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President Trump and House Republican leaders worked Thursday to win conservative support for legislation to repeal the Affordable Care Act, offering concessions to speed cutbacks in Medicaid and dismantle more of President Barack Obama’s signature health law. But in a bid to ensure passage of the Republican health care bill in the House, White House and Republican leaders risked losing support in more moderate quarters of their party — not only in the narrowly divided Senate, but in an increasingly nervous House. (Pear and Martin, 3/16)

President Trump, once the master pitchman for namesake vodka, steaks and now-moldering casinos, seems disinclined to attach his surname to the health care bill some allies have derided as “Ryancare.” He assured Americans on Thursday of the “improvements being made” to legislation that Speaker Paul D. Ryan initially suggested would scarcely change, amid grumblings that the White House is fuming over the plan’s star-crossed rollout. (Flegenheimer and Haberman, 3/17)

It’s a make-or-break moment in House Speaker Paul D. Ryan’s crusade to pass the GOP’s Obamacare replacement amid growing opposition from critics in his own party who see a chance to topple not only the bill but perhaps his young speakership as well. No other Republican has staked his political capital on passage of the House GOP plan to repeal and replace the Affordable Care Act as much as Ryan. (Mascaro, 3/17)

House Speaker Paul Ryan has told senior Republicans that he won’t change the main pillars of his plan to repeal and partially replace Obamacare, even as Republicans search for tweaks that can break their logjam over the legislation. With a steady trickle of Republicans coming out against the bill, Ryan is sending the message he won’t drop any of its four main elements -- refundable tax credits, health savings accounts, the phaseout of Medicaid expansion and the ban on insurers denying coverage over pre-existing conditions -- according to a senior Republican aide. (House, Edgerton and Kapur, 3/16)

Leaders of the three main factions in the House Republican Conference huddled Thursday with Speaker Paul Ryan (R-Wis.) to discuss possible changes to the healthcare bill as leaders work to secure enough votes for passage. No agreement was reached at the gathering, but participants described the discussions as productive. (Sullivan and Wong, 3/16)

Short of votes for their health care bill, Republican congressional leaders turned to President Donald Trump on Thursday to wrangle support for the divisive legislation they hope to push through Congress before Easter. But Trump sounded more like he was at the start of a negotiation than ready to close the deal. And combined with opposition from Republicans of all stripes, the president’s flexible stance suggested final passage of the bill could be delayed, potentially exposing the legislation to the same kind of extended public backlash that undermined former President Barack Obama’s Affordable Care Act from the start. (Werner and Fram, 3/16)

Pulling in different directions, Republicans are striving to get traction for a health care overhaul in danger of being dragged down by intra-party differences. Some GOP governors weighed in Thursday evening in a letter to congressional leaders saying the House bill gives them almost no new flexibility and lacks sufficient resources to protect the vulnerable. (3/17)

Republicans in Washington working to overhaul the Affordable Care Act say their strategy consists of “three buckets.” But it appears that all three may be leaking. (Rovner, 3/17)

One of the loudest critics of GOP health legislation is not a Democrat or even a conservative rebel, but a Republican loyalist and staunch defender of President Donald Trump. Freshman Sen. Tom Cotton of Arkansas is not known for clashing with leadership or plotting with conservative trouble-makers in the House, as Sens. Rand Paul of Kentucky and Ted Cruz of Texas are wont to do. Instead the 39-year-old Iraq and Afghanistan combat veteran, the nation's youngest senator, has carved out a hawkish and bold profile on foreign policy that many see as a platform for a future presidential run. (3/17)

Sen. Susan Collins (R-Maine), a key centrist vote in the Senate, said in an interview published Thursday that she opposes the House GOP ObamaCare replacement bill as it is currently written...Collins pointed to the Congressional Budget Office’s analysis of the bill earlier this week, which found that 24 million more people would be uninsured by 2026 under the plan. In particular, like other more centrist lawmakers in both chambers, Collins pointed to the finding that low-income people and seniors would have to pay far more for insurance under the House GOP bill than under ObamaCare. (Sullivan, 3/16)

Sen. Susan Collins on Thursday said she couldn’t back the House GOP’s Obamacare repeal-and-replace legislation, an expected — if crucial — defection for Republicans trying to corral enough votes to enact a repeal bill. “This is not a bill I could support in its current form,” Collins told the Portland Press Herald, saying the American Health Care Act’s coverage cuts go too far. (Diamond, 3/16)

The chairman of the conservative House Freedom Caucus revealed Thursday that he faced stronger-than-expected pushback from President Trump about entitlement reform in a recent meeting. “I probably was more optimistic on entitlement reform a few weeks ago than I am now,” Rep. Mark Meadows (R-N.C.) said during a panel on Capitol Hill hosted by the Heritage Foundation. (Marcos, 3/16)

Democratic U.S. Sen. Joe Manchin said Thursday he'll oppose any legislation that takes health care away from West Virginians and urged people to "bombard" President Donald Trump with calls and emails to halt the Republican plan. (3/16)

Sen. Joe Manchin III encouraged his constituents gathered at a town hall meeting here Thursday to phone the White House and implore President Donald Trump to slow down the effort to repeal and replace the 2010 health care law. “I would bombard the White House,” the West Virginia Democrat said. “I really think that President Trump is the only one that can stop this going on right now.” (Bowman, 3/16)

Democratic lawmakers have made a number of misleading claims about the House Republican replacement bill for the Affordable Care Act and findings in the Congressional Budget Office report. We compiled a roundup of their talking points, as a companion to our fact-check of White House claims about the CBO report. (Lee, 3/17)

President Donald Trump and many congressional Republicans campaigned on repealing the Affordable Care Act and replacing it with their own plan to overhaul the nation’s health care system. As the GOP develops its offering, its representatives are tossing around wonky health policy terms to describe their core strategies. Want to know what it all means? (3/17)

Flying out of Reagan National Airport on Wednesday, I was expecting a short reprieve from the issue that has consumed my work in health journalism for eight years — the Affordable Care Act and, lately, Republican efforts to replace it. The voyage turned into anything but, with some unexpected close encounters. (Galewitz, 3/16)

House Republican leaders on Thursday moved one step closer to passing legislation replacing much of the Affordable Care Act, as the House Budget Committee approved the bill despite opposition from the panel’s most conservative members. The 19-17 committee vote moved the bill closer to debate in the full House, which could begin as early as next week. But the “no’’ votes from three conservative Republicans signaled that the bill still faces challenges in the chamber. (Hackman, Peterson and Armour, 3/16)

Reps. Dave Brat, R-Va., Mark Sanford, R-S.C., and Gary Palmer, R-Ala., joined Democrats and voted against moving the legislation forward. The three lawmakers are all members of the House Freedom Caucus, a group of roughly 40 hardline conservatives who have criticized the bill in its current form, mostly on the grounds that it does not go far enough in repealing Obamacare and does not do so quickly enough. (Collins, 3/16)

The close vote illustrated the problems Republican leaders may encounter in corralling enough votes in their party to win passage on the House floor amid unified Democratic opposition. The measure now goes to the Rules Committee before reaching the House floor. (Cornwell, 3/16)

The threat that conservatives might have stopped the bill in the Budget Committee prompted a full-court press from GOP leadership to keep members in line. “This is the conservative health care vision that we have been talking about for 10 years,” Budget Chairwoman Diane Black told her colleagues in an opening statement. “I encourage you, don’t cut off the discussion.” (Cancryn, 3/16)

Republicans and Democrats offered 10 non-binding motions during the markup. The Budget Committee does not have the authority to actually alter the bill’s language, so instead the motions were drafted to express the committee’s support for amendments to the legislation. (Williams, 3/16)

“We’re very pleased with where we are, because we are on track and on schedule,” Ryan said of the bill during a press conference on Thursday as the Budget Committee took its vote. “We made a promise to repeal and replace Obamacare. We’re going to keep our promise to the people that elected us.” (Daugherty and Pugh, 3/16)

The bill will now head to the House Rules Committee, where leadership might make amendments to appease conservatives and moderates unhappy with the current legislation. The Rules Committee will be the final stop before the bill reaches the floor. ... Along those lines, the committee approved four non-binding recommendations from Republicans that will be sent to the Rules Committee, including a work requirement for able-bodied adults enrolled in Medicaid and another that would gear the plan’s refundable tax credits toward low-income people. (Hellmann, 3/16)

Efforts by Senate Republicans to reduce the number of Americans who would lose coverage under the GOP healthcare reform bill face some stark political arithmetic: Restoring coverage for many or most of the 24 million people projected to lose it would cost lots of money conservatives don't want to spend. On top of that, a higher price tag for the bill could jeopardize its ability to meet the Senate's strict budget reconciliation rules, through which Republicans hope to avoid a Democratic filibuster and pass the bill on a strictly party-line vote. Bills passed through reconciliation cannot raise the federal deficit more than 10 years out. (Meyer, 3/16)

Republicans seeking to overhaul the Affordable Care Act face growing signs that there could be big increases in premiums for individual plans next year, which poses a challenge as the lawmakers try to rally support for the replacement legislation. According to a nonpartisan report released by the Congressional Budget Office on Monday, the House Republicans’ bill, known as the American Health Care Act, could raise premiums by 15% to 20% for individual plans in 2018, compared with rates without the bill. (Wilde Mathews, 3/16)

The House GOP’s Obamacare repeal bill would dramatically expand health savings accounts, the tax shelter created in a 2003 law that established a new Medicare drug benefit. But the expansion Republicans now envision — lifting the annual maximum family contribution from $6,750 currently to $13,100 — would benefit very few people. A 2016 study by the Employee Benefit Research Institute, a trade group of major companies that offer benefits to their workers, found that in 2015 only 45 percent of people who had a health savings account contributed to it, though some of their employers put in money for them. The group estimated that 20-22 million people were enrolled in the high deductible health insurance plans that qualify them to start a health savings account, a number that is rising. (Zeller, 3/20)

Just shy of Medicare eligibility, [Erika] Snyder is part of the age 50 to 64 demographic that would face much higher insurance costs under the GOP plan, known as the American Health Care Act. The law would eliminate Obamacare subsidies that 3 million Americans in that age bracket currently rely on to purchase insurance. It would also allow insurers to charge older people up to 5 times as much as younger Americans for individual policies, while providing an age-based tax credit that experts say would fall far short of covering these additional costs. (Ross, 3/17)

The House Republican plan to overhaul the Affordable Care Act would delay, not repeal, the so-called "Cadillac tax" on the most expensive job-based health insurance plans. The news came as a disappointment to some in the Republican rank and file, as well as labor union members, who fought for years against the 40 percent excise tax, which is currently scheduled to begin in 2020 and would be pushed off until 2025 under the latest proposal. (Chakrabarti, 3/16)

Operators of tanning salons are hoping Republicans can lift some of the gloom that has hung over their sun beds for decades, a slump brought on by health concerns and accelerated by a tax imposed by the Obama health law. (Stech and Rubin, 3/16)

Obamacare required members of Congress to enroll in the law’s health insurance plans. But so far, Republicans aren’t planning to require lawmakers to participate in the new insurance market they’re proposing.In fact, no one really knows where lawmakers are going to have to get their health insurance under repeal. (Haberkorn, 3/16)

Older Floridians with health insurance through the Affordable Care Act will pay higher premiums under the Republican replacement proposal, called the American Health Care Act, than they do now under the current law also known as Obamacare, according to an analysis released Thursday by AARP. The AARP analysis found that an estimated 450,000 Floridians between 50 and 64 would face higher premiums under the AHCA — more than any other state. (Chang, 3/16)

Calling Florida “ground zero” for the impact of the GOP’s proposed health care plan, the AARP warned Thursday that more than 450,000 of the state’s residents age 50 to 64 would pay hundreds or even thousands of dollars more each year for coverage. The nonpartisan advocacy organization also said Florida would be the nation’s hardest hit by the plan’s so-called “age tax” — which allows insurance companies to charge older policyholders up to five times as much as younger ones. (Santich, 3/16)

In every state, Medicaid now covers at least some home- and community-based services for the disabled, including health aides, adaptive equipment and transportation. But the federal government does not require such coverage under Medicaid, as it does services such as doctor’s visits, nursing home care and laboratory tests. That means states may be tempted to drop the home-based services for the disabled first if federal Medicaid money dwindles and they have to find savings. (Ollove, 3/17)

Many in Texas are keeping a close eye on the Republican bid to replace the Affordable Care Act. One of the big changes is how it would affect low-income people, seniors, and people with disabilities who get help from Medicaid. And people on both sides of the political spectrum say the Lone Star State is not going to fare well. (Lopez, 3/17)

Colorado would lose out on $14 billion in federal funding for Medicaid by 2030 if Congress repeals the Affordable Care Act and replaces it with the Republican-backed plan known as the American Health Care Act, according to a new report Thursday. The report, by the nonpartisan Colorado Health Institute, also found that 600,000 fewer people would likely be covered by Medicaid in the state by 2030 than if the current law remains in place. That group represents people who would have been covered by expanded Medicaid eligibility rules that the American Health Care Act would phase out. Because those people would have low, though not quite poverty-level, incomes, the Colorado Health Institute predicts that many of them would be unable to afford insurance in the private market and would instead go without. (Ingold, 3/16)

The head of the American Medical Association (AMA) delivered a sharp warning Thursday to congressional Republicans, telling them to go “back to the drawing board” on their ObamaCare repeal-and-replace bill and warning that the bill's current version would take needed coverage away from people. Dr. Andrew Gurman, the president of the AMA, the country’s largest doctors group, delivered an “urgent call to congressional leaders to go back to the drawing board” on their bill to repeal and replace ObamaCare, legislation the GOP has dubbed the American Health Care Act. (Sullivan, 3/16)

The leading general in the battle to protect the Affordable Care Act isn’t a grizzled veteran or even a storied health care professional — he’s a young, fresh-faced policy wonk with a whole lot of optimism. Last month, Frederick Isasi took the helm of Families USA, the consumer group that has been one of the staunchest supporters of the health care law in Washington. He’ll fill the shoes of former executive director Ron Pollack — a longtime health care advocate who at 72, after 33 years at the helm of the organization, shows a few more of the scars he has earned as a weathered fighter in the health care wars. (Mershon, 3/20)

Andy Slavitt, who helped rescue the HealthCare.gov website after its botched roll out in fall 2013 and became a top health-care official in the Obama administration, is launching a new effort to bring bipartisanship back to health-care restructuring. He knows it might take a while to catch on. (Eilperin, 3/16)

Before he became president, Donald J. Trump called climate change a hoax, questioned the safety of vaccines and mocked renewable energy as a plaything of “tree-huggers.” So perhaps it is no surprise that Mr. Trump’s first budget took direct aim at basic scientific and medical research. Still, the extent of the cuts in the proposed budget unveiled early Thursday shocked scientists, researchers and program administrators. (Fountain and Schwartz, 3/16)

What goes on the chopping block: Research into cancer or Alzheimer’s? A Zika vaccine or a treatment for superbugs? Health groups say President Donald Trump’s proposal to slash funds for the nation’s engine of biomedical research would be devastating for patients with all kinds of diseases — and for jobs. (Neergaard, 3/16)

Funding from the National Institutes of Health flows to more than 2,600 institutions around the country and creates more than 313,000 full- and part-time jobs, according to a 2016 study. So it's not obvious how slashing billions from the NIH budget, as the Trump administration proposes, will bring more jobs to America. (Harris and Stein, 3/16)

“This is not a budget that’s designed to make America first,” Rush Holt, chief executive of the American Association for the Advancement of Science, told The Washington Post. His organization issued a statement warning that the cuts, if implemented, would “cripple the science and technology enterprise.” In the interview with The Post, Holt said the Trump budget blueprint is only the first step in the budgetary process and that, historically, science and medicine have enjoyed bipartisan support from appropriators on the Hill. But this was a rough morning for some people, he said. (Achenbach, 3/16)

As for the pharmaceutical industry: Trump has repeatedly promised drug makers he’ll make it easier and cheaper for them to bring new medicines to market, but he’s also counting on them to pay more for their regulatory reviews. His budget calls for hiking the fees that industry pays the Food and Drug Administration to review medical products, arguing that companies “can and should” pay their fair share. Trump aims to bring in $2 billion from these user fees in 2018, approximately double the current level. (Simon, 3/12)

At his inauguration, President Trump said the country was on the cusp of a revolutionary moment, ready "to free the Earth from the miseries of disease.” Last month, he doubled down on that vision in his address to Congress, speaking of the “marvels” Americans could achieve under his presidency. Item one was miraculous new medicines: “Cures to the illnesses that have always plagued us are not too much to hope,” he said. On Thursday, Trump announced a budget proposal that could turn the flow of innovation that underlies new medicines to a trickle. (Johnson, 3/16)

Industry groups and FDA funding advocates expressed dissatisfaction with the president's FDA budget request and raised concerns about the White House's signal that it would prefer to rely more heavily on industry user fees to fund the agency, than to increase taxpayer funds. Trump is proposing that FDA receive more than $2 billion in medical product industry fees in fiscal year 2018, an additional cost to the drug and device industries of about $1 billion as compared with 2017. It would replace the need for new taxpayer funds to pay for drug and device reviews, his budget outline says. (Karlin-Smith, 3/16)

“This is just a terrible proposal,” said Jon Retzlaff, chief policy officer of the American Assn. for Cancer Research. “To see a proposal that would gut NIH by 20% — that would put us back to the year 2000 in terms of funding. We’re astonished and dumbfounded. ”Noting that cancer research has “had so much momentum,” Retzlaff said that cuts of the magnitude proposed “will absolutely slow research” that could lead to new ways to prevent and treat the nation’s No. 2 killer, which claimed the lives of an estimated 595,690 Americans in 2016. (Healy, 3/16)

One of the National Institutes of Health’s only programs devoted to global health research and training is on the chopping block as part of President Trump’s vision for an overhaul of some government agencies. The administration’s budget blueprint, released Thursday, lays out sweeping cuts, including the elimination of the NIH’s Fogarty International Center. Public health experts say the closure of the center, if approved by Congress, could hamper future responses to the spread of infectious diseases and slow research that could help Americans. (Blau, 3/16)

But not all health-related projects are losers in Trump's plan. The president's proposal boosts HHS spending on opioid prevention and treatment efforts by $500 million, and also provides funds to the Justice Department to combat the epidemic. Some programs would tread water: WIC grants — money to states for healthcare and nutrition for low-income women, infants and children — are one example. (3/16)

Dane Leone, an analyst at BITG, called the budget proposal a “cartoon villain approach to biomedical innovation.” “The severity of the starting point for discussions will likely have tangible effects on how investors view the U.S. health-care sector,” he said. “The main takeaway from our view is that the Trump administration clearly lacks any appreciation for the importance of biomedical innovation and makes us take ongoing banter regarding drug price negotiations more seriously.” (Tracer and Edney, 3/16)

Ever since the Ebola and Zika epidemics, public health officials have advocated for a special emergency fund that would allow the United States to respond rapidly to disease outbreaks. This budget blueprint creates a new Federal Emergency Response Fund, but provides no specifics about how large it would be or where the funds will come from. (Sun, 3/16)

One of the casualties of President Donald Trump's proposed budget may be Meals on Wheels, the familiar food delivery program for homebound Americans. The aim is to decrease federal spending, but cuts to the service could backfire by raising health-care costs, the program warned...The program, which delivers meals to individual homes and senior centers, feeds more than 2.4 million Americans 60 and older—more than half a million of them veterans. It delivers about 218 million meals a year, according to a Meals on Wheels fact sheet. Most recipients live alone, take more than six medications, and rely on these meals for at least half the food they consume. (Mosendz, 3/17)

Some of the biggest losers in President Trump’s proposed budget are the rural communities that fueled his stunning White House victory. Funding that keeps rural airports open, grants that help build rural water and sewer projects, and money for long-distance Amtrak lines that serve rural communities would all disappear under Trump’s budget blueprint released Thursday. (McGrane, 3/16)

Republicans were quick to lodge objections on Thursday to President Donald Trump’s budget plans, many of which trim away smaller programs that help the sort of local communities he vowed to rejuvenate during the campaign. The response suggests Mr. Trump’s first blueprint for federal spending, like many before his, is likely to undergo a major rewrite by Congress. (Mann, Chinni and Hughes, 3/16)

The budget blueprint President Donald Trump released on Thursday would mark an abrupt federal withdrawal from the artistic and environmental projects that Californians hold dear, slashing wetlands restoration and zeroing out the funding of nearly 20 federal agencies — from the Corporation for Public Broadcasting, a major funding source for NPR and PBS stations, to the national endowments for the arts and humanities. (Murphy, 3/16)

On the evening of July 19, 2010, Major General Dana Pittard, the new commander of Fort Bliss in El Paso, Texas, got a call from the base’s 24-hour duty officer. A SWAT team had been sent to the house of a young sergeant named Robert Nichols. Nichols was inside with a gun, threatening to kill himself. Pittard arrived at the soldier’s home just in time to see the soldier step out of the house, put the gun to his chest and fire. Neighbors and police crowded the street, but Pittard was the only officer from the Army base at the scene. He went home, where his boxes were still packed from his move 10 days before, feeling disturbed and helpless. (Hattem, 3/17)

Leaders in the mental health and veteran fields say that New Hampshire is the first in the nation to implement a statewide effort to identify mental health patients with a military background and fashion outreach and treatment programs for them. At least one staff member at each of the state’s community mental health centers is a designated liaison for military issues. Hundreds of mental health workers have been trained on military culture. (Hayward, 3/16)

The Republican-led House approved legislation Thursday to make it easier for the Department of Veterans Affairs to fire, suspend or demote employees for poor performance or bad conduct, part of a renewed GOP effort targeting VA accountability in the new Trump administration. (3/16)

Was it murder or a tragic public health outbreak? Prosecutors and defense attorneys in the trial of a former executive charged in a 2012 U.S. meningitis outbreak offered jurors opposing theories Thursday about a public health crisis that killed 64 people and injured about 700 others in 20 states. (Lavoie, 3/16)

According to prosecutors, Barry J. Cadden ignored the warning signs that led to the 2012 fungal meningitis outbreak that killed more than 60 people across the country and sickened hundreds more. He was told that a clean room at the New England Compounding Center in Framingham was infested with bugs and mice and that oil had spilled on the floor. Tests confirmed the existence of mold. But he did nothing, prosecutors contend. (Valencia, 3/16)

Many people assume that patients addicted to heroin or other opioids either survive a high or die — but that there's no real damage to those who get up and walk away. Most emergency room doctors will tell you that's not the case... The trauma ranges from frostbite or broken bones after a fall on the ice to serious brain damage. (Bebinger, 3/17)

By about 3 p.m. Friday, a county morgue in east Ohio was already full — and more bodies were expected. Rick Walters, an investigator for the Stark County coroner's office, had just left for two death scenes: a suicide and an overdose. From the road, he called the director of the Ohio Emergency Management Agency to ask for help. He needed more space, he explained — specifically, a cold-storage trailer to act as an overflow morgue. (Phillips, 3/16)

Kansas’ highest court appeared receptive Thursday to declaring for the first time that the state constitution recognizes abortion rights, with a majority of the justices skeptical of the state’s argument against the idea as it defended a ban on a common second-trimester procedure. (Hanna, 3/16)

In what is certain to shape up as one of its most important decisions in years, the Kansas Supreme Court heard arguments Thursday morning on whether the Kansas Constitution’s Bill of Rights enshrines a right to abortion. The case is on appeal from the Kansas Court of Appeals, which, in an evenly divided decision last year ruled that the state Constitution recognizes a “fundamental right to abortion.” The appeals court affirmed a lower court decision by Shawnee County District Judge Larry Hendricks blocking a Kansas law banning the second-trimester abortion method known as “dilation and evacuation.” Hendricks found that the law imposes an “undue burden” on women seeking an abortion. (Margolies, 3/16)

Whole Woman’s Health, the abortion clinic that sued the state of Texas over 2013 abortion restrictions and won at the U.S. Supreme Court last year, will reopen its Austin location next month. The clinic, in Northeast Austin, had closed in 2013 after then-Gov. Rick Perry signed a law that required abortions to be performed in hospital-like surgical centers and that doctors have admitting privileges in nearby hospitals. Whole Woman’s Health challeged those provisions of the law on the grounds that they restricted access to the procedure. (Chang, 3/16)

The state’s major health insurance companies tried to calm concerns about a proposal to stabilize the state’s insurance market Wednesday with a letter promising that a “reinsurance” bill would lower rates. But Gov. Mark Dayton isn’t buying the promises. In a series of letters back to the insurers, Dayton on Thursday asked for firmer commitments...Reinsurance would spend as much as $300 million per year to cover the cost of the most expensive patients in the state’s individual health insurance market. That’s the market that covers people who don’t get health coverage through an employer or a government plan, and affects less than 5 percent of the state. (Montgomery, 3/16)

Statewide legislation is being considered in the Maryland General Assembly that would provide some relief for displaced employees of hospitals that close, such as University of Maryland Harford Memorial Hospital in Havre de Grace which is slated to close in the next several years. Del. Mary Ann Lisanti, whose district includes Havre de Grace, is sponsoring House Bill 932, requiring hospital operators to pay a fee to cover the cost of assisting any employees who lose their jobs because of the closing or merger. (Anderson, 3/17)

In a test of shifting attitudes about HIV, a group of state lawmakers has proposed that it no longer be a felony for someone to knowingly expose others to the disease by engaging in unprotected sex and not telling the partner about the infection. The measure by state Sen. Scott Wiener (D-San Francisco) and others would make such acts a misdemeanor, a proposal that has sparked opposition from Republican lawmakers. (McGreevy, 3/17)

Since November of last year, Dallas officials and cellphone provider T-Mobile have known that a mysterious technology glitch was wreaking havoc on the efficiency of the city’s 911 call center, tripping “ghost calls” to dispatchers and placing legitimate callers on hold for unsafe spurts of time. In January, they thought it was fixed. But by March, operators were once again slammed with an unprecedented backlog spike that prompted the city manager to write in a memo that at one point on March 6, there were 360 emergency calls on hold. (Mettler, 3/16)

Michigan Gov. Rick Snyder said Thursday his administration will enact the country's toughest lead limit for water in the wake of the lead contamination in Flint, following up on a proposal he first unveiled nearly a year ago. (3/16)

"The Commonwealth Fund" report gave Florida a rank of 45 out of 50 states, plus Washington D.C., when it came to the "Avoiding hospital use and cost" indicator. That's a drop of 13 points between 2012 and 2015. The report's authors attribute this largely to Florida's refusal to expand Medicaid. (Miller, 3/16)

Colorado’s health care system ranks sixth-best in the country, according to a new report in which researchers argue that states that fully embraced the Affordable Care Act saw the biggest improvements to their health systems. The report, released Thursday by The Commonwealth Fund, found that Colorado’s health care system jumped five spots in the organization’s Scorecard on State Health System Performance from before the Affordable Care Act to the present. That was the fifth-largest jump among all states. All of top five most-improved states — which also included California, Kentucky, New York and Washington — each expanded Medicaid under the Affordable Care Act and set up state-based insurance exchanges. (Ingold, 3/16)

As state regulators weigh the immediate question about whether the Aliso Canyon gas field is safe to reopen, a longer-term debate is also emerging: Is the storage field even necessary to power the grid and keep the lights on? Engineers plugged the largest gas leak and methane release in U.S. history about a year ago, after evacuations forced thousands of people from their homes in nearby Porter Ranch in north Los Angeles County. Citing health concerns, some of those residents say the field remains too risky to reopen. (Peterson, 3/16)

Among other things, the foundation raises money to provide hospitals with a CuddleCot, a $3,000 crib-cooling device that preserves the bodies of deceased newborns so their families can take a few days — sometimes longer — to have close contact. Redeemer and three other hospitals have been beneficiaries so far. Although the notion of the CuddleCot may sound macabre to some people, it reflects a profound change in the attitudes of hospitals, bereavement experts, and patients. No longer are babies whisked away to the morgue right after death. No longer are grief-stricken parents denied the chance to bond with their offspring. (McCullough, 3/17)

As Pennsylvania State University copes with an ongoing outbreak of mumps, infectious-disease experts are investigating why vaccinated young people are getting sick and whether a booster shot would help.  "We didn't see outbreaks like this 10 years ago," said Kelly L. Moore, director of the Tennessee Immunization Project and chair of the mumps work group for the Advisory Committee on Immunization Practices (ACIP).  Its vaccination recommendations become official policy  for the U.S. Centers for Disease Control and Prevention when approved by the CDC director. The government already recommends two shots, given at 12 to 15 months and just before entering school.  The second shot was added in 1989. (Burling, 3/16)

Cook could have practiced anywhere after she graduated last year from Ohio State University's College of Dentistry. But the daughter of Appalachian Ohio was intent on returning to her home region to practice. ...The emerging, interwoven plans all are part of a strong push to increase access to health care in Perry County, while also educating and training the local workforce for jobs in the health field. (Lane, 3/17)

The Minnesota Department of Human Services on Thursday called a Mayo Clinic plan to give preference to privately insured patients “very concerning” and said it will examine it for possible violations of civil and human rights laws. In response to a video transcript obtained by the Star Tribune in which Mayo CEO Dr. John Noseworthy explained the policy to employees, DHS Commissioner Emily Piper said in a statement early Thursday afternoon that her department has a lot of questions about “how it will implement the directive.” (Zamora, 3/17)

A state Senate health committee Thursday approved a bill to offer optional testing of Georgia newborns for Krabbe disease, a rare genetic disorder. The form of Krabbe that strikes newborns is caused by a change, or mutation, in the gene that carries the blueprints for an enzyme called galactosylceramidase, which is crucial to wrapping protective insulation called myelin around nerves... The disease is rare, striking between 1 in 100,000 and 1 in 350,000 babies. Infants with Krabbe typically die before their second birthday. (Miller, 3/16)

Work has begun on a 60,000-square-foot medical building at Deborah Heart & Lung Center in Burlington County. The $21.5 million building, which is being developed and will be owned by Landmark Medical Facilities of Milwaukee, will replace an existing building on Deborah's campus in Browns Mills. Deborah and independent community doctors have leased 86 percent of the space, the tax-exempt hospital said. Tenants will include Central Jersey Urgent Care, Garden State Diagnostic Imaging, and Epione Family Medicine, Deborah said. The building is expected to be completed in spring 2018. (Brubaker, 3/16)

John Corrigan, director of the Ohio Brian Injury Program, said 100,000 Ohioans suffer traumatic brain injuries each year and that 1.8 million adults in the state have had at least one traumatic brain injury causing unconsciousness. As many as 750,000, he said, are at risk of disability. At the summit, Corrigan detailed the Ohio Brian Injury Program's 14-month-old strategic plan, which runs through 2020. Goals are to increase reliable data about concussions; better train people studying to become health care and social service providers in concussion protocol; implement new procedures to recognize concussions in certain areas, such as education and behavioral health; and increase awareness among the public and policymakers. (Viviano, 3/16)

Lawmakers appear to have reached a compromise Thursday that would expand Georgia’s medical marijuana law. The agreement over Senate Bill 16 would add six illnesses and conditions eligible for treatment with medical marijuana in Georgia to include Alzheimer’s disease, AIDS, autism, epidermolysis bullosa, peripheral neuropathy and Tourette’s syndrome. It would additionally allow use for patients in hospice care, according to both state Sen. Ben Watson, R-Savannah, and state Rep. Allen Peake, R-Macon. (Torres, 3/16)

Massachusetts officials are warning the online marijuana directory Leafly that it may be violating state law by publishing ads for pot-delivery services they say are operating without state oversight. The website is one of the most popular in the cannabis industry, widely used by consumers to find nearby dispensaries and other licensed suppliers in states such as Massachusetts that have legalized the drug. (Adams, 3/17)

Using county-level data from the Census Bureau’s American Community Survey and broadcast television airings data from the Wesleyan Media Project, we examined the relationship between insurance advertisements and county-level health insurance changes between 2013 and 2014, adjusting for other media and county- and state-level characteristics. We found that counties exposed to higher volumes of local insurance advertisements during the first open enrollment period experienced larger reductions in their uninsurance rates than other counties. State-sponsored advertisements had the strongest relationship with declines in uninsurance, and this relationship was driven by increases in Medicaid enrollment. (Karaca-Mandic et al., 3/15)

[S]imulated patients called primary care practices seeking new-patient appointments in 10 diverse states (Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas) from November 2012 through March 2013 and from May 2014 through July 2014, before and after the major ACA insurance expansions. Callers were randomly assigned to scripts specifying either private or Medicaid insurance. ... Overall appointment rates for private insurance remained stable from 2012 (84.7%) to 2014 (85.8%) with Massachusetts and Pennsylvania experiencing significant increases. Overall, Medicaid appointment rates increased 9.7 percentage points (57.9% to 67.6%) with substantial variation by state. (Rhodes et al., 3/13)

Nationally, 12.7% of sexually experienced adolescents and young adults who were on a parent’s health insurance plan would not seek sexual and reproductive health care because of concerns that their parents might find out. This was highest among persons aged 15–17 years (22.6%). Overall, these persons reported lower prevalences of receiving certain recommended sexually transmitted disease (STD) services. However, receiving a sexual risk assessment (both males and females) and chlamydia test (females) was higher among persons aged 15–17 years who had time alone with a health care provider in the past 12 months compared with those who had not. (Leichliter, Copen and Dittus, 3/10)

About one third of all women and six in ten women who had given birth reported experiencing an unplanned birth. Most women perceived unplanned births to have negative effects on a woman’s life, particularly her socioeconomic well-being. Negative perceptions were more common among white women, higher-income women, more educated women, and women who have not experienced an unplanned birth. These findings underscore the importance of access to family planning services, which allow women to plan their pregnancies and prevent unplanned births. (Johnston et al., 3/9)

The American Health Care Act (AHCA), which recently passed the House Energy & Commerce and Ways & Means Committees, would leave most ACA changes to Medicare intact .... However, the AHCA would repeal the Medicare payroll surtax on high-income earners, along with virtually all other tax and revenue provisions in the ACA. Repealing this surtax would reduce revenue to the Medicare Hospital Insurance (Part A) trust fund by $117 billion between 2017 and 2026, according to the Joint Committee on Taxation. It would also weaken Medicare’s financial status by depleting the Part A trust fund three years sooner than under current law. (Cubanski and Neuman, 3/14)

Narrow provider networks are increasingly common in the individual health insurance market. Regardless of what system emerges from efforts to repeal and replace the Affordable Care Act, insurers are expected to continue to rely on narrow provider networks. The new administration has proposed to loosen federal network adequacy standards and delegate more authority to states. This paper examines how four states with significant regulatory experience have assessed and monitored the adequacy of provider networks in the nongroup market to ensure consumers have timely access to care. (Wishner and Marks, 3/16)

Seven states currently are implementing the Affordable Care Act’s (ACA) Medicaid expansion to nearly all low income adults up to 138% of the federal poverty level (FPL, $16,643 per year for an individual in 2017) in ways that extend beyond the flexibility provided by the law through a Section 1115 demonstration waiver approved by the Obama Administration. While Congress debates repeal and replacement of the ACA, including the Medicaid expansion, Section 1115 Medicaid expansion waiver activity is expected to continue under the Trump Administration .... This issue brief focuses on Section 1115 waivers that implement the ACA’s Medicaid expansion and highlights themes in approved, pending, and denied provisions to date as well as key issues to watch looking ahead. (Musumeci, Hinton, and Rudowitz, 3/14)

The assertion that "health care is a right, not a privilege" has become one of my favorites as we debate Obamacare vs. Trumpcare. But, as I've learned in my email and comment threads, them's fightin' words to many conservatives and sticklers for the Constitution. Our founding documents and their amendments make no direct or even indirect mention of health care as a "right," critics of this sentiment maintain. Americans no more have a "right" to see a doctor than they have a "right" to own a car or to have a place to live, food on their tables or clothes on their backs. (Eric Zorn, 3/16)

The Lord giveth and the Lord taketh away, but for governments it’s not that easy. Once something is given — say, health insurance coverage to 20 million Americans — you take it away at your peril. This is true for any government benefit, but especially for health care. There’s a reason not one Western democracy with some system of national health care has ever abolished it. (Charles Krauthammer, 3/17)

For proponents of the American Health Care Act, perhaps the most encouraging nugget in the Congressional Budget Office’s otherwise critical analysis is that insurance premiums could fall by 10 percent on average by 2026. Even this prediction is more mirage than reality, however, in part because of an obscure concept known as “actuarial value.” (Peter R. Orszag, 3/17)

Since Louisiana started adding new Medicaid patients in July 2016, more than 62,000 patients have gotten preventive care. More than 5,700 patients have gotten breast cancer screenings, and 74 were diagnosed with cancer. More than 1,300 people have been diagnosed with diabetes, and 5,900 have gotten colon cancer screenings. Those statistics have real consequences for people. The Louisianians newly diagnosed with breast cancer or diabetes should be able to get ongoing treatment for their illnesses. That could improve their health and extend their lives. (3/17)

In the summer of 2016, Representative Paul Ryan (R-WI) released “A Better Way,” a wide-ranging proposal that included a plan for reforming Medicaid. Its fate depended heavily on the presidential election, and now that Republicans hold majorities in both the Senate and the House of Representatives and Donald Trump is President, Ryan’s plan seems much more likely to become reality. The proposal would eliminate many aspects of the Affordable Care Act and make fundamental changes to the entire Medicaid program by setting a limit — a per capita cap — on federal Medicaid spending. (Andrew J. Goodman-Bacon and Sayeh S. Nikpay, 3/16)

In the nine months since Louisiana opted to expand Medicaid last June, health care in this state has completely changed, and as current medical students and future physicians, we do not want to go back. Under the Affordable Care Act and the subsequent Medicaid expansion, almost half a million more Louisianians gained insurance. Suddenly, in a state that has some of the worst -- and often the very worst -- health outcomes in the country, working mothers can afford to get checkups, young college grads struggling in service industry jobs can afford antibiotics, and Louisianians with pre-existing conditions (think diabetes, think genetic diseases, think cancer) are guaranteed the right to be able to purchase health insurance and to strive towards health. And so for the first time, we treated health care as a human right, rather than a privilege reserved for those who could afford it. (Frances Gill and Eric Schultz, 3/16)

Using conservative assumptions, the same study estimates that government recoups at least 56 cents for each $1 spent on childhood Medicaid by the time those children reach 60. Using another set of realistic assumptions, the same study estimates that the government’s entire investment is recouped by the time the child is 36. Medicaid is a cost-effective tool to improve economic mobility, a core principle of the American Dream. (Marianne Page, 3/16)

HHS estimates that since passage of the ACA, 55.6 million women now have access to contraception without copays. Although early research has not yet shown dramatic changes in contraceptive use post-ACA, in previous studies, eliminating contraceptive copays has increased women’s use of the most effective methods, and reduced rates of unintended pregnancies and abortions. (Lydia Pace and Eve Rittenberg, 3/16)

As a businessman who runs a large health care company, I can say that the Affordable Care Act – including its 2,600 pages of regulations — is the worst operational plan in government history. That’s because it was designed by bureaucrats and academics who don’t understand how health care works and how to make it operate efficiently. (Richard Jackson, 3/17)

When it comes to saving money on health care, it is so true that you can save a bundle by eliminating the sick. They’re tiresome, always complaining, they smell bad, and they’re ruining it for the rest of us. Put the seriously ill out of their misery, get them to die 10 days earlier than they normally would, you can run the system at a profit. Simple as that. (Garrison Keillor, 3/16)

The Republican health bill doesn’t have many outside supporters. Groups representing doctors, nurses, hospitals, retirees, patients of various diseases and even insurers have all criticized it. Some of the only outside praise has come from the chief executive of Anthem, the country’s second largest insurer. And therein lies another tale of the Trump administration’s conflicts of interest. (David Leonhardt, 3/17)

Have you heard the news? Democrats are going “on offense” to promote ObamaCare as Republicans consider the best way to replace it. Just one week ago NBC News reported that Democrats were “revving up” their “offensive” on health care. Now apparently the offensive is no longer merely idling in the political driveway but cruising around Capitol Hill. The progressive activists at Buzzfeed dutifully relay that the Democratic Senatorial Campaign Committee “is now posturing itself as on offense on the issue.” (James Freeman, 3/16)

Most of the debate about the Affordable Care Act has centered on how it affects health care. It’s time to pay attention to how ObamaCare has damaged federal finances. Lawmakers must bear in mind, even as they balance other important value judgments affecting the health and income security of millions of Americans, that the current repeal-and-replace effort represents a unique, fleeting opportunity to accomplish essential fiscal corrections. (Charles Blahous, 3/16)

The American Health Care Act is in trouble, with House Speaker Paul D. Ryan (R-Wis.) admitting Wednesday that the bill must change to make it through Congress. The reason? The Republican right and the Republican center want different things, and the rules under which the proposed Obamacare replacement can pass the Senate by a simple majority make it extremely hard to satisfy both sides. But the apparently difficult problems of policy reforms are just that: “apparent.” With some outside-the-box thinking, some dealmaking and a little humility, the AHCA can be saved. (Hugh Hewitt, 3/16)

Reconciliation is a fast-track process that allows budget-related legislation to pass the Senate without the prospect of a filibuster. The Byrd rule prevents reconciliation from being used to pass any measure for which the budgetary effects — “changes in outlays or revenues” — are “merely incidental to the non-budgetary components.” Republicans know they lack the 60 votes to break a filibuster in the Senate, so they designed their repeal-and-replace bill to satisfy the Byrd rule’s requirements. Yet there is a surprising flaw in their design — one that has so far drawn little notice, but that Senate Democrats will surely seize on. (Daniel Hemel and David Herzig, 3/16)

When faced with a tough question about nearly any aspect of the health bill moving through Congress, Republican officials like to mention their plan’s other “prongs.” In a briefing Tuesday, the White House press secretary, Sean Spicer, cited the prongs again and again. Paul D. Ryan, the House Speaker, is fond of mentioning them. So is Tom Price, the secretary of Health and Human Services. They say the bill needs to be understood as part of a larger strategy of reforming the health care system, not a piece of legislation that, alone, can achieve their goals. (Margot Sanger-Katz, 3/16)

Doctors, nurses and hospital executives have taken a stand to protect patients against the House Republicans’ American Health Care Act, the bill to eviscerate Obamacare. The potent voice of most health insurers so far is silent. Worse, some seem supportive. If major insurers support the Republican proposal, they would be making a tragic mistake, reinforcing their status as one of the country’s most reviled industries. (Tom Epstein, 3/16)

As the exciting saga of the American Health Care Act staggers forward, it’s easy to forget that new chapters of our old health care drama are still being written. On Wednesday, the department of Health and Human Services released its final estimate of the enrollment figures for Obamacare. ... If you’re not following health care policy closely, the significance of these changes may not be clear. But they are significant, and they matter, because they tell us how Obamacare is going -- and that matters not just for where we are now, but for the fate of any future Republican replacement. (Megan McArdle, 3/16)

As a conservative, I’d also like to see work requirements for able-bodied adults on Medicaid. Right now, 70 million Americans are enrolled in Medicaid, roughly nine million of whom are able-bodied adults with no children at home, But should we, in Reagan’s words, ”jump off the cliff,” or should we celebrate that this legislation includes the most transformational reform to Medicaid since its inception 50 years ago? (Rep. Robert Pittenger, (R-N.C.) 3/16)

Lots of people in the healthcare field heaved a sigh of relief last week when President Trump nominated Scott Gottlieb, a physician, venture investor and former official of the Food and Drug Administration, to be the FDA’s next commissioner. Some healthcare experts were relieved that, whatever Gottlieb’s particular qualities, at least he wasn’t someone from the camp of “we-have-to-destroy-the-agency-to-save-it” species of Trump appointee like, say, Environmental Protection Agency boss Scott Pruitt. (Michael Hiltzik, 3/16)

We entered a new phase as a species when Chinese scientists altered a human embryo to remove a potentially fatal blood disorder — not only from the baby, but all of its descendants. Researchers call this process “germline modification.” The media likes the phrase “designer babies.” But we should call it what it is, “eugenics.” And we, the human race, need to decide whether or not we want to use it. (Adam Cohen, 3/17)

Lawmakers need a stark reminder that advances in medicine and cures for human disease often come only after decades of painstaking scientific research — much of it funded by government grants. That’s why the $5.8 billion cut proposed for the National Institutes of Health on Thursday is as short-sighted as it is devastating for the nation’s researchers, doctors, and patients. (3/16)

The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children — and rural children in particular — are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and developmental disorders (MBDDs) than their wealthier counterparts. Now, in the latest of a series of reports, the agency documents the finding that rural children from small communities are more likely to have MBDDs than those living in cities and suburbs. (Kelly J. Kelleher and William Gardner, 3/16)

Evictions can lead to many health problems. According to a nationally representative study published by Harvard and Rice University researchers, evicted mothers are more likely to have depression and report worse health for themselves and their children. Disruptive life events like eviction and homelessness at a young age may have lifelong health impacts for developing children. (Lara Jirmanus, 3/16)

Iowa has been victimized by Gov. Terry Branstad’s Medicaid privatization for nearly a year. Handing over a $4 billion government health insurance program to profit-seeking companies did not make sense in theory, and in practice, it has been a nightmare for health providers and low-income Iowans. Enough is enough. It is time to return to the state-managed Medicaid system that had low administrative expenses, timely reimbursement for providers and consistency in coverage for patients. (3/16)

I appreciate that the healthcare system within which I work accepts most insurance plans, but when my patients change jobs, move, become eligible for Medicare, or their insurance plan switches networks, they are forced to get new doctors and establish care within a new system. Many critics of universal healthcare argue that it limits patient choice. However, in my experience there are overlooked negative consequences of having too many health insurance options. (Tenessa MacKenzie, 3/16)

The current excitement over the potential for stem-cell therapy to improve patient outcomes or even cure diseases is understandable. We at the Food and Drug Administration (FDA) share this excitement. However, to ensure that this emerging field fulfills its promise to patients, we must first understand its risks and benefits and develop therapeutic approaches based on sound science. Without a commitment to the principles of adequate evidence generation that have led to so much medical progress, we may never see stem-cell therapy reach its full potential. (Peter W. Marks, Celia M. Witten and Robert M. Califf, 3/16)

There is – Senate Bill 1336.This simple, commonsense measure benefits Arizona patients and health-care professionals. We write as surgeons who recognize the critical service provided by our nursing colleagues, Certified Registered Nurse Anesthetists (CRNAs). In many facilities, especially in rural or underserved communities, it is a CRNA – not an anesthesiologist – who is in charge of making sure the patient is asleep and comfortable for their procedure. (Eric Nelson, Robert Schuster and Steven Washburn, 3/16)