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House GOP leaders during a members-only conference call Saturday vowed to avoid a government shutdown and said they're closer to a deal to repeal and replace Obamacare, according to members who participated on the call. But Speaker Paul Ryan also downplayed the possibility of a vote next week, the same sources said. The Wisconsin Republican said the chamber will vote on a conference-wide deal when GOP whips are confident they have the votes for passage — but not until then. (Bade and Haberkorn, 4/22)

Donald Trump’s administration continues to push for a vote this week in the House to replace Obamacare, which the president said on Sunday is “in serious trouble.” Mick Mulvaney, director of the Office of Management and Budget, said on “Fox News Sunday” that the Senate Budget Committee sent language on the health bill to the House on Saturday night, as negotiations between Congress and the White House continue. (House and Edney, 4/22)

Lawmakers returning to Washington this coming week will find a familiar quagmire on health care legislation and a budget deadline dramatized by the prospect of a protracted battle between President Donald Trump and Democrats over his border wall. (Taylor and Fram, 4/22)

President Donald Trump, striving to make good on a top campaign promise, is pushing his fellow Republicans who control Congress to pass revamped healthcare legislation but the same intraparty squabbling that torpedoed it last month could do it again. Trump is looking for his first major legislative victory since taking office in January. House of Representatives Republicans are exploring compromises aimed at satisfying the party's most conservative members without antagonizing its moderates, but it remained unclear on Friday whether a viable bill would emerge. (Cornwell, 4/21)

In a series of Sunday morning Twitter messages, President Donald Trump warned the Affordable Care Act would falter without new funding, and pressured Democrats to support spending for his proposed border wall between the U.S. and Mexico to keep the health program going. Democrats are pushing to include funding for a set of Affordable Care Act subsidies in a must-pass spending bill that will need Democratic support to clear the Senate and likely the House. Mr. Trump’s administration has signaled an openness to including the funding, known as cost-sharing payments—in exchange for funding to build a border wall. (Hackman, 4/23)

A White House effort to win House approval next week for an ObamaCare repeal bill is running head-on into a divided GOP conference struggling to reconcile its differences.While centrist Rep. Tom MacArthur (R-N.J.) and conservative Rep. Mark Meadows (R-N.C.) say they are close to a deal, other Republicans say they are not a part of the agreement and that MacArthur is not bringing other centrists along with him. (Sullivan and Hellmann, 4/21)

Medicare, the old-age health program, emerged largely unscathed from the proposed legislation — even the $700 billion in Medicare “cuts” that Republicans used to highlight in attack ads. Those spending reductions have been retained, for now.But there are two provisions in the bill affecting the financing of Medicare that have received relatively little attention. (Kessler, 4/21)

Congressional leaders and White House officials have steered the nation to the brink of a government shutdown that virtually all parties agree would be a terrible idea. ... Here are the dynamics at play as members return from a two-week recess. ... Seeking to squeeze Democrats, Mr. Mulvaney has offered a trade of sorts: $1 of subsidy payments under the Affordable Care Act — paid to insurers to lower deductibles and other costs for low-income consumers who buy plans through the law’s marketplaces — in exchange for every $1 to pay for the border wall that the president wants to build. (Flegenheimer and Kaplan, 4/24)

Amid the collapse of the Republican plan to repeal and replace the 2010 health care law, President Donald Trump threatened the members of the House Freedom Caucus, the ultra-conservative faction that played a leading role in sinking the legislation championed by Speaker Paul D. Ryan and Trump. Trump pledged in a tweet to “fight them” in 2018, implying that he would back primary challengers. But there’s a problem: Of 21 caucus members who said they planned to vote no on the GOP bill, only one had anything like a close race last November. (Zeller, 4/24)

Amid uncertainty in Washington about the future of the Affordable Care Act, states are moving to bolster their own insurance markets, hoping to fend off big rate increases and pullbacks by insurers. Idaho, Oklahoma and Minnesota have passed bills that aim to blunt insurers’ costs for covering people who buy individual insurance and have health conditions that require expensive treatments. The measures would allow insurers to unload at least some of the expense of these enrollees’ claims onto state programs, typically using a version of reinsurance. (Wilde Mathews and Hackman, 4/23)

Access Health CT CEO James Wadleigh says he’s concerned that next year Anthem and ConnectiCare may quit Connecticut’s Affordable Care Act marketplace, where more than 100,000 Connecticut residents currently get their health coverage. (Radelat, 4/21)

President Trump and GOP congressional leaders have made a case that higher premium costs in Arizona are a key reason why the health law known as Obamacare needs to be repealed and replaced. ... Rates predictably skyrocketed this year. Arizona’s benchmark soared to the third-most-expensive among the same 44 states, according to HHS. (Alltucker, 4/24)

Surgeon General Vivek H. Murthy, an Obama administration holdover, was asked to resign by the Trump administration on Friday. He was replaced by his deputy, Rear Adm. Sylvia Trent-Adams, one of the first nurses to serve as surgeon general. Admiral Trent-Adams will for now be in an acting role. As of Friday evening, she had already replaced Dr. Murthy on the surgeon general’s Twitter account, and her portrait had replaced his on the agency’s Facebook page. One of the first comments on that post asked, “Where is Dr. Murthy?” (Ivory and Harris, 2/21)

Murthy, a holdover from the Obama administration, was asked to resign, according to a statement released Friday night by the Department of Health and Human Services. The statement said that “after assisting in a smooth transition into the new Trump administration,” Murthy “has been relieved of his duties.” Trent-Adams, a 24-year veteran of the Public Health Service Commissioned Corps and a former chief nurse officer of the Public Health Service, will fill the role for now, the statement said. (Bernstein, 4/22)

Dr. Murthy said in a long Facebook posting late Friday night that he believed Adm. Trent-Adams was “capable and compassionate” and described lessons he said he had learned from a job he had been honored to hold. “Healing happens when we are able to truly talk and connect with each other. That means listening and understanding. It means assuming good, not the worst. It means pausing before we judge. Building a more connected America will require us to find new ways to talk to each other,” he wrote. (Radnofsky, 4/22)

As the White House and Republican-led Congress take aim at federal funding for health providers that offer abortion services, some state lawmakers may step in to fill the breach. Last month, Maryland became the first state to guarantee funding for its Planned Parenthood clinics should the federal government strip funding, and similar efforts are afoot farther west. (Facher, 4/24)

Responding to criticism that he can’t be trusted to protect abortion rights, Democratic candidate for governor Tom Perriello on Thursday said Lt. Gov. Ralph S. Northam backed “the most anti-choice president” in American history by voting twice for Republican George W. Bush. (Moomaw, 4/21)

The conservative Family Foundation of Virginia is filing a legal challenge over the way the state did away with restrictive regulations for abortion centers. The group said Friday it filed an administrative appeal in Henrico County Circuit Court over the health and safety regulations, which were updated in October. (4/21)

The deputy chief of staff at the Cincinnati Veterans Administration Medical Center faces the end of her career and possible prosecution for writing three prescriptions for a private patient. But she says the VA is retaliating because she was blowing the whistle on its relationship with UC Health, which she says wastes tax dollars and hurts veterans. (Saker, 4/22)

Audio recordings obtained by The Atlanta Journal-Constitution reveal a VA manager overseeing a health care enrollment project intentionally withheld critical information from hospital staff across the country that would have made it easier for veterans to gain access to care. ... The manager describes how he’s been instructed to not provide detailed guidance to staff at more than 150 VA hospitals across the country. (Schrade, 4/21)

Sexual abuse of residents in long-term care facilities, assisted-living centers and nursing homes is a largely hidden problem nationwide. It hides behind reporting systems that fail to catalog such complaints separately from other forms of abuse that afflict the elderly and disabled. (Davis and Cummings, 4/23)

Prosecution of caregivers of at-risk adults is rare in Georgia, and it’s not because of a decline in the abuse, neglect and exploitation of elderly and disabled adults. Between 2008 and 2012, reports of such crimes climbed 65 percent in the state. But law enforcement and prosecutors are starting to seriously dig into the crimes. (Hodson, 4/23)

A taxpayer-funded  website for consumers leaves out nearly 8,000 substantiated complaints against senior care centers in Oregon. The complaints include cases of abuse, neglect and substandard care. Every one led the state to find a facility in violation of state rules. Here are 11 examples of complaints the website keeps hidden from view. Facilities are supposed to devise written plans for residents that specify things like how many people are needed to safely move them from a bed to a wheelchair. Under state rules, abuse can include an “active or passive” failure to provide the basic care needed to keep residents healthy and safe. (4/21)

Thousands of scientists and their supporters, feeling increasingly threatened by the policies of President Trump, gathered Saturday in Washington under rainy skies for what they called the March for Science, abandoning a tradition of keeping the sciences out of politics and calling on the public to stand up for scientific enterprise. (St. Fleur, 4/22)

Dressed in long sleeves and a sensible safari hat, Dr. Diane Brown carried a sign that read, “My patients need science because lupus is not cured, juvenile arthritis is not cured … CANCER is not cured!” Brown, a rheumatologist at Children’s Hospital Los Angeles, said she hadn’t attended any marches since President Trump took office at the beginning of the year. But on Saturday afternoon she joined thousands of others in downtown Los Angeles for the March for Science Los Angeles. The 52-year-old doctor said her sign had a special significance for her. Two of her patients were diagnosed with cancer last week. One was 8 years old. The other was just 4. (Netburn and Panzar, 4/22)

Among the movement’s goals: to push for evidence-based legislation and to communicate to the public the social and economic impacts of scientific research. Dr. [Diana] Sun, a dermatologist, and her son also hoped to change the public’s perception of scientists, who have long been portrayed as villains in movies and books like “Frankenstein,” they said. (Hernandez and McKay, 4/22)

Biotech and pharma companies have been tiptoeing around the Trump administration, worried about proposals to regulate drug prices. But companies that are now marketing their “bold” work in scientific discovery and developing new treatments largely lacked an official presence at the marches. (Joseph, 4/23)

Just hours after the Washington March for Science dispersed, organizers sent an email to demonstrators with the subject line, “What's next?” “Our movement is just starting,” the message read. It went on to urge marchers to take part in a “week of action,” a set of coordinated activities that range from signing an environmental voting pledge to participating in a citizen science project. (Kaplan, 4/23)

It’s a great time to be a cigarette company again. Far fewer Americans are smoking, and yet U.S. tobacco revenue is soaring, thanks to years of steady price hikes. Americans spent more at retail stores on cigarettes in 2016 than they did on soda and beer combined, according to independent market-research firm Euromonitor International. Consolidation and cost cutting are boosting profit. Big Tobacco shares are on a roll. (Maloney and Chaudhuri, 4/23)

Four out of five older Americans with hearing loss just ignore it, in part because a hearing aid is an unwelcome sign of aging. But what if hearing aids looked like stylish fashion accessories and could be bought at your local pharmacy like reading glasses? That's the vision of Kristen "KR" Liu, who's the director of accessibility and advocacy for Doppler Labs, a company marketing one of these devices. She thinks a hearing aid could be "something that's hip and cool and people have multiple pairs and it's fashionable." (Neighmond and Greenhalgh, 4/24)

Consumer electronics giant Bose Corp. is pushing legislation that would allow some hearing aids to be sold over the counter, a change that could accelerate the growth of an industry dominated by just a handful of companies. ... Lobbyists and congressional aides say the legislation (S 670, HR 1652) is likely to be tucked into the expected reauthorization of the Food and Drug Administration user fee agreements, which is due by Sept. 30. A hearing on the bill is tentatively scheduled for May 2 in the House Energy and Commerce Committee, lobbyists say. A panel spokeswoman said the committee was reviewing “a number of member priorities” and had no schedule updates. (Williams, 4/24)

As baby boomers increasingly assist their elderly parents with health issues large and small, families are having to rethink personal boundaries. Should a son accompanying his mother on a visit to her primary-care physician reveal that she is struggling with depression? Is it any business of an elderly man’s family that he is using Viagra? (Ward, 4/23)

Living alone can be tough for seniors. Some don’t have family nearby to check on them, and they worry that if they fall or suffer a medical emergency and can’t get to the phone to seek help, no one will know. That’s why hundreds of police agencies in small towns, suburbs and rural areas are checking in on seniors who live alone by placing an automated call to them every day. (Bergal, 4/23)

Doctors across the country are facing high rates of stress and burnout — a dangerous trend for doctors and patients that is now a hot topic in the medical profession... “Four hundred U.S. physicians take their own lives every year,” Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, told an audience Thursday at the federation’s annual meeting. (Teegardin, 4/22)

Within two years of having a heart attack, nearly 1 in 5 people stop taking lifesaving cholesterol-lowering drugs known as statins, according to a new study. And nearly 2 in 5 end up taking the drugs in lower doses or less often than they should, researchers report in JAMA Cardiology. “From a societal perspective, we need to make sure the highest-risk individuals are being treated with guideline-directed therapy,” said senior author Robert Rosenson, a professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York. (Seaman, 4/23)

Dr. Bart Ferket’s study of knee replacements begins with a few eye-popping facts. Since 2000, the annual rate of that surgery has more than doubled in the United States. More than 640,000 are now performed each year, at a cost of more than $10 billion. But in some cases, Ferket found, the patients receiving them had relatively mild symptoms, and derived limited physical benefits. Published in BMJ, his study concluded that surgeries on such patients were “economically unjustifiable.” (Ross, 4/24)

It seemed like a sensible advertising strategy. When a company discovered that women accounted for less than one-third of the purchases of its products, it shifted direction to appeal more directly to them. But when the company is the largest condom seller in America, at a time of heightened divisiveness regarding reproductive rights and women’s health, the situation can get a little more complicated. (Schonburn, 4/23)

Midwest farmers are warily watching as one strain of a highly contagious bird flu virus infects and kills humans in China and another less-worrying but still highly contagious strain infects a Tennessee poultry farm. Two years after a devastating bird flu outbreak in the Midwest, many farmers here say they now have a better idea of how to keep bird flu at bay. In January 2015, avian influenza, or bird flu, appeared in backyard flocks in Washington state. Within six months, the virus reached 15 states, including Iowa, Nebraska, Minnesota, and Missouri. About 50 million birds died. (Gerlock, 4/24)

Zehra Patwa learned only a few years ago that during a family trip to India at age 7, she was circumcised, which is common for girls in parts of Asia, Africa and the Middle East. Patwa, 46, doesn't remember undergoing the procedure, which is also called female genital mutilation or cutting and which has been condemned by the United Nations and outlawed in the U.S. But she doesn't want to. (4/23)

Eryn Brown reports: "Increasing numbers of women who produce more breast milk than they need are handing it over — or selling it — for others to use. It’s a boon to fragile infants and mothers who can’t produce enough milk, but it also poses challenging ethical and public health questions." (Brown, 4/24)

Confronting an opioid overdose epidemic that is killing at least 90 people every day, two federal agencies this month gave more than 700 nurse practitioners and physician assistants the authority to write prescriptions for the anti-addiction medication buprenorphine. ... Tens of thousands more nurse practitioners and physician assistants could be helping, too, by applying for a federal license to prescribe the potentially life-saving medicine. But laws in more than half the states are likely to prevent nurses from using their licenses in rural areas that need it most. (Vestal, 4/21)

The top government lawyers from 19 states are telling President Donald Trump and the Republican leaders of Congress not to pass health insurance changes that would stop the flow of federal drug treatment money. A letter sent Friday by a group of attorneys general for 19 states plus Washington D.C., is the latest in a series of actions from Democrats who hold those offices to oppose Trump's policies and actions. (Mulvihill, 4/21)

When Carin Miller’s son was about 19 years old, he began to abuse heroin by snorting pills, eventually moving on to shooting up. This went on for six years before he got help. Lucas Miller’s history of drug use started in high school with smoking marijuana. When he moved out of his parents’ house, one of his housemates had access to between 750 to 1,500 pills at any given time between five houses located in Frederick, Maryland. “My son was addicted to heroin, he’s in recovery by the grace of God since Thanksgiving 2014, I think that’s where we are at,” Miller said. (Nocera, 4/21)

The world knows Prince, who died a year ago Friday of a fentanyl overdose. Hundreds of other Minnesotans who've died during the years-long epidemic of heroin and other opioids remain largely unknown to anyone beyond those who loved them. Their names and causes of death are recorded in the Minnesota Health Department's database of the dead. (Sepic, 4/24)

Sanford’s medication-assisted therapy clinic in Bemidji prescribes buprenorphine to eliminate opioid cravings for women while they are pregnant, which also reduces the chances of premature births. The treatment itself leaves newborns prone to withdrawal symptoms after birth, so it is somewhat controversial, but mothers often cannot overcome opioid addiction without it, said Dr. Joe Corser, who directs the clinic. (Olson, 4/22)

Many Ohioans know the powerful painkiller fentanyl as a cold-blooded killer that preys indiscriminately on addicts: rich and poor, urban and rural, male and female. And most of them never knew what killed them. (Johnson and Candisky, 4/23)

Recovering alcoholics tend to avoid the bar. But when the bar is your office, that's not so easy. New Orleans bluesman Anders Osborne figured out how to get back to work despite the temptations, and now he's trying to help others. (Elliott, 4/22)

From his modest office at Lincoln Community Hospital, an hour and a half east of Denver, Kevin Stansbury views the state budget from a different lens. At the Capitol, the debate is focused on balancing $26.8 billion. In Hugo, population 750, the dollar signs are people...Now Lincoln Community faces the prospect of cuts to services, layoffs or worse. It is one of a dozen or so rural hospitals poised to lose millions as part of a deal at the Capitol to balance the budget by trimming hospital payments for uncompensated care. (Ingold, 4/23)

Here’s how it works: The hospitals pay fees to the state based on the number inpatient days and outpatient hospital charges. The money is pooled and matched near dollar-for-dollar by the federal government. Minus administration costs, the larger pot of money is then redistributed to hospitals based on a formula that redistributes the wealth. The formula gives more to hospitals that serve large populations of Medicaid patients and those in rural areas. Not all hospitals get back the money they put into the system, and Colorado uses some of the fee collections to cover the Medicaid expansion population under the Affordable Care Act. (Griffin, 4/23)

The California Department of Public Health has issued penalties to 14 California hospitals, including three in Los Angeles County, for incidents that could have caused serious injury or death to patients, the state health agency announced this week. The penalties — as well as more than $1.1 million in fines — were issued for incidents between 2012 and 2016. The Department of Public Health conducted an investigation in each case. (Branson-Potts, 4/21)

If Maryland were to be hit by a public health emergency — such as a natural disaster or an outbreak of a serious disease — officials here are better prepared than in many other states, according to a new survey. On a 10-point scale, Maryland rates 7.5 for its efforts to prepare for and respond to such emergencies, according to the 2017 National Health Security Preparedness Index.The index is compiled annually by the nonprofit Robert Wood Johnson Foundation to assess preparedness for "community health emergencies." The foundation looks at more than 100 measures, such as monitoring food and water safety, flu vaccination rates, and numbers of paramedics and hospitals. The measures are grouped into six categories that are given a ranking on the 10-point scale. (Wood, 4/22)

The Missourians Achieving a Better Life Experience, or MO ABLE, accounts can be used to pay for qualified expenses related to living with disabilities and special needs. People can contribute up to $14,000 a year, and those who do get a tax deduction of up to $8,000, or $16,000 if married and filing jointly. (Lecci, 4/24)

A Tennessee-based health care company plans to develop a $100 million cancer treatment center in New Orleans, Greater New Orleans Inc. announced Friday (April 21). The 30,000-square-foot space, to be called the Louisiana Proton Therapy Center, will be housed within the University Medical Center campus on Canal Street and provide an alternative to radiation therapy for cancer patients. Provision Healthcare, a cancer care firm based in Knoxville, partnered on the project with UMC, LCMC Health and LSU Health Sciences Center New Orleans. GNO Inc. estimates that the new center will create 60 new direct jobs with an average salary of around $100,000, plus another 63 new indirect jobs. (Lipinski, 4/21)

New Hampshire is one of 17 states in the country that control liquor sales. But unlike many of these states, New Hampshire has no sales or income tax, so state-run liquor stores have become quite a lucrative source of revenue. (Sutherland, 4/24)

Researchers now want to explore the possibilities of a house or apartment crammed with sensors that track everything from how you look in the mirror, to the way you walk from bedroom to kitchen, to what you flush down the toilet. A home outfitted with the right sensors might hail an ambulance when you collapse with a heart attack, or mean the difference between living alone and surrendering to nursing home care. (Canon, 4/21)

Health officials are investigating a cluster of multi-drug-resistant tuberculosis cases in eight elderly Hmong residents in Ramsey County, but say the risk to the general public is low. The outbreak first appeared in 2016, but just one case has been recorded this year and no new cases have been detected since state officials notified health care providers last month. (Howatt, 4/21)

A measles outbreak in Hennepin County has sickened 12 children — all of them unvaccinated and all of them from Somali families, according to the department — throwing a spotlight on low immunization rates among Somali children. Now state and county public health workers are doing their best to contact Somali parents and underscore the value of immunization. (Mahamud and Howatt, 4/22)

Public health professors, physicians and students at Oregon Health & Science University Hospital want to go beyond "stitching up'' gunshot and stab wounds of victims who end up in the emergency department. On Saturday, the school will host a community forum to bring together doctors, police and families affected by shootings, domestic violence or suicides, seeking to play a larger role to reduce violence in the metro Portland area...The conference was born out of anger and concern after the June mass shooting at a popular gay nightclub in Orlando, Florida, which left 49 people dead and 53 wounded, followed by a sniper's attack on Dallas police in July, killing five officers. (Bernstein, 4/21)

Alex Scott cannot speak.If he could, he might be able to answer a crucial question that has pitted the people who speak for him against one another and left him stranded in a Northern Virginia hospital for three weeks. At issue: Does the 45-year-old with cerebral palsy need a feeding tube? (Vargas, 4/21)

Penn's Village is one of around 200 similar organizations around the country that help people who may not have family members nearby age in place by linking them with volunteers and reputable service providers. Stella Buccella, another Penn's Village volunteer, drove Nettis from her home near the Philadelphia Museum of Art to Jefferson that morning and picked her up afterward. Some volunteers just visit or help seniors with technology. Penn's Village has about 275 members. A full membership costs $600 a year. Limited funding is available to help low-income residents with dues. (Burling, 4/24)

Scavo High School is planning to use $23,000 from the Mid-Iowa Health Foundation to become what’s known as a “trauma sensitive school.” The community schools coordinator for Scavo, Lyn Marchant, says the money will help teachers and students recognize the connection between strife at home and performance in school. (Dillard, 4/23)

One of the most effective ways of making medicine more inclusive is to have doctors, nurses, pharmacists, social workers, psychologists and occupational therapists all work together to learn about each patient as a person, and help them manage their care... To bring this into practice, medical school programs across the country are starting to bring engaged patients into the classroom, allowing them to share their story and become more than just a statistic in a textbook. (Bansal, 4/23)

Shortly after David Hess died in a struggle with staffers at Wordsworth last fall, the state shuttered the West Philadelphia facility, decrying it as “an immediate and serious danger” to the children who lived there. ... Interviews, court records, state inspection reports, and police records reveal a trail of injuries to children, from broken bones to assaults to the suffocation death of Hess. Along the way, lawyers, licensing inspectors, and others found conditions there appalling and sounded the alarm with little success.  (Phillips and Palmer, 4/22)

Prosecutors say an Alaska dentist charged with Medicaid fraud pulled a sedated patient's tooth while riding a hoverboard. Seth Lookhart was charged with 17 counts of Medicaid fraud after prosecutors say he billed Medicaid $1.8 million last year for IV sedation used in procedures that didn't call for it. (4/21)

A new law limits the amount of compensation an Iowa worker can receive for a shoulder injury. Critics say the change makes workers disposable, but proponents point out that the law also provides tuition so injured employees can retrain for new careers. (Boden, 4/23)

The agency that provides Ohio's nursing home inspectors -- the officials charged with making sure the state's most vulnerable receive proper care -- is understaffed by at least a dozen employees and, for years, has failed to meet federal deadlines for evaluating facilities... A key deadline for inspecting the state's nursing homes has not been met since fiscal year 2011, records show. (Caniglia and Corrigan, 4/23)

One Atlanta health care technology startup, Patientory, wants to make it easier for patients to access and share their electronic medical records using technology known as blockchain, which is behind the digital currency Bitcoin. Currently, many hospitals may keep things on one central server. (Shamma, 4/21)

Republicans have put themselves in a deep hole on ObamaCare, both politically and on the health-market merits, but maybe they’ll grab the rescue line now dangling in front of them. A potential compromise among the House’s contentious GOP factions could begin the climb out. (4/21)

Ever since House Republicans balked at a plan to end health insurance for 24 million Americans by repealing Obamacare, President Trump has been casting around for alternative strategies. One idea is to take another crack at legislation. To that end, Republicans have spent recent days struggling to craft a plan that both hard-line conservatives and more moderate members could support. Another idea is to sabotage President Obama's signature legislation by blocking funds for cost-sharing subsidies that help lower-income people purchase insurance. (4/23)

President Trump has a new bargaining chip in the drive to repeal and replace Obamacare. He recently expressed willingness to end the law’s “cost-sharing reduction” subsidies — which reimburse insurers for covering out-of-pocket costs like deductibles and co-pays for low-income exchange enrollees — in order to bring Democrats back to the negotiating table. That’s exactly what he should do. (Sally C. Pipes, 4/23)

President Trump is in a big rush for House Republicans to repeal the Affordable Care Act by the time he reaches the 100-day mark on Saturday. This revives what for many Americans has been an agonizing process of watching their access to health care become a political football in the worst tradition of Washington deal-making — secretive drafting, rushed votes, multiple closed-door sessions and minimal debate. (Andy Slavitt, 4/24)

The nation’s biggest health insurer, UnitedHealth Group, had a pretty good quarter, judging from the preening by its executives during a conference call with Wall Street analysts this week. The company turned a profit of $2.2 billion on revenue of $48.7 billion for the quarter ended March 30. That was partially the result of the company’s bailing out entirely on Affordable Care Act individual insurance exchanges, on which it was losing money. ... they weren’t shy about proposing changes to the law that they think will make it better. Interestingly, every change they mentioned would make the ACA work a lot better for UnitedHealth, though not for its customers. (Michael Hiltzik, 4/21)

Most Arizona counties have just one remaining insurer for the Affordable Care Act. The Arizona Health Care Cost Containment System (AHCCCS) holds the solution to this problem. AHCCCS works and works well, providing health-care services to 1.8 million Arizonans annually. (Victoria Kauzlarich, 4/23)

A study published April 12 in the journal Health Affairs reported that states such as Ohio that expanded Medicaid to cover the working poor, an option offered by the Affordable Care Act, “did not experience any significant increase in state-funded expenditures, and there is no evidence that (Medicaid) expansion crowded out funding for other state priorities.” That study, by Harvard’s Benjamin D. Sommers and MIT’s Jonathan Gruber, suggests that Ohio’s Medicaid expansion has been a good deal for Ohio and Ohioans. (Thomas Suddes, 4/23)

The burden of substance abuse disorders can fall heavily on the families and friends of those who battle addictions. But society also pays a great deal through increased crime. Treatment programs can reduce those costs. For at least two decades, we’ve known substance use and crime go hand in hand. More than half of violent offenders and one-third of property offenders say they committed crimes while under the influence of alcohol or drugs. (Austin Frakt, 4/24)

Innovative medical research is fueled by creative and tenacious minds. Yet many of the researchers who do this vital work find themselves frazzled by a long-hours culture that not only hinders their creative ability but may also discourage the Nobel laureates of the future from joining their ranks. We need better balance between our work and our lives. (Robert Lechler, 4/21)

Only after this fundamental research did we have the ability to create novel antibodies. Then, various companies and agencies worked for almost ten years to develop antibodies into therapeutics. One such antibody drug, rituximab, was approved by the FDA in 1997. In 2005, my mother received her first injection of rituximab. Suffering from an autoimmune disease, she faced imminent loss of her vision. Rituximab halted the disease and prevented her from going blind. Now, when I look at my mother, I see the power of science. (Justin Wolfe, 4/22)

When President Trump and his (male) aides sit at a conference table deciding to cut off money to women’s health programs abroad, they call it a “pro-life” move. Yet here in Haiti, I’ll tell you the result: Impoverished women suffer ghastly injuries and excruciating deaths. Washington’s new women’s health policies should be called “pro-death.” (Nicholas Kristof, 2/22)

And so it is that, when the appropriations subcommittees in the Michigan House and Senate took up Gov. Rick Snyder's proposed health budget a few weeks ago, figuring out what health services the state needs to provide and how to pay for them were not exactly at the top of their to-do list. The first objective, as Sen. Jim Marleau, R-Lake Orion, tacitly acknowledged last week, was to find $124 million in the Snyder administration's health care budget that could be diverted to pay for a tax cut. (4/22)

For the last year and a half I have relied on a paid caregiver to help me get through each day. She arrives early in the morning and clocks in using a timekeeping app on my smartphone. Because my speech is limited, I type out instructions for her to read or I have my smartphone read them to her using the device's speech function. This continues throughout my caregiver's seven-hour shift as I use various templates saved on my phone: "Please fill my water glass" or "I would like to brush my teeth." (Jamison Hill, 4/24)

The 911 emergency phone call system was designed half a century ago, back when cellphones and email didn’t exist and Americans relied on land-line telephones and CB radios to call for help. The system has built-in deficiencies, particularly when it comes to helping blind and hearing-impaired callers. A bill being considered in Jefferson City would add Missouri to the growing list of states trying to make the system better. (4/23)

Will the injustices visited upon Richard Meredith never end? ... As a young adult, he was sent to live at a state institution where, at the age of 24, he was subjected to a lobotomy that left him profoundly disabled. ... It was a life that ended unexpectedly on Sept. 1, 2013, after workers at the state-run Mental Health Institute in Clarinda mistakenly gave him a peanut butter sandwich rather than the doctor-ordered pureed food he was able to swallow. ... His family sued the state and the Iowa Department of Human Services, which ran the institute. ... the two sides agreed recently to settle the case for $150,000. But as part of the deal, the Iowa Department of Human Services insisted on clawing back $25,000 of that from Richard Meredith’s estate as reimbursement for some of the Medicaid dollars spent on Meredith’s care at the MHI. (4/23)

We have many areas in dire need of pipe upgrades in Wisconsin. ... Last year alone, an Environmental Protection Agency study found 64 Wisconsin water systems that exceeded lead limits, including those in Lake Mills, Stoughton, Neenah, Racine and several schools. (Emily Mills, 4/21)