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A potential shakeup in Arizona's Affordable Care Act marketplaces is resurrecting President Barack Obama's 2010 health-care law as a political issue in this year's U.S. Senate race. The developments mean customers will have fewer subsidized plans to pick from next year, and in some rural counties, they could have no options at all. UnitedHealthcare, the national insurance giant, on Tuesday signaled that it intends to abandon Arizona's Affordable Care Act marketplace in 2017. Blue Cross Blue Shield of Arizona, the only other insurer to offer plans in all of Arizona’s 15 counties, also is considering pulling out of some areas. (Nowicki, 4/24)

After years of struggling with bug-ridden computer systems, MNsure leaders are beginning to consider another path: paying someone else to handle the health insurance exchange’s technology. (Montgomery, 4/22)

The conservative Republican Study Committee (RSC) on Friday submitted its recommendations for a Republican replacement for ObamaCare as it seeks to shape a plan being formed by a group of House chairmen. ... The proposal would replace ObamaCare’s refundable tax credits with a tax deduction, which tends to provide less help to low-income people by reducing the taxes people owe rather than allowing for the possibility of getting money back in a refund. ... The law would undo ObamaCare’s provision that bars insurance companies from refusing to cover people with pre-existing conditions and instead set up a system of high-risk pools for them. By repealing ObamaCare, the measure would also undo the law’s expansion of Medicaid, which has provided much of the coverage gains that have led to an estimated 20 million people gaining insurance from ObamaCare. (Sullivan, 4/22)

With a byzantine end-it-to-save-it maneuver, Arkansas Gov. Asa Hutchinson put his imprint on the hybrid Medicaid expansion he inherited and effectively saved the subsidized insurance program. But there's little guarantee that the Republican governor and legislative leaders won't face the type of budget shutdown fight that's accompanied the program since its inception. ... a bigger question looms: What will it take to save the program when lawmakers take up the issue again in several months? (DeMillo, 4/24)

It seems as though just about everyone in state government likes the Oklahoma Health Care Authority’s Medicaid Rebalancing proposal. Except for the part about $100 million in up-front costs. ... The Health Care Authority administers both the state Medicaid system and Insure Oklahoma, a program that subsidizes private health insurance premiums for low-income Oklahomans. To prevent the state’s Medicaid system, known as SoonerCare, from collapsing, the OHCA proposes growing Insure Oklahoma. To do that, it is asking for a $1.50 increase in the cigarette tax to stabilize Medicaid reimbursement rates, and about $100 million in seed money by 2020 so it can add about 176,000 people in Insure Oklahoma. (Krehbiel and Hoberock, 4/24)

Charges of Medicaid fraud against three administrators of the now defunct Carlsbad Mental Health Center were dismissed in magistrate court Thursday. Noel Clark, Darril Woodfield and Michael Stoll were indicted in June 2015 by the office of Attorney General Hector Balderas following an investigation they said revealed over-billing and falsification of documents at Carlsbad Mental Health Center. (Onsurez, 4/22)

One of the most closely watched hearings on a proposed drug in years convenes Monday morning in Hyattsville, Md., where a panel of medical experts will consider an application by Cambridge’s Sarepta Therapeutics Inc. for approval of a Duchenne muscular dystrophy treatment. (Weisman, 4/25)

Billy Ellsworth, a teenager with an inexorable and devastating degenerative muscle disease, will bring a football with him to a Maryland hotel conference center on Monday. For months, he has been brainstorming a way to prove to a panel of scientists and physicians that the experimental drug he has been taking for more than four years has kept him strong and well — and he’d like to punctuate his brief testimony in the clearest possible way: by throwing them the ball. (Johnson, 4/23)

The U.S. Food and Drug Administration on Friday proposed a ban on electrical stimulation devices (ESDs) that are used to curb individuals from engaging in self-injurious or aggressive behavior, saying they pose an "unreasonable and substantial" risk to public health. (4/23)

Seven years after U.S. regulators slapped their strictest warning on two popular smoking-cessation medicines citing risks of suicidal behavior, a large international study found no such risk. (Johnson, 4/22)

A staggering share of veterans who served in Iraq and Afghanistan have been returning home with mental illnesses brought on by their time overseas. But as hundreds of thousands struggle with post-traumatic stress disorder, many are going without the help they need, which is prompting several states to step in. (Fifield, 4/23)

Melissa Gillett recalls the sickly sweet, nearly vomit-inducing smell during her runs around Bagram Airfield in Afghanistan, where she served as a member of the Minnesota National Guard. The revolting odor emanated from a large “burn pit,” one of many the U.S. military has used over the years in Iraq, Afghanistan and other places to dispose of trash, chemicals and more. Gillett did her best to avoid the burn pit’s smoke, steering clear if she couldn’t peer through it, but she said she breathed it in pretty much nonstop during her six-month tour of duty in late 2009 and early 2010. And now the 29-year-old Fargo woman is sick, very sick. (Ojeda-Zapata, 4/24)

An Oklahoma bill that could revoke the license of any doctor who performs an abortion has headed to the governor, with opponents saying the measure in unconstitutional and promising a legal battle against the cash-strapped state if it is approved. In the Republican-dominated legislature, the state's House of Representatives overwhelmingly approved a Senate bill late on Thursday. Governor Mary Fallin, a Republican, has not yet indicated whether she will sign it. (Herskovitz, 4/22)

Missouri lawmakers passed a budget last week that spends millions in state money to block Planned Parenthood from accessing federal funding. The plan puts Missouri alongside at least a dozen other states in a national effort to strip public money from the country's largest abortion provider. The federal government says states don't have the authority to steer Medicaid funding away from Planned Parenthood, and courts have blocked some of those efforts. But Missouri's budget writers say eliminating federal dollars from women's health programs means federal restrictions no longer apply. (Aton, 4/24)

During an anti-abortion protest Saturday in Richmond, across the street from the Planned Parenthood center at 201 N. Hamilton St., Baird Stokes told protesters that his mother was just $19 short of aborting him 63 years ago. (Shulleeta, 4/23)

David Daleiden said he doesn’t take it personally that state law enforcement agents searched his Orange County home earlier this month. But the seizure of equipment and footage he used to produce a controversial series of undercover videos about Planned Parenthood seems to have fired up the now famous anti-abortion activist for a fight. (Kosseff, 4/23)

Dark chocolate is in. So, too, is beef jerky. And full-fat ice cream? You bet. Driven by fast-changing definitions of what is healthy to eat, people are turning to foods they shunned just a couple of years ago. Studies now suggest that not all fat, for example, necessarily contributes to weight gain or heart problems. That has left companies scrambling to push some foods that they thought had long passed their popularity peak — and health advocates wondering what went wrong. (Strom, 4/22)

Bernie Sanders on Sunday came out against a plan being considered by the city of Philadelphia to tax soda as a means of paying for universal pre-kindergarten programs. He argued on NBC’s “Meet the Press” that it would be regressive, affecting the poorest families who often buy soda precisely because it is inexpensive. (Bassett, 4/24)

Stacey McHoul left jail last summer with a history of heroin use and depression and only a few days of medicine to treat them. When the pills ran out she started thinking about hurting herself. ... Jail officials gave her neither prescription refills nor a Medicaid card to pay for them, she said. Within days she was back on heroin — her preferred self-medication — and sleeping in abandoned homes around Baltimore’s run-down Sandtown-Winchester neighborhood. Thousands of people leave incarceration every year without access to the coverage and care they’re entitled to, jeopardizing their own health and sometimes the public’s. (Hancock, 4/25)

The immense new CVS dominates the corner of Pennsylvania and West North avenues. ... CVS, its front shelves crammed with brightly-packaged processed foods and household cleaning supplies, is an island of abundance for this West Baltimore neighborhood, one of the city’s poorest. It’s a contrast that shows what’s changed and what hasn’t in the past year, since Freddie Gray, a 25-year-old black man, died of injuries sustained in police custody, unleashing days of protests. ... But if 2015’s protests emphasized police brutality and race relations, the absence of more stores like CVS that are easily accessible to people in impoverished, predominantly black neighborhoods underscores Baltimore’s other persistent inequities. (Luthra and Snow, 4/25)

U.S. health and safety officials issued new guidelines on Friday to help protect workers from exposure to Zika, a mosquito-borne and sexually-transmitted virus that causes the birth defect microcephaly and other neurological disorders. (Steenhuysen, 4/22)

HHS Secretary Sylvia Mathews Burwell will travel to Puerto Rico next week in the administration’s most high-profile attempt to prepare the island and the U.S. mainland for the Zika virus. Puerto Rico already has 448 cases of Zika, and local mosquitoes have the virus, meaning they could spread it directly to people. The CDC estimates the virus could infect as many as 700,000 Puerto Ricans — or 20 percent of the island's population — by the end of the year. (Haberkorn, 4/22)

Billy Ryan visits Roy's Trailer Park on Florida's Stock Island every two months. It's part of his regular rounds as an inspector for the Florida Keys Mosquito Control District. "Hey I'm just checking on the yards for the mosquito control," he tells one resident, Marie Baptiste, as he heads into her yard. "OK?" No problem, she tells him. People who live in the Keys are used to seeing mosquito control inspectors. Since an outbreak of dengue fever in 2009, the inspectors have conducted routine house-to-house checks in areas where the Aedes aegypti mosquito breeds. (Klingener, 4/22)

With two new travel-related Zika cases and 15 total, Broward County trails Miami-Dade, which now has 39 cases. Florida is reporting a total of 93 Zika cases, five of which are in pregnant women, and three that are still showing symptoms. (Miller, 4/22)

A pregnant San Francisco woman who had recently been in Central America tested positive for the Zika virus, public health officials said Friday. The woman has experienced no symptoms of Zika, but got tested because of known risks to babies born to women who were infected during pregnancy. Her test came back positive Thursday. (Allday, 4/22)

Sen. Jeanne Shaheen met today with health experts from around the state to discuss how New Hampshire is preparing for the Zika virus. (Moon, 4/23)

Ohio's spike in opioid overdoses and deaths is a public health problem that requires an urgent influx of resources to treat addiction, stem the supply of prescription narcotics, and educate children and parents about the dangers, law enforcement officials and health experts said Friday. (Ross, 4/23)

A showdown is looming in the Missouri statehouse over an effort to make Missouri the final state in the nation to gain a prescription drug monitoring program. State Sen. Rob Schaaf, R-St. Joseph, has promised to filibuster House Bill 1892, which would let doctors check a database before giving patients a prescription for opioid painkillers, and require pharmacists to report filling opioid prescriptions within 24 hours. (Phillips, 4/24)

The founder of a Detroit-based drug recovery program is being recognized at the White House amid efforts to respond to a nationwide problem with prescription opioid and heroin abuse. (4/22)

While six southeast Michigan hospitals received top grades in prevention of avoidable errors, accidents and infections, many more have work to do to improve their performance, according to a study released today. Southeast Michigan Hospitals receiving A grades in the Hospital Safety Scores spring ratings published by the national nonprofit watchdog the Leapfrog Group were the University of Michigan’s hospitals and health centers; Garden City Hospital; Huron Valley-Sinai in Commerce Township; St. Joseph Mercy in Chelsea; St. John River District near St. Clair, and Promedica Bixby Hospital in Adrian. (Helms, 4/25)

Florida is facing some serious doctor shortages in the next decade because of growth and an aging population. A statewide hospital network hopes more residency slots will help. The Safety Net Hospital Alliance of Florida is hoping to boost the number of doctors in Florida by creating 66 medical residencies for new doctors. (Miller, 4/22)

Eastern State Hospital no longer has Medicare funding after a survey found it did not comply with requirements of participation for psychiatric hospitals. The Centers for Medicare and Medicaid Services recently submitted a termination notice, effective April 21, citing the hospital’s failure to correct a set of deficiencies surveyors noticed during a June survey of the Williamsburg hospital, the Daily Press reported. (4/22)

Dr. Matthew Davis has treated patients at New Hampshire Hospital – a state-run psychiatric facility in Concord – for the last four years. But come June 30, Davis isn’t sure where his job will stand. He’s part of a group of 17 psychiatrists and nurses at the hospital trying to unionize as it faces a change in employer and a dearth of information. (Morris, 4/23)

Thousands of nurses from Lucile Packard Children's Hospital and Stanford Hospitals and Clinics said Friday they are prepared to call a strike after failing to reach a deal in three days of mediation with hospital administrators over wages and benefits. (Seipel, 4/22)

Blue Cross Blue Shield of Texas has reached a deal with Hospital Corporation of America that avoids dropping the health care system's Texas facilities from the insurer's network come May 1 after their existing contract would have expired, Methodist Healthcare System announced late Friday. (O'Hare, 4/23)

You've probably heard of the credentials M.D. and R.N., and maybe N.P. The people using those letters are doctors, registered nurses and nurse practitioners. But what about PSC.D or D.PSc? Those letters refer to someone who practices pastoral medicine – or "Bible-based" health care. It's a relatively new title being used by some alternative health practitioners. The Texas-based Pastoral Medical Association gives out "pastoral provider licenses" in all 50 states and 30 countries. Some providers call themselves doctors of pastoral medicine. But these licenses are not medical degrees. That has watchdog organizations concerned that some patients may not understand what this certification really means. (Silverman, 4/25)

Paying doctors to better coordinate care for Medicare beneficiaries in Arkansas and seven other states helped hold down the cost of patients' medical care over a two-year period, although the savings didn't fully offset the cost of the extra payments, a report found. Still, the authors of the report by Mathematica Policy Research said the Comprehensive Primary Care Initiative's effect on medical expenses was bigger than they expected. (Davis, 4/24)

The Department of Health Services projects it will save at least $300 million over the next six years with an overhaul of Wisconsin's long-term care programs, according to an agency document released Friday. (Godar, 4/22)

Vaccination rates in Florida schools are at their lowest levels in a decade, the Florida Department of Health reports. (Solochek, 4/22)

Owners of assisted-living facilities are lobbying lawmakers for authority to provide several highly sought medical services — a campaign that is sparking concern among patient advocates and dividing the industry. (Lazar, 4/25)

On that December evening, Shaun Conley walked through the door of his pretty brick house in The Woodlands, scooping up kids as they ran to him. His smile stayed bright through dinner, through baths and story time, never once betraying the churn in his gut. (Deam, 4/24)

When Dr. Benjamin Danielson reported for work during his second week as medical director of the Odessa Brown Children’s Clinic in Seattle’s Central District, the formidable woman then in charge of the clinic announced they’d be taking a tour. (Kelleher, 4/25)

The New Hampshire Department of Environmental Services has announced updated drinking water well test results for the water contaminant PFOA in Southern New Hampshire. So far, the state has tested over 350 wells, mostly within a 1.5 mile radius of the Saint-Gobain performance plastics plant. Of those, 52 private wells have tested above the state’s threshold of concern: which is 100 parts per trillion of the contaminant. The well with the highest concentration came in at 1600 parts per trillion. So far, these wells are located in Merrimack and Litchfield, with one Manchester well testing above the threshold. (Corwin, 4/22)

Seattle Public Utilities this weekend is testing the water from a handful of homes it suspects might have so-called gooseneck fittings between the water main and the house — and the results expected next week could determine if the utility has a lead problem. (Mapes, 4/24)

The cheapest and easiest protection: If water has been sitting in the pipes for six hours or longer, let it run for two minutes before drinking or cooking. (4/22)

Supporters of legalizing marijuana for medical use in Missouri now have only one option this year – the ballot box. That comes after the state House last week defeated House Bill 2213. In its original form, the measure would have allowed for medical cannabis centers in Missouri, which would have sold medical cannabis to patients with a "debilitating medical condition." (Griffin, 4/24)

Bernie Sanders can make a real difference in the causes he’s championed, even if he doesn’t become president. That’s particularly true for one of his signature issues: health care. No matter what happens with the Democratic presidential nomination, the Vermont senator can keep pushing to to fill in the holes of Obamacare, while creating the building blocks for the single-payer system he has advocated for his entire political career. (Jonathan Cohn, 4/23)

The dream of bringing single-payer healthcare to the United States is a hardy one. It's still with us despite years of disrespect by the general public, intense opposition from powerful stakeholders in the healthcare economic status quo, and the enactment of the very non-single payer system known as Obamacare. Should we give up on the dream, already? (Michael Hiltzik, 4/23)

When Americans rely on a third party — private insurance, Medicare, or Medicaid — to pay most of their medical bills, they forfeit their power as consumers. Our ill-conceived system of subsidized health plans provided by employers and taxpayer-funded “free” treatment through the government ends up stripping patients of their economic clout. Doctors and hospitals have little incentive to compete by lowering prices, because patients rarely bother to ask about prices. ... It’s only when medical services aren’t reimbursed by a third party — think of Lasik eye surgery or veterinary care or the growing number of direct-pay “concierge” practices that don’t accept health insurance — that the consumer is king. When providers are paid directly by customers, transactions are transparent, prices fall, choices proliferate, and consumer convenience becomes a priority. (Jeff Jacoby, 4/24)

Hillary Clinton and Bernie Sanders have a new issue to disagree about: the wisdom of a soda tax. A tax on sugary soft drinks, like the one proposed in Philadelphia and endorsed by Mrs. Clinton this week, divides the left. It can be seen as achieving an admirable public health goal of less sugar consumption or as a very regressive tax that falls more on the poor than the rich, since the poor tend to drink more soda. While not the biggest issue the two candidates have tussled over, it is one that may reverberate across the country in coming years as more cities and states use the tax to raise revenue or improve citizens’ health. (Margot Sanger-Katz, 4/22)

UnitedHealth is leaving most of the Obamacare exchanges where it has been selling policies. Does this mean insurance companies are losing confidence in the program? Is Obamacare about to enter a death spiral? Almost certainly not. (Robert Field, 4/25)

When CVS Health in February began taking over pharmacy operations at more than 1,600 Target stores, CVS Pharmacy President Helena Foulkes called the changeover "an important milestone." "Our heart is in every prescription we fill, and providing accessible, supportive and personalized healthcare is part of our DNA," she said. Accessible, supportive, personalized — those are all good things. But noticeably missing from Foulkes' list of consumer-friendly DNA components was this: affordable pricing. (David Lazarus, 4/22)

What I propose is a universal scorecard for all new drugs, to be overseen by the Food and Drug Administration, with information on how their cost and effectiveness measure up against similar medications. This could be a simple graphic that would fill the screen at the end of every video ad and be highly visible in every print ad. It should become a routine part of discussions with doctors whenever medications are prescribed, and should be provided by pharmacies alongside basic drug safety information. (Richard A. Friedman, 4/23)

In January, the state’s application for a Section 1115(a) Medicaid waiver was approved by the Centers for Medicare and Medicaid Services. This waiver would provide the state with access to up to $150 million over five years to improve behavioral health services. These funds are intended to increase capacity for delivering substance use disorder services and mental health services, to promote integration of behavioral health and primary care services, and to provide better care transitions for people leaving county jails and nursing homes. (State Sen. Lou D'Allesandro, 4/23)

Since 2014, aid-in-dying bills have been introduced in at least 26 states and Washington, D.C. While it’s important to provide a humane option to the dying, it’s also essential that lawmakers focus on the need to provide broader access to palliative and hospice care so that terminal patients do not choose death because pain relief is unaffordable. They must ensure that doctors be trained in prescribing life-ending medication and must encourage professional groups to offer education and support for those who want to provide such aid. And they should make funding available to study the effect of these laws. (4/23)

No argument against the proposed Trans-Pacific Partnership trade agreement packs more emotional punch than the claim that the deal would be bad for people’s health — and even result in avoidable deaths — both in the United States and in the 11 other signatory nations. The argument ... is that the TPP would unduly extend U.S. patent and intellectual property protections for the pharmaceutical industry, thus driving up prices for lifesaving medicines. ... The United States and the world need medical innovation, but it costs money — billions of dollars sometimes — to develop a drug. One way to spur investment is to offer innovators a temporary government-guaranteed monopoly on commercial exploitation. (4/24)

[Alyson Williams'] $11-an-hour salary is the average starting wage for a certified nursing assistant, according to the Massachusetts Senior Care Association, which represents the nursing home industry. Some entry-level employees make even less. A long-needed one-time raise in pay may be in the offing, however, in the form of the state House of Representatives’ version of the budget unveiled last week that includes “not less than $35.5 million” in additional funding to be used to boost earnings and benefits for about 46,000 nursing home workers. (4/22)

African-Americans are more likely than whites to receive the least optimistic diagnoses. Schizophrenia is consistently overdiagnosed, while more manageable conditions such as depression or post-traumatic stress disorder are often underrecognized or misdiagnosed — resulting in higher incidents of seclusion, use of restraints and involuntary commitment, and lower levels of support for patients and their families. This is a big reason why African-Americans and Hispanics are far more likely to be arrested and incarcerated than whites, and why jails have become such tragically overused centers of mental health care. It contributes to the deaths of African-Americans, some of whom appear to have mental disorders, at the hands of law enforcement officers. And it helps explain why, at times, these generations of mental health advances feel so illusory. (William Lawson, 4/24)

The main aim of pediatrics is prevention. Prevention of diseases, of injury, of emotional problems, of developmental and intellectual delays. Our armamentarium include vaccines; screening instruments; and guidance on development, safety, and nutrition. It's time to add one more item to our tool kit: screening our young patients for health and emotional problems related to poverty. (Daniel Taylor, 4/24)

In the United States, poverty hurts. We have long known there is a correlation between wealth and health. Richer people live longer lives. This is especially true in Philadelphia, where life expectancy at birth can vary by as much as 20 years between rich and poor neighborhoods. (Drew Harris, 4/22)