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UnitedHealth Group Inc., the largest U.S. health insurer, has decided to call it quits in two state Affordable Care Act markets in the latest challenge to President Barack Obama's health-care overhaul. The insurer won't sell plans for next year in Georgia and Arkansas, according to state insurance regulators. Tyler Mason, a UnitedHealth spokesman, confirmed the exits and declined to say whether the company would drop out of additional states. Many insurers have found it difficult to turn a profit in the new markets created by the Affordable Care Act, where individuals turned out to be more costly to care for than the companies expected. (Tracer, 4/9)

The Affordable Care Act suffered another jolt late last week with the news that UnitedHealth Group, the nation’s largest health insurer, was making good on its threat to pull out of Obamacare, beginning with its operations in Georgia and Arkansas. ... This development is troubling, especially if it UnitedHealth pulls out of other bigger states, or if other major insurers such as Aetna and Anthem follow suit. But experts have cautioned not to make too much of UnitedHealth’s flight from the market. While it is one of the largest insurers on the national scene, UnitedHealth nonetheless is a bit player in Obamacare and holds a much smaller market share than other rivals like Aetna and Blue Cross Blue Shield. (Pianin, 4/10)

UnitedHealthcare will not offer any health plans on Georgia’s insurance exchange in 2017, state officials say. The giant Minnesota-based health insurer also said this week that it will pull out of Arkansas’ exchange for next year. ... UnitedHealthcare is the only company so far that has informed Georgia’s insurance department that it won’t be participating in the exchange next year, Glenn Allen, a department spokesman, said Friday. The company is one of nine offering plans in Georgia’s exchange this year. Under the Affordable Care Act (ACA), all states have exchanges — most of which are federally run — that help consumers find and buy health coverage. (Miller, 4/8)

The Republican-dominated Legislature convenes Wednesday for its fiscal session. At stake is the future of the Arkansas version of Medicaid expansion that provides health insurance to about 267,000 low-income Arkansans. ... Twenty-seven votes are required in the 35-member Senate and 75 votes in the 100-member House to reauthorize use of federal Medicaid dollars to purchase private health insurance for low-income Arkansans in fiscal 2017, which starts July 1. "It is going to be a hard lift, absolutely," said Sen. David Sanders, R-Little Rock, one of three legislative architects of the private-option program that Gov. Asa Hutchinson calls Arkansas Works. (Wickline, 4/10)

Hutchinson has said that while he opposes the Affordable Care Act, continuing Medicaid expansion is the best path forward for the state. The program is projected to save Arkansas $757 million over the next five years and help rural hospitals stay afloat. Thirty House members and 10 senators, all Republicans, voted against the bill to create Arkansas Works last week. ... The opponents’ votes were not enough to stop the legislation from passing during the special session, but they would be enough to block an appropriation bill. (Lyon, 4/10)

Arkansas Gov. Asa Hutchinson signed into law Friday his plan to keep the state's first-in-the-nation hybrid Medicaid expansion and urged fellow Republicans to avoid a Washington-style shutdown fight over their efforts to defund the program. The bills outline Hutchinson's proposal to rework the program, which uses federal funds to purchase private insurance for more than 250,000 low-income people. (DeMillo, 4/8)

Democrats frustrated at the Republican-led House and Senate majorities’ pursuit of a lawsuit against Gov. Bill Walker for authorizing Medicaid expansion attempted Friday to de-fund continued legal action. In both bodies, the attempts were defeated along majority/minority lines. (Brooks, 4/10)

Minority Democrats unsuccessfully sought to force a vote on whether the Legislature should continue pursuing a challenge to Gov. Bill Walker's authority to expand Medicaid on his own. (4/8)

Utah's governor and lawmakers have agreed on a pared-down plan to expand Medicaid after wrestling with the issue for years, but the law still needs approval from federal officials. The plan, which Gov. Gary Herbert approved in late March, is estimated to insure about 16,000 people, mostly childless adults who are homeless or in treatment and offender programs. (4/10)

Women outnumber men 2 to 1 in new Delaware Medicaid enrollees, which officials say signals a concerning trend around the number of women in poverty in the state. Since Delaware expanded its Medicaid program through the Affordable Care Act in January 2014, women have overwhelmingly enrolled for benefits. New data unveiled at the monthly Delaware Health Care Commission meeting showed that at the end of January women made up 63 percent of the 9,896 new enrollees. (Rini, 4/11)

The state's health exchange expects to enroll more than 470,000 New Yorkers in its new low-cost option for coverage this year. Testifying at an Assembly hearing this week, exchange Executive Director Donna Frescatore said New York chose to participate with the Essential Plan. The plan is an option under the federal Affordable Care Act starting in 2016. It's aimed at adults who don't qualify for Medicaid but have been unable to afford private coverage. (4/9)

Kaiser Health News staff writers Ana B. Ibarra and David Gorn report: "Moving into a realm usually reserved for health care regulators, the California health marketplace Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers. The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation." (Ibarra and Gorn, 4/8)

A good portion of the new investments in digital health over the past two years have come from end users of the technology. The number of health systems setting up their own venture capital arms has exploded, with hospital groups seeking both commercial success and the possibility of discovering technologies that will help solve their business problems. The health systems going down this path have moved well beyond passive investment. They are becoming incubators and accelerators, guiding young companies and entrepreneurs through the healthcare regulatory and commercial maze. “They're investing more and more, and at an earlier stage than ever before,” said Unity Stoakes, president and co-founder of StartUp Health, which invests in and coaches digital-health hopefuls. “It reminds us of 1995 Internet when Netscape first IPO'ed. (Kutscher, 4/9)

In an emergency, hospitals, by law, must treat any patient in the U.S. until he or she is stabilized, regardless of the patient's immigration status or ability to pay. Yet, when it comes time for the hospitals to discharge these patients, the same standard doesn't apply. Though hospitals are legally obligated to find suitable places to discharge patients (for example, to their homes, rehabilitation facilities or nursing homes), their insurance status makes all the difference. (Schumann, 4/9)

For decades, community health workers have tried to fill the system’s gaps. Often hired by the local health department, they take on diverse public health initiatives -- running diabetes or nutrition education programs, counseling patients to stick to their medication regimens or teaching new mothers about vaccinations. But now, hospitals across the country are turning to them in a bid to revamp patient care. They are using these aides to strengthen their relationships with patients and surrounding neighborhoods -- improving the community’s health and, along the way, their own finances. (Luthra, 4/11)

Stace Holland started hunting for ways to slash unnecessary costs the minute he took over an endangered rural hospital that was losing $6 million a year. It didn't take long for him to find plenty. He persuaded the dietary contractor to reduce fees by $15,000 a month. He switched emergency medicine contractors to save $200,000 a year. And he persuaded some full-time employees to drop to 32 hours a week, yielding cost savings equal to cutting 15 FTEs. ... Holland faced a challenge that is all too familiar to rural hospital leaders around the country: declining patient volumes; a preponderance of low-paying Medicare, Medicaid and uninsured patients; public and private rate squeezes; high incidence of chronic disease and drug abuse; difficulty in recruiting physicians; and a shortage of funds to invest in new equipment and services. Kentucky's successful expansion of Medicaid and private insurance under the Affordable Care Act eased those financial pressures, but didn't eliminate them. (Meyer, 4/9)

An emergency room clogged with patients is an unwelcome sight for everyone involved — patients, doctors and other caregivers alike. Hospitals responded in the past by sending incoming ambulances to other hospitals, sometimes 10 to 15 critical minutes away. But under a policy that took effect this month, hospitals in Milwaukee County are no longer allowed to divert ambulances when their emergency departments have a high volume of patients. (Boulton, 4/9)

Federal officials are expected to argue in court starting Monday that a large hospital merger in the Chicago area could hurt consumers and should be stopped. It would be the latest in a series of efforts by regulators to push back against a wave of consolidation among major health care providers. But a frenzy of smaller transactions is also profoundly changing the landscape, many of which face little regulatory resistance. The deals are often for a couple of doctors here, or a hospital there, making them too small to attract much attention. (Abelson, 4/8)

Hospitals in Milwaukee have implemented new measures in response to a new county policy that prohibits them from sending incoming ambulances to other hospitals. In Milwaukee County, hospitals used to divert ambulances to other facilities when their emergency departments had a high volume of patients. M. Riccardo Colella, director of medical services for the Milwaukee County Office of Emergency Management, said that critically ill patients were being diverted to more distant hospitals. (4/10)

A second troubled government-run hospital on a Native American reservation in South Dakota was given an extension Friday to reach an agreement with federal officials to make significant quality-of-care improvements to avoid losing its Medicare and Medicaid funds. (Cano, 4/8)

Even before Scott Steiner started treatment for a rare gastrointestinal cancer that had spread throughout his abdomen, a dangerous side effect threatened his health. His doctor had prescribed the cancer drug Gleevec, but Steiner’s insurance refused to cover its $3,500 monthly cost. Steiner, a warehouse manager for a publisher of Bible-themed literature, and his wife, Brenda, a part-time nurse, made just $30,000 a year. No way could they afford the drug on their own. It was a scary brush with “financial toxicity,” as researchers call the mix of economic stress, anxiety and depression cancer patients often endure. (McGinley, 4/9)

Money is low on the list of things most people want to think about after a doctor says the scary word "cancer." And it's not just patients — physicians also want to weigh the best treatment options to rout the cancer, unburdened by financial nitty gritty. But a growing body of evidence suggests that, far from crass, ignoring cost could be harmful to patients' health. (Johnson, 4/8)

Healthcare organizations, for a variety of good and bad reasons, are slow to adopt and update their information technology. And the cybercriminals know it. As hospital IT teams spend much of their time and money figuring out how to meaningfully deploy electronic health records and harness the data for emerging payment and delivery models, the bad guys continue to hone their technology and calibrate their attacks, creating boom times for data defenders. With at least six hospitals targeted in the past month, healthcare leaders are scrambling for protection. These available wares include legal services, security consultancy, training, systems testing, cyber insurance, security software that runs on and defends computer systems, and remote-hosted software and services that can include fully staffed security operations centers that provide computerized and human watchdogs on the lookout for cyberthreats 24/7. (Conn, 4/9)

At least six major health systems across the country have suffered debilitating cyberattacks this year, including most recently Columbia-based MedStar Health. The rate has unsettled health system information technology administrators who are now working together to block future attacks. (Cohn, 4/10)

Wearing a Fitbit? If so, you already know that electronic fitness trackers can let you keep records on your smartphone of how many steps you've walked, how much you've slept, maybe your heart rate, or even where you've been. But what can the gadget tell your doctor? A few things that are pretty useful, it turns out. Doctors at an emergency room in New Jersey recently used heart-rate data from a patient's Fitbit to quickly figure out what treatment he needed to get his suddenly irregular heartbeat under control. They published the case study online this month in the Annals of Emergency Medicine. (Kodjak, 4/11)

White women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s and 50s in a slow-motion crisis driven by decaying health in small-town America, according to an analysis of national health and mortality statistics by The Washington Post. Among African Americans, Hispanics and even the oldest white Americans, death rates have continued to fall. But for white women in what should be the prime of their lives, death rates have spiked upward. In one of the hardest-hit groups — rural white women in their late 40s — the death rate has risen by 30 percent. (Achenbach and Keating, 4/10)

Poor people who reside in expensive, well-educated cities such as San Francisco tend to live longer than low-income people in less affluent places, according to a study of more than a billion Social Security and tax records. The study, published in The Journal of the American Medical Association, bolsters what was already well known — the poor tend to have shorter lifespans than those with more money. But it also says that among low-income people, big disparities exist in life expectancy from place to place, said Raj Chetty, professor of economics at Stanford University. (Zarroli, 4/11)

It's widely known that your chances of surviving cancer are better if you're married. But a new California-based study released today reports that the benefits of being married also vary by sex, race, ethnicity and birthplace, with white bachelors and white single women in the Golden State doing worse than their married counterparts. (Seipel, 4/11)

What’s it like to grow old in rural America? Millie Goolsby is a retired nurse, so when she experienced chest pain five years ago, she recognized the signs of a potential heart attack. But her family didn’t call 911. The drive from her home to the hospital in Klamath Falls, Ore., requires at least half an hour. ... Through his 95th summer, Bill Kolacny was tending the tomato patch on the 400-acre Wyoming ranch where he and his wife, Beverly, had lived for 25 years. When he began to weaken from heart failure in December, all he wanted was to die in their log home on the Clark Fork River. But the nearest hospice organization, in Red Lodge, Mont., isn’t licensed to care for patients in Wyoming. (Span, 4/8)

Public health experts are growing alarmed about a lack of new funds from Congress to fight the Zika virus. The White House this week said that it could not wait any longer for Congress to act, and shifted about $500 million in leftover Ebola funds over to fight Zika. But the White House said that is only a temporary solution, and raised pressure on congressional Republicans to fulfill the administration’s emergency request for $1.9 billion in new funds. (Sullivan, 4/10)

Florida health officials confirmed two new Zika virus infections on Friday — raising the statewide total to 84 cases, most in the nation — as former Republican presidential candidate Sen. Marco Rubio said he supports President Obama's request to Congress for $1.9 billion in emergency funding to combat the spread of the infectious disease. Hosting a press conference with local and state officials at his Doral office, Rubio said ensuring the appropriate use of federal funds to combat Zika was the best way for the Obama administration to win the support of congressional Republicans, who broke for spring recess in March without acting on the president’s February request. (Chang, 4/8)

If C. Everett Koop became the highest-profile surgeon general ever by giving the AIDS epidemic a national profile, Vivek Murthy wants to be the surgeon general who united America to combat opioid abuse. Over the last few months, Murthy went from stressing nutrition, exercise and the benefits of not smoking to a far more urgent message about the lethal painkillers. He has become a much more visible public figure as he speaks out in Washington and takes his message on the road to communities hard hit by the double whammies of opioid and heroin use. (Kenen, 4/8)

Rep. Bob Dold, R-Illinois, is calling for bipartisan support in passing a bill taking aim at the nation's rising opioid addiction and overdose problems. (Flores, 4/9)

Despite what recent headlines across the nation might suggest, heroin didn’t just appear in suburban, small-town and rural America overnight. A decade and more ago, counties in Appalachia were recording deaths from overdose of opioids – mostly prescription painkillers, but heroin as well – in excess of 20 per 100,000 residents. And a number of reports indicate rural law enforcement agencies across the country were confiscating heroin. (Sisk, 4/9)

When pondering how to keep low-level drug offenders out of jail, officials in Albany, New York, faced a challenge: How could they pay for a case manager to coax addicts onto the straight and narrow, sometimes by tracking them down on the streets? The money turned up in a previously untapped source: President Barack Obama's health care law, which by expanding Medicaid in some states has made repeat drug offenders eligible for coverage, including many who are homeless or mentally ill and have never been covered before. (4/11)

For weeks, Senate Appropriations chairman Kurt Schaefer seemed determined to make major changes to Missouri’s Medicaid program. In the end, the federal health insurance program for the state’s poorest citizens emerged largely unscathed. Leading up to the Missouri Senate’s vote Thursday to approve its version of the state’s $27 billion budget, Schaefer repeatedly railed against projected Medicaid cost increases. ... Yet the budget for the Missouri Department of Social Services approved by the Senate on Thursday trimmed only about $57 million from the more than $7.9 billion proposed by the governor for Medicaid. (Hancock, 4/10)

The state made mistakes on more than 9 million adjusted Medicaid payments reviewed in a recent audit, the federal government says. Those mistakes, it adds, cost the federal government $1.5 million over five years — money the state should repay. The stated denies the audit’s findings, saying the payments were correct. (Bonner, 4/8)

Florida is poised to become the second big state after New York to shield patients from surprise out-of-network medical bills, and California may not be far behind if lawmakers there can cinch a similar deal with physicians. The issue has caught fire around the country, with even health professionals facing the personal experience of unexpected bills for hundreds or thousands of dollars. Consumers Union reported last year that among people who had emergency department visits, hospitalizations or operations in the previous two years, 37% received a bill for which their health plan paid less than expected; among those who received a surprise bill, nearly 1 out of 4 got a bill from a doctor they did not expect to get a bill from. (Meyer, 4/8)

Women in California no longer need their ob-gyn to prescribe the pill, the patch or other popular forms of birth control. As of Friday, a visit to the pharmacist will do. (Seipel, 4/8)

As of Friday, girls and women in California can pick up hormonal contraceptives, including pills and patches, at pharmacies without first visiting a doctor. Supporters of the change say that requiring an annual doctor’s visit creates unnecessary barriers to contraception and that easing access could reduce unintended pregnancies. ... Many people are raising questions about the new system, in which females of any age in California no longer need a doctor’s prescription to get certain types of birth control. California becomes just the third state to allow women to obtain hormonal birth control directly from a pharmacist, though many more are currently considering similar legislation. (Karlamangla, 4/8)

Late last month, the District began using the commercial service to transport patients with less-serious symptoms. The new system is intended to free up city medics and ambulances for more dire cases and ease the strain on a department that has struggled to handle a growing number of medical calls. City paramedics or firefighters still respond to each 911 call and assess each patient’s condition. In the more serious cases, they transport patients as usual. During the first week, 2,135 people were taken to hospitals; 678 were transported by the private service, or about 32 percent of the overall cases. They represent about half of the patients with less-serious conditions. (Williams, 4/10)

After a string of legislative victories in Ohio, including passage of a bill blocking tax money from Planned Parenthood, abortion opponents this spring are pushing more restrictions on women seeking an abortion. (Candisky, 4/11)

The federal Health Resources and Services Administration is giving nearly $6 million to Maine in support of home visits for mothers and infants. The agency says the money will help the state expand voluntary home visiting services to women during pregnancy and to parents with children up to kindergarten age. (4/10)

It’s hard to say which irritates Vietnam War veteran Martin Wines more — his chronic, itchy skin condition or the government’s botched attempt to help him get it treated. The Des Moines veteran says regular sessions in a special ultraviolet light booth are the only thing that provides relief from the scaling and itching of his severe eczema. The local Department of Veterans Affairs hospital doesn’t have such a booth, so a VA dermatologist referred him several years ago to Iowa Methodist Medical Center for treatment. (Leys, 4/10)

An independent analysis of Colorado's proposed universal health care system estimates it would cover 83 percent of residents and create a massive new entity that would dwarf most U.S. corporations. (Olinger, 4/9)

Debbie Birch’s kidneys failed last year. That made her one of more than 2,000 people in Idaho who regularly need dialysis, using a machine to filter their blood when their kidneys no longer do the job. But the 63-year-old woman is now caught in a rift between a national dialysis company and her health insurer. No dialysis centers within driving distance of Birch’s home in Caldwell will take her insurance plan, the Bronze Choice plan sold on Idaho’s exchange. (Dutton, 4/9)

Mid-Atlantic Health Care plans to convert a largely vacant building in downtown Baltimore into a $20 million skilled nursing facility with 80 beds where frail, elderly residents could go for rehabilitation after a hospital stay. (Mirabella, 4/8)

A St. Louis nonprofit is helping people with Alzheimer's disease stay in their homes longer, which its founder says benefits patients while saving taxpayers money that would otherwise go toward paying for nursing home care. (4/10)

Children's advocates are calling on lawmakers to revive the KidsCare program as part of ongoing state budget negotiations, hoping to break an impasse in legislative efforts to restore health-insurance coverage for children in low-income families. (Alltucker, 4/9)

The board that regulates Missouri physicians has denied a medical license to a St. Louis-area doctor who has twice been sentenced to federal prison. The Missouri Board of Registration for the Healing Arts found that Rajitha Johnson, 56, formerly Rajitha Goli, did not present satisfactory evidence of “good moral character. (Kohler, 4/9)

Danette Peeples felt broken. For more than two years, she looked at women who were pregnant and thought: "Why can't this happen to me?" Though she had one child, the Hatboro resident wanted a sibling for her young son. After two years of trying, she began to lose hope — until a friend told her about the changes that have occurred in reproductive technology. (Callahan, 4/9)

More than a dozen former patients have been sued by Medical Society Business Services Inc., also known as the Bureau of Medical Economics. The surgeons’ collection agency has filed its lawsuits after collecting payments from patients’ insurers that were less than the full amount sought by the medical practice, court records show. (Alltucker, 4/10)

The giant health insurance company UnitedHealth inspired lots of hand-wringing and hyperventilation last year when it announced that it had lost hundreds of millions of dollars on Affordable Care Act exchanges and was considering withdrawing from the market in 2017. Although that news prompted numerous Obamacare critics to declare the impending death of the program, we were skeptical. United, which makes most of its money in the large-group (employer) market, always was a reluctant participant in the individual exchanges, and was largely inept at pricing and managing those products. (Michael Hiltzik, 4/8)

New York is a city with some of the worst income inequality in the country. But when it comes to inequality of life spans, it’s one of the best. Impoverished New Yorkers tend to live far longer than their counterparts in other American cities, according to detailed new research of Social Security and earnings records published Monday in The Journal of the American Medical Association. They still die sooner than their richer neighbors, but the city’s life-expectancy gap was smaller in 2014 than nearly everywhere else, and it has shrunk since 2001 even as gaps grew nationwide. (Margot Sanger-Katz, 4/11)

State Medicaid agencies have launched a wide array of payment and care-delivery reforms, some of which go further than the federal government's efforts. While they hold out the promise of delivering higher-quality care, it's unreasonable to expect they will deliver lower costs, at least in the short run. Why do I say that? Let's start with the basics. Nearly a quarter of Americans, almost 80 million people, now get their healthcare through Medicaid. About a quarter of them are elderly or disabled. (Merrill Goozner, 4/9)

Tasked by policymakers with crafting a way to assist Oklahomans who rely on Medicaid, and aware that simply expanding the program is a political nonstarter, Nico Gomez produced a plan he calls the Medicaid Rebalancing Act of 2020. Lawmakers should give it a close look. ... Gomez proposes creating a new option to Insure Oklahoma, covering adults ages 19 to 64 whose incomes are below 133 percent of the federal poverty level (roughly 175,000 Oklahomans). They would be provided a choice of commercial insurance plans and be made to pay a premium. This program would include potential cost savings for such things as healthy lifestyle choices and preventative screenings. The cost would be about $100 million in state dollars, to be matched by $900 million in federal dollars. (4/10)

Presidential candidate John Kasich delighted Medicaid expansion advocates and infuriated his fellow Republicans in 2013 when he warned expansion foes that failing to help poor people could deny them a place in heaven. He aimed those comments at GOP critics of his decision to do an end-run around the state's Republican-controlled Legislature and expand Medicaid to Ohioans with incomes up to 138% of the federal poverty level as authorized by the Affordable Care Act. About 660,000 people have gained coverage under Kasich's expansion. (Harris Meyer, 4/8)

With the end of the 2016 General Assembly session, Virginians are receiving updates from their legislators about our accomplishments. What Virginians are not hearing about is our failure to expand Medicaid for many of the commonwealth’s 400,000 most vulnerable patients — or what we plan to do to prevent the impending mergers of four of the nation’s largest health insurers from driving up premiums for all Virginians and the cost of doing business in Virginia. (Scott Surovell, 4/10)

One of the peculiarities of American abortion law is that in the days when abortion was illegal, women who had an abortion were not prosecuted for the crime. The criminal law targeted the doctors and unlicensed practitioners who performed the abortions. They were the ones arrested, tried, and sometimes convicted for knowingly procuring or performing an abortion, not the women who had knowingly hired them. Women were subpoenaed to testify as witnesses against their abortionists at trial, but with few exceptions, women didn’t do time. (Carol Sanger, 4/11)

Republican presidential frontrunner Donald Trump horrified both conservatives and progressives recently when he expressed support for banning abortion and instituting “some form of punishment” for women who get the procedure. With his comments, Trump — who backtracked on his position after an immediate uproar — used language that the anti-abortion movement has studiously avoided in their attempt to paint laws restricting women’s access to reproductive healthcare as “protecting” rather than harming women. But what has been largely overlooked in the media storm surrounding Trump’s comments is that women are already being punished by the anti-choice laws being passed in states across the country. (Dorothy Chaney, 4/10)

Missouri GOP senators are playing with fire in their maneuver to force abortion service providers to hand over patients’ private medical records. If senators persist with threats to conduct contempt proceedings, they almost certainly will find themselves in an embarrassing court battle that they are unlikely to win. Federal law is very clear about medical providers’ requirement to protect their patients’ privacy. Senators appear to be trying to compel providers to break federal law. Mary Kogut, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, and James Miller, owner of Brentwood-based Pathology Services Inc., have been issued subpoenas and could face contempt proceedings as early as this week if they do not comply. (4/10)

David Daleiden is not a reporter. His grossly misleading, politically irresponsible videos purporting to implicate Planned Parenthood in illegal behavior make that clear. It's an insult to responsible journalism. The only question Attorney General Kamala Harris needs to answer for her investigators' raid of Daleiden's home Tuesday is: What took her so long? (4/7)

Medicine struggles with a chronic disease: racism. Medical schools try to combat this disease with diversity initiatives and training in unconscious bias and cultural sensitivity. I’m about to graduate from the University of Virginia School of Medicine, so I’ve been through such programs. They’re not enough. (Jennifer Adaeze Anyaegbunam, 4/11)

Time is precious and in short supply in daily primary-care practice. In order to survive financially, primary-care practices have to schedule as many visits as possible each day, because insurers have long paid inadequately for them while overpaying for specialty care. The net result is a daily schedule of rushed visits that are all too often unsatisfying and frustrating, not only for patients but also for their primary-care physicians. In this setting, the annual physical has degenerated into little more than an impersonal checking of a few boxes on the computer, performing a quick perfunctory physical exam, and ordering some screening studies. Little wonder, then, that calls for its elimination have started to emerge. (Allan Goroll, 4/11)

In my addiction medicine practice in central Ohio, I see five to six new heroin addicts a week. My patients are mostly young, under the age of 25, Caucasian and predominantly female. Since there is a volitional component to any addiction, many people, it seems, want to dismiss the heroin addicts among us as "junkies" who have chosen their lifestyle and will get what they deserve. (Peter Rogers, 4/10)

It wasn’t the hardest phone call I’ve ever made, but it was certainly awkward. I was cold-calling the National Rifle Association. Because the NRA is well-known for offering gun safety training, I wanted to know whether the organization had ideas on how to reduce the number of firearm suicides. Half of all suicides in the United States are by firearm, and roughly two-thirds of all firearm deaths are suicides. Given the NRA’s opposition to virtually all gun regulation, I knew this was a touchy area. (Jennifer Stuber, 4/8)

When Congress enacted the Veterans Access, Choice and Accountability Act of 2014 in the wake of revelations about bureaucratic dysfunction at the Veterans Affairs Department, the plan was to reduce wait times at VA hospitals, give veterans access to outside health care and allow the VA to quickly terminate problem employees. How is the VA doing? For starters, government statistics show that hospital wait times are 50% longer than two years ago. (Kyndra Miller Rotunda, 4/10)

The story is a not uncommon one: A person who is injured or undergoes surgery becomes addicted to the prescribed pain pills — and ends up with an even more dangerous medical problem. Officials at the Ohio Bureau of Workers’ Compensation, whose claim fund pays for medication for injured workers, saw dosages so shockingly high that they created a program to spell out a list of permitted drugs and dosages. (4/11)

On the wooden back porch of an Old Louisville home, birds broke the silence with their joy-filled chirps after a downpour of rain. A small replica of Michelangelo’s David towered triumphant in the middle of the manicured yard, like a reminder of old century opulence. Here, in this house of serenity, gay men infected by an unacknowledged plague once came to die. That was the mid-1980s, when those infected by HIV and suffering from AIDS faced a limited future. Abandoned by their families and forgotten by the world, some patients were forced to the streets, homeless, hopeless and alone. (Amanda Beam, 4/10)

Next year, San Francisco will become the first U.S. city to guarantee fully paid family leave to almost everyone who works there. May it also be the last. Or rather, may it be the last that makes employers pay so much of the cost. The way San Francisco has designed its program risks undermining support for the policy -- and there's little doubt that more generous and accessible family-leave policies benefit both workers and the overall economy. Workers who get paid parental leave are more likely to stay in their jobs and have healthier children, which can lower government social spending in the long run. (4/9)

Now that deaths from opioid overdose exceed those from car crashes, the medical community has come to recognize an error of historic proportions. In 2014, U.S. doctors wrote 245 million prescriptions for Vicodin, OxyContin and other painkillers in the highly addictive family of opium derivatives known as opioids. That practice spares many patients from pain following accidents or surgery, but the cost is more than 20,000 deaths a year. (Faye Flam, 4/8)

Once a decade, the United Nations organizes a meeting where every country in the world comes together to figure out what to do about drugs — and up to now, they've always pledged to wage a relentless war, to fight until the planet is “drug-free.” They've consistently affirmed U.N. treaties written in the 1960s and 1970s, mainly by the United States, which require every country to arrest and imprison their way out of drug-related problems. But at this year's meeting in New York City later this month, several countries are going to declare: This approach has been a disaster. We can't do this anymore. Enough. (Johann Hari, 4/10)

Lily Parra is 4 months old and needs a heart. But she has been told she can’t have one. Not because she’s too sick but because of deep-seated discrimination against those who have — or might have — a developmental disability. An operation that could give Lily a shot at life, and hope to her family, is being denied apparently not because of Lily’s medical condition but because of who she may become. (Timothy P. Shriver, 4/8)