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Senate Republicans, aided by Vice President Mike Pence and an ailing Georgia colleague who gingerly made his way to the Capitol with the aid of a wheelchair and a walker, voted Thursday to undo an Obama administration rule preventing states from blocking funding for family planning clinics that also provide abortions. (Steinhauer, 3/30)

The bill erases a regulation imposed by former President Barack Obama shortly before he left office that lets states deny family planning funds to organizations only if they are incapable of providing those services. Some states have passed laws in recent years denying the money to groups that provide abortions. (Jalonick and Fram, 3/30)

The measure, a priority for groups that oppose abortion, would give a thumbs-up to Tennessee and other conservative states to resume policies blocking Planned Parenthood clinics from getting federal funding through the Title X family-planning program. Those dollars can’t be used for abortions, but conservatives feel abortion providers shouldn’t receive any taxpayer funds. While courts have not allowed states to withhold Medicaid money from Planned Parenthood, they’ve generally allowed states to redirect family-planning dollars to other health providers. (Cunningham, 3/30)

Pence cast the deciding 51st vote in favor of nixing the rule, after the legislation stalled in a 50-50 tie. Republican Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine) sided with Democrats to vote against repealing the Obama-era rule, prompting the need for the vice president to break the tie. (Carney, 3/30)

“We’re talking about federal family planning funds and I don’t think that those funds should be subjected to state restrictions,” Collins told POLITICO. “It’s important to recognize that there is already a bar against using federal funds for abortion and that bar stays in effect. That’s a prohibition that I personally support, but I’m a strong supporter of family planning funds.” A spokesperson for Murkowski said the vote is "consistent with the senator's long-held belief that men and women should have access to the family planning and reproductive health services they need, including cancer tests and health screenings." (Kim and Ehley, 3/30)

The Republicans needed 51 votes to clear the procedural hurdle. Senate majority leader Mitch McConnell held the vote open for an hour Thursday morning, as he waited for Republican Senator Johnny Isakson, flying in Thursday from his home state of Georgia, to land and rush over from the airport. Recovering from two back surgeries, the most recent performed on March 15, Isakson had gotten clearance from his doctor to return to Washington Thursday “for one day only,” said a spokeswoman. He used a walker to navigate the Senate floor. Elsewhere, he was seen being pushed in a wheelchair by an aide. (McGrane, 3/30)

Republicans argue rescinding the rule doesn’t decrease funding for women’s health and that community health centers that don’t provide abortions can be an alternative if Planned Parenthood loses funds. Stripping Planned Parenthood of federal funds has long been a prime goal of social conservatives, though federal law prohibits the use of taxpayer dollars to pay for abortions, except in cases of rape, incest, or grave risk to the health of the mother. (Andrews, 3/30)

The legislation, which already cleared the Republican-controlled House on a largely party-line vote, is part of a series of bills being passed by Congress under the so-called Congressional Review Act, which allows federal regulations put in place during the final days of the previous administration to be undone by simple majority passage. (Mascaro, 3/30)

Senate Republicans “didn’t listen to women across the country who made it clear that restricting women’s access to the full range of reproductive care is unacceptable,” said Washington Democrat Patty Murray. Republicans “are already gearing up to attach riders to budget bills in order to cut off critical services at Planned Parenthood to millions of patients,” she said on the Senate floor. (Rowley, 3/30)

The Obama administration's rule was finalized in December in response to 13 states that denied Planned Parenthood federal funding for family planning and maternal health, which is provided under Title X of the 1944 Public Health Service Act. The program has provided about $286 million annually in recent years to certain health providers and Planned Parenthood receives about $25 million of that money. (Siddons, 3/30)

Senior House Republicans said Thursday that they expected the federal government to continue paying billions of dollars in subsidies to health insurance companies to keep low-income people covered under the Affordable Care Act for the rest of this year — and perhaps for 2018 as well. (Pear and Abelson, 3/30)

“While the lawsuit is being litigated then the administration funds these benefits. That’s how they’ve been doing it and I don’t see any change in that,” Mr. Ryan of Wisconsin told reporters Thursday. Mr. Ryan is the highest-ranking Republican to address the issue and his comments suggest Republicans aren't preparing to take immediate steps to undermine the ACA, the 2010 law also known as Obamacare for the president who signed it. (Peterson, 3/30)

House Republicans sued the Obama administration over these "cost-sharing reductions," or CSRs, which reimburse insurers for giving discounted deductibles to low-income ObamaCare enrollees. The GOP argued the payments were being made unconstitutionally, without a congressional appropriation. (Sullivan, 3/30)

One week after the GOP ObamaCare repeal and replacement plan collapsed, Speaker Paul Ryan (R-Wis.) said Thursday he would not commit to holding another healthcare vote. “I’m not going to commit to when and what the vote is going to look like, because it’s my job to make sure that House Republicans can coalesce and come together and draw a consensus," Ryan told reporters at his weekly news conference. (Wong, 3/30)

A member of the conservative Freedom Caucus took to the House floor on Thursday to warn that passing the GOP leadership’s healthcare plan would result in the party losing its majority. Rep. Louie Gohmert’s (R-Texas) speech came after President Trump took to Twitter earlier in the day to attack members of the Freedom Caucus, saying Republicans “must fight them, & Dems, in 2018!” Gohmert said the GOP bill scuttled last week that was aimed at repealing and replacing ObamaCare wouldn’t have really kept the party’s seven-year promise for a better healthcare alternative. (Marcos, 3/30)

House Republicans appear to have made little progress in their attempt to revitalize the effort to repeal and replace the 2010 health care law following a stunning defeat last week. GOP lawmakers held a series of meetings across the Capitol this week to discuss the path forward on the legislation (HR 1628), including a Republican-only Energy and Commerce meeting on Thursday about health care and separate meetings of the Republican Study Committee and the moderate House Tuesday Group on Wednesday. (Williams and Mershon, 3/30)

The centrist Tuesday Group affirmed at a meeting Wednesday that it will not meet with the conservative House Freedom Caucus to negotiate changes to an ObamaCare replacement bill, according to Rep. Chris Collins (R-N.Y.)...He said the Tuesday Group had a meeting on Wednesday and he can state “unequivocally” that other members of the group agree they should not meet with the Freedom Caucus.  (Sullivan, 3/30)

A U.S. Senate bill meant to provide more insurance options for individuals living in markets with no HealthCare.gov plans could exacerbate the problem by taking away both participation incentives and money from insurers. On Wednesday, Tennessee Republican Sens. Lamar Alexander and Bob Corker introduced legislation that will allow people who live in counties with no health insurance options on the Affordable Care Act exchange to use their subsidy to purchase any plan outside of the exchanges. (Dickson, 3/30)

Anthem Inc. is likely to pull back from Obamacare’s individual insurance markets in a big way for next year, according to a report from analysts who said they met with the company, a move that could limit coverage options for consumers at a politically crucial time for the law. Anthem “is leaning toward exiting a high percentage of the 144 rating regions in which it currently participates,” Jefferies analysts David Windley and David Styblo said Thursday in a research note. (Tracer, 3/30)

Anthem Inc is likely to exit from a large portion of its Obamacare individual insurance markets next year, Jefferies analysts said, nearly a week after Republican leaders pulled legislation to overhaul the U.S. healthcare system. Anthem is one of the few health insurers that still sells plans under Obamacare. Humana Inc, Aetna Inc and UnitedHealth Group Inc pulled out after reporting hundreds of millions of dollars of losses. (Banerjee, 3/30)

Gov. Sam Brownback of Kansas vetoed a bill on Thursday that would have expanded Medicaid in his state, setting up a potential showdown next week with a Legislature that, while heavily Republican, has come to favor extending the largely free health coverage to as many as 180,000 additional poor adults. Although the bill was easily approved in both chambers of the Legislature, supporters would need to muster three additional votes in the House and two in the Senate to override the veto by Mr. Brownback, a conservative Republican. (Goodnough and Smith, 3/30)

The action by Mr. Brownback, who has been a staunch opponent of the law known as Obamacare, was expected. “It fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs,” the governor said in a statement. (Levitz, 3/30)

The Legislature’s vote to expand Medicaid under the Affordable Care Act, also known as Obamacare, received national attention both because Kansas is a solidly Republican-leaning state and because the state Senate’s vote took place shortly after congressional Republicans abandoned a plan that would have repealed the ACA and blocked states from expanding Medicaid after March 1. (Lowry and Woodall, 3/30)

Just more than an hour after the governor’s veto announcement, members of the Kansas House began a contentious, emotional debate on whether they should override the veto. Rep. Susan Concannon, a Beloit Republican, said legislators shouldn’t let concerns about possible changes at the federal level to the Affordable Care Act stop them from expanding KanCare. “If this isn’t the right time, when is the right time? Are we going to wait for some more hospitals to close?” asked Concannon, referring to the closure of a hospital in Independence. (Wingerter and Koranda, 3/30)

Kansas Gov. Sam Brownback on Thursday vetoed a state bill that would have set the stage for an expansion of Medicaid, saying he wanted to incorporate a work requirement and opposed funding for Planned Parenthood. Brownback, a Republican, opposes abortion, which is among the services Planned Parenthood provides. Brownback also cited concerns about the cost of the proposed Medicaid expansion in his veto statement. Brownback, who represented Kansas in the House and Senate, also cited the potential for a GOP overhaul of the 2010 health law (PL 111-148, PL 111-152) among his reasons for rejecting the state bill. (Young, 3/30)

The epic collapse of the Obamacare repeal bill created an odd opportunity for 19 states that have long shunned Medicaid expansion. Billions in Obamacare cash remain on the table. And for the first time, that cash comes with a Trump administration promise to give states unprecedented flexibility to remake the program with a conservative slant — for instance, by imposing work requirements or requiring more recipients to pay premiums. Yet with few exceptions, most of the holdout states are walking away from the money and what they regard as a broken entitlement program. (Pradhan, 3/31)

Lawmakers voted Thursday to keep Arkansas' hybrid Medicaid expansion for another year as the state's governor prepares to seek new limits on the first-in-the-nation program. The House approved by a 77-13 vote the state's Medicaid budget, which includes the hybrid expansion. The proposal now heads to Gov. Asa Hutchinson's desk. More than 300,000 people are on the program, which uses Medicaid funds to purchase private insurance for low-income residents. (DeMillo, 3/30)

Lynn Rodemann, 36, has been politically active for her entire life, but these days finds it difficult to stomach following the news. That's because she and her partner, James Hosticka, 41, receive their healthcare coverage from Medicaid, via a 2014 Ohio expansion of the government healthcare program that was a component of the Affordable Care Act, the federal healthcare law also known as Obamacare. (Tobias, 3/30)

President Donald Trump's plan to kill Obamacare died last week. Or maybe it didn't. The repeal effort seems to have assumed zombie status — somewhere between dead and alive. This is never-say-die Washington, where big legislative proposals that are in the casket one day can show signs of a pulse and start climbing out the next. (Benac, 3/31)

Stacey and Eddie Albert lead pretty healthy lives. She's a nutritionist. He's a personal trainer. They rarely go to the doctor, other than their annual physicals. For years, they were covered by Horizon Blue Cross Blue Shield of New Jersey. In 2013, they paid about $360 a month for a plan that met their needs. That all changed the following year, when Obamacare took effect. (Luhby, 3/31)

When Representative Mark Sanford of South Carolina, fresh off helping torpedo his party’s bill to repeal the Affordable Care Act, showed up at the Berkeley County Republican meeting on Saturday, he was met with applause and praise in one of the most conservative corners of his district. So less than a week later, after President Trump on Thursday warned the Freedom Caucus that he would “fight them” when they face re-election next year, Mr. Sanford was hardly cowering in fear. Instead, he and other members of the Freedom Caucus returned fire. (Martin and Steinhauer, 3/30)

In a series of tweets that began in the morning, the president warned that the powerful group of hard-line conservatives who helped block the party’s health-care bill last week would “hurt the entire Republican agenda if they don’t get on the team, & fast.” The president vowed to “fight them” as well as Democrats in the 2018 midterm elections, a warning that his allies said was intended in the short term to make members of the Freedom Caucus think twice about crossing him again. But Trump’s pledge was met with defiance by many in the bloc, including some members who accused him of succumbing to the establishment in Washington that he had campaigned against. (Wagner, DeBonis and Costa, 3/30)

The White House is so troubled by the failure of outside groups to promote the health care plan backed by President Donald Trump that a senior aide is being dispatched to rectify the situation. Katie Walsh, a longtime top lieutenant to chief of staff Reince Priebus, is leaving the administration to join the nonprofit group America First Policies. (3/30)

The departure of deputy chief of staff Katie Walsh, a key ally of Trump’s chief of staff Reince Priebus, caps a rough stretch for Trump, who has seen his young administration dogged by allegations of Russia ties, his travel ban executive order blocked twice in court, and the health care bill he supported go down in flames. (Goldmacher, Nussbaum, Palmeri and Isenstadt, 3/30)

Scott Pruitt, the head of the Environmental Protection Agency, moved late on Wednesday to reject the scientific conclusion of the agency’s own chemical safety experts who under the Obama administration recommended that one of the nation’s most widely used insecticides be permanently banned at farms nationwide because of the harm it potentially causes children and farm workers. (Lipton, 3/29)

The chemical compound chlorpyrifos, also known as Lorsban, has been used by farmers for more than a half-century to kill pests on crops including broccoli, strawberries and citrus. The EPA banned its spraying indoors to combat household bugs more than a decade ago. But only in recent years did the agency seek to ban its use in agriculture, after mounting scientific evidence that prenatal exposure can pose risks to fetal brain and nervous system development. (Dennis, 3/29)

Medical research can’t be done in the dark. But should taxpayers be covering the light bills at university labs across the country? The Trump administration’s answer is no. The president has proposed a massive $7 billion budget cut for the National Institutes of Health over the next 18 months. And Secretary of Health and Human Services Tom Price said this week that he may find those savings in the “indirect expenses” that NIH funds, which includes everything from buying lab equipment to paying the electric bills for thousands of academic research labs from Harvard to Ohio State to Stanford. (Keshavan, 3/31)

From research on stem cells and DNA sequencing to experiments with fruit flies and surveys of human behavior, projects funded by the National Institutes of Health aim to make Americans healthier. A new analysis finds that NIH-funded research also fuels the kinds of innovations that drive the U.S. economy. Between 1990 and 2012, close to 1 in 10 projects made possible by an NIH grant resulted in a patent, usually for a university or a hospital. (Healy, 3/30)

As the Trump administration begins to shape its policy on drugs, tension is growing between a treatment-focused approach, embodied in a new commission on opioids headed by New Jersey Gov. Chris Christie, and the aggressive prosecution of drug crimes promised by Attorney General Jeff Sessions. President Donald Trump signaled support for a less-punitive strategy toward opioids by assigning the task force to Mr. Christie, who has made drug rehabilitation a centerpiece of his governorship. ... That sympathetic tone contrasted with Mr. Trump’s vow last month to a police group to be “ruthless’’ in stopping the drug trade and Mr. Sessions’ pledge to “hammer” drug dealers. (Reinhard, 3/31)

Experts keeping their eyes on ways to curb the number of overdoses in the U.S. say there's one very important person missing in President Donald Trump's commission—the nominee for top federal regulator of prescription drugs. ... Trump on Wednesday introduced a high-profile group that is tasked with reporting on ideas and progress towards curbing the nation's opioid epidemic. It includes New Jersey Gov. Chris Christie—who has led several statewide efforts to address heroin addiction—U.S. Attorney General Jeff Sessions, Defense Secretary James Mattis and HHS Secretary Tom Price. (Johnson, 3/30)

President Trump has appointed Florida Attorney General Pam Bondi to a commission to help fight opioid abuse on a national level. While she won’t be leading the panel, Bondi will be a member of the President’s Opioid and Drug Abuse Commission. (Cordner, 3/29)

Funding for the treatment of the U.S. opioid addiction epidemic would have been a top casualty of Republican’s failed Obamacare replacement plan: Mental health advocates warned of it. So did Democrats, and some of the Republicans who eventually helped kill their party’s repeal-and-replace bill. Private equity didn’t believe a word of it. After years of investment in substance abuse treatment under the Affordable Care Act, equity firms...watched Republican efforts to dismantle Obamacare with little worry that it would curtail what had become a mental health gold rush in the years since the health law passed. (Newkirk, 3/30)

Ohio doctors, dentists and other health professionals will be able to prescribe only up to seven days of painkillers for adults and five days for kids and teens under new rules announced Thursday. The limits apply to acute pain patients, with exceptions for cancer, hospice or medication-assisted addiction patients. Prescribers can override the limits if they provide a specific reason in the patient's medical record. (Borchardt, 3/30)

Ohio authorities are trying to slow an epidemic that last year killed a record 3,050 Ohioans. Prescription opiates often are the gateway to heroin, and 74 percent of those who died of a drug overdose in 2015 had a previous prescription for a controlled substance, the state said Thursday. (3/30)

Gov. John Kasich said Thursday he doesn't think Ohio's new medical marijuana program will help mitigate the state's opioid crisis, though recent studies indicate otherwise. Kasich was asked at a news conference announcing new opioid prescription limits what role medical marijuana might play in addressing the growing number of opiate overdose deaths in Ohio. Kasich said telling kids not to do drugs but  that marijuana is OK sends a mixed message. (Borchardt, 3/30)

Medical personnel who don't follow the rules will be in danger of losing their license, Kasich said at a Statehouse news conference. The rules are not expected to take effect until this summer. "You are going to have to abide by these rules or else you're in serious trouble, whether you're a doctor, a dentist or a nurse," he said. (Johnson, 3/30)

Heroin use — which has been at the epicenter of a ruthless and relentless opioid epidemic sweeping the country — has increased fivefold over a decade, and dependence on the drug has tripled, researchers say. A major study released Wednesday found that the sharpest increase in heroin use and addiction was among young, white men with lower education and income levels. (Bever, 3/30)

Sixty-five percent of the U.S. prison population is addicted to drugs or alcohol, but only 11 percent receive treatment, according to a study by the National Center on Addiction and Substance Abuse. Germaine Jackson is one of those inmates. A recovering alcoholic, he was one of thousands to fall victim to the national opioid epidemic. “It got to the point where I had no money, I had to steal to support my habit,” he says. (Russell, 3/30)

A new and lethal strain of synthetic heroin resulted in five overdose deaths in Minnesota this year, and officials believe another five undetermined deaths will also be linked to the drug. The five cases are the first confirmed in-state deaths caused by carfentanil, a drug from China that is 100 times more potent than the already dangerous fentanyl. Carfentanil is federally approved to immobilize large animals such as elephants for surgery, and two salt-sized specks of the opioid can cause instant death, a local emergency room doctor said Thursday. (Chanen, 3/31)

The majority of carfentanil originates in China, and somewhere along the illicit drug supply chain it's added to other opiates, says Ken Solek, assistant special agent in charge of the Twin Cities office of the Drug Enforcement Administration. Drug users, and even some dealers, are often unaware of what they have," Solek said. "Most of the intelligence we have, based on our investigations, are that people do not know that they are taking carfentanil," said Solek. (Sepic, 3/30)

Opioid addiction is now a national crisis, and doctors worry that abuse too often begins when surgical patients are given prescriptions for large numbers of pain pills.  Orthopedic teams are rethinking how they manage pain, often employing a cocktail of drugs designed to reduce pain and inflammation in the crucial first days after surgery.  If patients can keep opioid use to a minimum then, the thinking goes, they'll use fewer of the pills in total and switch to less dangerous medications faster. (Burling, 3/31)

Those of you who have experienced pain, especially gnawing, chronic pain, know that it affects your happiness, outlook and ability to function. In the past couple of years, the treatment of chronic pain has undergone an earthshaking transformation as opioid addiction continues to claim — and ruin — lives. (Bazar, 3/31)

Sometimes, life kicks you when you’re down. According to new research, that crummy, achy, sneezy feeling you get when you have a cold is worse if you are also feeling lonely. (Netburn, 3/30)

A study published Thursday in Health Psychology found that among people who fell ill after being exposed to a cold virus, those who were lonely were more likely to report severe runny nose, sneezing, sore throat and other symptoms. That adds to the evidence linking loneliness to more serious health problems including heart disease and early death. (Hobson, 3/30)

It didn't matter how many people a study subject knew. What seemed important was whether people felt lonely, which can happen whether you know a lot of people or only a few. "High quality relationships can occur within any size social network," the research team wrote. People who felt lonely said their cold symptoms felt more severe. The researchers did not measure how sick people actually were. (Burling, 3/30)

If all goes to plan, more than 300,000 infants in the United States will sleep in cardboard boxes before year’s end. That’s according to a Los Angeles-based business called Baby Box Co., which is working with health organizations nationwide to give away thousands of boxes for parents to use as baby beds. It’s part of an educational model aimed at reducing sudden infant death syndrome, or SIDS, in the United States. But that idea doesn’t rest well with prominent doctors, researchers and organizations focused on SIDS, who characterize the boxes as untested and unregulated for infants. (Hafner, 3/30)

Peruse the infant formula aisle, or check out the options for prenatal nutritional supplements, and you’ll find that nearly all these products boast a “brain nourishing” omega-3 fatty acid called DHA. But despite decades of research, it’s still not clear that DHA in formula boosts brain health in babies, or that mothers need to go out of their way to take DHA supplements. (Callahan, 3/30)

Hepatitis infection may increase the risk for Parkinson’s disease, though the reasons for the link remain unknown. British investigators used records of 100,390 patients hospitalized with various forms of hepatitis or H.I.V. from 1999 to 2011. They compared Parkinson’s incidence in these patients with incidence in more than six million people admitted for medical or surgical conditions like cataracts, knee replacement or varicose veins. (Bakalar, 3/30)

The astronomer Carl Sagan said that extraordinary claims require extraordinary evidence. Last week, a physician made the extraordinary claim that he had an effective treatment for sepsis, sometimes known as blood poisoning. Sepsis is a bodywide inflammation, usually triggered by infection, and the leading cause of death in hospitals, taking 300,000 lives a year. So, even a 15 percent improvement in survival would save 40,000 lives — the number of Americans who die on the highway each year, or from breast cancer. (Harris, 3/30)

For many, the Fourth of July evokes jovial memories of backyard cookouts and fireworks, but for Amberlea Childs, the summer holiday conjures a haunting memory that changed her life. Childs was diagnosed with breast cancer a day before July Fourth weekend in 2010. She was 36, newly engaged, and had a lump the size of a large walnut in her right breast. She visited a radiologist to get it checked. (Howard, 3/31)

Sometimes, Marjorie Sostak’s son apologizes to her. “Mom, I’m so sorry that you got me for a son and not somebody better,” he’ll tell her. She tells him she wouldn’t trade him or his sister for anything. But she wishes she’d gotten him help sooner. (Becker, 3/30)

You knew that spinach was good for your heart. But researchers at Worcester Polytechnic Institute are now taking spinach leaves and transform them into human heart tissue ... that beats. Scientists used the delicate structure of a spinach leaf as scaffolding to grow a new vascular system, in a marriage of human and plant that, researchers say, could one day be implanted into a damaged human heart. (O'Keefe and Chakrabarti, 3/30)

An Iowa State neuroscience lab has discovered a way to study the early stages of protein-misfolding diseases like Parkinson’s or Chronic Wasting Disease, and this may aid the development of new treatments. These diseases are tricky to detect in incubation period. For example if someone has Alzheimer’s, it won’t be apparent that person is sick until they start exhibiting symptoms. (Boden, 3/29)

Panera Bread appears to be the first major restaurant chain to offer its customers information about the amount of added sugar in the beverages it sells. “We’re going to help you understand that you can have a soft drink, but please know that when you drink it, you may be drinking well in excess of the federal government’s daily recommended allowance of sugar,” said Ron Shaich, the founder and chief executive of Panera. (Strom, 3/31)

Rich countries like the United States import tons of stuff from China and other less-developed nations. In so doing, we not only send our dollars abroad — we’re also exporting premature deaths that would have occurred here if we had to make those goods ourselves. Indeed, one of the reasons it’s cheaper to produce things elsewhere is that other countries have fewer rules about keeping dangerous pollutants out of the air. So we save money and people in other parts of the world shave years off their lives. (Kaplan, 3/31)

An ambitious proposal to create a single statewide insurance plan for every Californian — including undocumented residents, seniors on Medicare and people who now get their health coverage through work — began to take shape on Thursday when two legislators released details about what services would be covered and who would run the giant program. (Murphy, 3/30)

Sen. Ricardo Lara, D-Bell Gardens, released policy details about a plan to create a single-payer health care system for all California residents on Thursday. Lara’s proposal would drastically alter the insurance market in the state. Under the single-payer plan, the state would negotiate prices for services and prescriptions with providers, pharmaceutical companies and others. (Luna, 3/30)

When Richard Corcoran was sworn in as speaker of the Florida House in November, he laid out his vision for healthcare. “Let us show Washington, D.C., and the rest of the country how well the people would benefit from a free-market, consumer-driven healthcare system,” said Corcoran, R-Land O’Lakes. (Auslen, 3/30)

The final day of the Georgia General Assembly brought last-minute approval of some health care bills – along with disappointment over pieces of legislation that didn’t pass. The failures included the high-profile effort to halt “surprise’’ medical bills, and a proposal to require Georgia schools and day care centers to test their drinking fountains and sinks for lead contamination in the water. (Miller, 3/31)

The cost of cigarettes sold in California will go up significantly, starting Saturday. That’s when the provisions of Proposition 56 – formally known as the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 and approved by voters last November– go into effect. The cigarette tax rate on Saturday spikes from the current 87 cents to $2.87 per pack of 20 cigarettes. (Glover, 3/30)

Florida’s universities say they need more money to hire additional mental health counselors and law enforcement officers. University officials said they’re seeing a dramatic rise in students needing help coping with anxiety, depression and academic stress. (Mueller, 3/30)

California’s doctors and dentists have renewed their push for more money to treat Medicaid patients now that the state has been spared the drastic cuts proposed under the failed GOP health care bill. But Democratic Gov. Jerry Brown — and some health advocates — say they have other priorities for improving the low-income health program, which serves some 14 million residents, or about a third of the state’s population. (Feder Ostrov, 3/30)

Andrea Marquez came to a House committee hearing Monday armed with three things: Kool-Aid packets, her makeup bag and a big bottle of Jack Daniels. The 17-year-old high school student from El Paso told the House Licensing and Administrative Committee hearing Monday that the Kool-Aid pouches were the same size as packets that could hold powdered alcohol — a form of dehydrated booze that can be mixed with water, soda or juice. (Samuels, 3/30)

St. Luke's Health System said Thursday that it and a sister network in Bryan-College Station had cut their payroll by another 620 employees, the biggest fallout yet from the Colorado-based parent company's continuing financial slide. The purge, which includes 459 layoffs, has brought the total number of cuts at Catholic Health Initiatives' Texas division since August to 1,295, about 30 percent more than MD Anderson Cancer Center's 1,000-employee workforce reduction in January. In those seven months, St. Luke's has laid off 810 employees, compared to MD Anderson's 788. (Ackerman, 3/30)

An open house was held Thursday for a new health facility for firefighters in Howard County that opened earlier this month. Officials said the facility creates an opportunity for firefighters to receive specialized care in a profession where occupational health hazards are often not fully addressed by traditional clinics...Before the facility opened, the department contracted services with another company, but that option was often inefficient, officials said. Sudden cardiac death accounts for most on-duty deaths, according to a 2016 study by the National Fire Protection Association, a nonprofit that outlines fire and building safety standards. (Wasson, 3/31)

Dr. Moises Garcia's goal in treating patients with liver ailments is to provide medical care to head off transplants, but his work also keeps him in contact with those who have undergone, or will undergo, that operation. Now, in an unusual twist, Garcia faces the prospect of a transplant himself. A degenerative disease he's known about for decades has him searching for a kidney donor. (Phelps, 3/30)

A former Chief Justice of the New Hampshire Supreme Court has been hired to work for Dartmouth-Hitchcock Medical Center. Former Chief Justice John Broderick will start next week as Senior Director for Public Affairs. Dartmouth-Hitchcock says Broderick will advocate on behalf of the hospital to policymakers and business and community leaders in the region. (Rodolico, 3/30)

Summa Health staffers of every stripe on Thursday experienced mixed-reality technology to help design operating rooms that will be built in the health system's new West Tower. Summa is one of the first hospital systems in the country to use Microsoft HoloLens technology to design its operating rooms. The health system will break ground in May for the $350-million, 300,000-square-foot building that will serve as the new front door to the Akron Campus. (Conn, 3/30)

The Cleveland Clinic will hold a groundbreaking ceremony for the Lakewood Family Health Center on Tuesday, April 4. The 62,000-square-foot, three-story center will be built at the southwest corner of Detroit and Belle avenues, on the site of a former medical office building. (Farkas, 3/30)

Marijuana has become easy to find at the Texas Capitol — at least in terms of references to the drug. More than a dozen bills are pending in the Texas Legislature this session, aimed at lifting prohibitions on Texans who want to use marijuana for medical and recreational purposes. (Sechler, 3/30)

The Georgia state Senate on Thursday overwhelmingly passed a bill that would expand the state's limited medical marijuana law to include people with 15 medical conditions, up from nine currently. The bill now goes to Governor Nathan Deal to sign into law. (Woodall, 3/30)

After a harrowing separation surgery and a long recovery in two different hospitals, formerly conjoined twins Eva and Erika Sandoval made the journey back to their Antelope home Wednesday afternoon in separate car seats. The 2-year-old sisters, born conjoined from the chest down, were separated Dec. 6 at Lucile Packard Children’s Hospital Stanford. During a 17-hour procedure, a team of 50 medical staff split their shared liver, pelvis and digestive system and removed the third leg they once shared. Each girl now has a full set of organs and one leg of her own. (Caiola, 3/29)

Because insurers can no longer vary their offers of coverage based on applicants’ health status, the [Affordable Care Act] established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. ... we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90–$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0–$49 per month. (Jacobs, Cohen and Keenan, 3/29)

Vaccines have been one of the most useful tools for achieving substantial reductions in childhood mortality. However, progress in reducing deaths has been slower for infants too young to be vaccinated than for infants and children old enough to receive vaccines. ... This vulnerability of infants who are too young to be vaccinated can be addressed by means of maternal vaccination. Moreover, several infections, such as influenza and hepatitis E, are considered to be associated with increased morbidity and mortality during pregnancy. ... This article synthesizes the evidence for current maternal immunization recommendations, reviews new developments in this rapidly evolving field, and outlines critical areas for future research that will provide a framework for a comprehensive maternal immunization platform. (Omer, 3/30)

This database study linked National Practitioner Data Bank claims data with physician specialty and found that the overall rate of claims paid on behalf of physicians deceased by 55.7% from 1992 to 2014. Mean compensation amounts and the percentage of payments exceeding $1 million increased during that time, with wide differences in rates and characteristics across specialties. ... The increases ranged from $17 431 in general practice ... to $114 410 in gastroenterology ... and $138 708 in pathology. (Schaffer et al., 3/27)

This Visualizing Health Policy infographic spotlights public opinion on health reform in the United States as of 2017. The largest percentage of Democrats and Republicans give top priority to lowering out-of-pocket costs for health care. However, other priorities vary by political party: 63% of Republicans vs 21% of Democrats view Affordable Care Act (ACA) repeal as a top priority, while 67% of Democrats vs 55% of Republicans view lowering the cost of prescription drugs as a top priority. (Kirzinger et al., 3/29)

Methadone accounted for approximately 1% of all opioids prescribed for pain but accounted for approximately 23% of all prescription opioid deaths in 2014. State drug management practices and reimbursement policies can affect methadone prescribing practices and, in turn, might reduce methadone overdose rates within a state. ... Drug utilization management policies that reduce the use of risky opioids such as methadone might reduce opioid-related morbidity and mortality. This evidence of decreases in methadone overdoses and use of preferred drug list policies could serve as a model for future decreases in other specific opioid drug-related mortality. (Faul, Bohm and Alexander, 3/30)

Findings: In this economic analysis using a simulation model, home telemonitoring was considered to be cost-effective in developed countries for patients at high risk for the neovascular form of age-related macular degeneration ($35 663 per quality-adjusted life-year gained). Home monitoring for age-related macular degeneration currently would cost society $907 and be cost saving for patients, incurring $1312 in government expenditures during 10 years. Meaning: This simluation model suggests that supplementing usual care with home telemonitoring for patients at high risk for developing neovascular age-related macular degeneration not only reduces risk of vision loss but also is cost-effective, although incurring net costs for Medicare. (Wittenborn et al., 3/30)

President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law on April 16, 2015. The law, passed by a strong bipartisan majority in both chambers of Congress, replaced a controversial existing Medicare physician payment system in effect since 1999. The new law makes fundamental changes in the government's approach to physician payment. ... This policy brief focuses primarily on the context in which these changes are taking place, implementation challenges, and the debate over the law and the concepts that underlie it. (Findlay, 3/27)

This note briefly describes the cost-sharing reductions in current law and illustrates their impact by looking at how these provisions affect average deductibles and out-of-pocket maximum limits in benchmark silver plans in 2017 in states using the federally facilitated marketplace. (Rae, Claxton and Levitt, 3/22)

Utterly flummoxed last week, after only seven years to prepare their promised repeal and replacement of Obamacare, House Republican leaders proclaimed new worlds to conquer -- or just as likely, to be conquered by -- and expressed a desire to move on, most likely to tax reform. (Kevin O'Brien, 3/31)

It's unsettling that President Donald Trump seemed to treat the failure of his plan to repeal and replace the Affordable Care Act like a business venture that had soured. Oh, well, on to the next entrepreneurial adventure, which he said would be tax reform. OK, but who's going to clean up the mess left by the Kill Obamacare fiasco? The law still has flaws that need to be fixed, and they can be without repealing the statute and starting over again. (3/31)

Republicans often suggest that Obamacare is “collapsing” without ever acknowledging the role they’ve played in undermining the law and the state insurance exchanges it created. They have an opportunity now to do even more damage to those exchanges — and to their constituents — by reneging on Obamacare’s commitment to help low-income Americans afford care. Congressional Republicans set up this situation by trying to evade an obligation Congress created in the 2010 law (also known as the Affordable Care Act). The law makes low-income Americans who are not covered by an employer’s group plan eligible both for tax credits to lower their premiums and for subsidies to reduce their out-of-pocket costs. Without that assistance, poor families may not be able to afford to see a doctor even if they have insurance. (3/31)

Within hours after taking the oath of office, President Donald Trump executed his first official act: an executive order redeeming his campaign pledge to, on “day one,” begin repeal of the Affordable Care Act (ACA).1 The New York Times characterized his action as itself “scaling back Obamacare,” and the Washington Post said the order “could effectively gut [the ACA’s] individual mandate” to obtain health insurance coverage. But consumer advocate Ron Pollack dismissed Trump’s action as “much ado about very little.” (Timothy Stoltzfus Jost and Simon Lazarus, 3/29)

Here’s a radical idea for reframing the health-care debate on the ruins of the GOP’s half-baked plan: Let’s listen to doctors rather than politicians. And let’s begin with a simple formula offered last week by the National Academy of Medicine: “Better health at lower cost.” Better and cheaper. It’s hard to argue with that prescription. Because the real health-care crisis in America is about delivery of care, more than the insurance schemes that pay the bills. Costs are continuing to rise, even as public health in America declines. We’re getting less for more. And the GOP’s proposal to starve Obamacare will make that downward spiral worse. (David Ignatius, 3/30)

The recent Republican debacle on health care could prove to be an opportunity. It highlighted, yet again, the complexity of the U.S. system, which continues to be by far the most expensive and inefficient in the advanced world. But President Trump could actually use the legislative collapse to fix health care if he went back to basics and to his core convictions on the topic, which are surprisingly intelligent and consistent. (Fareed Zakaria, 3/30)

Shortly after the election in November, the incoming Trump administration and the Republican leadership in Congress decided on an approach that was risky, and proved to be fatally flawed. They wanted to move rapidly, before opposition could coalesce, to pass a repeal-only bill using budget reconciliation so that Republicans could muscle it through the Senate without needing any Democratic votes. After passing repeal, with a delay of two or three years for terminating key provisions of the ACA, the plan was then for Congress to take its time to bring forward a replacement plan, perhaps broken up into several different bills addressing different features of the health system. (James C. Capretta, 3/31)

When Speaker of the House of Representatives Paul Ryan’s plan to repeal the Affordable Care Act and replace it with a hastily crafted alternative was scuttled last week, two things became clear. First, after seven years of decrying “Obamacare” and more than 50 votes to amend or repeal the health care plan, the GOP had failed to craft a palatable replacement. The American Health Care Act instantly became a historically unpopular piece of legislation, with just 17 percent of the public favoring the plan in polls taken just before its consideration by the House. (3/31)

Repeal-and-replace (for Obamacare) is not quite dead. It has been declared so, but what that means is that, for now, the president has (apparently) washed his hands of it and the House Republicans appear unable to reconcile their differences. Neither condition needs to be permanent. There are ideological differences between the various GOP factions, but what’s overlooked is the role that procedure played in producing the deadlock. And procedure can easily be changed. (Charles Krauthammer, 3/30)

I had the great fortune to chat with my daughter’s preschool class last week about what I do as a health care ethicist — not the easiest thing to explain to 5-year-olds. I decided to talk with them about fairness and then play a game about resource allocation that seemed apropos of discussions we are having in the United States about health care. (Ryan F. Holmes, 3/29)

The failure of Obamacare’s opponents in Washington is prompting reconsideration among its opponents outside Washington. The end of the congressional effort to repeal the law has deprived leaders in 19 states of their rationale for rejecting federal money to expand Medicaid. (3/30)

All that stood between 150,000 Kansans and health insurance was Gov. Sam Brownback, but he did not let that give him pause.He did not defer to the 82 percent of Kansans who now support Medicaid expansion. Nor did he give any fact-based reasons for quickly vetoing a bill that would save lives, save money and save rural hospitals in his state, which has lost out on $1.8 billion in federal aid since 2014 by refusing the help. (3/30)

Four hundred thousand more Virginians could get health-care coverage, quickly and at minimal cost to the state. All that’s needed is for anti-Obamacare dead-enders in the General Assembly finally to put the well-being of their people over partisanship, as Republicans in a variety of deep-red states now are doing. (3/30)

The future of Medicare and Medicaid may depend on Sen. Charles Grassley. He is one of a handful of Senate Republicans who could serve as a firewall against harmful changes to these crucial programs that Iowa seniors rely upon. The GOP’S American Health Care Act would have cut $880 billion from Medicaid. With so many Iowa seniors depending on Medicaid for long-term care, it is perplexing that Sen. Grassley supported the AHCA. We hope the senator will reconsider his position the next time Republicans attempt to gut Medicaid. (Max Richtman, 3/30)

President Donald Trump has named Scott Gottlieb as his nominee to be the next commissioner of the Food and Drug Administration (FDA). As compared with some of the other people whose names were floated publicly for the position, Gottlieb is a traditional choice, a physician who served in a deputy commissioner role under President George W. Bush. Observers who opposed Commissioner Robert Califf because of his relationships with drug companies will surely express concern about Gottlieb’s consulting in this area. But he would have been on the short list for any Republican administration. If confirmed, Gottlieb would take the helm of the FDA at a time when it faces a number of key challenges. We highlight these challenges, to emphasize the talents required of the next commissioner. (Amitabh Chandra and Rachel E. Sachs, 3/29)

President Donald Trump has nominated Scott Gottlieb as U.S. Commissioner of Food and Drugs. The Trump administration’s approach to the Food and Drug Administration (FDA) is guided by a libertarian belief in markets over science, and Gottlieb apparently shares this view. He has argued that the agency displays an “unreasonable hunger for statistical certainty” and a “profound lack of confidence in the ability of doctors to make careful judgments.” He seems poised to weaken phase 3 testing requirements.1 The administration considered nominees with even more extreme views, including the belief that the FDA should not be in the business of regulating drug efficacy. (Daniel Carpenter, 3/29)

In all the discussions about the proposed health care law, it was easy to overlook a statement made by Attorney General Jeff Sessions on March 15: “I think we have too much of a tolerance for drug use – psychologically, politically, morally… We need to say, as Nancy Reagan said, ‘Just say no.’” ... Sessions’ statement aligns with his stated commitment to increase the number of private prisons, as in February 2017, he revoked the directive by President Obama to reduce the number of for-profit prisons. ... Between Sessions’ statements about our country being too tolerant of drugs and his plans to expand private prisons, we appear to be heading back toward criminalizing addiction, rather than treating it. (Margie Skeer, 3/30)

Maryland faces a horrific opioid epidemic, which claimed nearly 1,100 lives in 2015, the last full year for which data exist. Though a growing share of the toll is attributable to heroin and illicit fentanyl, prescription opioids still account for a large portion: more than 32 percent of the deaths in 2015, to be exact. Legal drugs, often obtained initially with a physician’s authorization, drove the upsurge of opioid addiction in the 21st century and continue to create havoc. (3/30)

Claire McCaskill is no shrinking violet. So the Missouri senator’s much-publicized incursion this week into the opioid epidemic that is rocking this country should surprise no one. That includes Sen. Ron Johnson, the Republican chairman of the Senate Committee on Homeland Security and Governmental Affairs on which McCaskill sits. Johnson said he was disappointed in the Democrat’s go-it-alone decision to demand marketing information, sales records and studies from opioid manufacturers. (3/30)

On March 16, 2017, President Donald Trump submitted his budget titled “America First,” with a proposal to cut the 2018 National Institutes of Health (NIH) budget by 18.3%, or approximately $5.8 billion. It is the first time a president has proposed a cut of this magnitude since the NIH received its first appropriation in 1938, with an initial investment of $400,000 in the National Cancer Institute. Since that time, the NIH budget has grown to $32 billion, with nearly 80% being awarded through competitive grants to more than 300,000 investigators at 2500 universities, medical schools, and other research institutions in every state and around the world. (Ingrid T. Katz and Alexi A. Wright, 3/29)

The Boston Globe Spotlight series paints a disturbing picture of the current state of mental health care in the Commonwealth. Vulnerable people and their families are left to fend for themselves. Individuals who suffer from severe and debilitating mental illness are often criminalized or lack access to appropriate treatment. Our criminal justice system has become the de-facto provider of behavioral health services. The response of the legislature to tragic stories from our first responders, our courts, and our family members has been anemic at best. Our system does not adequately serve those with severe mental illness, and it is well beyond the time to take bold action. (Kenneth Donnelly, 3/31)

Medical malpractice reform appears to be back on the federal policy agenda. The appointment of Tom Price, a long-time proponent of tort reform, as secretary of health and human services, in conjunction with Republican control of both houses of Congress, has created fertile conditions for several Republican proposals that have languished for years without the requisite support. Although it has been debated many times, a major federal foray into medical liability, a state-based area of law, would be unprecedented. The prospect raises several questions: Which reforms are on the table? Would they be effective? And is the time right? (Michelle M. Mello, Allen Kachalia and David M. Studdert, 3/29)

Gov. Matt Bevin continues to waste public resources — including the federal courts’ time — by attacking the rights of Kentuckians to make private decisions about their lives and their families’ futures. Bevin’s latest assault would effectively outlaw abortion in Kentucky by shutting down the state’s last abortion provider. Fortunately, a history of U.S. Supreme Court decisions stands as a bulwark against this attack on reproductive rights. (3/30)

As suddenly as they announced it, Iowa House Republicans withdrew a piece of legislation that would have banned abortions as early as six weeks of pregnancy, or once a fetal heartbeat could be detected, which would have effectively banned all abortions. But not before Democrats on the House Human Resources Committee spent a frantic 30 hours trying to figure out what they could do to protect Iowa women’s constitutional right to choose. The answer is, not much. (Rekha Basu, 3/30)

Research shows that in states where abortion access has been severely limited, some women terminate their pregnancies on their own, sometimes using extreme methods such as inserting sticks or toxic liquids into their wombs. The potential shutdown of Kentucky’s only remaining licensed abortion facility, EMW Women’s Surgical Center in Louisville, puts Kentuckians in danger. (Marcie Crim, 3/30)

Not that long ago, Americans lived in fear of infectious diseases such as polio. In the early 1950s, polio caused more than 15,000 cases of paralysis each year. Following the introduction of vaccines in 1955 and 1963, the number of polio cases fell rapidly to less than 100 in the 1960s and fewer than 10 in the 1970s. Since 1979, no cases of polio have originated in the United States. Your uncle, President John F. Kennedy, joined with then-Surgeon General Dr. Luther Terry, in “urging that every person who has not been vaccinated immediately do so with the vaccine now available.” You could build on your family’s legacy of science-based, public health prevention. Instead, you are sowing fear and doubt at the highest levels of government by doubling down on your conspiracy theory that the use of thimerosal in vaccines causes brain disorders, including autism. (Susan Peschin, 3/30)

To better understand the profession from the perspective of those who are new or relatively new to it, my organization, the American Medical Association, recently surveyed a total of 1,200 medical students, residents, and physicians with 10 or fewer years on the job. The survey asked, among other things, why they became physicians, what challenges they face professionally, and whether they are satisfied with their career choice. One answer that was loud and clear: medical students, residents, and young physicians overwhelmingly view the profession as a calling, one driven by an innate desire to help others. Nearly three-quarters of those surveyed said they heard this calling while still in their teens. (Patrice A. Harris, 3/30)

By providing care of last resort for all Cuyahgoa County residents no matter their income or level of health insurance; by adding clinics in the Cleveland schools; by expanding its primary care network throughout the county and by taking over responsibility for the medical care of Cuyahoga County jail inmates, the MetroHealth System continues to be an irreplaceable asset for the county and its residents. ... And what has Cuyahoga County done in return? Cut its subsidy by double-digits. Cut MetroHealth's share of the county health and human services levies down to 14 percent from 18 percent just four years ago. Refused to put even this funding on a sustainable basis. (3/31)

California is supposed to be the heartland of resistance to all things Donald Trump, but then what to make of the effort by Golden State Democrats and Republicans in Washington to stop runaway disabilities torts? Congress passed the Americans with Disabilities Act (ADA) in 1990 to ensure that handicapped people aren’t discriminated against or denied access to services. But due to regulatory overgrowth, the 275-page ADA building code now specifies everything from the height of bathroom mirrors to the size of toilet-paper dispensers. (3/30)