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Major insurers in some states are proposing hefty rate boosts for plans sold under the federal health law, setting the stage for an intense debate this summer over the law’s impact. In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6% in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3% increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4% across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25%. (Radnofsky, 5/21)

Wellmark Blue Cross Blue Shield is proposing to raise rates by almost 43 percent for its South Dakota members who've signed up for individual Affordable Care Act health plans outside of the federal health care exchange. Wellmark is the largest private health insurer in the state. About 14,000 South Dakotans have ACA-compliant plans through the company. (Burbach, 5/21)

Vermont officials are considering turning to Connecticut’s health insurance exchange as an alternative to that state’s struggling Obamacare marketplace. Officials in Vermont have given the state’s exchange, Vermont Health Connect, deadlines to make improvements; the first one comes at the end of this month. But if those deadlines aren’t met, state officials are expected to explore alternatives, including using the federal government’s HealthCare.gov exchange. (Levin Becker, 5/21)

The Obama administration is keeping the pressure on Florida to expand Medicaid under the Affordable Care Act. On Thursday, it proposed cutting more than $1.6 billion over two years in funding for Medicaid's Low-Income Pool in Florida. The offer, made in a letter from the Centers for Medicare and Medicaid Services to state officials, signals public progress in the negotiations that have been ongoing for months in that there actually is something on paper. (Scott, 5/21)

The federal government opened the door on Thursday to a compromise that could ease Florida’s budget impasse, rooted in a disagreement over Medicaid expansion and the cost of caring for the uninsured. In a letter to Florida’s top health care official, the Obama administration said that it could authorize $1 billion for the 2015 fiscal year and $600 million for the 2016 fiscal year to reimburse hospitals for treating patients who do not have insurance. The cost would be shared by the state and federal governments. The $1 billion offer is less than half of what the state requested for this year for the Low-Income Pool program, which is set to expire June 30. (Alvarez, 5/21)

The CMS is appearing to blink in its stare down with Florida over Medicaid expansion. The agency informed state officials that it tentatively plans to renew a waiver that has provided Florida billions in supplemental Medicaid funding to help hospitals with uncompensated-care costs. The Obama administration had tied renewal of the waiver—which it warned a year ago was ending—to Florida's expansion of Medicaid to adults with incomes up to 138% of the federal poverty level. HHS and CMS officials have said the administration does not want to provide supplemental hospital-care funding for people Florida could cover through a Medicaid expansion. The state filed a lawsuit in return, as it felt the Obama administration was trying to force it to expand coverage, something the U.S. Supreme Court had ruled against. (Dickson, 5/21)

Federal health officials told Florida Thursday that the state should expect big reductions in future years for a hospital payment program that's at the crux of a political stalemate blocking passage of a new state budget. In a letter to state health officials, the U.S. Centers for Medicare and Medicaid Services said the state may justify needing about $1 billion in government funding for uncompensated care next year, or less than half of what it got this year, and even less in subsequent years. That's a clear message from Washington that Florida needs to reform its hospital payment system. (Bousquet, 5/21)

The Centers for Medicare and Medicaid Services also told the state Thursday that as part of this “transition,” the LIP program also would decline to $600 million in 2016-17. The program is funded with local, state and federal dollars and the current almost $2.2 billion LIP includes $1.3 billion in federal money. News of the reduced health care cash is certain to shape the Legislature’s special session planned for next month to craft a state budget and debate a proposed, privatized form of Medicaid expansion pushed by the state Senate, but fiercely opposed by Scott and the House. (Kennedy, 5/21)

According to CMS, $1 billion from federal, state and local resources would “maintain stability while the system transitions’’ to new ways of paying hospitals for the high cost of treating poor patients as the federal government phases out the current funding system known as the low income pool, or LIP. Miami’s Jackson Memorial Hospital is by far the largest recipient of LIP money. Tampa General Hospital, All Children’s Hospital in St. Petersburg and Broward Health also are big recipients. They were promised $731 million this year in payments provided through federal and local tax money totaling nearly $2.2 billion. Carlos Migoya, chief executive of Jackson Health System, whose hospital network risked losing about $200 million a year without renewal or replacement of LIP, said the federal government’s letter was “a good starting point.” (Bousquet and Chang, 5/21)

Florida Gov. Rick Scott (R) last month sued the Obama administration over what he called an effort to force his state to expand Medicaid under ObamaCare, by withholding funds for a separate federal program that compensates hospitals for treating uninsured people, called the Low Income Pool (LIP). The allegations of coercion have spilled onto Capitol Hill, where Republicans have announced a hearing on the issue this summer and have written to President Obama calling on him to stop the “overreach.” (Sullivan, 5/21)

The Obama administration told Florida on Thursday it should prepare to receive significantly less funding under its Low Income Pool — but the money isn’t completely drying up. (Pradhan, 5/21)

While the Senate and House scrambled last week to agree on terms of a proclamation for a special session, Gov. Rick Scott had followed through on a threat to draft his own proclamation -- and on his terms. Those terms specifically excluded any discussion of Medicaid expansion that the Senate wants. Scott's document said "specifically excluding legislation expanding Medicaid eligibility." The Senate would never agree to such a blanket restriction. (Bousquet, 5/21)

The House Energy and Commerce Committee on Thursday unanimously approved a medical cures bill shortly after reaching a bipartisan $13 billion deal to pay for the legislation. (Sullivan, 5/21)

A U.S. House of Representatives committee on Thursday unanimously approved a bill to speed new drugs to the market, overcoming last-minute wrangling over how to pay for the legislation. The bill, known as the 21st Century Cures Act, requires the Food and Drug Administration to incorporate patient experience into its decision-making, streamline its review of drugs for additional uses, and consider more flexible forms of clinical trials. (5/21)

A bill in the House of Representatives that aims to speed approval of drugs and medical devices would set aside $10 billion over five years for the National Institutes of Health and about half a billion dollars for the Food and Drug Administration, rare funding increases that the bill’s sponsors say will help carry out the sweeping legislation and spur biomedical innovation. (Tavernise, 5/21)

House committee members Thursday voted unanimously to move the proposed 21st Century Cures Act toward consideration by the full body. The bipartisan support reflected in House Energy and Commerce Committee members' 51-0 vote in favor of the bill came after lawmakers hashed out an agreement on ways to offset its estimated $13 billion cost. (Johnson, 5/21)

The House Energy and Commerce Committee unanimously passed its 21st Century Cures bill Thursday morning, putting the bipartisan legislation on track for a vote in the House next month. (Norman, 5/21)

As Sen. Chris Murphy (D-Conn.) tries to revive Congress’s long-stalled mental health reform bill, he is demanding changes to one of its most controversial provisions. For years, the biggest sticking point for the House’s Helping Families in Mental Health Crisis Act has been the expansion of involuntary outpatient treatment. That idea has created a sharp divide between mental health groups and has prevented the bill from advancing. (Murphy, 5/21)

The Senate Appropriations Committee on Thursday advanced a $77.6 billion funding bill for military construction and veterans benefits that includes an amendment allowing Veterans Affairs doctors to recommend the use of medical marijuana. (Shabad, 5/21)

U.S. Sen. Cory Gardner on Thursday made good on his promise to push for over-the-counter contraceptives, introducing legislation aimed at making it easier for women to prevent unwanted pregnancies. The legislation encourages drug manufacturers of "routine-use contraceptives" to file an application with the Food and Drug Administration to sell their products over the counter. (Bartels, 5/21)

In a bid to strengthen its foothold as a dispenser of expensive prescription drugs, CVS Health Corp. agreed Thursday to pay $10.4 billion to acquire Omnicare Inc. Omnicare is a growing player in the fulfillment of prescriptions for diseases like cancer and multiple sclerosis, where the per-patient cost of medications can range from $50,000 to $100,000 annually. (Walker, 5/21)

Drugstore operator CVS Health Corp (CVS.N) said Thursday it will spend $10.1 billion to buy Omnicare Inc (OCR.N), a company that supplies prescription medicines to nursing, assisted living and other healthcare facilities. The move gives CVS, the second-largest U.S. drugstore operator, access to the older, sicker U.S. population and builds on its specialty pharmacy, which provides drugs to people with expensive chronic conditions such as rheumatoid arthritis. (5/21)

As the American population gets older, pharmacies and other health care providers are increasingly positioning themselves to capitalize and serve the needs of this demographic. This group often needs drugs for chronic conditions like diabetes and heart disease, as well as lifesaving medications for sudden conditions like infections or pneumonia. (Thomas and Bray, 5/21)

CVS Health will pay more than $10 billion for pharmaceutical distributor Omnicare in a deal primed to feed its fast-growing specialty drug business and tap a lucrative and growing market: care for the elderly. The acquisition announced Thursday will give one of the biggest U.S. pharmacy benefits managers national reach in dispensing prescription drugs to assisted living and skilled nursing homes, long-term care facilities, hospitals and other care providers. Omnicare's long-term care business operates in 47 states and the District of Columbia. (Murphy, 4/21)

The deal will dramatically add to CVS' revenue next year, and integrating the companies also will lead to savings in purchasing and other operations, CVS said. It will contribute about 20 cents to CVS' earnings per share next year, after excluding one-time transaction-related costs. (Yu, 5/21)

Karen Ignagni was the woman who could have killed Obamacare. Instead, the nation’s top health insurance lobbyist helped President Barack Obama to pass his sweeping health reform. And she became emblematic of the compromises and controversies that still define the Affordable Care Act today. (Palmer, Haberkorn and Demko, 5/21)

Karen Ignagni, the longtime leader of the health-insurance lobbying group America’s Health Insurance Plans, will leave to become chief executive officer of EmblemHealth, a not-for-profit health plan based in New York. (Armour, 5/21)

Dan Durham, AHIP's executive vice president, will serve as the lobbying group's interim CEO. Speculation has swirled that a former member of Congress could take Ignagni's place. (Herman, 5/21)

House lawmakers were warned Thursday night that their personal data may have been compromised in a cyberattack involving health care plans from CareFirst Blue Cross Blue Shield. In an email to lawmakers obtained by POLITICO, House administration officials said hackers may have gained access to “limited personal information for House employees” — including members enrolled in Blue Cross Blue Shield plans set up under Obamacare. (French, 5/21)

Information-technology staffers at CareFirst Blue Cross and Blue Shield believed they had contained a data hack back in June, 2014. But on Wednesday, the not-for-profit insurer serving Maryland, Washington and northern Virginia, said the personal information of 1.1 million individuals was breached. Experts say any delay in responding to a breach could magnify the compromised security and increase public relations damage. (Rubenfire, 5/21)

The Health and Human Services budget passed by Minnesota’s Senate and House of Representatives will increase health care costs for the working Minnesotans covered by MinnesotaCare. The Health and Human Services budget (Senate File 1458) stops well short of the House’s attempt to repeal MinnesotaCare, but it raises out-of-pocket costs and premiums. Lawmakers made these changes to a time-tested, proven tool for affordable health care despite a projected surplus in the fund that pays for it. (Horowitz, 5/21)

Low-income childless adults on Wisconsin's BadgerCare Plus Medicaid program may have to pay higher premiums if they engage in risky behavior. The Legislature's Joint Finance Committee approved Gov. Scott Walker's proposal that could lead to the change as part of a wide-ranging Medicaid motion Thursday. (5/22)

The Legislature's finance committee has rejected Gov. Scott Walker's cuts to Wisconsin's popular SeniorCare program. Gov. Scott Walker's budget proposal calls for cutting $97 million from the senior citizen prescription drug discount program. It also would require participants to first sign up for the federal Medicare Part D drug program and use SeniorCare as backup coverage. (5/22)

As final details of the state's next budget for health and human services emerged Wednesday, Republicans hailed a fiscally conservative approach to serving the state’s neediest populations, while doctors’ groups and advocates for the poor saw little to celebrate. (Walters, 5/21)

Planned Parenthood would be ousted from the state’s program to provide breast and cervical cancer screenings for low-income women under the budget compromise approved by a House-Senate conference committee Wednesday. A tiered funding system that the Texas Senate sought for the joint federal-state Breast and Cervical Cancer Services program — which provides cancer screenings for poor, uninsured women — was meant to effectively eliminate Planned Parenthood's role in the program. (Ura, 5/21)

In the latest blow to Planned Parenthood, Texas lawmakers have approved a budget measure to exclude the organization’s health clinics from a state program that funds breast and cervical cancer screenings and helps women pay for treatment. (Martin, 5/21)

The state Senate Thursday night passed an expansive bill aimed at influencing the state’s fast-changing health care landscape, a measure driven largely by Senate leaders’ concerns about large hospital systems gaining too much market power and driving up costs. (Levin Becker, 5/21)

A group representing 25,000 doctors in Massachusetts issued new guidelines Thursday for prescribing pain medication, citing an epidemic of opioid abuse that claimed the lives of more than 1,000 people in the state last year. (5/21)

Boston Children’s Hospital is extending its reach to patients far outside Boston, with a deal to acquire a large and growing group of doctors in New York, New Jersey, and Connecticut. (Dayal McCluskey, 5/21)

[Jeff] Gold may be the first physician in Massachusetts practicing under a model called direct primary care. For a flat monthly fee, Gold offers patients one-hour same-day appointments, no wait. The doctor is available 24/7 in person, at the office, at the patient’s home, via text, email or Skype. (Bebinger, 5/21)

Indiana approved a yearlong needle-exchange program Thursday for a rural county at the center of an HIV outbreak that spurred a new state law allowing such programs to curb the spread of diseases among intravenous drug users. State health Commissioner Dr. Jerome Adams' approval for Scott County includes a public health emergency declaration that will allow it to operate a needle-exchange through May 24, 2016. The southeastern Indiana county has operated a temporary needle-exchange since early April under executive orders Gov. Mike Pence signed in response to the largest HIV outbreak in state history. (5/21)

Physician-assisted suicide is illegal in all but five states. But that doesn’t mean it doesn’t happen in the rest. Sick patients sometimes ask for help in hastening their deaths, and some doctors will hint, vaguely, how to do it. This leads to bizarre, veiled conversations between medical professionals and overwhelmed families. Doctors and nurses want to help but also want to avoid prosecution, so they speak carefully, parsing their words. Family members, in the midst of one of the most confusing and emotional times of their lives, are left to interpret euphemisms. (Dembosky, 5/21)

Heroin, today, is killing more and more people in rural america. One Mexican cartel has seeded low-cost heroin around rural towns in the Southwest and Midwest, selling it cheap and easy, almost like pizza. Madison, Neb. — population 2,500 — is just a speck of a town, a two-hour drive from the big-city bustle of Omaha. But it's not far enough away to avoid the growing impact of heroin. (Calvan, 5/22)

The former director of a drug treatment center in Des Moines mismanaged more than $130,000 intended for client benefits, according to a state audit released Wednesday. Mindy Williams, former executive director of Center for Behavioral Health in Des Moines, falsified receipts and other documentation when seeking reimbursements for incentive benefits issued to clients, according to a special report by state Auditor Mary Mosiman's office. Those incentive benefits included gas cards, gift cards and bus passes used to help clients continue seeking services. (5/20)

Tulsa County began recycling prescription drugs 10 years ago. More than $16 million worth of medicines have been given to the poor. Steve Inskeep talks to Linda Johnston, director of Social Services. (5/22)

Johnson & Johnson will pay $7.8 million to settle the state of Arkansas’s claims the company illegally marketed its Risperdal antipsychotic medicine, a case that featured a billion-dollar award against the drugmaker that was thrown out. (Feeley, 5/21)

To the surprise of many, in March, the legislature of Maryland passed 2 bills that would amend an outdated health insurance mandate that excluded same-sex couples from coverage for in vitro fertilization treatments. (Adashi, 5/20)

While there are a number of drugs designed to treat ... infections, resistant strains are emerging at a rate that is currently outpacing the development of effective new drugs. Methicillin-resistant Staphylococcus aureus (MRSA) alone kills more than 19,000 Americans every year--more than emphysema, HIV/AIDS, Parkinson's disease, and homicide combined. ... pharmaceutical companies do not have strong economic incentives to develop new antibiotic drugs. ... This brief provides an overview of antibiotic resistance, including a summary of its current impact, the factors that contribute to its spread, and the policy recommendations put in place by federal and global public health agencies. It also reviews the debate around the regulation of antibiotic use in agriculture and examines new developments in policy and research. (Chin, 5/21)

[Researchers sought to] measure the effect of [primary care provider] PCP turnover on patient experiences of care and ambulatory care quality ... [using a] cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA) .... Turnover was associated with a reduced likelihood of having a positive rating of their personal physician of 68.2% vs 74.6% and a reduced likelihood of getting care quickly of 36.5% vs 38.5%. In contrast, PCP turnover was not associated with lower quality of ambulatory care except for a lower likelihood of controlling blood pressure .... In 9 measures of ambulatory care quality, the difference between patients who experienced no PCP turnover and those who had a PCP turnover was less than 1 percentage point. (Reddy, 5/18)

The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for ... Food and Drug Administration (FDA) approved prescription contraceptives and services for women. ... over 200 corporations have filed lawsuits claiming that including coverage for contraceptives or opting for an “accommodation” from the federal government violates their religious beliefs. ... the Supreme Court ruled that “closely held” for-profit corporations may be exempted from the requirement. This ruling, however, only settled part of the legal questions raised by the contraceptive coverage requirement .... The nonprofits are seeking an “exemption,” meaning their workers would not have coverage for some or all contraceptives, rather than an “accommodation,” which entitles their workers to full contraceptive coverage but releases the employer from paying for it. (Sobel and Salganicoff, 5/18)

This policy brief presents 10-year trends in several key health and wellness indicators for children ages 0-5 in California. ... [It] covers the years 2003 to 2011-2012, a period in which public health efforts for children focused on childhood obesity and improved nutrition, access to low-cost and free dental services, and the expansion of children’s health insurance programs. CHIS data show improvement in health insurance coverage and access to dental services for low-income children over the 10-year period. However, the percentage of children who were overweight for their age remained unchanged among those in households with incomes below 200 percent of the federal poverty level. ( Holtby, Zahnd and Grant. 5/21)

Medical debt continued to be an issue for American families at the end of 2014, with an estimated one in four nonelderly adults reporting medical debt. Further, medical debt is more of a challenge for middle-income adults, who lack the public coverage options available to low-income adults and lack the financial resources of high-income adults. Of some concern, most adults incurred their family medical debt during periods with health insurance coverage. ... [That] suggests that changes in covered services and cost-sharing requirements would cushion the impacts of higher medical bills for low- and middle-income families. Medical debt resulting from uncovered services was reported by 9.3 percent of low-income adults and 12.7 percent of middle-income adults. (Karpman and Long, 5/21)

The share of adults with problems paying family medical bills in the previous 12 months fell an estimated 4.7 percentage points between September 2013 and March 2015. Overall, an estimated 9.4 million fewer adults had problems paying family medical bills .... we find that nearly three-quarters of the adults who have problems paying family medical bills forgo needed health care because they cannot afford it. Expansions of health insurance coverage under the ACA are likely to reduce but not eliminate problems with the affordability of health care, while ACA policies designed to limit cost sharing may expand access to care that would otherwise be viewed as unaffordable. (Karpman and Long, 5/21)

The survey, conducted February 18 – April 5, 2015, after the close of the second open enrollment period, includes individuals who purchased ACA-compliant coverage inside or outside of a Marketplace, as well as those who are currently enrolled in “non-ACA compliant” plans. ... Most (59 percent) of those who did shop for a plan this year (including those who purchased a new plan and those who shopped around but decided to renew a previous plan) say they had about the right number of plans to choose from. ... A large majority of those in ACA-compliant plans, including three quarters (74 percent) of those with Marketplace coverage, rate their overall health insurance coverage as excellent or good. More than half also say their plan is an excellent or good value for what they pay for it (Hamel et al., 5/21)

(HHS) has used the ICD system as the foundation for reimbursement since 1983 .... The ICD-9-CM consists of over 14,000 diagnostic codes that are three to five characters in length, and there are an additional 4,000 ICD-9-CM procedural codes that are three to four characters in length. The ICD-10-CM codes are three to seven characters in length and total 68,000 different codes; the ICD-10-PCS codes are seven characters in length and total roughly 87,000 codes. ... The transition to ICD-10 will be costly—and health care providers, especially those in smaller, independent practices, will face financial and administrative burdens .... a more detailed disease classification system is a good thing. It may allow researchers to study disease and injury more easily and, over the long term, may foster better disease management. However, adoption of the new ICD-10 comes with significant costs and trade-offs. (Grimsley and O'Shea, 5/18)

The number of U.S. children and teens being treated for mental health issues has risen by about 50 percent in the past 20 years -- with most of those kids having relatively mild symptoms, a new study finds. The research, published in the May 21 issue of the New England Journal of Medicine, comes at a time of growing concern over young people's mental health treatment. (Norton, 5/20)

The rate of severe mental illness among children and adolescents has dropped substantially in the past generation, researchers reported Wednesday, in an analysis that defies public perceptions of trends in youngsters’ mental health. The new report, published in The New England Journal of Medicine, comes at a time of fierce debate over the rates and treatment of childhood mental disorders. Critics argue that modern psychiatry is over-diagnosing and treating an increasing number of the worried well or merely quirky. (Carey, 5/20)

In-hospital outcomes among patients undergoing carotid artery stenting (CAS) in the United States varied four-fold after adjusting for differences in patient risk factors in an analysis of data from a large, nationwide stenting registry. Significant variation was seen among hospitals performing CAS in both in-hospital stroke and death, with the risk-adjusted variation ranging from 1.2% to 4.7%, researcher Beau M. Hawkins, MD, of the University of Oklahoma Health Sciences Center, Oklahoma City, and colleagues wrote in the journal JACC: Cardiovascular Interventions, published online May 18. (Boyles, 5/19)

Patients mulling whether to get a common procedure to unclog blocked arteries may not get enough information from their doctors to make the best choice, a small study suggests. Researchers analyzed recordings of 59 conversations between cardiologists and patients about a common procedure called percutaneous coronary intervention (PCI), which is done to reopen arteries and restore blood flow to the heart - and found just two discussions covered all the points needed for patients to make an informed decision. (Rapaport, 5/20)

U.S. women who give birth by cesarean section are more likely to face medical complications such as unplanned hysterectomies and the need for blood transfusions, according to a large, federal study based on birth certificate data released on Wednesday. Cesarean births also caused more ruptured uteruses and intensive care unit admissions, the Centers for Disease Control and Prevention reported, after reviewing data from 3.5 million births in 41 states and Washington, D.C., in 2013. (Beasley, 5/20)

In senior housing facilities where residents are required to relocate as heath issues worsen, seniors tend to isolate themselves and may hide health conditions out of fear of relocation, according to a new study. Transitioning from independent living to assisted living to skilled nursing in one place can be disruptive and stressful, as researchers have known for 30 years, the authors write in The Gerontologist. (Doyle, 5/15)

Fewer American men are receiving prostate cancer screening in the wake of a national panel's conclusion that the test does men more harm than good, a new study finds. What's more, primary care doctors appear to have broadly accepted the U.S. Preventive Services Task Force's (USPSTF) ruling that the harms of prostate screening outweigh the benefits, according to a second study. (Thompson, 5/17)

Burnout rates among medical residents are reaching epidemic levels, new research suggests. A survey conducted by investigators at the University of North Carolina, Chapel Hill, showed that approximately 70% of residents met criteria for burnout. "We can't continue to ignore this problem of burnout," said Emily Holmes, MD, chief resident, University of North Carolina, Chapel Hill. "Burned out residents become burned out physicians." Dr Holmes presented the results here at the American Psychiatric Association (APA) 2015 Annual Meeting. (Anderson, 5/17)

Raising a child alone may take a lasting toll, leading to poorer health and more struggles with daily tasks after age 50, according to a new international study. Social safety nets and resources from extended families may blunt this effect in some countries more than others, and researchers found the association with poor health was strongest in the U.S., England, Sweden and Denmark, compared to southern European countries. (Doyle, 5/21)

The process for approving new drugs in the U.S. takes a long time and costs a lot of money. But in trying to speed things up too much, Congress runs the risk of allowing drugs to reach the market that aren't necessarily safe. Some lawmakers -- led by Energy and Commerce Committee Chairman Fred Upton, a Republican from Michigan, and Diana DeGette, a Colorado Democrat -- assert that drugs are slow in coming because the Food and Drug Administration has been failing to innovate quickly enough. But last year the agency approved more new drugs than in any other year in almost two decades. (5/22)

We are free to tell you that a clinical trial shows the drug Vascepa to be an effective treatment for persistently high triglyceride levels. But should the drug’s manufacturer, Amarin, tell you or your doctor the same thing, the company would face criminal prosecution and civil liability. Therein lies a First Amendment anomaly, one that may finally be resolved by a lawsuit that Amarin filed earlier this month against the Food and Drug Administration. (David B. Rivkin Jr. and Andrew Grossman, 5/21)

We often ask Congressional Republicans how they prefer the Supreme Court to rule in the ObamaCare subsidies case—as a matter of politics, putting aside the law. The smarter ones usually demur, because they know the risks are real, the damage is potentially large, and many of their colleagues are complacent even at this late hour. With a ruling in King v. Burwell approaching in June, there are troubling signs that Republicans in Congress are headed for another friendly-fire massacre that ends in a victory for President Obama. To borrow the novel idea of Wisconsin Senator Ron Johnson, this time Republicans would be smarter to try to win the inevitable debate with a unified and politically defensible strategy. (5/21)

Republicans have always had a problem where rhetoric meets reality on the Affordable Care Act. In the abstract, the law has never been overwhelmingly popular, but many of the things the law actually does — like preventing insurance companies from denying coverage because of pre-existing conditions — are extremely popular. And so, if Republicans actually succeed in reversing the law’s progress in a meaningful way — as they might with the King v. Burwell lawsuit that could take coverage from millions of people — they may realize, like the dog that caught the car, that this wasn’t such a hot idea after all, and they might not know what to do about it. (Paul Waldman, 5/21)

Sometimes, fixing one statistical problem creates a new one. For years, the Current Population Survey conducted by the U.S. Census Bureau overestimated the number of people without health insurance. Last year, the Census Bureau revised the survey to correct the error, which was likely caused by the way the government asked Americans about their coverage. The fix, which had been in the works since 1999, should produce more-accurate estimates. But responses obtained with the new methodology aren’t compatible with responses collected using the previous approach, making it harder to examine uninsured rates over the years at a crucial moment—as Americans try to gauge the success of the Affordable Care Act. (Jo Craven McGinty, 5/22)

It’s been a battle for the ages over Medicaid expansion between the Obama administration on one side and Gov. Rick Scott and the Florida House of Representatives on the other this year. Just days ahead of the budget special session, the U.S. Department of Health and Human Services has blinked first. In a letter sent to the Florida Agency for Health Care Administration today, the U.S. Department of Health and Human services has tentatively agreed that $1 billion is how much hospitals and safety-net providers can expect to be made available for uncompensated care next year, through a program known as LIP, or the Low Income Pool. ... That pretty much of a win for Scott, at least for this year. That $1 billion is close to what the LIP has been for many years, with the exception of last year, and it’s a lot better than zero, which was the concern raised in the closing days of the regular legislative session. So does that mean Scott and House Speaker Steve Crisafulli can declare victory and ignore Medicaid expansion? Not quite. (5/21)

Now the urgency is even greater for Florida to accept billions in federal Medicaid expansion money and provide private health coverage to more than 800,000 Floridians. The Obama administration signaled Thursday it is prepared to cut by more than half the federal money it sends to an account that helps hospitals cover the cost of treating the uninsured. That reaffirms that the most fiscally and morally responsible action for the Legislature to take in its June special session is to adopt the Senate's bipartisan plan, accept the Medicaid expansion money and transform how poor people get medical care. (5/21)

If we simply reject the Washington model and never pass a Florida solution, the federal government will certainly have no reason to consider alternatives to the Medicaid expansion contemplated by Obamacare. However, if the Senate, House and Gov. Scott work together to present Florida's best offer for coverage expansion, we can put our state in the best posture to negotiate free-market guardrails that emphasize personal responsibility and control the future cost and growth of the Medicaid program for Florida's taxpayers. (Florida Senate President Andy Gardiner, 5/22)

How will the Florida Legislature divvy up $80 billion? Each year the Legislature meets for 60 days to sort through all types of issues, but the only bill they are required to pass is an annual spending plan referred to as the appropriations bill — more commonly called the state budget. This year the Republican-led House and Senate failed to pass that one bill before session ended. The two chambers could not reach a consensus on whether or not to accept federal funds to expand Medicaid coverage to an additional 840,000 of Florida’s working poor. The full Senate wanted to, the House leadership did not. (Paula Dockery, 4/21)

If you’ve ever spent hundreds on a smartphone or thousands on a new car, you know what it’s like to hunt for the best deal. Yet when paying for state and local government services worth billions, Americans often hand politicians a blank check without ever knowing if they could get more for their money. Year after year, elected officials behind closed doors negotiate labor contracts for 19 million state and local government workers. The result? Skyrocketing salaries, health-care costs and pension benefits are making services like public schools and policing unaffordable for taxpayers. According to the Bureau of Economic Analysis, compensation for government workers nationwide has grown 21% since 2000, compared with only 9% in the private economy. (Matthew J. Brouillette, 5/21)

CVS Health’s $10 billion deal for Omnicare portends lower doses of pharmacy M&A. The drugstore’s purchase gives it entrance to nursing homes and expands specialty medicine distribution. But the increasingly concentrated industry is bumping up against antitrust concerns and may have to live with fewer transactions. (Robert Cyran, 5/21)

The Center for Medicare and Medicaid Innovation (CMMI), created by the Affordable Care Act (ACA), is catalyzing profound changes in U.S. health care. Congress gave CMMI $10 billion for fiscal years 2011 through 2019 to test “innovative payment and service delivery models to reduce program expenditures . . . while preserving or enhancing the quality of care”; it has the power to expand any model that reduces costs without reducing quality or improves quality without increasing costs and to make it an ongoing part of Medicare. Since CMMI began operations, it has created numerous programs .... But it faces four key challenges. (Lawrence P. Casalino and Tara F. Bishop, 5/21)

We believe the Innovation Center's work to date has demonstrated that government can learn, work with the private sector, and implement evidence-based policy with creativity, efficiency, and effectiveness — and in doing so, catalyze improvement in health care delivery across the United States. Of course, the Center has also faced challenges — beginning with the difficulty of measuring quality in health care. Although CMS has driven health care improvement through quality measurement, the science of quality measurement continues to evolve. (Rahul Rajkumar, Matthew J. Press and Patrick H. Conway, 5/21)