Petrovich asked her oncologist point blank: “Am I going to count on you to help me achieve a good death?” To her relief, he told her he would have no problem prescribing a lethal dose of drugs under California’s new law allowing such prescriptions for the terminally ill. But many in California’s medical community are grappling with the law that goes into effect June 9. Some physicians have told their patients they are not willing to play a role in intentionally ending a person’s life. (Watson, 6/3)

California's new law allowing life-ending drugs for the terminally ill has the strictest requirements of any of the five states that permit such prescriptions. Many physicians say they are nervous about prescribing lethal doses of drugs for the terminally ill. The law in the nation's most populous state took decades to pass and goes into effect June 9. There are concerns it will lead to hasty decisions, misdiagnosis, and even waning support by insurers for palliative care, in which dying people can be sedated to relieve their suffering. (Watson, 6/3)

Legislation before state lawmakers in New York would significantly change medical malpractice law by allowing patients to sue years after an alleged misdiagnosis or mistreatment. (Klepper, 6/2)

A consumer group says Gov. Dannel P. Malloy should avoid “going back to the days of Corrupticut” and replace Insurance Commissioner Kathleen Wade as the key state regulator on a proposed mega-merger between Anthem and Cigna insurance companies. (Radelat, 6/2)

In this rural town, the forces of poverty and addiction drove a needle-sharing drug problem that caused the first-known HIV outbreak related to the current opioid crisis in America. Now, as Austin struggles to recover from its outbreak last year, the Centers for Disease Control and Prevention has identified 220 counties across the U.S. where similar conditions create vulnerability to eruptions of HIV and hepatitis C. (Campo-Flores and McKay, 6/2)

Public-health officials reported that two more detainees at an Eloy immigration-detention center have confirmed cases of measles, bringing the total to 13 cases tied to the facility in Pinal County. (Alltucker, 6/2)

Within months of starting the process of adopting her son, Susan Callahan knew something was wrong. Aron, who was 7, had trouble communicating and started getting violent at home and school, trying to hit his mother and teachers. Callahan took him to a psychiatrist, where he was diagnosed with a range of conditions, including post-traumatic stress disorder and developmental disabilities. Desperate, his parents sought help from the state. But when Aron finally found adequate care nearly a decade later, it was not in Hawaii but more than 3,000 miles away, at a specialized facility in Kansas. (Starleaf Riker, 6/2)

A family medicine physician in Franklin declared Tuesday in a blog post that his practice will no longer administer vaccines because of what he calls questionable safety. An eight-point blog post on the website of Cool Springs Family Medicine lays out Dr. Daniel Kalb's concerns about vaccinations and autism, the safety of Gardisil, a vaccine against human papilloma virus, and ingredients in vaccines. ... The U.S. Centers for Disease Control and Prevention has said that vaccinations do not cause autism. (Fletcher, 6/2)

In 2010, there were nearly 219,000 adults age 65 and over in the nine-county Kansas City metropolitan area. That was 11.4 percent of the population. By 2030, the area’s 65-plus population is projected to grow to more than 416,000 people, or nearly 18 percent of the population. (Margolies 6/2)

A Shakespearean actress from West Philadelphia, represented by a major national law firm, has filed a class-action suit claiming the city put her family - and tens of thousands of other Philadelphians - at a "significantly greater risk" for lead poisoning. Eleni Delopoulos, 37, who lives with her 2-year-old son and husband, filed suit Thursday in Philadelphia Court of Common Pleas. The suit contends the city has been aware of high levels of lead in the tap water for years and failed to warn residents of contamination. (Wood, 6/3)

Sixteen months after her arrest, Katie Darovitz — one of at least 500 women prosecuted under Alabama’s toughest-in-the-nation chemical endangerment law — has had her case dismissed. ... Though Darovitz’s case is unusual in some of its details, in other ways it is typical of the cases ProPublica and AL.com examined. Like Darovitz, 20 percent of mothers charged with chemical endangerment used marijuana only; like Darovitz, about a quarter had no prior criminal record. And like Darovitz, many of the mothers were turned over by hospitals, which sometimes conducted drug tests without mothers’ knowledge or consent. (Martin, 6/2)

Aaron Dimler was on his way. The captain of his football team at Roseville High School, he had a job, a long-term girlfriend and a scholarship worth $240,000 to study and play football at Macalester. Then he started taking Xanax. (Shipley 6/2)

Nearly 5,800 Massachusetts patients certified to use medical marijuana are in limbo after state officials suspended the professional license of the doctor who authorized their use of the drug. (Lazar and Freyer, 6/3)

We conducted a cross-sectional survey and review of websites of 95 national/international medical organizations that produced 290 clinical practice guidelines ... In all, 63% (60/95) of organizations producing clinical practice guidelines reported receiving funds from a biomedical company; 80% (76/95) of organizations reported having a policy for managing conflicts of interest. ... Among all guidelines, 6% (18/290) disclosed direct funding by biomedical companies, 40% (117/290) disclosed financial relationships between committee members and biomedical companies (38% of guideline committee members, 773/2,043), and 1% (4/290) disclosed financial relationships between the organizations producing the guidelines and biomedical companies. (Campsall et al., 5/31)

A weak antibiotic pipeline and the increase in drug-resistant pathogens have led to calls for more new antibiotics. Eight new antibiotics were approved by the U.S. Food and Drug Administration (FDA) between January 2010 and December 2015 .... This study evaluates the development course and pivotal trials of these antibiotics for their innovativeness, development process, documented patient outcomes, and cost. ... Seven had similar mechanisms of action to those of previously approved drugs. ... The drugs spent a median of 6.2 years in clinical trials ... and 8 months in FDA review .... Seven of the drugs are substantially more expensive than their trial comparators. ... Recently marketed antibiotics are more expensive but have been approved without evidence of clinical superiority. (Deak et al., 5/31)

This brief provides an overview of initiatives to connect the justice-involved population to Medicaid coverage and care in three states—Arizona, Connecticut, and Massachusetts. These states are leading efforts in these areas and provide key lessons about how to coordinate across health care and corrections and the potential of such initiatives to better link individuals to physical and behavioral health services. ... Each of the case study states is connecting individuals to Medicaid coverage at multiple points within the justice system. ... The study states also connect individuals to health care in the community as they are released from jail or prison. ... effects on criminal justice outcomes have not been measured. (Ryan et al., 6/1)

The [Affordable Care Act] established PCORI [the Patient-Centered Outcomes Research Institute] with a clear mandate to carry out the “funding of comparative clinical effectiveness research” over 10 years. PCORI was to focus distinctly on CER [comparative effectiveness research] and not duplicate the types of research funded by the Agency for Healthcare Research and Quality, the National Institutes of Health, or other entities. However, a Center for American Progress analysis in 2014 found that only one-third of PCORI’s funding was going toward CER. (Emanuel, Spiro and Huelskoetter, 5/31)

Clinical trials that are embedded into usual care have the potential to yield outcomes of great relevance to the institutions where they are performed and at the same time to yield information that may be generalizable to the health care system at large. In this article, we review four clinical trials that were conducted in three health care systems using their extant electronic health record (EHR) systems. We find that EHR-based clinical trials are feasible but pose limitations on the questions that can be addressed, the processes that can be implemented, and the outcomes that can be assessed. We think that the current requirements for ethics review should be reconsidered for such trials, in which the risk for participants that can be attributed to research is low. (Fiore and Lavori, 6/2)

State Medicaid programs are under increasing pressure to contain pharmaceutical spending. Many states have attempted to limit spending through greater Medicaid managed care penetration, which rose nationally from 54.5% in 1999 to 74.9% in 2011. It is not clear how this expansion has affected beneficiaries with serious mental illness .... Our cross-sectional analyses suggested that carve-out states with greater managed care penetration spend significantly less per enrollee on pharmaceuticals for the treatment of mental disorders: our panel data analyses did not generate statistically meaningful results. (Schwartz et al., 5/17)

Pediatricians rarely receive training in gender-affirming health care, and as a result, few transgender youths who are eligible for such healthcare actually receive it, experts say. (Seaman, 5/31)

When cigarette smokers quit, societal healthcare costs immediately plunge, a new study shows. If 10 percent of American smokers gave up cigarettes and the rest cut back by 10 percent, the U.S. could shave $63 billion off medical costs the next year, the analysis found. (Cohen, 5/27)

A study released Tuesday shows that the rate of Texans without insurance has dropped to its lowest point since the late 1990s because of the Affordable Care Act, Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation reported. Prior to the implementation of the ACA in September 2013, the uninsured rate in Texas was about 26 percent - more than one in four. By this March, that rate had dropped to about 18 percent, the study said. Researchers found declines in every age group, ethnic and racial demographic, and across income levels. Texans between the ages of 50 and 64 showed the steepest decline, dropping to 10 percent from 21 percent during that time period. (Deam, 5/31)

“Time after time, the president has chosen to ignore the will of the American people and re-write federal law on his own without a vote of Congress. That’s not the way our system of government was designed to work.” With these words, Speaker of the House John Boehner (R-OH) announced in late 2014 that the House of Representatives had filed a lawsuit challenging one of the major struts of the Affordable Care Act (ACA). The Obama administration, the House alleged, was illegally reimbursing health plans for reducing the out-of-pocket spending of their low-income enrollees. (Nicholas Bagley, 6/1)

The viability of health insurance exchanges established under the Affordable Care Act is in doubt. One important factor is the government's decision to allow noncompliant insurance plans to continue operating, which shrank the ACA's intended insurance risk pools. (John Hsu, 6/2)

You’d think if there’s one thing Congress could reach rapid bipartisan agreement on, it’s money to fight Zika. But no, not this Congress. Members fled Washington last week for their Memorial Day break without approving funding to fight the mosquito-borne virus, even as Thomas Frieden, director of the Centers for Disease Control and Prevention, warned that “speed is critical. A day, a week, a month can make all of the difference.” (5/31)

Rest assured. The Zika emergency response will be funded, and immediate needs are already being funded. The issue now is whether the funding will be paid for or irresponsibly added to the national credit card. That’s where Republicans disagree with Democrats and the administration. (Rep. Tom Cole, R-Okla., 5/31)

Without using the word endorse, House Speaker Paul Ryan announced in a newspaper op-ed Thursday that he will be voting for presumptive Republican presidential nominee Donald Trump in November. He said he feels confident that a President Trump would carry out the Republican policy agenda. Last month, I raised the question of whether Trump would follow the politically risky healthcare policy path Ryan has blazed on Medicare, Medicaid and other big issues. The House speaker apparently has concluded that he would. (Harris Meyer, 6/2)

Under the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Congress granted private Medicare Advantage health plans more money per Medicare beneficiary than it granted traditional, government-run Medicare. In other words, the per beneficiary cost paid by the US taxpayers was higher for those enrolled in the private plans than for those enrolled under the traditional, government-run Medicare program. (Uwe Reinhardt, 6/1)

The Affordable Care Act (ACA) aims to tie incentives to better health rather than more health care. Toward that end, by 2018 the Centers for Medicare and Medicaid Services (CMS) intends to link the majority of its reimbursement to value-based incentives. Recently, CMS announced the Medicare Part B Drug Payment Model,1 a national policy experiment to determine how alternative incentive structures affect physicians’ prescribing behavior. (Deborah Schrag, 6/2)

The benefits promise to be tremendous. The expansion is expected to provide health care to a total of 375,000 uninsured Louisiana residents, one-third of them in New Orleans. Under the expansion, families can make up to 138 percent of the poverty level. An estimated 70 percent of people who will be added to the Medicaid rolls are working but have no insurance through their jobs and can't afford to purchase it. (6/2)

The problems of opioid abuse – both prescription and illegal drugs – are well documented. But the solutions are not always simple, particularly when balancing the need to manage a patient’s pain with the addictive qualities of certain medications and the potential for abuse or even diversion. When prescribed and monitored appropriately, opioids offer much-needed relief. For years, physicians were emphatically urged to control their patients’ pain, measuring pain as “the fifth vital sign.” As a result, physicians tried to provide appropriate relief to mitigate their patients’ suffering. (Rhett Brown, 6/2)

For once, the headlines about the latest health scare are not hyperbole: The end of the Antibiotics Era may be nigh. Staving it off will require fast and creative thinking not only in medical science, but also in public policy. Public-health officials were horrified but not surprised to find a Pennsylvania woman who had an infection with the same kind of drug resistance first identified last fall on farms in China. The E. coli found in the woman carried the same genetic mechanism of resistance to colistin -- a last-resort antibiotic -- that was discovered in Chinese livestock that were routinely fed the drug. And this mechanism is easily spread from one bug to another. (6/2)

As the promise and the pitfalls of precision medicine gain increasing attention,1,2 enthusiasm about the field has been heightened by a rapid reduction in the cost of high-throughput genomic sequencing and a dramatic increase in the identification of potential molecular targets for therapy. Biomarker tests for molecularly targeted therapies can help physicians to select the most effective therapy for a patient’s condition and avoid treatments that could be ineffective or harmful. If precision medicine is to reach its potential, such biomarker tests will have to be developed in a timely fashion. (Gary H. Lyman and Harold L. Moses, 6/1)

Five years ago this month, the Food and Drug Administration released some striking images of the damage that smoking can do. These stark and disturbing pictures dominated the news cycle, as millions of Americans got a glimpse of the unvarnished truth. In one, healthy lungs were juxtaposed with blackened and diseased ones that had been poisoned by tobacco. Another photo zoomed in on a human mouth, the teeth stained and rotted, and the lower lip abscessed. Yet another showed a women wailing in pain from the deadly effects of secondhand smoking. The F.D.A.’s message to the public was that tobacco companies would soon be required to include such images on every pack of cigarettes. Kathleen Sebelius, the secretary of health and human services at the time, welcomed the move. (Joanna Cohen, 6/3)

Perceptions of hearing loss by health care professionals and society are often based on the notion that hearing loss is an inevitable and relatively inconsequential part of aging despite increasing evidence of the detrimental effect that hearing loss can have on cognitive, social, and physical functioning. In parallel, few adults with hearing loss understand the options and pathways for seeking hearing health care, and front-line health care professionals receive little training about how to screen, refer, or educate patients on hearing loss. ... Efforts to strengthen cross-disciplinary training of individuals in both the hearing sciences and public health (silos that historically have had little interaction) are needed to advance research at the interface of these fields and to support broad-based public information campaigns to educate consumers. (Frank R. Lin, William R. Hazzard and Dan G. Blazer, 6/2)

I have spent the past year of my life managing a chronic foot injury. My left foot started hurting after a run last May, and, well, it never really stopped. At best, the injury lies dormant for a few weeks, barely bothering me. At worst, it can cause intense pain to walk my dog down the block. So I've spent the past year in doctors' offices, in MRI scanners, and in late-night Google search sessions trying to understand what went wrong and how to fix it. (Sarah Kliff, 6/1)