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In one of his first acts as President Trump’s Veterans Affairs secretary, Robert Wilkie intends to reassign several high-ranking political appointees at the center of the agency’s ongoing morale crisis and staffing exodus, according to three people familiar with his plans. Wilkie, who will be sworn in Monday, wants to form his own leadership team, these people say, and to ease lawmakers’ continued concern that VA, historically a nonpartisan corner of the government, has become highly politicized. He discussed the proposed personnel moves with Trump in recent days aboard Air Force One, while en route to a veterans convention in Kansas City, Mo., said an official close to the White House who, like others, spoke on the condition of anonymity to discuss sensitive matters. (Rein, 7/29)

Sen. Bernie Sanders' "Medicare for all" plan would increase government health care spending by $32.6 trillion over 10 years, according to a study by a university-based libertarian policy center. That's trillion with a "T." The latest plan from the Vermont independent would require historic tax increases as government replaces what employers and consumers now pay for health care, according to the analysis being released Monday by the Mercatus Center at George Mason University in Virginia. It would deliver significant savings on administration and drug costs, but increased demand for care would drive up spending, the analysis found. (Alonso-Zaldivar, 7/30)

For months, federal immigration officials along the 268-mile stretch of border that separates New Mexico and West Texas from Mexico had been testing a policy of separating migrant parents from their children. What they didn’t plan for was how to reunite them. When a federal judge ordered the Trump administration to reconnect more than 2,600 children separated from their families after a national outcry, the two government agencies in charge—the Department of Homeland Security and the Department of Health and Human Services—didn’t have a firm grip on the number of children involved or exactly where they were. (Malas and Caldwell, 7/27)

Adayanci Perez Chavez, who was separated from her father when they crossed the border from Guatemala more than two months ago, has watched as one playmate after another has checked out of the migrant children’s center in Michigan where they have spent their days studying, playing and meeting with their case managers. One by one over the past few weeks, 90 percent of the children at the center, managed by Bethany Christian Services in Kalamazoo, have been put on planes and reunited with parents who had been held at immigration detention centers across the country. (Jordan, 7/27)

A judge ordered independent oversight of U.S. immigration authorities’ handling of detained children amid allegations that some were being forcibly medicated at a Texas facility. U.S. District Judge Dolly Gee said at a hearing in Los Angeles Friday that “persistent” problems require oversight and she’ll appoint someone in the next two weeks. (Hurtado, 7/27)

The 15-year Honduran immigrant girl— who for three weeks had been held at the Homestead detention center for immigrant minors—had just escaped from the care of facility workers who were taking her to a routine doctor’s appointment Friday morning, Homestead police said. ...The Department of Health of Human Services, the entity that regulates the facilities, in June said that the Homestead detention center was housing about 1,200 immigrant children, including 70 who at the time were separated from their parents at the border. (Madan, 7/29)

President Donald Trump’s appointees in the health department have deleted positive references to Obamacare, altered a report that undermined the administration’s positions on refugees and added anti-abortion language to the strategic plan — part of an ideological overhaul of the agency’s research office. While every administration puts its imprint on the executive branch and promotes ideas that advance its own agenda, this one has ventured several steps further — from scrubbing links to climate change studies from an Environmental Protection Agency website to canceling an Interior Department study on coal mining risks and suppressing reports on water contamination and the dangers of formaldehyde. (Diamond, 7/28)

Meanwhile, an HHS official was escorted out of the agency on Friday —

Ximena Barreto — a Donald Trump political appointee who used social media to spread conspiracy theories about a supposed pizza shop sex ring and made other inflammatory remarks — was escorted from Health and Human Services Department headquarters Friday, according to an individual with knowledge of the situation. Barreto resigned, the individual said. HHS did not immediately respond to a request for comment. An email sent to Barreto’s HHS account Friday night produced a bounce-back message that the message was “undeliverable.” (Diamond, 7/27)

Barreto-Rice expressed a general disdain for Democratic politicians in her posts, including one that claimed “our forefathers would have hung" former President Obama and Clinton for treason, and claimed that Islam was a “f---ing cult, not a religion.” An HHS official told The Hill earlier this year that Barreto-Rice would be reassigned away from the department's communications staff, but that no official complaints on her work for HHS had been received. (Bowden, 7/27)

Abortion rights advocates are exploring how technology might preserve or even expand women’s access to abortion if the Supreme Court scales back Roe v. Wade. A nonprofit group is testing whether it's safe to let women take abortion pills in their own homes after taking screening tests and consulting with a doctor on their phones or computers. Because the study is part of an FDA clinical trial, the group isn’t bound by current rules requiring the drugs be administered in a doctor’s office or clinic. (Ravindranath and Rayasam, 7/29)

Oregon voters will decide whether the state should continue providing funding for abortion in November's elections. The Secretary of State’s office announced Friday that an initiative proposing to amend the Oregon constitution to prohibit state spending, or the spending of local public money, on abortion had gathered enough signatures to be placed on the ballot, according to a report from Oregon Public Broadcasting. (Folley, 7/27)

Supporters of Initiative Petition 1 submitted 117,799 valid signatures, state election workers determined. That's just 221 signatures above the minimum required to secure a state constitutional amendment on the November ballot. Oregon Life United relied on volunteers to gather the signatures, The Oregonian/OregonLive has reported. The proposal is expected to appear on the ballot as Measure 106. (Borrud, 7/27)

A new women's healthcare clinic applying for a license to perform abortions could be set to open soon in New Orleans East, according to WVUE Fox 8. The clinic, Deanz Health Care for Women at 5437 Crowder Blvd., is reportedly owned by Dr. Rashonda Dean, and has garnered the attention of the pro-life group, Louisiana Right to Life, which wrote about the proposed clinic on its website. (Brasted, 7/28)

Baltimore health clinics fear a proposed federal gag rule that would prohibit money from going to centers that perform or refer patients for abortions would undercut their ability to care for the city’s most vulnerable residents. The U.S. Department of Health and Human Services has proposed a rule that would withhold funding from the Title X Family Planning Program. The federal agency is taking public comments on the issue, which is being criticized by local lawmakers and health officials, until Tuesday. (McDaniels, 7/30)

And in other women's health news —

The House on Friday passed a bill allowing women to buy menstrual hygiene products with pre-tax money from health flexible spending accounts. Rep. Grace Meng (D-N.Y.) pushed for the legislation as part of her ongoing "fight for menstrual equality." ... Meng’s provision to the Restoring Access to Medication and Modernizing Health Savings Accounts Act established health flexible spending account funds that can be used on all products related to menstruation, including tampons, pads, liners, cups, sponges and other similar products. (Gstalter, 7/28)

In response to alarming racial disparities, New York City announced a new initiative last week to reduce maternal deaths and complications among women of color. Under the new plan, the city will improve the data collection on maternal deaths and complications, fund implicit bias training for medical staff at private and public hospitals, and launch a public awareness campaign. (Waldman, 7/30)

The state is leading the charge to reverse the nationwide trend: Since 2006, California has cut its rate of women dying in childbirth by more than half. And it's a state whose impact could make a big difference: One in eight infants born in the United States is born there. (Montagne, 7/29)

And in other news —

As fertility rates fall nationwide, Connecticut continues to rank among the lowest in the country — a trend doctors attribute to women here delaying childbearing. In 2016, the most recent year for which state-level data is available, Connecticut had 53.4 births per 1,000 women ages 15 to 44, compared with a national average of 62 per 1,000 women, according to data from the Centers for Disease Control and Prevention (CDC). (Rosner, 7/29)

In the long-running debate over just what causes Alzheimer’s disease, one side looks to have scored a victory with new results with an in-development drug. But there’s enough variation in the data to ensure that the squabbling factions of Alzheimer’s will have plenty to fight about. At issue is the so-called amyloid hypothesis, a decades-old theory claiming that Alzheimer’s gradual degradation of the brain is caused by the accumulation of sticky plaques. And the new drug is BAN2401, designed by Biogen and Eisai to prevent those amyloid plaques from clustering and attack the clumps that already have. (Garde, 7/30)

Puzzled by those controversial Alzheimer’s disease data from Biogen and Eisai? We asked an expert to break down what they mean for patients, for science, and for the future of what could be a promising treatment for a devastating disease. Dr. Howard Fillit, chief science officer of the Alzheimer’s Drug Discovery Foundation, joined us to answer STAT Plus subscribers’ questions on BAN2401, the therapy from Biogen and Eisai that just completed Phase 2 testing. (Garde, 7/27)

Chi Van Dang generally declines to discuss the science that made him famous. A leading authority on cancer metabolism, he routinely is asked to speak about how tumors reprogram biochemical pathways to help them slurp up nutrients and how disrupting these noxious adaptations could be a powerful approach to treating cancer. (Dolgin, 7/29)

Eating disorders pose serious hazards to adolescents and young adults and are often hidden from family, friends and even doctors, sometimes until the disorders cause lasting health damage and have become highly resistant to treatment. According to the Family Institute at Northwestern University, nearly 3 percent of teenagers between the ages of 13 and 18 have eating disorders. Boys as well as girls may be affected. Even when the disorder does not reach the level of a clinical diagnosis, some studies suggest that as many as half of teenage girls and 30 percent of boys have seriously distorted eating habits that can adversely affect them physically, academically, psychologically and socially. (Brody, 7/30)

"Pitch change" — the vocal quality we use to emphasize words — is a crucial part of human communication, whether spoken or sung. Recent research from Dr. Edward Chang's lab at the University of California, San Francisco's epilepsy center has narrowed down which part of the brain controls our ability to regulate the pitch of our voices when we speak or sing— the part that enables us to differentiate between the utterances "Let's eat, Grandma" and "Let's eat Grandma." (Watson, 7/27)

The family of Ebola viruses has just gotten a bit bigger. The government of Sierra Leone has announced that a new species of Ebola, the sixth, has been discovered there in bats. It has been called, provisionally, the Bombali virus, after a district in the north of the country where it was found. There’s no evidence the new virus has infected people, although EcoHealth Alliance, an environmental nonprofit group involved in the discovery, said on Twitter that it has the potential to infect human cells. (Branswell, 7/27)

The pediatrician was blunt but not unkind. Even so, her unequivocal message made Jan Wiese bristle. “You know, this is really not normal,” the Northern Virginia doctor said as she examined 2-year-old Lucy Wiese for the first time. Struck by the little girl’s medical history, especially her repeated skin infections, the doctor recommended that Lucy see a pediatric immunologist in Baltimore. (Boodman, 7/28)

Was it hard to concentrate during that long meeting? Or, does the crossword seem a little tougher? You could be mildly dehydrated. A growing body of evidence finds that being just a little dehydrated is tied to a range of subtle effects — from mood changes to muddled thinking. "We find that when people are mildly dehydrated they really don't do as well on tasks that require complex processing or on tasks that require a lot of their attention," says Mindy Millard-Stafford, director of the Exercise Physiology Laboratory at Georgia Institute of Technology. She published an analysis of the evidence this month, based on 33 studies. (Aubrey, 7/30)

Providing supportive services to children and teens struggling with gender identity can be invaluable in ensuring a smooth transition and potentially lower their risk of suicide, said Dr. Chris Salgado, section chief of UHealth’s LGBTQ Center for Wellness, Gender and Sexual Health. According to a report from the Center for Excellence for Transgender Health, 41 percent of transgender people who responded to its survey attempted suicide. (Himes, 7/28)

People with intellectual disabilities are seven times more likely to experience sexual abuse compared with others, according to an investigation published by NPR earlier this year. That series showed a hidden epidemic of abuse occurring in schools, homes and treatment centers that often goes unreported and unpunished. (Arcuni, 7/29)

Jonah Hill and Emma Stone are starring in a new TV series that tackles sensitive issues of mental illness and the pharmaceutical industry. The Netflix series, a black comedy titled “Maniac,” follows two participants of a murky late-stage pharmaceutical drug trial. Hill plays a man diagnosed with schizophrenia, while Stone plays a woman fixated on broken relationships. (7/29)

A quarter of the adults who went to hospital emergency departments with sprained ankles were prescribed opioid painkillers, a study shows, in another sign of how commonly physicians turn to narcotics for even minor injuries. The state-by-state review revealed wide variation in the use of opioids for the sprains, from 40 percent in Arkansas to 2.8 percent in North Dakota. All but one of the nine states that recorded above-average opioid prescribing are in the South or Southwest. None is in the parts of Appalachia or New England that have been hit hardest by the opioid epidemic. (Bernstein, 7/27)

Many states have responded to the national opioid epidemic by limiting how many pain pills doctors can prescribe, contributing to the decline in opioid prescriptions filled at pharmacies across the country. But a Penn study, published Tuesday in Annals of Emergency Medicine, suggests that to truly tackle the opioid epidemic that has strained communities like Philadelphia, states may need a more granular approach. “Previous studies were sort of the 30,000-foot view. It’s very hard to figure out what’s the underlying problem,” said M. Kit Delgado, an assistant professor of emergency medicine and epidemiology at Penn and the study’s lead author. “Now, when you limit it to specific conditions, such as a minor injury or all patients that got opioids after a specific type of surgery, we can better understand if there’s still variation or a lot of prescribing.” (Gantz, 7/24)

Brian Stoll faced a dilemma as his wedding day approached. For more than a year, he had been smoking marijuana to treat severe back pain, but to remain in good standing with the Church of Jesus Christ of Latter-day Saints and get married in the temple, he had to stop using pot. Since marijuana was illegal under Utah law, church leaders told him, it was forbidden. Stoll turned to an opioid painkiller and has continued using it since his marriage three years ago, despite unpleasant side effects and its inability to match the soothing qualities of marijuana. (Lee, 7/29)

More than 300 people have overdosed in Washington, D.C. just in the last two weeks after consuming what is suspected to be synthetic marijuana, known as K2. The crisis is offering a glimpse into a wrenching national problem — the Centers for Disease Control and Prevention is tracking multiple outbreaks across the country associated with synthetic cannabinoids use and The Food and Drug Administration recently warned of "severe illnesses and deaths" that have resulted from the use of contaminated synthetic marijuana products in recent months in several states. (Peñaloza, 7/27)

Christian Bax, the embattled director of the state's Office of Medical Marijuana Use, is resigning after a three-year stint marked by rule-making delays, rocky litigation and continued criticism over patients' problems accessing the drug since medical cannabis was broadly legalized more than a year ago. (Koh, 7/27)

President Donald Trump’s administration signed off Sunday on Gov. Scott Walker’s $200 million plan to lower Affordable Care Act premiums. It was the latest effort by the GOP governor to work within the confines of Obamacare as he simultaneously tries to end the federal health care law. (Marley and Hernandez, 7/29)

Nicole Black got a call around 1:45 a.m. on July 4 that her daughter Crystle Galloway had fallen in the bathroom of her Tampa, Fla., condominium and that something was wrong. She had hit her head, Ms. Galloway’s daughter said, and by the time Ms. Black raced from her home two blocks away, she was slumped over the bathtub, foaming at the mouth and her lips were swollen. Ms. Black called 911. Later that day, Ms. Galloway slipped into a coma. She died five days after. But weeks later, questions persist about what happened after the 911 call and whether race played a role in how Ms. Black and her daughter were treated. (Zaveri, 7/29)

While federal prosecutors in Dallas prepare for upcoming health care fraud trials, the FBI and other investigators are continuing to raid more medical businesses, looking for evidence of illegal kickbacks. Last week, the FBI searched the Dallas offices of Next Health, which owned a network of testing labs and pharmacies. Next Health is already facing fraud allegations from insurance giant United Healthcare, which claims the company gave people gift cards to urinate in cups in Whataburger bathrooms. (Krause, 7/29)

Five Louisiana residents now face federal charges for allegedly imprisoning and abusing an autistic woman, two years after they were arrested on state charges in the case. Prosecutors allege a litany of horrors against the 22-year-old victim in an indictment made public Thursday evening. They say the woman was kept in a cage outside the Tangipahoa Parish home where the suspects lived. Prosecutors said she was coerced into manual labor such as bathroom and kitchen cleaning and subjected to psychological and physical abuses: threats of harm or death if she didn't obey, beatings, being burned with a cigarette lighter and having human waste from a septic tank dumped on her. (7/27)

University of Minnesota doctors are raising alarms about “diagnostic discordance,” a little-discussed but potentially dangerous problem that occurs when a patient is transferred from one hospital to another but ends up with a different list of diagnoses after arriving. In one of the first studies to examine the phenomenon, the doctors found discrepancies in 85 percent of transfers. In some cases that was because patients developed new conditions, but in others it resulted purely from miscommunication between hospitals. (Olson, 7/28)

Taking a hay-lined stage at the Ohio State Fair's first soapbox, candidates for Ohio governor disagreed on everything from Obamacare to drug sentencing. Republican Mike DeWine defended his stance on Medicaid expansion, saying he would keep it but add a work requirement for those who were able. Democrat Rich Cordray doubted DeWine's sincerity on the issue, saying DeWine once sued to dismantle Medicaid expansion, which is part of Obamacare. (Balmert, 7/28)

A gunman left a trail of five dead in a South Texas town Friday evening, including at a nursing home and a victim’s residence. Reports of gunfire around 7 p.m. led police to the Retama Manor Nursing Center in Robstown, west of the coastal city of Corpus Christi. Two men and a woman were found dead at the scene, authorities said. Investigators believe the dead at the nursing home include the shooter, city spokesman Herman Rodriguez told The Washington Post on Saturday. (Horton, 7/28)

Ten former Ohio State University students filed a lawsuit that says the university facilitated the abuse of a now-deceased doctor accused of a decades of sexual assault. The lawsuit, filed Thursday in federal court in Columbus, says OSU officials learned about Richard Strauss' inappropriate conduct as early as his first year of employment there in 1978. (Heisig, 7/28)

A third lawsuit filed against Ohio State University alleges that university officials knew about sexual abuse by former physician Richard Strauss but failed to stop it, and even facilitated it. The lawsuit was filed late Thursday in federal court in Columbus on behalf of 10 victims, including former Ohio State student Steve Snyder-Hill. (Smola, 7/27)

A 6-month-old baby died suddenly Monday after he rolled over in his crib and choked on his vomit at a Texas day care, his parents say. Michael Carter Donnell's parents told TV station WOAI that the San Antonio day care workers were warned that the baby was starting to roll over and that he occasionally vomited when he was lying on his abdomen.  (Gross, 7/29)

Health authorities have confirmed a case of measles in a child who became infected in another country and then traveled to Boston, and they urged people who may have been exposed to watch for symptoms of the highly contagious virus. ...Health officials urged anyone who experiences such symptoms to contact their health care provider immediately by phone. (Freyer, 7/27)

Tom Rawlings, currently the director of the Office of the Child Advocate, will take over as interim chief of the Georgia Division of Family and Children Services on Aug. 1. He will replace Virginia Pryor, who is leaving for a position in Los Angeles with Casey Family Programs, a foundation that promotes foster care and child welfare. (Miller, 7/27)

A Virginia Commonwealth University doctor has filed a $15 million defamation suit against four colleagues and the VCU Health System’s physician group after his lawyers say he suffered retaliation when he raised concerns about insufficient heart care for chemotherapy patients. Tiziano Scarabelli claims colleagues “embarked on a campaign to defame and discredit” him with attacks on his professional conduct and false sexual misconduct allegations. (Dodson, 7/28)

Many physicians — from all specialties — share [Dr. Emily] Anderson-Elder’s frustration and levels of stress incurred while working in insurance-based health care systems. In the 2018 Medscape National Physician and Depression Report, 42 percent of family physicians admitted to having burnout or depression, listing “too many bureaucratic tasks (charting, paperwork)” and “too many hours at work” as the leading factors in burnout. Although direct primary care has been around for some time, it is just now gaining a toehold with both physicians contemplating the switch to a different way of providing care and patients willing to give it a shot, so to speak. (Kadlub, 7/28)

Lawrence and Carla McCue listened from the last row as the mayor spoke to veterans at the Los Angeles National Cemetery on Memorial Day. Lawrence, 75, proudly wore his Marine Corps outfit and sat in his motorized wheelchair, with his dog Oreo at his feet. Carla, 62, snapped photos. Veterans and their families had come from across Southern California for this event. The McCues traveled from across the street in a Jeep Grand Cherokee that, like the couple, had seen much better days. (Oreskes, 7/29)

Just a fraction of people with serious mental illness commit crimes of any kind, but the city's criminal courts, jails and prisons are straining to cope with increasing numbers of nonviolent offenders who have untreated mental illness. At least a third of the men and women in Nashville jails have a mental illness, according to Sheriff Daron Hall.  While the budget for the Tennessee Department of Correction increased by more than 54 percent between 2008 and 2017, the budget for the Tennessee Department of Mental Health and Substance Abuse Services has remained the same. (Wadhwani, 7/28)

It is estimated that more than 1 million Tennesseans ages 18 and older have a mental health or substance use disorder. Many are uninsured. Studies have shown that the risk for serious mental illness is generally higher in cities, but those living in rural areas can face greater barriers to diagnosis and treatment due to lack of services and access to transportation. Experts say the state has one of the best first-response systems in the country, serving every Tennessee county, but before and after a mental health emergency finding help can be a challenge. (Bliss, 7/28)

At least eight doctors and other health care workers at Redding’s Shasta Regional Medical Centers lost their homes in the Carr fire, but they reported for work as scheduled. ...Hundreds of health care workers in the Redding area also can’t return to their homes because of orders to evacuate. (Anderson, 7/28)

In a surprising series of twists, Iowa Board of Medicine Executive Director Mark Bowden began the day Friday expecting to be fired, then learned he was keeping his job, after which the state unexpectedly announced his professional competency was going to be re-evaluated on Monday. The board discussed Bowden’s job status in closed session Thursday, with Bowden in attendance. At Friday morning’s board meeting, shortly before the board was scheduled to take some form of action on his job status, Bowden read a public statement in which he said the board’s treatment of him was “unfair beyond belief,” adding, “I do not intend to dignify your offer that I submit a resignation in lieu of termination.” (Kauffman, 7/27)

White Earth bought the truck, once owned by famed Sioux Chef Sean Sherman, with a $40,000 grant from the Minnesota Department of Agriculture through a program that targets food deserts — regions where grocery stores with fresh, healthy options simply don't exist. ...The truck also cooks up bison burgers and serves traditional swamp tea at tribal events. (Gunderson, 7/27)

The Senate plans to stay in Washington for August this year, and here’s an idea to keep busy: Pass some House health-care reforms that are modest improvements even Democrats should like. The House last week passed a set of bills that included changes in Health Savings Accounts, or HSAs, which are tax preferred accounts that allow individuals to save for future medical expenses. (7/29)

Our health outcomes, including life expectancy, rank near the bottom. Except in the Medicare population. Once people have access to healthcare, their health dramatically improves. Medicare has a secret for the rest of the country: We can expand Medicare to cover everyone, improve it to cover prescription drugs and eliminate deductibles and co-payments, and save money in the process. The secret lies in Medicare’s 2-3 percent administrative overhead, a fraction of private insurance companies’. (Dr. George Bohmfalk, 7/26)

Each year, for well over a decade, more people have faced higher health insurance deductibles. The theory goes like this: The more of your own money that you have to spend on health care, the more careful you will be — buying only necessary care, purging waste from the system. But that theory doesn’t fully mesh with reality: High deductibles aren’t working as intended. (Austin Frakt, 7/30)

To transform the health care system, we need patients, physicians, and employers to think differently about the benefits of seeking care close to home. Insurance plans will need to incentivize people to do so. (Michael Wagner, 7/30)

Why is paying for health care such a mess in America? Why is it so hard to fix? Cross-subsidies are the original sin. The government wants to subsidize health care for poor people, chronically sick people, and people who have money but choose to spend less of it on health care than officials find sufficient. These are worthy goals, easily achieved in a completely free-market system by raising taxes and then subsidizing health care or insurance, at market prices, for people the government wishes to help. (John H. Cochrane, 7/29)

Last year’s Republican effort to repeal Obamacare might seem quite similar to this summer’s battle over the nomination of Judge Brett M. Kavanaugh to the Supreme Court. But don’t be fooled. In July 2017, Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) joined Sen. John McCain (R-Ariz.) to defy GOP leaders and defeat legislation to scrap the Affordable Care Act. Now, with McCain home battling brain cancer, the two moderate Republicans are in the crosshairs of well-organized campaigns that are expected to pour millions of dollars in advertising into the small-market towns throughout Maine and Alaska. (Kane, 7/28)

Free or low-cost transport to medical appointments for those who need it has been a mandatory Medicaid benefit since the program’s inception in 1966. It’s specified in federal regulation. Scattered cases of fraud have marred the administration of Medicaid transportation and the desire to rein in Medicaid spending has led some policy-makers to consider ways to limit this benefit, formally called non-emergency medical transportation (NEMT). Our new research examines the value of non-emergency medical transportation for people with three relatively common and expensive diseases. We demonstrate that such transportation provides a healthy return on investment (ROI) for two of the three conditions. Trimming non-emergency medical transportation in Medicaid runs contrary to trends in other health insurance markets and is likely pennywise and pound foolish for Medicaid’s coffers. (Michael Adelberg, Patricia Salber and Michael Cohen, 7/30)

In the early days of the American automobile industry, consumers could buy a Model T in any color they wanted, so long as it was black. Such will be the "service and selection" to be expected in the United States if a single-payer system, where the government pays for all medical treatment, is implemented for health care. A single-payer system will cause the health care sector to implode, with profound implications for Iowa, the United States and the world's economy. (Jonathan Yates, 7/27)

The debate over the best path forward on health care, although not currently in the national spotlight, continues in Washington and across the country. We must not let this issue become eclipsed by the other pressing political and legislative issues currently facing our nation. Health care is of critical importance to the future well-being of millions of Americans. Without one’s health, one really has nothing. Since its enactment, there have been continual efforts to dismantle the Affordable Care Act. Most recently, the individual insurance mandate, essential to maintaining a viable, stable system and maximizing affordable insurance coverage to those who most need it, was repealed. If we lose the ACA, we face the possibility of ending the progress of Medicaid expansion, ending preexisting condition protections and better coverage for people with serious and chronic conditions, eliminating premium and subsidy assistance for low-income individuals and families, and deregulating insurers. It would also allow states more autonomy to create health-system polices that will likely further reduce insurance coverage in many states, including Indiana. (Richard Feldman, 7/29)

Legislative Democrats are pressing Missouri’s Republican attorney general, Josh Hawley, to withdraw the state from a national lawsuit seeking to gut the Affordable Care Act, which would return us to the days when a chronic illness — or even changing jobs — could leave you without health care insurance coverage. That Hawley has so far refused to relax his opposition to Obamacare is no surprise. A U.S. Senate candidate in need of party backing, he has toed the GOP’s line against sanity on health care. But in the event he is still open to argument, he should consider the devastating impact this suit, if successful, will have on the Missourians he seeks to represent. (7/26)

A significant factor contributing to the high Texas numbers is the fact that the state has not expanded Medicaid under the Affordable Care Act. The state also has such stringent eligibility requirement for adult Medicaid that most working adults do not qualify. (7/28)

Just after midnight on July 10, Judy Rosa woke and saw the light and heard the TV still on in the finished basement of her Seabrook Beach, N.H., home. She called to her son, Philip, to turn them off. But something made her go downstairs herself, where she found Philip dead of a drug overdose. Yet his obituary a week later was unusual. It did not say Philip died “suddenly” or “unexpectedly.” No, the obituary read: “Philip J. Carnovale, 32, of Boca Raton, Fl., lost his courageous battle with addiction Tuesday, July 10, 2018.” Explaining the choice to reveal Philip’s addiction, Rosa said, “It’s about awareness.’’ (Margery Eagan, 7/30)

In 1976, a young, first-time mother entered the hospital in spontaneous labor. She had not missed any prenatal visits, those visits had revealed no abnormalities, her pregnancy was full-term, and she carried one fetus positioned headfirst. In other words, hers was a prototypical low-risk pregnancy. She felt great. Then a physician ruptured her amniotic sac, hastening labor. “I went,” she told me years later, “from feeling nothing to being totally in excruciating pain.” A nurse attached her to what was then a relatively new device — an electronic fetal monitor. Physicians reviewed the monitor strip and told the mother she had to make a decision, and fast. “They said either that I would die, or my baby would die, or both of us would die, if I didn’t have a caesarean. They said her heart was in distress.” At about 10.5% of births, caesareans were far less common in the United States in 1976 than they are today, when almost one in three births is by caesarean section. (Jacqueline H. Wolf, 7/29)

 This week Robert Wilkie was confirmed as Secretary of Veterans Affairs. I had the honor of serving under him as Director of VA’s Center for Women Veterans during his brief tenure as Acting Secretary and recognize the vast array of urgent issues that will immediately require his attention once he is sworn in – not least of which is calming the personnel churn that has plagued the department in recent months. Among these matters is determining whether VA should amend its regulation on providing medical care for transgender veterans. As part of his nomination process, Wilkie said if he were to be confirmed, VA’s policy on providing care to transgender veterans “will remain unchanged.” This would be good news if VA currently provided all medically necessary care to transgender veterans; however, it does not. (Kayla Williams, 7/29)

Reports of bipartisanship’s demise may be a little bit exaggerated, because if there’s one thing Republicans and Democrats can still occasionally agree on, it’s cutting taxes or increasing spending, especially to the benefit of favored industries, and charging the cost to the national debt. Irresponsibility, in other words, has a broad constituency. Case in point: the House of Representatives’ 283-to-132 vote Tuesday to eliminate permanently the 2.3 percent excise tax on the medical device industry’s revenues. Fifty-seven of the 283 “yeas” came from the blue side of the aisle. (7/29)