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Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back. Blue Cross and Blue Shield plans — market leaders in many states — are seeking rate increases that average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota, according to documents posted online by the federal government and state insurance commissioners and interviews with insurance executives. (Pear, 7/3)

Oregon’s insurance regulator has approved big premium increases sought by health plans for 2016 under the health law, and in some cases ordered higher raises than insurers requested, signaling that the cost of insurance for people who buy it on their own could jump after two years of relatively modest growth. Around the U.S., the biggest insurers have proposed hefty premium increases for the year ahead, based on what they say they now know about the costs of covering people newly enrolled under the Affordable Care Act. Supporters of the health law have been counting on state regulators to rein in hefty premium increases for the law’s third year in full effect. (Radnofsky, 7/3)

Hillary Rodham Clinton sharpened her partisan rhetoric to appeal to Democratic primary voters [in New Hampshire] Friday by issuing a dire warning: President Obama's health care law would disappear if a Republican wins the White House in 2016. ... "If the country elects a Republican president, they will repeal the Affordable Care Act. That is as certain as I can say it," she continued, noting the unlikelihood that Democrats take over the Senate and House next year. (Rucker, 7/3)

Mrs. Clinton’s speech demonstrated the challenge she faces: She must keep a wary eye on Mr. Sanders without attacking him, but she must also seem engaged and rouse her supporters, so attacks on the Republican field on issues like the Affordable Care Act have been her approach. She kept to that script here on Friday, warning that a Republican president would repeal the health care law, and she denounced the administration of George W. Bush for “poor management” of the economy that led to the recession. (Haberman, 7/3)

U.S. Republican presidential candidate Chris Christie said on Sunday Supreme Court justices of his liking would not have legalized same-sex marriage and would have struck down a key provision of a national health care law. ... "If the Christie-type justices had been on that court in the majority, we would have won those cases in the Supreme Court rather than lost them," he told "Fox News Sunday" in an interview. (Lange, 7/5)

It t has never been a way to win friends and influence voters, but New Jersey Gov. Chris Christie isn’t shying away from reform of two “do-not-touch” entitlements—Medicare and Social Security. His goal is to cut the long-term debt since formally announcing his improbable campaign for the GOP presidential nomination last week. ... During an interview today on “Fox News Sunday,” Christie doubled-down on his pledge to pursue major entitlement reform if he somehow overcomes other huge political liabilities to win the primary and general elections next year. “I put that plan forward and I’m going to keep talking about it,” Christie said. They say don’t touch it. I’m going to hug it.” (Pianin, 7/5)

In diners and in pubs, at house parties and during town-hall-style events, Governor Christie spent his first week on the campaign trail as a declared presidential candidate trying to sell his policies to New Hampshire voters. Christie has delivered four policy speeches so far, giving specific proposals on how to overhaul Social Security and Medicare, on national defense, on the economy and on education. Christie this month said he will deliver two more, one on reforming the country’s criminal justice system and another on immigration. (Hayes, 7/4)

Dr. Michael Kaplan looked across his desk at a woman who had sought out his Long Island Weight Loss Institute .... By the end of the 50-minute session, the woman had chosen Dr. Kaplan’s most expensive weight-loss plan: $1,199 for six weeks’ worth of meal-replacement products, counseling and vitamin supplements. ... Then he delivered some good news: Her insurance would probably reimburse her for at least a small portion of the bill, thanks to a provision in the federal health care law that requires insurers to pay for nutrition and obesity screening. The news was pleasing to the patient. But it has also created a financial opportunity for a corner of the diet industry that has often operated on the fringe of the medical establishment: for-profit diet clinics overseen by doctors. (Abrams and Thomas, 7/4)

Healthcare professionals say the landmark health reform law, the Affordable Care Act, is accelerating changes in how hospitals treat patients with chronic conditions like diabetes, heart failure and obesity. Successfully treating those patients, who use many more healthcare services, have higher rates of hospitalization and more frequent emergency department visits, is challenging because many of their conditions are aggravated by unhealthy eating habits and inactivity. Chronic disease rates increase steadily as patients age, making this issue particularly key to the Medicare program. (Taylor, 7/5)

The court's other major decision at the end of the term upheld nationwide subsidies in the Affordable Care Act. And as [Walter] Dellinger observes, Chief Justice John Roberts' opinion for a 6 to 3 majority was "surprisingly favorable" to the law. "The first five pages of the chief justice's opinion ... is the best articulation of the case for the Affordable Care Act anybody has written," Dellinger says. The decision did something else important. It sided with the liberal view that legislation should be interpreted in terms of its overall purpose and not by flyspecking a phrase here and there. (Totenberg, 7/6)

The Supreme Court showdown over the Affordable Care Act may be over, but the legal offensive against the law isn’t. Lawyers representing the Republican-controlled House of Representatives and the Obama administration took their best shots at each other’s arguments this week in their battle over Obamacare. The case, filed in federal court in Washington, D.C. last year, is about whether the executive branch overstepped its bounds in how it’s paying for and enforcing parts of the health law. (Gershman, 7/2)

Despite the recent Supreme Court ruling upholding ObamaCare subsidies, opponents of the law remain poised to strike a key blow against another component of the health care overhaul in a matter of months. Republicans, with help from Democrats, have gained momentum in their long-running effort to repeal the law's controversial 2.3 percent excise tax on medical devices. ( Beaucar Vlahos, 6/4)

Indiana, which has a conservative Republican governor and Legislature, is pioneering an experiment that requires low-income patients to contribute monthly to a special health account. ... Charging poor people small premiums or fees for care — long favored by conservatives who contend that "skin in the game" engages patients in their health — has historically produced mixed results. But at a time when Obamacare remains deeply unpopular among Republicans, the idea is attracting new interest as GOP governors seek ways to put a conservative stamp on expanding coverage. Indiana's experiment may provide a glimpse at where the health law is headed in some parts of the country. (Levey, 7/4)

About 1 million low-income Ohio residents could be required to pay a new monthly cost for Medicaid health coverage or potentially lose it under a Republican provision in the state budget, officials estimate. The idea, which will require federal approval, was part of the $71.2 billion, two-year spending blueprint that Republican Gov. John Kasich signed Tuesday. (Sanner, 6/2)

Despite a key win in the Supreme Court and pressure from liberal activists, North Carolina's legislative leaders said this past week that they have no plans to expand the state's Medicaid rolls through President Barack Obama's 2010 health care law. Demonstrators who have routinely come to the Legislative Building to protest Republican policies arrived again this past week on the coattails of a Supreme Court decision to uphold subsidies for individuals who purchased insurance on federal exchanges. They demanded Republican Gov. Pat McCrory and General Assembly leaders either accept federal funding to expand Medicaid enrollment through the Affordable Care Act, or come up with their own plan to close the insurance gap. (Moritz, 7/4)

It has been five years since the Affordable Care Act (ACA) became law, and new data and numerous real-life stories are beginning to reveal how close or how far the ACA has come toward meeting its objective in Washington state. One challenge has been expanding the reach of insurance to more people. Today, more than 91 percent of the state’s population has coverage — the highest rate in decades, according to state officials. But coverage alone isn’t a measure of success. Equally important is whether people can afford their insurance and medical bills and whether they can get access to care that makes them healthier. (Stiffler, 7/4)

When nursing becomes painful or difficult in the days after giving birth, women can turn to certified lactation consultants for advice and relief. But some Illinois women say that when they tried to get their insurers to pay for the service, their claims were repeatedly denied. The Affordable Care Act identifies breast-feeding benefits as a preventive service like contraception and lung cancer screening, which the law requires insurers to cover at no cost to policyholders. Recently a nonprofit that advocates for breast-feeding mothers sent a letter to the Illinois Department of Insurance requesting that insurers be forced to pay for the services of certified lactation consultants. (Venteicher, 7/3)

Aetna aims to spend about $35 billion to buy rival Humana and become the latest health insurer bulking up on government business as the industry adjusts to the federal health care overhaul. The proposed cash-and-stock deal, announced early Friday, would make Aetna a sizeable player in the rapidly growing Medicare Advantage business, which offers privately run versions of the federally funded health care program for the elderly and some people with disabilities. (Murphy, 7/3)

The deal would bring together two of the biggest health insurers in the United States. The combined company would have estimated operating revenue of $115 billion this year and serve more than 33 million people. The proposed merger occurs as the nation’s largest for-profit health insurers seek ways to reduce costs and capitalize on growing opportunities in the government and individual markets. The companies say they will be able to operate more efficiently and negotiate more effectively with large health systems, which have also been consolidating. (Bray and Abelson, 7/3)

Health insurer Aetna Inc on Friday said it would buy smaller rival Humana Inc for about $37 billion in cash and stock, in the largest ever deal in the insurance industry. The combination will push Aetna close to Anthem Inc's No.2 insurer spot by membership, and would nearly triple Aetna's Medicare Advantage business. The deal will face antitrust scrutiny. (Roumeliotis, 7/3)

Aetna Inc. agreed to buy rival health insurer Humana Inc., paying about $35 billion in cash and stock for the second-largest U.S. provider of private health plans for the elderly. The transaction, which prices Humana at $230 a share, combines the second- and fifth-largest U.S. health insurers by market size. The deal values Louisville, Kentucky-based Humana at 23 percent more than its closing price on Thursday, and including assumed debt totals about $37 billion. (Serafino, Hammond and Tracer, 7/3)

Aetna Inc. said Friday that it had agreed to buy Humana Inc. for $34.1 billion in cash and stock, following weeks of frenzied merger talks among the largest health insurers. Under the deal, Aetna would pay about $230 a share for Humana, a premium of 23% from Thursday’s close and 29% from the company’s share price before The Wall Street Journal in late May first reported Humana was exploring a sale. Including debt, the companies said, the deal is valued the deal at $37 billion. (Hoffman, Mattioli and Wilde Mathews, 7/3)

Health care-insurance firm Aetna announced a $37 billion agreement Friday to acquire smaller rival Humana in a deal that continues the rapid consolidation in the U.S. health care industry. In the first six months of the year, a record $296 billion in deals have been announced in the industry, according to Dealogic, a research firm that specializes in mergers and acquisitions. (Hjelmgaard and Riley, 7/3)

Aetna (AET) will acquire all outstanding shares of Humana (HUM) for a combination of cash and stock, at roughly $230 per Humana share, according to a joint statement. That's 23% higher than Humana's closing price on Thursday. The new company will have more than 33 million members, and bring in estimated revenue of about $115 billion per year, with 56% coming from government-sponsored programs such as Medicare. (Yan, 6/2)

With Aetna Inc. and Humana Inc. pairing off, pressure is mounting on other major health insurers to make their own deals. Cigna Corp.’s tie-up with Anthem Inc. could be the next one on deck. Cigna rebuffed a bid from Anthem last month, and both were said to have been interested in Humana. But after the acquisition announced Friday, their options just got narrower. (Tracer and McLaughlin, 7/6)

More than a third of the U.S. population has health coverage through an insurer that either wants to make a huge acquisition or is about to be swallowed up in one. Aetna laid out a plan on Friday to spend around $35 billion to buy the Medicare Advantage provider Humana Inc. That came a day after Centene Corp. and Health Net Inc. announced a smaller deal and a couple of weeks after Anthem Inc. went public with its offer of more than $47 billion for Cigna Corp. (Murphy, 7/3)

The nation’s five largest health insurance companies are circling one another like hungry lions closing in on prey. ... As insurers grow larger, will consumers benefit from the companies’ ability to bargain with hospitals and doctors for lower prices? Will diminishing competition translate to fewer choices of plans? And what effect will mergers have on innovation in health care? The answers depend largely on how successfully the other insurers, particularly those that were created or attracted by the Affordable Care Act, can compete with these much larger companies. (Abelson, 7/5)

The CEOs of Aetna and Humana say the $37 billion merger they announced Friday will help consumers because of the two companies' complementary strengths in technology and relationships with health care providers. The combined company's government business — Medicare, Medicaid and Tricare — will be based in Louisville and will be the biggest part of the company, totaling about 56% of the combined companies' projected 2015 operating revenue of about $115 billion. (O'Donnell and Ungar, 7/3)

Riding high on Wall Street and flush with cash, big health insurers in particular have been on the prowl for deals. Atop the shopping list are companies that boost their government business. “The Affordable Care Act is really driving this merger mania,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “There are billions of dollars pouring into the system, and it's money to buy insurance.” President Obama's signature health law has unleashed the biggest expansion of insurance coverage in half a century, lifting stock prices and revenues across the healthcare industry. (Terhune, 7/2)

In the game of merger musical chairs the five biggest health insurers have been playing lately, Aetna Inc. and Humana Inc. hustled to grab the first seats. The two insurers disclosed their $34.1 billion tie-up after 2 a.m. EDT Friday, as the holiday weekend was beginning and after reports that rivals Anthem Inc. and Cigna Corp. had rekindled talks. ... The frenzied talks, sparked earlier this year by an overture to Humana, reflect managed-care companies’ desire to diversify and cut costs in the wake of the federal Affordable Care Act and other changes in the health-care industry. (Wilde Mathews, Hoffman and Mattioli, 7/5)

Senate Majority Leader Mitch McConnell (R-Ky.) is blaming ObamaCare for the consolidation of insurers after health insurance giant Aetna announced the purchase of a Louisville-based health insurance company on Friday. “For more than 30 years, Humana has been a cornerstone of economic growth and a great philanthropic partner in our community,” he said Friday in a statement. (Kamisar, 6/3)

The two chief executives said Friday changes stemming from the Affordable Care Act, which has pushed the industry toward individual coverage and new ways of paying providers, helped set the stage for their deal. The health law was “an action-forcing event that has catalyzed a lot of very important discussions,” Aetna CEO Mark Bertolini said. Humana CEO Bruce Broussard flagged changes in the health-care system that are often tied to the law, including an increasing focus on selling to individuals rather than employers. (Wilde Mathews, Hoffman and Matioli, 7/3)

Centene Corp. on Thursday said it agreed to buy Health Net Inc. in a cash-and-stock deal valued at $6.3 billion, as health insurers increasingly look for tie-ups that can help them cut costs and grow scale. St. Louis-based Centene, a Medicaid-focused health insurer, expects the deal to boost its presence in California and other western states, while allowing for $150 million a year in synergies in the second year after closing. (Dulaney, 7/2)

Centene has jumped into the mix of managed-care companies scrambling to bulk up as the health care overhaul changes their business with a $6.3-billion bid for fellow insurer Health Net. The deal announced Thursday gives St. Louis-based Centene a chance to expand in two hot growth areas for health insurers, the state- and federally-funded Medicaid program for the poor and people with disabilities; and the federally-supported Medicare Advantage program, which has seen its overall enrollment triple over the past decade. (Murphy, 7/2)

The consolidation steamboat that's charging its way through the health care insurance industry added another target as St. Louis-based Centene Corp. agreed to acquire Los Angeles-based Health Net in a deal valued at $6.8 billion. The companies said Thursday that they expect to achieve $150 million in synergies — which typically means cost cuts or savings from improved operations — within two years of the deal's completion. (Bomey, 7/2)

U.S. doctors and hospitals received more than $20 million last year in payments related to AstraZeneca Plc’s diabetes drug Bydureon, more than for any other medication, newly released company disclosures show. Drugmakers spent more than $10 million in 2014 on each of 10 different drugs through cash payments and items of value given to U.S. doctors and hospitals, according to a Bloomberg compilation of the data released Tuesday by a U.S health agency. Three of the drugs with the most doctor payments are diabetes medications, which vie in a crowded market of competing products. ... Jerry Avorn, a professor of medicine at Harvard Medical School, said some of the diabetes drugs linked to bigger payments aren’t the recommended first choices for doctors. (Langreth and Chen, 7/2)

Maryland's hospitals and doctors took in more than $7.6 million in payments for research, speeches and other work from drug and device manufacturers in 2014, according to federal authorities who have been releasing payment data periodically. The money is a share of about $6.5 billion in funds paid to U.S. hospitals from 1,444 companies, data supplied by the Centers for Medicare and Medicaid Services shows. (Cohn, 7/2)

Frustrated by insurance paperwork and then a yearlong effort to have a cash-only medical practice, Dr. Maribel Aviles gave up. For a few years she just did volunteer and missionary work. "I have fallen so many times, and if I died today, I want to be remembered for what I did, not what I lacked," the family physician said. So last year, Aviles picked herself back up and opened one of the first direct primary care practices in Central Florida. (Miller, 7/4)

Kathryn “Kat” Pietila of Macomb Township lost her husband to cancer but wonders if he would have survived if he wasn’t a patient of Dr. Farid Fata, the criminally convicted “cancer doctor” from Oakland Township. ... Pietila, a former Oakland County resident, believes her husband is among the hundreds of victims of Fata, 49, of Oakland Township, who will be sentenced next week after pleading guilty last September to 13 counts of health care fraud, one count of conspiracy and two counts of money laundering. He admitted he prescribed unnecessary and expensive tests and treatments to 553 patients from his Oakland County offices to perpetrate a $34 million fraud of Medicare, officials said. The number of victims is actually higher, the feds say. (Cook, 7/2)

House leaders on Thursday released an updated version of a medical cures bill that slightly reduces a funding increase for the National Institutes of Health. The latest changes to the bill were posted on the House Rules Committee website just before the long weekend, as well as floor consideration of the bill next week. The bill’s bipartisan backers have been working out its $12 billion in offsets. (Sullivan, 7/2)

The U.S. Food and Drug Administration approved Vertex Pharmaceuticals Inc.’s cystic-fibrosis drug Orkambi, which could treat as many as 8,500 patients in the U. S.—but at a whopping annual wholesale cost of $259,000 per patient. ... The drug is the latest to carry a potentially budget-busting price tag. Others are for cancer and hepatitis C. (Armental and Burton, 7/2)

But frustrated that no game-changing treatments were in sight, the [Cystic Fibrosis Foundation's] leaders in 1999 placed what many considered a risky bet, deciding to invest millions of dollars in a small California biotech firm. ... That initial bet, which over time grew into a $150 million investment, has paid off in a big way. It led to the approval in 2012 of a breakthrough drug — the first that treats the underlying cause of cystic fibrosis rather than the symptoms, in a small subset of patients. On Thursday came another big win: The Food and Drug Administration approved a second drug for the group also helped fund development; that drug eventually could aid roughly half of the 30,000 cystic fibrosis patients in the United States. (Dennis, 7/2)

Debates over public health and personal liberty can seem utterly of the moment in response to new and evolving threats -- an outbreak of measles at Disneyland this year triggered California politicians to put the law forward. And remember when the scary specter of Ebola triggered some politicians to implement mandatory quarantines for physicians and nurses who traveled to Africa to treat Ebola patients -- over the objections of public health experts? But a flashback to our nascent nation in the summer of 1776 -- when liberty was pretty much the topic of the day -- can reveal just how long the debate over government health policies has been running, and how the meaning of "freedom" has changed when it comes to access to preventive medicine. (Johnson, 7/2)

When Theranos chief executive Elizabeth Holmes announced Thursday that her company's finger-stick blood test had won clearance from the Food and Drug Administration the outcome of the review wasn't the news. It was that she had gone to the FDA in the first place. Holmes' company, a Silicon Valley darling estimated to be worth $9 billion, has been poised to upend the blood business since it began offering its tests to the public in 2013. With just a few drops of blood, its technology can reportedly scan for dozens of disease and conditions near instantaneously. But for a company that has received so much attention, there has been surprisingly little information about how its technology works and the company has maintained -- and still maintains -- that it is not required to seek regulatory approval for its products. (Cha, 7/3)

The Food and Drug Administration says it will take a closer look at cough and cold medicines for children that contain codeine. "We are evaluating all available information and will also consult with external experts by convening an advisory committee to discuss these safety issues," says an announcement posted Wednesday on the FDA website. (Goldschmidt, 6/2)

For nearly a century, insulin has been a life-saving diabetes treatment. Now scientists are testing a tantalizing question: What if pills containing the same medicine patients inject every day could also prevent the disease? ... Hayden Murphy is among more than 400 children and adults participating in U.S. government-funded international research investigating whether experimental insulin capsules can prevent or at least delay Type 1 diabetes. Hospitals in the United States and eight other countries are involved and recruitment is ongoing. To enroll, participants must first get bad news: results of a blood test showing their chances for developing the disease are high. (Tanner, 7/3)

The Food and Drug Administration has approved several new weight-loss drugs in recent years, but the best-selling diet pill in America isn’t among them. That title belongs to phentermine, a generic drug that has been around for decades and has managed to hold its own despite the arrival of new competitors. The drug is viewed as effective and relatively safe to help jump-start diets in patients who are obese. However, phentermine — a stimulant that can give users an inexpensive high — has a long history of misuse. It has also frequently flown under the radar of regulators, who tend to focus their resources on deadlier drugs like opioid painkillers. (Thomas, 7/4)

In November, the U.S. Food and Drug Administration gave Mallinckrodt Pharmaceuticals an ultimatum: Either prove its generic version of a popular drug was the same as the brand name, Concerta, or voluntarily remove it from the market. The FDA gave the drugmaker, which has U.S. headquarters in Hazelwood, six months to make either move. But time is up and its drug, which is used to control the symptoms of attention deficit hyperactivity disorder, or ADHD, is still on the market. (Liss, 7/3)

As more expensive specialty drugs come on the market to treat some of the most serious chronic diseases, more states are stepping in to cushion the financial pain for patients who need medicine that can cost up to hundreds of thousands of dollars a year. At least seven states — Delaware, Louisiana, Maine, Maryland, Montana, New York and Vermont — limit the out-of-pocket payments of patients in private health plans. Montana, for instance, caps the amount that patients pay at $250 per prescription per month. Delaware, Maryland and Louisiana set the monthly limit at $150 and Vermont at $100. Maine sets an annual limit of $3,500 per drug. (Ollove, 7/2)

When a young couple from Florida couldn't get their insurance company to pay for in-vitro fertilization, they turned to the Internet for help. Using a crowd-funding website called Indiegogo, they set up a campaign to raise $5,000. Online contributions of more than $8,000 ultimately rolled in from friends, family and strangers. And now they have a baby. That's the power of a crowd, says Slava Rubin, CEO of Indiegogo, based in San Francisco. Crowd-funding has grown along with the Internet as people increasingly band together to support charities, raise money for movies and other projects — and now seek money to pay medical bills. (Zamosky, 7/3)

In the 71 days since she first saw her doctor about a suspicious lump in her right breast, Ricki Harvey has had 40 appointments about her medical care. ... At Harvey’s side every step of the way were “patient navigators,” in her case nurses, whose job is to help guide cancer patients through a system that has become so complex and fragmented that it is beyond the ken of many people, especially at such a vulnerable time. (Bernstein, 7/3)

The search for ways to treat and prevent concussions has spawned screening tools, helmet sensors, electronic mouthpieces, diagnostic blood tests and brain imaging devices. ... But as the industry booms, medical experts are raising concerns that it is a business where much of the science is sketchy, belief frequently outruns fact, and claims of technological breakthroughs evaporate soon after they are made. (Meier and Ivory, 7/3)

When Jamie Tyrone found out that she carries a gene that gives her a 91 percent chance of developing Alzheimer’s disease beginning around age 65, she sank into a depression so deep that at times she wanted to end her life. Then she decided to fight back. She exercised. She changed her diet. She began taking nutritional supplements .... Perhaps the only thing as bad as Alzheimer’s disease is the fear among a growing number of older Americans that they may be at risk of the neurodegenerative disorder, which robs memory and cognitive ability and is the leading cause of dementia. (Kunkle, 7/4)

A federal database meant to help patients learn more about physicians is full of massively flawed data — and no one seems able to explain why. The errors highlight a disturbing reality: Not only do average people have trouble getting accurate information about doctors, but so does the federal government. Even worse, the mistakes appear to open the door for less-scrupulous doctors to distance themselves from pasts that include medical board actions, lawsuits or even criminal charges, according to data and health care experts interviewed by The Enquirer. (Hunt, 7/3)

States have enacted 51 new abortion restrictions so far this year, according to a new report from the pro-abortion rights Guttmacher Institute. There have been more new restrictions so far this year than all of last year, the report finds, while noting that there usually are more new laws in odd-numbered years, when more legislatures are in session. (Sullivan, 7/3)

A federal lawsuit against a manufacturer of laparoscopic power morcellators that was expected to be the first to reach a trial has been settled for an undisclosed amount, an attorney for the plaintiff said Thursday. The case was filed against device maker Lina Medical ApS by Scott Burkhart, a Pennsylvania man whose wife, Donna, died in February 2013. The 53-year-old had a morcellator-aided hysterectomy 11 months earlier for heavy bleeding, according to the lawsuit. She learned after surgery that she had a hidden cancer called leiomyosarcoma. (Kamp, 7/2)

Measles killed a Washington woman in the spring — the first such death in the U.S. in 12 years and the first in the state in 25, health officials said Thursday. The case wasn't related to a recent measles outbreak that started at Disneyland and triggered a national debate about vaccinations, according to the Washington State Department of Health. Officials said it was a different strain. The Washington woman lacked some of the measles' common symptoms, such as a rash, so the infection wasn't discovered until an autopsy, department spokesman Donn Moyer said. (Bellisle, 7/3)

Health officials on Thursday confirmed the country's first measles death since 2003, and they believe the victim was most likely exposed to the virus in a health facility in Washington state during an outbreak there. (Izadi, 7/2)

The woman was probably exposed to measles at a medical facility during a measles outbreak this spring, according to the health department. She was at the hospital at the same time as a patient who later developed a rash and was diagnosed with measles. Patients with measles can spread the virus even before showing symptoms. The woman, who died of pneumonia, had other health conditions and was taking medications that suppressed her immune system, the health department said. (Szabo, 7/3)

Inspectors for the Department of Veterans Affairs say a community-referral program designed to make private medical treatment available for veterans is plagued by delays in care, improper patient scheduling practices, cost overruns and other problems. The findings make it clear that former military personnel who have suffered stress and medical complications because of delayed treatment in VA medical centers are now encountering the same problems when they get referred by the VA for private care. (Wagner, 7/3)

Since 2011, Vets4Warriors has fielded more than 130,000 calls from military personnel stationed around the world. The counselors say their military service and nonclinical approach help them form a bond with callers that can break down mistrust. Now the hotline faces its own problems. Though the program has been lauded as a model, the Pentagon has ended its funding as part of an effort to cut costs and streamline services. (Philipps, 7/4)

An emotionally charged aid-in-dying bill is seriously ailing in the California Legislature. It soon could go into a deep coma. ... The proposal is slated for its first Assembly hearing Tuesday in the Health Committee. But sponsors say it's short two to five votes. Ten are needed to clear the 19-member panel. ... Sponsors have already delayed the committee hearing once. And they say that unless enough votes surface by Tuesday, they'll put the bill on life support until at least late August, but probably until next year. (Skelton, 7/5)

In a scathing audit, state tax officials slammed nonprofit health insurer Blue Shield of California for stockpiling "extraordinarily high surpluses" — more than $4 billion — and for failing to offer more affordable coverage or other public benefits. The California Franchise Tax Board cited those reasons, among others, for revoking Blue Shield's state tax exemption last year, according to documents related to the audit that were reviewed by The Times. These details have remained secret until now because the insurer and tax board have refused to make public the audit and related records. (Terhune, 7/5)

The Los Angeles Police Department’s mental evaluation unit is the largest mental health policing program of its kind in the nation, with 61 sworn officers and 28 mental health workers from the county. The unit has become a vital resource for the 10,000-person police force in Los Angeles. (O'Neill, 7/6)

An adult dose of a hepatitis A vaccine was given to about 250 immigrant children at a Texan detention facility, U.S. Immigration and Customs Enforcement officials said. As of Saturday, no adverse reactions had been reported, said Richard Rocha, an ICE spokesman, in an email. While significant adverse reactions were not expected, healthcare professionals said they would monitor children for any side effects in the next five days. (Schachar, 7/4)

Over the past six years, Colorado has conducted one of the largest ever real-life experiments with long-acting birth control. If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years, state officials asked, would those women choose them? They did in a big way, and the results were startling. The birthrate for teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment. There was a similar decline in births for another group particularly vulnerable to unplanned pregnancies: unmarried women under 25 who have not finished high school. (Tavernise, 7/5)

A court’s ruling that a New Jersey nonprofit hospital essentially functioned as a for-profit business, and therefore owed property taxes, could have implications for hospitals and nonprofit organizations across the state. The opinion issued late last month was the result of a lawsuit filed against Morristown by Atlantic Health System Hospital Corp., parent company of Morristown Medical Center, after the town denied the hospital’s property-tax exemptions in the years 2006 through 2008. (Ramey, 7/5)

A federal appeals court has upheld a $237 million judgment against a South Carolina hospital in a false Medicare claims case. A three-judge panel of the 4th U.S. Circuit Court of Appeals unanimously rejected Tuomey Healthcare System’s challenge Thursday. ... a jury found that Tuomey submitted nearly 22,000 false claims to Medicare under an arrangement with doctors that amounted to an illegal kickback scheme. Prosecutors said the fraudulent claims totaled $39 million. (7/2)

The Wolf administration is backing off a proposal to restructure Medicaid payments to nursing homes that a trade association found would have rewarded 13 homes accused by Pennsylvania state prosecutors of failing to meet residents' most basic needs. Pennsylvania's Human Services Secretary Ted Dallas told advocacy groups Thursday that responses to the proposal prompted his agency to reconsider it. (6/2)

A Florida doctor charged with corruption alongside New Jersey Sen. Bob Menendez has been released under a bond agreement. U.S. Magistrate Judge James Hopkins approved an $18 million bond package for Dr. Salomon Melgen on Thursday, and he walked out of jail with his wife and daughter hours later. (Sedensky, 7/2)

Miami-Dade’s public hospital system is counting on more patient admissions, more emergency room visits and more surgeries next year to cover a projected spending increase of about $95 million over the prior year, largely because of the hiring of additional full-time employees, the return of merit pay raises and rising prices for medical supplies and pharmaceuticals. As the county’s public hospital network, Jackson Health System runs four hospitals, about a dozen primary-care clinics, two nursing homes and other medical facilities and services that are projected to cost $1.66 billion for the year beginning Oct. 1, according to a budget proposal released this week. (Chang, 7/4)

More than 1,000 spouses and children of city schools employees were purged from the district's benefit rolls after an audit found they weren't eligible for health insurance plans. The audit yielded $3.6 million in savings, according to schools CEO Gregory Thornton. In reviewing records of 5,336 city school employees, auditors found that 651 children and 392 adults no longer qualified for coverage as dependents. (Green, 7/2)

After leading the prosecution of some of New Hampshire's most heinous criminals, John Kacavas' professional life now takes place far outside the glare of the media spotlight. Not that Kacavas - who stepped down as U.S. Attorney for New Hampshire in April - sees his new role, as the chief legal counsel for Dartmouth-Hitchcock Medical Center, as such a departure from his old one. (Siefer, 7/4)

A new study by the University of Virginia found that the number of civil commitments of people in mental distress rose last year, perhaps in response to changes enacted after the fatal encounter between Sen. R. Creigh Deeds and his mentally ill son. “Roughly speaking, there’s been about a 10 percent increase,” said Richard J. Bonnie, director of the Institute of Law, Psychiatry and Public Policy at U-Va. and chairman of the state Supreme Court’s Commission on Mental Health Law Reform from 2006-2011. (Kunkle, 7/2)

A graduate student has sued Fordham University, seeking $5 million in damages and saying the college violated her civil rights by demanding her entire record of mental health treatment as a condition for returning. The federal lawsuit by Emily Pierce also names the U.S. Education Department's Office of Civil Rights, saying the agency has been investigating her discrimination complaint for two years but has gone silent. (Virtanen, 7/3)

The sprawling field hospital that springs up in rural southwest Virginia every summer has been called the largest health-care outreach operation of its kind. This year, the event will have another first. Unmanned aerial vehicles — drones — will deliver medicine to the Wise County Fairgrounds in part to study how the emerging technology would be used in humanitarian crises around the world. (Portnoy, 7/3)

Heroin use has spiked sharply in the past few years, a trend that has alarmed local as well as state politicians. In 2013, the number of fatal heroin overdoses had nearly doubled from the amount since 2010, and it surpassed the state’s 387 homicides. After flirting with the idea of declaring a state of emergency concerning the heroin epidemic, Gov. Larry Hogan (R) created the task force to develop a response to the crisis by December. (Koh, 7/2)

As the rate of HIV cases among young people rises in Maryland, public health officials are scrambling for new ways to address the problem — or risk undermining years of success. Among those newly diagnosed with HIV statewide, the proportion of those ages 20 to 29 nearly doubled — from 16 percent in 2003 to 31 percent in 2012, the most recent data available. The proportion of infected teens increased at about the same pace. (McDaniels, 7/4)

The co-owners of a 45-bed nursing facility here that cares for people with severe and persistent mental illnesses have decided to shutter the business. “We just got our rate-setting form from the state, telling us that our per-day reimbursement would be going down by $4.96 per person, per day,” said Mary Harding, director of nursing at Applewood Rehabilitation, Inc. The decision comes on the heels of state officials announcing last month that Osawatomie State Hospital had reached its maximum capacity and had begun putting would-be patients on a waiting list. (Ranney, 7/3)

A Seattle doctor who primarily treats gay men is protesting a King County policy that restricts his patients with sexually transmitted diseases from receiving free antibiotics for their partners — while heterosexual couples routinely get the treatment. Dr. Warren Dinges, who runs the downtown Seattle Infectious Disease Clinic, said he’s seen a spike in the past several months in chlamydia and gonorrhea infections in his patients. (Aleccia, 7/4)

Medicare and Medicaid, the two mainstays of government health insurance, turn 50 this month, having made it possible for most Americans in poverty and old age to get medical care. While the Affordable Care Act fills the gap for people who don’t qualify for help from those two programs, there are important improvements still needed in both Medicare and Medicaid. (7/3)

[Chief Justice John] Roberts’s ruling advanced a crucial conservative objective, that of clawing back power from the executive branch and independent agencies that increasingly operate essentially free from congressional control and generally obedient to presidents. If conservatives cannot achieve their objectives, including ACA repeal, through the legislative branch, conservatism’s future is too bleak to be much diminished by anything courts do. If, however, conservatives can advance their agenda through Congress, they will benefit from Roberts’s ACA opinion, which buttresses legislative supremacy. (George F. Will, 7/3)

The urge to merge is sweeping managed health care. Aetna announced Friday a $37 billion deal to acquire Humana. Anthem and Cigna are in merger talks and could be next. The national for-profit insurers are on an anxious mission to consolidate. These combinations will sharply reduce competition and consumer choice, as five big insurers shrink, probably, to three. This trend is a direct consequence of ObamaCare, reflecting the naïveté of its architects and the fulfillment of their myopic vision. (Scott Gottlieb, 7/5)

In the past three months, the health-care industry has added 135,000 jobs. Between January 2001 and December 2004, the net job creation was ... negative-78,000. So not a super high bar, to be fair. (Using that standard, you could also say that the horse-drawn carriage industry created more jobs in the past three months than the entire U.S. economy between 2001 and 2004.) But the broader point, that the health-care industry is going gangbusters, is also true. And it's been true since President Obama took office. Over the 78 months of Obama's presidency, the industry has lost jobs in only three — all between May and December 2013. Otherwise: Up, up, up. (Philip Bump, 7/2)

The most noteworthy part of President Barack Obama's speech Wednesday was the note he wrote in black ink on a hallway wall to the students of Taylor Stratton Elementary: Dream big dreams. Otherwise the president's Affordable Care Act speech at the Madison elementary school was a tame Q&A session for about 160 people who were either supporters or too corporate to heckle. If the speech had to have a title it could have been: coverage costs and the costs of coverage. (Holly Fletcher, 7/2)

Let me start by saying this is not a political screed against Obamacare; I’m thrilled that some 18 million Americans now have health insurance who didn’t before the law took effect, lowering the percentage of uninsured adults from 18% in 2013 to 11.9% today. But I’m growing concerned that for some people — especially older, middle- and lower-income adults — the Affordable Care Act is becoming The Unaffordable Care Act. (Richard Eisenberg, 7/5)

Providers, insurers, and governments, among others, have sharply changed direction in order to comply with the Affordable Care Act (ACA). They’re experimenting with new health-care delivery and payment models and exploring new opportunities for information technology. All of this action, aimed at providing access to high-quality affordable care to Americans everywhere, has inspired robust debate. But one sector of our society is still lagging behind. Higher education has yet to transform to meet the needs of health-care reform. That’s a problem. As health-care changes, so must higher education. (Rainu Kaushal, 7/2)

And as we’ve seen in the past couple of days, one of the biggest pieces of unfinished business the administration confronts is the incomplete expansion of Medicaid. The question is whether Obama can make any progress toward fixing this problem. On Wednesday, Obama went to Tennessee to tout the success of the ACA and encourage the state to expand Medicaid, and though the visit was described as a “victory lap,” Tennessee shows just how deep the challenge on Medicaid is. (Paul Waldman, 7/3)

If the uncertain legal future of the Affordable Care Act seemed reason enough to keep stalling on Medicaid expansion in Kansas during the legislative session, that excuse is gone. The tax credit subsidies in states that use the federally run online exchange prevailed in last week’s 6-3 decision at the U.S. Supreme Court, leaving intact the ACA coverage of nearly 70,000 Kansans among millions of Americans. With that chaos averted, state leaders are free to judge the proposed expansion of Medicaid on its own merits, which are compelling. (7/2)

According to a recent study, Alaska is either in a recession or on the brink of one. It’s time for nonpartisan solutions, not time to play Russian roulette with the economy. Alaska will lose 4,000 jobs across the economy by September. Blocking a vote on a Medicaid expansion bill that’s passed in Democratic and Republican states and would create 4,000 Alaska jobs isn’t smart politics. The public supports it across party lines. (State Rep. Les Gara, 7/4)

The Supreme Court’s recent decision to ignore the letter of the law and uphold the Obama Administration’s unconstitutional rewrite of Obamacare undermines the American people’s trust and confidence in our nation’s highest court. Justice Scalia summed up the Court’s actions rightly when he called them “absurd” and opined that “words no longer have meaning” under the Court’s ruling in King v. Burwell. (Rep. Brian Babin, R-Texas, 6/3)

Morning in America did nothing to boost insurance — in fact, the share of Americans with private coverage declined, and because Medicaid din’t grow the overall rate of uninsurance rose from 12 percent in 1980 to 15.6 percent in 1989. In other words, nothing in the economic record — not even the record of the great conservative hero — suggests that you can grow your way into universal health coverage. (Paul Krugman, 7/4)

Don’t like same-sex marriage, contraception, HIV testing or even child labor laws? Never you worry: Just say that a higher power has exempted you, even if your exemption means trampling on other people’s rights. ... Last year’s Hobby Lobby ruling allowed companies to exempt themselves from an Obamacare requirement that insurance plans cover birth control, and now congressional Republicans want to expand that exemption. A frightening section of a House appropriations bill would let any employer or insurance company deny health-care coverage for any service that they have a “moral or religious objection” to, even if that service is required by law. This could include mental health screenings and vaccinations, in addition to contraception and abortion. (Catherine Rampell, 7/2)

According to an account in the New York Times, the [U.S. Chamber of Commerce], which describes itself as representing the interests of more than 3 million businesses, is quietly supporting efforts around the world to resist tighter controls on tobacco use. The Times published e-mails and documents showing how the chamber has lobbied to curtail anti-smoking measures outside the United States. How does advancing a product that kills people prematurely serve the interests of businesses? The chamber ought to be the first organization to grasp that smoking puts a terrible burden on societies, draining their public health and medical resources and stealing away lives that could be productive for years to come. (7/4)

The U.S. government has fallen shamefully short of honoring its commitment to veterans in recent years. One reform measure after another has failed to resolve chronic problems with health care provided by the Department of Veterans Affairs. On Capitol Hill, a new attempt is in the works — this time focusing on workforce shortages and leadership vacuums, including in Missouri. The Delivering Opportunities for Care and Services (DOCS) for Veterans Act seeks, among other things, to bolster recruitment efforts through salary increases and tuition loan assistance. It also would expand partnerships with existing agencies to establish more mental health residency programs, particularly in rural and underserved areas. (6/2)

For years, research on prostate cancer has sought an approach to screening that is more individualized than a one-size-fits-all measurement of the level of prostate-specific antigen in a man’s blood. These efforts are now paying off. That’s why it’s time to re-evaluate the nation’s current approach to prostate cancer. Even though we anticipate 221,000 new diagnoses this year, and 28,000 deaths, recommendations drafted in 2010 and finalized in 2012 strongly discourage PSA screening men without symptoms for this disease. (Deepak A. Kapoor, 7/5)

Scientists have made enormous gains in reducing deaths from coronary heart disease, the leading cause of heart attacks, but it is astonishing how much they still don’t know. That leaves patients and their doctors uncertain about the best way to fight a disease that is still the leading cause of death for both men and women in the United States. ... The most surprising gaps in knowledge involve two of the most common treatments: when to use stents — small wire cages — to prop open coronary arteries and how far to drive down blood pressure. (7/3)

The Food and Drug Administration recently moved to eliminate trans fats from the American diet, and food activists and the public-health lobby are claiming a historic victory. Yet this is a rare case of the Obama Administration regulating from behind. Markets had as much to do with the fall of trans fats as government did with their rise. (7/5)

Existing antibiotics underpin much of modern medicine but are rapidly losing their ability to treat many deadly infections, according to the Centers for Disease Control and Prevention. Yet even as more strains of drug-resistant bacteria emerge, the introduction of new antibiotics has slowed down. Congress should enact a proposed new regulatory pathway that will help spur the investment that can bring new lifesaving treatments to the public. ... To revitalize the search for lifesaving antibiotics, the Food and Drug Administration needs a new way to approve them. Legislation proposed in both the House and the Senate would create a new regulatory pathway that would enable the FDA to approve drugs specifically for patients whose serious infections can’t be treated with existing drugs, and for whom there are few or no other treatment options. (Jonathan Leff and Allan Coukell, 7/2)

Jaws dropped earlier this year when Gov. Jerry Brown told the Legislature that he wanted to set aside $300 million for two years' worth of specialty drugs for Medi-Cal users, state prisoners and others covered by state health programs. Even with a general fund of more than $110 billion, $300 million is nothing to sneeze at. This week, a new study suggested that Brown may have been low-balling the cost of those new drugs. By a lot. (Jon Healey, 7/2)

[Calif. Gov. Jerry Brown] did something last week that more governors should, signing legislation that compels almost all schoolchildren in California to be vaccinated. While the state had been fairly liberal in granting exemptions to parents who cited strongly held personal beliefs, the new law insists that there be a sound medical reason for opting out. Some children with compromised immune systems, for example, simply cannot be given the shots. I imagine that [Robert Kennedy Jr.] was displeased. I’ll confine myself to imagining, because I’m not about to hop on the phone with him again. He’d just subject me to the scaremongering he practiced in his campaign against the California law. (Frank Bruni, 7/4)