�鶹Ů��

Racing the calendar, Senate leaders are pushing toward congressional approval of a bipartisan compromise that reshapes how Medicare pays physicians as lawmakers return from a spring break tangled up in domestic and foreign policy disputes. ... The Medicare doctors' legislation presents Senate Majority Leader Mitch McConnell, R-Ky., with his most pressing problem. The $214 billion package would permanently retool how Medicare reimburses physicians and it also would provide money for children's health, community health centers, low-income patients and rural hospitals. ... The Senate returns to work Monday, which gives leaders two days to finish the bill or risk fielding complaints from physicians and seniors. Doctors say payment cuts make them less likely to treat patients of Medicare, which helps the elderly pay medical bills. McConnell's biggest problem is that senators from both parties are clamoring to amend the legislation. (Fram, 4/11)

Doing nothing could work where doing something falls short. House Republicans have voted over and over to repeal President Barack Obama's health law, to no avail. Democrats in the Senate still stand in the way, and ultimately there is Obama's veto power. But what Congress hasn't done is putting the law in jeopardy now. The Supreme Court is considering a challenge that centers on interpretation of one confusing phrase in the giant law — a few words that the Republican-led Congress could easily have clarified, but won't. The Supreme Court's decision, expected by late June, has the potential to gut the law. Still, doing nothing is often politically risky. (4/12)

Senators return this week to a familiar fight over abortion and Loretta Lynch’s long-stalled confirmation to be attorney general — and the partisan gridlock shows no signs of easing. Both sides are confident they have the upper hand politically, and neither party wants to relent in a fight over abortion ahead of the 2016 election. (Kim and Everett, 4/13)

Backers of legislation to set up a new system of Medicare payments to doctors and other providers are seeking to settle a flurry of last-minute skirmishes that threaten its quick passage in the Senate when Congress returns from a two-week recess Monday. The main concern is from conservatives who are frustrated that two-thirds of the measure’s $214 billion cost would be financed through higher deficits and are looking at ways to pay for the measure without resorting to borrowing. (Hughes, 4/12)

Conservative objections over spending are raising doubts over whether the U.S. Senate can quickly approve legislation fixing the Medicare physician payment system, in a possible setback for Republicans keen to show they can get things done. Some Senate conservatives are threatening to insist that the measure be fully paid for, after the House of Representatives passed a version of the "doc fix" bill two weeks ago that would expand the federal deficit. (Cornwell, 4/10)

The Senate is expected to vote next week on the permanent Medicare payment reform bill that overwhelmingly passed in the House last month. But exactly how that vote will happen is still unclear, especially since a group of conservatives wants to upend leadership’s plans to approve the bill fast. (Haberkorn, 4/10)

The House-passed plan to end the annual congressional ritual of blocking deep, automatic cuts in Medicare reimbursements for doctors has just run into more hot water. Before the Senate takes up the measure after a two-week break, Paul Spitalnic, the chief actuary for the Centers for Medicare and Medicaid Services, released a new analysis. It cautions that the bill passed by the House in March will increase Medicare spending by $150.5 billion in the coming decade – with much of that tacked onto the deficit. (Pianin 4/12)

The CMS actuary is warning that the House’s SGR repeal-and-replacement bill will in the long run create the same shortfalls in Medicare physician payments that Congress thought it was remedying with H.R. 2. ... [Spitalnic] warns that when the bill’s 5 percent annual bonuses in physician payments expire as scheduled in 2024, a major payment cut for most physicians would follow the next year. The payment structure would also be troublesome in years with high inflation, according to the actuary. By 2048, Medicare prices under the new system will actually be less than those called for under the SGR, Spitalnic wrote. (Haberkorn, 4/10)

The rate of uninsured Americans fell to 11.9% in the first quarter of 2015, down one percentage point from the end of 2014, according to a Gallup survey. The rate was the lowest since Gallup began tracking it with the Healthways company in 2008, and a sharp decrease from a high of 18% on the eve of the rollout of the Affordable Care Act in the fall of 2013. The polling firm said the rate showed the effects of the health law, but also that it had some distance to go in fulfilling its goals of broadly extending health coverage. (Radnofsky, 4/13)

The law's future is still up in the air, and will turn on factors ranging from an upcoming Supreme Court decision on consumer subsidies to actions by Republican leaders in states opposed to Medicaid expansion. The Gallup-Healthways survey found that the share of adults who lack insurance dropped to 11.9 percent for the first three months of this year, the lowest level since that survey began its tracking in 2008. The latest update overlaps with the period when the health law's second sign-up season was winding down. (Alonso-Zaldivar, 4/13)

In recent years, as millions of individual consumers coped with new and different kinds of health insurance, small businesses got some breathing room. Millions of small businesses nationwide — and an estimated 70% of California's small firms that offer employee health insurance — haven't yet faced all the sweeping changes that resulted from the Affordable Care Act. (Zamosky, 4/12)

[I]t turns out that the health plan for about 900 elite athletes — provided through the U.S. Olympic Committee — fails to meet minimum requirements of the Affordable Care Act. Under the law’s individual mandate, almost all Americans are required to have insurance or face a penalty, which is due when their income taxes are paid. When it became apparent in recent months that athletes could face penalties for the 2014 tax year for having inadequate coverage — through no fault of their own — federal health officials decided to grant exemptions to all affected athletes who apply, according to federal health officials. (Sun, 4/11)

[Rep. Dave] Brat says the repeal of the Affordable Care Act, as envisioned in the House GOP budget proposal, would save “our nation more than $2 trillion.” The congressman, an economist, gets his figure from an outdated CBO estimate of 10-year ACA costs. An updated analysis, published eight days before Brat’s statement, put the cost at $1.75 trillion. But there’s a much larger problem: Brat’s claim only deals with the expense side of the ACA and ignores built-in special taxes and health care efficiencies that the CBO has said more than enable the program to pay for itself. (Fiske, 4/11)

Obamacare’s first tax season includes all the elements needed to ignite a political firestorm. Yet with only days to go until the filing deadline, nothing’s burning. Americans are reckoning for the first time with the most unpopular part of the law — the individual mandate — and having to prove they’ve had health insurance or to cough up a penalty. As they’ve done their taxes, many people have learned they owe money because they underestimated income when buying subsidized coverage in 2014. Some have had to delay their returns because the government in February sent an inaccurate form on their subsidy total. (Villacorta and Mershon, 4/12)

The New York health exchange says uninsured residents have until April 30 to enroll for coverage even though the open enrollment period for 2015 has ended. State health officials say they are also working with state and federal tax agencies to provide information to income tax preparers to share with clients. (4/12)

The deadline for filing 2014 tax returns is Wednesday. Uninsured Minnesotans who are discovering they owe a penalty for not having health insurance last year can reduce penalties for 2015 by enrolling through the state insurance exchange before the end of April. (Zdechlik, 4/11)

Some customers of Connecticut’s health insurance exchange say problems with the exchange-generated forms they need to file their taxes have left them unable to file their taxes just days before the deadline. The tax forms are known as 1095-As and are supposed to go to everyone who purchased a private insurance plan in 2014 through public exchanges like Connecticut’s Access Health CT. (Levin Becker, 4/11)

So far, 28 states have expanded their Medicaid programs, while 22 states—mainly with Republican-controlled state legislatures, have opted out, citing cost as their primary reason for not expanding. Under the ACA, the federal government picks up the 100 percent of the cost of expansion for three years, then 90 percent thereafter. (Ehley, 4/10)

The Montana Legislature has backed expansion of the state’s Medicaid program under Obamacare, a startling turnaround after supporters’ repeated setbacks during the current session. The action provides the Obama administration a much needed boost given how efforts have foundered in other states such as Tennessee, Wyoming, Utah and Florida. ... The state Senate initially cleared expansion in a 28-21 vote on March 30 and now must take one last step — approving a minor House funding amendment that’s not seen as controversial — before the legislation can head to Gov. Steve Bullock’s desk next week. (Pradhan, 4/11)

On Saturday the Montana House gave final approval to a bill expand Medicaid coverage to Montana's working poor on a 54-to-42 vote. ... Last Thursday, after it won preliminary approval there was a motion to re-refer the bill to the House Appropriations Committee. It was successfully challenged and blocked. It was re-offered Friday afternoon. A clearly angry Appropriations Chair Nancy Ballance charged a gentlemen’s agreement over the rules had been broken. "This duplicity in my opinion is unbecoming of a leader in this body and I believe that we can no longer trust the integrity in this body of the minority leader," Balance said. Audible groans could be heard on the House floor and most of the Democratic caucus immediately rose from their seats to signal their objection. (Yamanaka, 4/13)

When it came to passing Medicaid expansion in the Montana House last week, its opponents ended up on the losing side of bare-knuckled political power, which is seldom pretty. ... From the view of Republicans who lost the Medicaid-expansion battle, it’s easy to see why they feel rules were twisted or ignored for political expediency. But in the end, it came down to a simple principle exercised by the winners: majority rules. A coalition of all 41 House Democrats and a dozen or so Republicans support the Medicaid-expansion bill that came to the House — and decided to use that majority power to define the rules and pass the bill, which is likely on its way to Gov. Steve Bullock’s desk for his signature. (Dennison, 4/12)

The state Senate is advancing a plan that would let Florida use federal Medicaid expansion money to subsidize a new state-run marketplace for private insurance. It would be available to low-income Floridians who work and pay small monthly premiums. The proposal has the support of influential business organizations, hospitals and grass roots consumer advocacy groups. But for both political and logistical reasons, it is a long shot in the final weeks of Florida's legislative session. (McGrory, 4/11)

Gov. Rick Scott headed for California on Sunday for a two-day mission to lure jobs to Florida, leaving behind a seemingly intractable budget battle and a growing rift between his administration and the Florida Senate. The feud between Scott and the Senate blew out into the open last week, with Scott blaming senators for sabotaging his Medicaid negotiations with the federal government, and senators publicly scolding his agency heads. The main source of the disagreement is over Medicaid. (Rohrer, 4/12)

Millions of people have gained health coverage through Medicaid since states began expanding the program under the Affordable Care Act. That also means more Americans may find themselves caught in a little-known law that lets states go after their assets after they die. For more than 20 years, federal law has allowed states to recover almost all Medicaid costs if recipients are 55 or older when they die. This now applies to many of the 11 million people who joined Medicaid since the health law’s expansion of the state-federal insurance program. (Armour, 4/12)

The high cost of a drug used to treat Medicaid patients with hepatitis C drew scrutiny from lawmakers earlier this year, but other drugs are also driving up the state's costs and likely will continue to do so for several years, government data reveals. From fiscal year 2010 through 2014, drug costs for Missouri's Medicaid program rose 33 percent, to $1.16 billion. Meanwhile, the number of claims fell slightly, by less than one-tenth of one percent, according to Missouri Department of Social Services data provided to The Associated Press. (French, 4/11)

A federal appeals court blocked parts of a Missouri law that sharply restricted actions of people who help others obtain insurance coverage under the Affordable Care Act, in a case that supporters hope could affect similar state laws across the country. The U.S. Court of Appeals for the Eighth Circuit on Friday ruled that challengers to the law were likely to succeed in their arguments that Missouri had improperly tried to impede the federal government’s efforts to implement the health-care overhaul. (Radnofsky, 4/10)

A federal appeals court in St. Louis has ruled that Missouri and other states cannot limit the ability of insurance navigators to help consumers sign up for coverage through HealthCare.gov, the government-run online exchange. ... Claiming the law was unconstitutional, consumer and advocacy groups — including St. Louis Effort for AIDs, Planned Parenthood of the St. Louis Region and Southwest Missouri — filed a lawsuit in U.S. District Court in Jefferson City. (Liss, April 10)

An appeals court ruled Friday that Missouri can't limit health insurance navigators' ability to help people obtain insurance under President Barack Obama's health care law — a ruling that advocates say could have implications for other states that have instituted similar restrictions. The 8th Circuit Court in St. Louis blocked some parts of a Missouri law that limits the information certified counselors authorized by the health care law could give people seeking health insurance. However, the court said the state can institute licensure requirements for navigators and counselors. (French, 4/10)

States that opted to use the federal health insurance marketplace instead of establishing one of their own can’t restrict the ability of certified navigators to help consumers, a federal appeals court ruled Friday. The decision by the U.S. Court of Appeals for the 8th Circuit largely affirms an earlier ruling by a federal district court that blocked implementation of a Missouri law. (McLean, 4/10)

The key to success for many stock funds this year has been simple: Buy health care. While the Standard & Poor’s 500-stock index ended the first quarter up just 0.6 percent, shares of health care companies gained 7 percent, continuing a trend that has been quietly unfolding for years. (Lim, 4/11)

Many of the companies in the health-care system are rethinking business strategies, and Inova Health System, the Northern Virginia hospital giant, is no exception. Last June, Inova announced a venture with insurance titan Aetna — one of the first such partnerships in the country between entities usually economically at odds — to deliver care more affordably. (Gregg, 4/12)

Nearly as old as the railroad that slices through this southern Illinois city just east of the Mississippi River, St. Elizabeth’s Hospital has been a downtown bedrock since 1875. Started by three nuns from a Franciscan order in Germany, the Catholic hospital still seeks "to embody Christ’s healing love" to the sick, the aged and the poor, according to its mission statement. It is so tied to the city that when the local economy slumped in 2009, the nonprofit St. Elizabeth’s gave $20 to every employee to spend on Main Street, sending hundreds of shoppers out to the mostly mom- and pop-owned stores. (Galewitz, 4/13)

KPMG LLP has agreed to acquire the assets of health-care consulting firm Beacon Partners Inc., as the Big Four accounting and professional-services giant continues beefing up its services to clients in the health-care industry. Financial terms aren’t being disclosed for the deal, which KPMG announced Sunday. (Rapoport, 4/12)

A home health care worker in Durham, N.C.; a McDonald’s cashier in Chicago; a bank teller in New York; an adjunct professor in Mayfield, Ill. They are all evidence of an improving economy, because they are working and not among the steadily declining ranks of the unemployed. Yet these same people also are on public assistance — relying on food stamps, Medicaid or other stretches of the safety net to help cover basic expenses when their paychecks come up short. (Cohen, 4/12)

Wallenbrock is among millions of working Americans whose low wages are supplemented by government support. Families in which at least one member is working now make up the vast majority of those enrolled in major public assistance programs like Medicaid and food stamps, according to a new study. It’s a “hidden cost” of low-wage work, researchers say, and it costs taxpayers about $153 billion a year. According to researchers, this is the first time anyone has calculated how much is spent providing assistance to workers whose wages don’t cover their families’ expenses. The study, from the University of California Berkeley’s Center for Labor Research and Education, found that most spending on public assistance goes not to the unemployed, but to members of working families. (Kaplan, 4/13)

No matter how much you earn, people who earn more than you are likelier to be healthier and live longer. That's the takeaway from a new report by researchers at the Urban Institute and Virginia Commonwealth University examining the complex links between health, wealth, and income. (Tozzi, 4/13)

There's no question mammograms can save lives by detecting breast cancer early. But they can also result in unnecessary testing and treatment that can be alarming and costly. In fact, each year the U.S. spends $4 billion on follow-up tests and treatments that result from inaccurate mammograms, scientists report in the current issue of Health Affairs. (Neighmond, 4/13)

Medical researchers call it the "Angelina Effect," the surge in demand for genetic testing attributable to movie star Angelina Jolie's public crusade for more aggressive detection of hereditary breast and ovarian cancer. But there's a catch: Major insurance companies including Aetna, Anthem and Cigna are declining to pay for the latest generation of tests, known as multi-gene panel tests, Reuters has learned. The insurers say that the tests are unproven and may lead patients to seek out medical care they don't need. (Humer, 4/12)

The Army is overhauling mental health services after years of war in Iraq and Afghanistan, aiming to end an era of experimentation in which nearly 200 programs were tried on different bases. At Joint Base Lewis-McChord and elsewhere, the Army has pushed counseling teams out of hospitals to embed with troops. It’s also cutting back the use of private psychiatric hospitals while expanding intensive mental health programs at military facilities like Madigan Army Medical Center. (Bernton, 4/11)

At the peak of the controversy, dozens of medical personnel were rushed to Arizona as fill-ins, mobile-care units were deployed in Phoenix, and overtime hours increased. Since June, 305 employees have been added. In primary-care clinics — where the need was desperate — 53 additional doctors, nurses and clerks are on staff. (Wagner, 4/11)

The supervisor at Roudebush Veterans Affairs Medical Center who sent an email that appears to mock veteran suicides has resigned. Robin Paul, who managed the Indianapolis hospital's transitional clinic for returning veterans, submitted her resignation on Tuesday. ... Paul said the email was taken out of context and was never intended to mock veterans. (Cook, 4/10)

Taking a stand against the rapidly expanding use of telemedicine, the Texas Medical Board voted Friday to sharply restrict the practice in the state, siding with organizations representing doctors over the objections of industry representatives who said the new rules would reduce access to medical care at a time of increasing demand. The vote was the latest salvo in a four-year battle between the state board, which licenses and regulates doctors, and Teladoc, a national company based in Dallas that provides telephone or video consultations with doctors on its staff, typically for routine problems like urinary tract infections, sore throats and rashes. (Goodnough, 4/10)

The Texas Medical Board dealt a blow to Dallas-based Teladoc and other telemedicine companies when it voted Friday to approve rules sharply limiting the use of telephone and video consultations to remotely treat patients, the New York Times reported. This latest vote follows an emergency rule issued by the board in January that required physicians to see a patient for an in-person visit before prescribing drugs. Teladoc won a temporary injunction of that rule. (4/11)

Advocates and mental health practitioners say that California's approach to mental health — and particularly to involuntary treatment — is deeply fragmented across its 58 counties. Lawmakers are trying to address the inconsistency of policies and approaches, but activist groups often disagree about the appropriate balance between protecting patients' civil liberties and forcing treatment on people who may be in danger or pose a danger to others because of severe mental illness. (Sewell, 4/13)

Preston L. Williams has been living in substandard, even hazardous, conditions for some time now despite having been accepted into a District program designed to rehabilitate homes for low-income people, particularly older people who want to age in place. Williams, 68, an Army veteran with serious back and pulmonary problems, breathes with the help of an oxygen tank. Yet he inhabits a home with mold, gaping holes in the walls, leaky plumbing and a long flight of narrow steps — all things the city’s Department of Housing and Community Development has promised to fix or improve, he said. (Kunkle, 4/12)

When Martin Harrison was brought to an Alameda County jail near Oakland, Calif., in 2010 on an outstanding DUI warrant, he received a health screening from a licensed vocational nurse who worked for Corizon, a private company that provided healthcare for the county correctional system. Harrison, 50, was in severe alcohol withdrawal and hallucinating, and his family says the nurse should have recognized he was in crisis. (Royse, 4/11)

Unionized doctors began a strike Saturday at student health clinics on University of California campuses in Southern California, saying administrators had acted unfairly during negotiations for the physicians' first contract. Doctors and dentists in Northern California started the rolling walkout Thursday morning at five Northern and Central California campuses ... Union members say the strike is in protest of the UC administration refusing to provide financial information that they need to negotiate contracts and bolster health center resources. (Mozinga, 4/11)

Health officials say that more than 100 people in southeastern Indiana have tested positive for HIV, an expansion of an outbreak that caused the state to declare a health emergency last month. Health officials had said they expected the number of HIV cases in Scott County, about 30 miles north of Louisville, Ky., to rise ever since they discovered the problem. The spread of the virus, which causes AIDS, has been linked to the use of contaminated syringes and the painkiller Opana in the area. (Parvini, 4/11)

As California lawmakers pursue legislation erasing the personal belief exemption that allows parents to avoid vaccinating their children, the issue has dominated lives and reconfigured the behavior of parents in the affluent environs of west Los Angeles. (White, 4/11)

The Washington state House moved forward Friday on an effort to reconcile the state’s medical and recreational marijuana industries. The chamber first passed a Senate measure addressing the medical side before moving on to a House bill dealing with the recreational law. Because the Senate bill was amended in the House, it will head back to the full Senate for a final concurrence vote, while the House bill will go first to a Senate committee for consideration. (LaCorte, 4/10)

Federal law guarantees an education for children with developmental disabilities like autism until the age of 21. But after turning 21 (each state determines the exact date), those young adults lose the specialized help and structure they've had for most of their lives. And there is no equivalent state or federal support required to take over. (Snow, 4/12)

Care for the uninsured on the Outer Banks comes in the form of a clinic that feels like home. (Singh, 4/13)

One out of every 10 people in Minnesota speaks a language other than English within the home. Their limited ability to speak and understand the language has become a struggle in their daily lives of accessing necessities. This battle becomes especially prominent within the health-care setting because of a lack of adequate interpreter services. A study in the Journal of the American Medical Association revealed that limited English proficient patients who do not receive adequate interpreter services when needed are unlikely to understand their diagnosis and treatment provided by their physician. (Hossain, 4/10)

Republican Gov. Larry Hogan proposed a budget compromise on Saturday that restores a significant portion of funding for education, state employee pay and health programs sought by the Democratic-led Legislature, but it’s unclear whether lawmakers have the will or ability to pass some of Hogan’s legislative initiatives tied to the deal with time running out on the legislative session. (Witte, 4/11)

Citing concerns about federal rules on birth control and same-sex marriage, the [Wyoming Catholic College] decided this winter to join a handful of other religious colleges in refusing to participate in the federal student-aid programs that help about two-thirds of students afford college. For students here, the decision means no federal loans, work-study money or grants to finance their annual $28,000 tuition, which includes housing in gender-segregated dorms and three meals in the school’s lone dining hall. (Healy, 4/11)

The Food and Drug Administration’s lethargic regulation of dietary supplements containing a dangerous stimulant described in recent reports in The Times is a classic example of what happens when industry representatives infiltrate the agency that is supposed to regulate them. The worrisome ingredient is BMPEA, a chemical nearly identical to amphetamine that is added to weight-loss and workout products in an effort to enhance their effect. Whether it does so is unclear, since there have never been tests of its effectiveness and safety in humans. (4/13)

[T]he Sugar Association industry lobby has stepped up its campaign to convince Americans and their government that sugar is good for us. Or, at least, not bad for us. Consider the 2015 Agriculture Department dietary guidelines now being prepared by the Obama administration. A scientific advisory committee is recommending Americans hold calories from added sugars to 10 percent of their diets .... The head of the Sugar Association wrote to the advisory committee to say there was no “proof of cause and effect” linking “ ‘added sugars’ intake with serious disease,” nor any “significant scientific agreement” to justify telling the American public sugar is “a causal factor in a serious disease outcome.” (Dana Milbank, 4/10)

Many people have no idea that heart disease kills a woman almost every minute or that the incidence of heart attacks in younger women has been increasing. Many don’t know that women’s heart disease symptoms are frequently different from or more subtle than men’s, that their first signs of a heart attack may be nausea, backache, extreme fatigue or shortness of breath, instead of crushing pain in the chest. ... So, while we’ve made important progress against heart disease in women, we need to finish the fight. (Barbra Streisand, 4/10)

In the wake of a savage attack on a pregnant woman and the removal of her fetus, Colorado lawmakers are planning to introduce a bill that would criminalize fetal homicide. If the bill passes, the state would join nearly 40 others that make fetuses a distinct class of victims. (The federal Unborn Victims of Violence Act of 2004 similarly makes it a crime to kill or injure a fetus in certain circumstances.) ... This type of legislation, however, is not about protecting the rights and well-being of the pregnant woman. Rather the reverse: The risk is that, without statutory reform, the pregnant woman as a category of victim will remain overlooked, while the fetus gets special protection. (Deborah Tuerkheimer, 4/13)

The Obama administration gives the Affordable Care Act a lot of credit — too much. Among the things administration officials constantly point out is that health-care spending has grown much slower than projected since the law began phasing in, which takes a lot of pressure off the federal budget. Updated projections show trillions of dollars less in health-care spending. But experts have argued over why that’s happened, and most of the explanations don’t involve Obamacare. (Stephen Stromberg, 4/10)

One classic example of government doing it better is health insurance. Yes, conservatives constantly agitate for more privatization — in particular, they want to convert Medicare into nothing more than vouchers for the purchase of private insurance — but all the evidence says this would move us in precisely the wrong direction. Medicare and Medicaid are substantially cheaper and more efficient than private insurance; they even involve less bureaucracy. (Paul Krugman, 4/10)

In 2009, Congress launched a program to provide vital oversight to Medicare, the Recovery Audit Contractor (RAC) program, which leverages the expertise of independent contractors to review post payment Medicare claims and determine if they have been billed according to Medicare policy. Since the RAC program began, these contractors have returned more than $9 billion back to the Medicare Trust Fund while reviewing less than 2% of all Medicare claims. This work to recoup dollars that have been inappropriately billed helps prolong the life of this vital healthcare program. So, what’s the problem? Congress has benched the RACs, the only program looking out for taxpayer dollars, while Medicare hemorrhages billions due to provider complaints that they are “burdened” by Medicare oversight programs. (Kristin Walter, 4/10)

Most Floridians want it. So do thousands of businesses and the medical community. So do Republicans and Democrats in the Florida Senate. Yet 80 Florida House Republicans are denying 800,000 Floridians access to health care by refusing to accept Medicaid expansion money from Washington. It is immoral, and it is financially irresponsible. Of those 80 House Republicans, 13 represent Tampa Bay districts. Call them. Email them. Ask them why they are blocking health insurance for your families, friends and co-workers. (4/10)

The success of the Montana expansion effort, spearheaded by Democratic Gov. Steve Bullock, comes as Medicaid expansion appears to have died this year in Tennessee and Wyoming and is struggling in Florida, Alaska, and Utah. Montana hospital leaders were thrilled, given the financial difficulties facing the state's smaller rural facilities. But supporters had to hold their noses and accept provisions that even the bill's Republican sponsor, Sen. Edward Buttrey, said would discourage thousands of low-income residents from signing up, according to a report by Modern Healthcare's Virgil Dickson. (Harris Meyer, 4/11)

Two months ago, the Branstad administration announced its intent to contract management of Medicaid to private companies. ... Everyone understands there is no free lunch in health care, and the $745 million (earnings plus savings) meal price for Medicaid managed care will come at someone's expense. Will access to care be limited? Will Medicaid provider payments, already well below actual costs, be cut even lower? The state's RFP does not answer these questions, but clearly the profit-based incentives of this kind of plan put limited access and payment cuts on the table, creating a scenario that completely undermines progress made by the Iowa Health and Wellness program. (Kirk Norris, 4/12)

Rampant cigarette smuggling isn’t the problem in New York. It’s a symptom of the problem: sky high tobacco taxes. New York state and New York City in February announced a $180 million lawsuit against the shipping company UPS over what officials allege was unlawful delivery of nearly 700,000 cartons of cigarettes from 2010-14. This misguided lawsuit demonstrates once again that too many in government do not understand the root cause of cigarette smuggling. New York state levies the highest cigarette tax in the nation, $4.35 per pack, and New York City tacks on an additional $1.50 local tax. All told, the cost of one pack there can run to $12 or more. (Patrick M. Gleason, 4/12)

Between May 2009 and January 2010, five Palo Alto teenagers ended their lives by stepping in front of trains. And since October of last year, another three Palo Alto teenagers have killed themselves that way, prompting longer hours by more sentries along the tracks. The Palo Alto Weekly refers to the deaths as a “suicide contagion.” And while mental health professionals are rightly careful not to oversimplify or trivialize the psychic distress behind them by focusing on any one possible factor, the contagion has prompted an emotional debate about the kinds of pressures felt by high school students in epicenters of overachievement. (Frank Bruni, 4/11)

Nationally, drugs account for more deaths than car crashes, shootings or alcohol, according to data from the Centers for Disease Control and Prevention. The CDC estimates that 120 Americans die from drug overdoses every day. ... What is most tragic about these deaths from opioid overdose is that there is an antidote that is safe, effective and literally lifesaving: naloxone (also called Narcan). It's easy for almost anyone to administer. (Leana Wen, 4/10)

The French Assembly’s recent approval of three amendments aimed at battling anorexia could set the stage for a new fashion trend from Paris: models on the plus side of size 0. The amendments take aim at dangerously thin models, websites that promote unhealthy weight loss, and commercial photographs that digitally alter the appearance of models’ weight. These amendments are only a small part of a sweeping health care reform bill. But given France’s stature as a fashion-industry leader, it is the “skinny model” parts of the bill that have received international attention. (4/11)