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Blue states are defying the Trump administration in a bid to protect ObamaCare and keep their insurance markets stable. Several states, including California and Maryland, are looking to put limits on short-term insurance plans, even as the Trump administration is poised to expand access to them nationwide. The states are doing so because they fear the availability of the short-term plans will drive up premium costs for ObamaCare. (Weixel, 6/2)

Republican Sen. Chuck Grassley this week told people gathered at an Iowa town hall that politicians should "give up" on repealing and replacing the Affordable Care Act. During the meeting Thursday in Orange City, Grassley started answering a question about bipartisan efforts to improve the legislation before saying, "Oh, by the way, we've got to give up on repeal and replace." A video of his answer was posted online by American Bridge 21st Century, a Democratic organization. (Nozicka, 6/1)

Sen. Lamar Alexander, R-Tenn expressed hope for President Donald Trump's soon-to-be unveiled health care plan for self-employed workers and talked about his failed efforts to convince the president that higher tariffs on steel and other imports are a bad idea. He said during a Williamson County Association of Realtors luncheon Friday the two subjects were examples of how he has both agreed and disagreed with the president at times. (Buie, 6/1)

The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs. "The impact is tremendous," said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don't need treatment beyond surgery and hormone therapy, he said. The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test. (Marchione, 6/3)

Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major international study that is expected to quickly change medical treatment. ... The study found that gene tests on tumor samples were able to identify women who could safely skip chemotherapy and take only a drug that blocks the hormone estrogen or stops the body from making it. The hormone-blocking drug tamoxifen and related medicines, called endocrine therapy, have become an essential part of treatment for most women because they lower the risks of recurrence, new breast tumors and death from the disease. (Grady, 6/3)

The cancer in question is driven by hormones, has not spread to the lymph nodes and does not contain a protein called HER2. Generally, after surgery, such patients receive endocrine therapy, such as tamoxifen, which is designed to block the cancer-spurring effects of hormones. Otis Brawley, chief medical and scientific officer of the American Cancer Society, called the trial a good example of “precision medicine” and said it would save many women from unneeded chemotherapy. (McGinley, 6/3)

In the U.S., the most recent data shows around 135,000 new cases yearly of the specific breast cancer studied, says Dr. Joseph Sparano, an oncologist at Montefiore Medical Center, a professor of medicine at the Albert Einstein College of Medicine and the lead author of the study. Twenty-five percent of those patients won't qualify for chemotherapy because of age or medical problems. Out of the 100,000 or so patients who could take the gene test to help make a decision about chemotherapy, he says at least two-thirds fall into the middle range that can benefit from the study findings. (Watson, 6/3)

The studies are part of a growing movement among cancer doctors and researchers to de-escalate treatments for certain tumor types, as drugs become increasingly expensive. The average U.S. monthly price of oncology drugs more than doubled to $15,535 in 2015 from $7,103 in 2006, according to a May report in the Journal of Oncology Practice. Overall U.S. spending on cancer drugs doubled from 2012 to 2017, to nearly $50 billion, according to IQVIA Institute for Human Data Science. (Loftus, 6/3)

Immunotherapy is a source of great hope in cancer care. It has rescued some patients from the brink, while giving others a reason to believe that they, too, could beat the long odds. But these therapies are also creating a vexing dilemma for doctors: Their patients, citing television ads and media accounts of miraculous recoveries, are pushing hard to try them, even when there is little to no evidence the drugs will work for their particular cancer. (Ross, 6/4)

Along way to go, but getting there — that’s the verdict on the highly anticipated data Grail released Saturday about its liquid biopsy for cancer. The Illumina spinoff is almost as well known for its executive departures and ability to raise buckets of money as for its out-of-the-park goal: detecting tumors super-early, when even cancers with a horrible prognosis might be treatable, by analyzing DNA that has escaped its cells and is floating in the blood. (Begley, 6/2)

On Saturday night, the controversy around the experimental cancer immunotherapy drug NKTR-214 ratcheted higher following a new data presentation at the American Society of Clinical Oncology annual meeting. Nektar Therapeutics and Bristol-Myers Squibb, the owners of NKTR-214, are undertaking a hugely expensive program to run nearly two dozen clinical trials spanning 20 indications across nine types of solid tumors. Phase 3 studies in melanoma, kidney cancer, and urothelial cancer are starting soon. (Feuerstein, 6/3)

Black men with advanced prostate cancer fared surprisingly well in two new studies that challenge current thinking about racial disparities in the disease. Blacks are more likely to get prostate cancer and to die from it than whites, but the new research suggests getting access to the same treatment may help balance the odds — even if it doesn't greatly extend life after cancer has spread. Given the same standard treatments, blacks with advanced disease may do even better than whites, the studies suggest. (Tanner, 6/1)

She watched her sister dying, slumped over her kitchen table, unconscious and gasping. When the police and paramedics came, they turned her sister onto the floor and sprayed naloxone up her nose—once, then a second dose. The anti-opiate did its work in minutes: Her sister woke up. Three days later, she opened the door to the police again. Derek Back, a police officer in plainclothes, and Tiffany Duggan, an addiction recovery coach, hadn’t come with an arrest warrant but a potential lifeline: a bed in a drug treatment facility. (Trickey, 6/2)

Congress faced a startling public health and political problem throughout 2016 as the number of people dying from opioid addiction climbed. The number of Americans succumbing to fatal drug overdoses more than tripled between 1999 and 2015, affecting a whiter and more geographically diverse population than previous drug crises. Lawmakers ultimately approved some modest policies aimed at curbing prescription drug abuse and provided $1 billion to support state efforts.  Two years later, the situation is more dire and the political imperative to act is even more intense. Drug overdose deaths rose another 12 percent from October 2016 to October 2017, according to Centers for Disease Control and Prevention provisional data. (Raman, Siddons and McIntire, 6/4)

U.S. Surgeon General Jerome Adams became a vocal advocate for improving how the criminal justice system handles drug offenders in no small part because of his brother Phillip, who is battling substance abuse in a Maryland state prison. Adams, Phillip and the rest of their family believe Phillip’s incarceration is a direct result of his gradual spiral into addiction. A Vicodin pill at a high school party led Phillip to use Percocet, which led to harder drugs and crime from there. It wasn’t long before Phillip was revolving in and out of prison for offenses that included theft, forgery and dealing crack cocaine. (Clason, 6/4)

Laws passed over the past decade lowered some barriers that patients struggling with substance abuse face in getting treatment, giving them more parity with other medical coverage. But the fight is on to give those laws more teeth. Improving parity essentially ensures that insurance plans equally cover mental health and substance abuse services, and medical and surgical services. But so far, this year’s opioid bills, which last Congress were packaged with mental health legislation, do not take as many steps to close the coverage gap as some would like.  (McIntire, 6/4)

State lawmakers passed a bill late Thursday meant to make it easier for patients with mental health and addiction issues to get insurance coverage for treatment. Advocacy and other groups pushed the bill in response to concerns that treatments for mental health and substance use disorders are not being covered at the same level as those for physical medical conditions despite a federal law prohibiting such disparities. Advocates considered the issue especially pressing given the epic of opioid addiction that has gripped the U.S. and Illinois. (Schencker, 6/2)

New Hampshire has some of the highest rates of opioid abuse in the country. ...In the past few years the number of children taken into state custody has more than doubled, according to DCYF. (Gotbaum, 6/2)

In the turf war between hospitals and health insurers over physician practices, hospitals are winning by a long shot. But they'd be ill advised to get too comfortable. A slew of recent activity shows that insurers are clawing their way back, whether by outright purchases of medical practices or targeting outpatient facilities that employ doctors. (Livingston, 6/2)

As health systems explore the wild frontier of consumerism, more and more of them seek direction from industry outsiders. Boardrooms have always been filled with trustees from a cross section of industries, but now expertise in driving consumer engagement, an appreciation for data analytics, a knowledge of information security, and an understanding of how to recruit and retain employees are all at a premium. It's the evolution of the board's role and seeing how all of the pieces fit together to affect the bottom line. These insights will become more critical as payers use different metrics as a performance yardstick. (Kacik, 6/2)

Puerto Rico's Institute of Statistics announced Friday that it has sued the U.S. territory's health department and demographic registry seeking to obtain data on the number of deaths following Hurricane Maria as a growing number of critics accuse the government of lacking transparency. The lawsuit was filed Thursday, the same day Puerto Rico Gov. Ricardo Rossello told CNN there would be "hell to pay" if officials don't release mortality data. Puerto Rico's Health Department released some information Friday, saying an additional 1,397 overall deaths were reported from September to December in 2017, compared with the same period the previous year. However, officials did not provide causes of death for any of the 11,459 total people deceased during the period. (Coto, 6/1)

The measure comes in a week when a Harvard University-backed study showed that some 5,000 people -- and maybe more -- may have perished as a result of Maria, even as the government’s official death count remained at 64. The extreme underestimating of fatalities may have contributed to what many on the island criticized as an inadequate federal response. Most outside experts had little recourse to challenge the official estimates as the catastrophe was unfolding. "After the experience in Hurricane Maria, and with the new hurricane season beginning, it’s urgent to configure public information services so that after the next hurricane, information about fatalities registered in Puerto Rico flows in an open manner," Mario Marazzi-Santiago, the executive director of the institute, said in a press release. (Levin and Rivera, 6/1)

Aiming to squelch an Ebola outbreak that has infected 54 people, killing almost half of them, aid workers in the Democratic Republic of the Congo have begun giving an experimental vaccine to people in the rural region at the epicenter of the outbreak. Epidemiologists working in the remote forests have not yet identified the first case, nor many of the villagers who may have been exposed. Investigators will need to overcome extreme logistical hurdles to reconstruct how the virus was transmitted, vaccinate contacts and halt the spread. (Baumgaertner, 6/1)

I have an extra vein into my heart that, in most people, disappears during embryonic development. My eyeballs are shaped more like lemons than like baseballs. And I once woke up after a foot surgery to hear the doctor say, “I’ve never seen anything like that before. ”I’m not the only one who is loaded with physiological quirks. A survey of friends revealed tonsils that kept growing back after tonsillectomies; a missing kidney that was discovered missing only after age 40; and blood that tests positive for syphilis, even though there is no syphilis. I heard about extra toes, fingers and nipples. One friend never grew wisdom teeth. Another grew seven of them. (Sohn, 6/3)

Walter Gardner knew his life was at risk: Nearly 100 pounds overweight, he had developed Type 2 diabetes and needed several prescriptions. Traditional medical appointments had little effect on the 55-year-old’s health. Then he was offered a way to spend more time with his doctor. Gardner seized the opportunity. “I needed to do something or I probably wasn’t going to make it to 60,” he said. (Levingston, 6/2)

Strokes are a major burden in the United States. They strike nearly 800,000 people a year and kill about 133,000, according to the U.S. Centers for Disease Control and Prevention. The new guidelines released by the American Heart Association and American Stroke Association earlier this year say that the clot-removing procedure could help people up to 18 to 24 hours after a stroke if the clot is located in a large blood vessel in the brain and the patient still has brain function. (Cohn, 6/1)

A Delaware man who for years advocated for increased organ donations has died while lingering on the list for a kidney transplant. Fifty-six-year-old Bill Murray of Wilmington had spent the last five years receiving dialysis for chronic kidney disease. During those years, he advocated for kidney-disease awareness and the need for organ donation to help the tens of thousands of Americans waiting for a transplant. (6/2)

For six years now, life has been really good for James. He's got a great job as the creative director of an advertising firm in New York City. He enjoys spending time with his wife and kids. And it's all been possible, he says, because for the past six years he's been taking a drug called ketamine. Before ketamine, James was unable to work or focus his thoughts. His mind was filled with violent images. And his mood could go from ebullient to dark in a matter of minutes. (Hamilton, 6/4)

Growing numbers of Americans face the immense and often overwhelming challenge of caring for an aging parent or other loved one, a burden that will skyrocket as 76 million baby boomers move into their 80s and need help coping with dementia, cancer, heart disease or just plain frailty and old age. Social trends and medical progress are working against each other. Half of the 35 million family caregivers who now assist older adults have full-time jobs. Families are more geographically dispersed. Adult children are squeezed between raising their own families and managing a dizzying array of housing needs, health care, insurance, finances and supportive services for their elders. (Crosby, 6/2)

A common cinnamon food additive that is widely used to flavor e-cigarettes had harmful effects on human lung cells in a laboratory culture, disrupting the cells’ innate host defense system, scientists report. The compound, called cinnamaldehyde, gives cinnamon its characteristic flavor and smell and is generally considered safe when added to food. But like many chemicals in e-cigarette emissions, it has not been thoroughly evaluated for safety when inhaled rather than ingested, said Phillip Clapp, who recently completed his doctorate in the lab of Dr. Ilona Jaspers, deputy director of the University of North Carolina at Chapel Hill’s Center for Environmental Medicine, Asthma and Lung Biology. (Rabin, 6/1)

The bacteria can take over a person’s intestines and be difficult to eradicate. The infection causes fever, vomiting, cramps and diarrhea so severe that it kills 14,000 people a year in the United States alone. The first line of treatment for the attacking microbes, called Clostridium difficile, is antibiotics. But a group of Norwegian researchers asked if something more unusual — an enema containing a stew of bacteria from feces of healthy people — might work just as well. (Kolata, 6/2)

The Boston Reentry Study looks at whether witnessing deadly violence as a child can have a lifelong impact, tracking 122 men and women released from prison in Massachusetts between 2012 and 2014 to see how they're adjusting to life outside. Researchers found that 42 percent of people they spoke to had seen someone killed during their childhood. (Young, 6/1)

Kaiser Health News: Bubble Pop? Brownie Batter? Vapes’ Added Flavors Fuel E-Cig Debate 

A heated debate is redrawing alliances in the tobacco control movement as federal officials wrestle with how to regulate the growing e-cigarette market. The players include researchers, smoking-cessation advocates and “vaping” connoisseurs.“ It’s become very divisive in a community that was largely united against Big Tobacco,” said Samir Soneji, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, who researches tobacco control policy. (Luthra, 6/4)

Missing from the news conference was the city's health director. Nearly seven months after being elected, [Mayor LaToya] Cantrell still has not hired a health director for a department that is a lifeline to people with urgent medical needs in emergencies. Official press conferences are annual standard fare each June 1, with the city health director among those who provide an update on storm season preparations and the protocol for activating shelters. But on Friday, there was no health director on hand to discuss urgent medical need shelters, as is typical for preparedness news conferences. (Litten, 6/1)

A government agency reports that most Florida nursing homes and assisted-living facilities do not have backup power despite new requirements enacted after a dozen people died in a sweltering center following Hurricane Irma. The state Agency for Health Care Administration says only 48 nursing homes and 91 assisted-living facilities have installed equipment and had state inspections as of May 25. The new rules that went into effect Friday require all facilities to have backup power for cooling for at least 96 hours. (6/2)

The Nemours CareConnect app can connect Florida families with medical help every day of the week, 24 hours a day during hurricane season, which officially started June 1. (Prieur, 6/3)

Baylor St. Luke’s Medical Center in Houston temporarily suspended its renowned heart transplant program on Friday following two deaths in recent weeks, saying it needs to reassess what went wrong and determine the path forward. The decision to put the program on a 14-day inactive status — meaning it will turn away all donor hearts during that time — came about two weeks after ProPublica and the Houston Chronicle reported that in recent years the program has performed an outsized number of transplants resulting in deaths and lost several top physicians. (Ornstein and Hixenbaugh, 6/1)

"Although extensive reviews are conducted on each unsuccessful transplant, the recent patient outcomes deserve an in-depth review before we move forward with the program," Doug Lawson, CEO of Catholic Health Initiatives Texas Division, which owns St. Luke's, said in a statement. "Our prayers are with the families, as well as all those on the waiting list." (6/2)

For weeks, officials at St. Luke's and its affiliated Baylor College of Medicine have defended the program, saying they had made improvements after a string of patient deaths in 2015. Officials said the program's one-year survival rate after heart transplants had reached 94 percent in 2016 and 2017. But in recent months, more patients have died. James "Lee" Lewis, a 52-year-old pipefitter from Bay City, died on March 23, nearly three months after operating room equipment malfunctioned during a key stage of his transplant surgery. Another patient, a 67-year-old bankruptcy lawyer named Robert Barron, died on May 5, three months after his transplant. A third patient died in recent weeks, prompting the hospital's decision Friday. (Hixenbaugh and Ornstein, 6/1)

No topic has dominated California's governor race like President Donald Trump. The Republicans want to be like him; the Democrats want to oppose him. But whoever wins will face a long list of challenges from housing and homelessness to health care. Here's a look at some of the debates that have emerged during the race, which includes Democrats Gavin Newsom, Antonio Villaraigosa, John Chiang and Delaine Eastin and Republicans John Cox and Travis Allen. (Cooper, 6/2)

A Polk County judge Friday temporarily blocked Iowa’s “fetal heartbeat” abortion law from being enforced while a legal challenge is underway. The law, which bans most abortions after about six weeks of pregnancy, was supposed to take effect July 1. (Sostaric, 6/1)

Gov. Dannel P. Malloy on Friday vetoed a bill that would have prohibited him or future governors from cutting education-cost sharing grants to cities and towns as a means of addressing a budget shortfall that develops during the fiscal year. He also allowed a bill to become law without his signature, a first for the governor. The new law he declined to sign allows pregnant women to purchase health insurance from Access Health CT outside the enrollment period. (Pazniokas, 6/1)

Physicians, researchers and hospitals broadly agree that cesarean sections have become too common. That’s powered efforts to limit them to ever fewer cases. Still, it can be hard to gauge the track record of most Kansas hospitals. When a national group came asking for numbers that reveal how regularly C-sections are performed, many hospitals in the state didn’t reply. Among those that did respond to the health advocacy Leapfrog Group, about half had reached or exceeded a federal goal to scale back C-sections. (Llopis-Jepsen, 6/1)

Every school day, Zion Kelly passes by the locker once used by his slain twin brother, Zaire, who was shot in the head during an attempted robbery in their Washington, D.C. neighborhood last September. Zaire is one of more than 170,000 youths between the ages of 5 and 24 that have been killed by gun violence in the United States since the Centers for Disease Control and Prevention (CDC) began collecting data in 1981. (6/1)

So the hospital last week opened a new Clinical Decision Unit, next to the emergency department, to free ER rooms faster without compromising care. The unit is designed to observe and provide tests to patients who come to the ER and aren't ready to go home once they are seen by a doctor, but don't need to be admitted to the hospital. They can include people treated for chest pains, asthma and hypertension. (Cousineau, 6/2)

A major tobacco company is pouring millions of dollars into a ballot initiative that would repeal the country’s strongest effort yet to ban the sale of flavored tobaccos, which are attracting a whole new generation of users including children and teens. A $12 million campaign primarily funded by R.J. Reynolds is urging San Francisco voters next Tuesday to reject the city’s ban on selling flavored vaping products, hookah tobacco and menthol cigarettes. The flavored tobacco comes in brightly colored packages and tastes like bubblegum, mango or chicken-and-waffles, which public health advocates say are designed to entice young people. (Colliver, 6/2)

Kaiser Health News: Outsiders Swoop In Vowing To Rescue Rural Hospitals Short On Hope — And Money

Beau Gertz faced a crowd of worried locals at this town’s senior center, hoping to sell them on his vision for their long-beloved — but now bankrupt — hospital. In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at this town hall meeting in March to revive the Surprise Valley Community Hospital — a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts and tend to aging loved ones. (Feder Ostrov, 6/4)

The alleged sexual harassment that cost Dallas County's former health chief his job caused problems in a health care program that serves thousands of HIV and AIDS patients in North Texas, according to the woman making the allegation. The woman -- who worked for former Health Director Zachary Thompson -- had oversight responsibilities for the county's Ryan White office. The office is supposed to manage tens of millions of federal dollars per year to help poor, uninsured HIV/AIDS patients. A federal report made public this week found the office riddled with incompetence, mismanagement and a lack of training. (Martin, 6/2)

Fairview Health Services shuffled its leadership structure and trimmed a few dozen jobs earlier this year while transitioning to a new “operating model” — management-speak for a change that aspires to make it easier for patients to get care across the growing health care system. The new structure at Minneapolis-based Fairview is focused on “service lines” rather than the geographic location of various hospitals and clinics. Part of the goal, Fairview executives said, is to eliminate “unhealthy competition” in which one Fairview hospital might be rewarded for gaining market share at the expense of another Fairview facility. (Snowbeck, 6/3)

People born in New York City who do not identify their gender as either male or female would have the option of choosing a third category for their birth certificates under a new proposal. Mayor Bill de Blasio and City Council Speaker Corey Johnson said the new category of “X’’ would be available through the proposal, which is expected to be introduced by Johnson on Thursday with public hearings to be held later this month. Currently, if parents of a newborn do not want to identify a sex, they can say the sex of the child is undetermined or unknown. The “X’’ category would be something adults could choose for their own birth certificate. (Hajela, 6/3)

In the waning days of the legislative session, Missouri Rep. Sarah Unsicker stood up during a long stretch of floor action and urged her colleagues to establish a committee to study the state's rising maternal mortality rate. ... Missouri ranks 42nd nationally with 32.6 pregnancy-related deaths per 100,000 live births, according to data published in March by the UnitedHealth Foundation, the nonprofit arm of the insurance company UnitedHealthcare. (Marso, 6/3)

The former CEO of a multi-state physical therapy chain based in Houston was sentenced Friday to 19 years in federal prison and ordered to pay $15 million in restitution, according to the U.S. Attorney's Office. Team Work Ready CEO Jeffrey Eugene Rose Sr., 56, had been convicted in 2016 -- along with two of the company's other top officials -- of conspiracy, health care fraud, wire fraud and money laundering, after submitting more than $18 million in fraudulent claims at clinics in Texas, Louisiana, Georgia, Memphis and Alabama, prosecutors said in a press release. (Barned-Smith, 6/1)

There are 3,015 independent water systems serving communities in California. As of May, 269 of these suppliers were out of compliance with state drinking water standards. Select your county to see if the water supplier for your community is out of compliance. (6/1)

A new self-training kiosk at Hennepin County Medical Center seeks to train more Minnesotans so they understand CPR and aren't afraid if they ever need to use it. Designed in shape and simplicity like a Whac-A-Mole arcade game, the console takes people through the basics of hands-only CPR, or cardiopulmonary resuscitation, and has them practice compressions on a dummy chest to get the pressure and pacing right. (Olson, 6/1)

A clinic owner in Delaware has been arrested and charged with submitting fraudulent applications for medical marijuana. Delaware State police said Saturday that Carolan Krajewski has been charged with forgery and tampering with public records. Krajewski is owner of Delaware Holistic Medicine in Lewes. The clinic was formerly known as Disjointed. (6/2)

Sheriff Antionette Irving is rushing to retain a medical contractor for the Richmond City Justice Center after the private company responsible for providing treatment to the jail’s 900-plus inmates backed out of its contract following a critical review. Correctional Medical Care Inc. gave notice in April, only nine months after coming aboard, that it would end its three-year, $20.5 million agreement with the Richmond Sheriff’s Office on July 14. (Robinson, 6/3)

For years, local mental health agencies say they rarely relied on Central State Hospital for emergency admissions of acutely ill patients in the Richmond region. ...Now, local mental health officials rely increasingly on Central State and other state institutions as private psychiatric facilities admit fewer acutely ill patients under temporary detention orders. (Martz, 6/1)

This year's tick season got off to a slow start in Minnesota. ...Earlier this spring, the Centers For Disease Control and Prevention reported that between 2004 and 2016, Minnesota had nearly 27,000 confirmed cases of tick-borne infections.(Moen, 6/3)

"I don't know how she died," her daughter, Charlene Roberts, told KRON-TV . "Did she have a stroke or fell? I don't know what happened." Roberts, who gave her mother's age as 76, said the woman had dementia and two hearing aids and went missing on May 20 from a mental health facility. (5/31)

Call it the New Marijuana Math: 91,000 Floridians are buying 56 pounds of pot a week under the orders of 1,400 doctors. A year and a half after an amendment to the state constitution legalized medical marijuana, the fledgling industry is finally starting to show some muscle. (Garvin, 6/1)

Stunned by massive losses in last fall’s state legislative races, some Virginia Republicans — enough of them, at least — this year began to acknowledge the senselessness of their opposition to extending Medicaid health insurance to some 400,000 citizens under the Affordable Care Act. That shift, after four years of groupthink GOP obstruction, at last yielded a breakthrough Wednesday, when both houses of Richmond’s Republican-controlled legislature passed a budget expanding Medicaid. The irony was that it is precisely in some of the state’s most heavily Republican counties — rural areas of Southside and Southwest Virginia — where a lack of health insurance was most widespread, in many areas amounting to 20 percent of adults under the age of 65. (6/2)

Congratulations to the Virginia legislature for voting this week to expand the state’s Medicaid rolls. As the White House and Congress do all they can to pare health insurance coverage nationwide, Virginia’s move will push the other way, extending medical security to 400,000 more people. In November, voters in Idaho, Nebraska and Utah, where Medicaid expansion is expected to be on the ballot, will have an opportunity to do the same — and, if they do, raise to 36 the number of states taking advantage of the Affordable Care Act’s generous Medicaid deal. (6/1)

Virginia's expansion of Medicaid this week is giving hope to advocates in other states. After Virginia overcame years of Republican opposition to pass the expansion under ObamaCare, supporters are giving renewed attention to what could be the next states to expand: Utah and Idaho, where initiatives are set to be on the ballot this November. Activists in Nebraska are also gathering signatures and say they are on track to get the issue on the ballot there. (Peter Sullivan, 6/2)

It’s very hard to feel good about any part of American politics today, I realize. When it isn’t a circus starring Roseanne Barr or Dinesh D’Souza, it’s a nightmare, with President Trump separating immigrant families, obstructing justice and damaging American interests abroad. I never expected to live through so dark of a period in Washington. Outside of Washington, however, the picture really is different. In many cities and states, people aren’t only trying to minimize Trump’s damage. They’re actively using politics to improve lives. (David Leonhardt, 6/3)

Despite great progress, the (Gov. John) Kasich Administration recently asked the federal government for permission to add new regulations that will put more than 300,000 Ohioans at risk of losing health care, including more than 50,000 in the Cleveland area. These rules would let Ohio rip away peoples' health care if they don't work or do a county work program for 80 hours a month. Withholding treatment for chronic health conditions or mental health services will NOT help people get or keep a job. (Amanda Woodrum, 6/2)

Huge news out of Virginia Wednesday: The State Senate approved expanding Medicaid to cover 400,000 low income residents, putting an end to years of Republican intransigence and opposition. As health care advocate Topher Spiro put it, “This is a major victory that will transform the lives of thousands of families.” ...Indeed, it’s possible Utah will become the 34th to do so. On Tuesday, state election officials said a voter initiative to expand Medicaid collected enough signatures to appear on the ballot in November. Polls show that two thirds of Utah voters support the Medicaid expansion in their state. So it’s unlikely to be close. At least, that’s what will happen if the voters get to decide. (Helaine Olen, 5/31)

Why did American health care costs start skyrocketing compared with those of other advanced nations starting in the early 1980s? At the same time this was happening, American longevity gains were failing to keep up with peer countries. In addressing these twin mysteries in a recent article, experts suggested two main reasons: The United States didn’t impose the same types of government cost controls on health care that other nations did, and we invested less in social programs that also promote health. (Austin Frakt, 6/4)

According to a new Harvard University study out this week, 4,645 people are dead as a result of the hurricane and its aftermath. ...If the study is correct, it means Hurricane Maria is the most deadly natural disaster in modern U.S. history. It’s hard to overstate the abysmal moral failure contained in that revised number. (6/1)

It is eight months now since Hurricane Maria ravaged Puerto Rico, leveling 70,000 homes and leaving 3.3 million people without power or water and the health care system in tatters. By any measure, the catastrophe was on a level with Hurricanes Katrina and Sandy, two other storms that devastated large regions of America. But the response, as demonstrated most recently by a report that estimates the death toll as more than 70 times larger than the official one, has been slow and inadequate. There are various reasons for that, including Puerto Rico’s distance from the United States mainland and local mismanagement, the latter exemplified by an infamous repair contract inexplicably granted soon after the hurricane to a Montana firm with two employees. ...But the chief reason has been the perception in Washington, and especially in the White House, of Puerto Rico as a second-class United States territory where poverty, hardship and shoddy government are accepted as the norm. (6/3)

Ever since the seminal 1957 decision of Salgo v. Stanford, U.S. courts and the health profession have recognized that there is a duty for providers to disclose not only the risks of treatments, but also their alternatives. This is essential to respecting dignity, autonomy and freedom of choice for patients. The Trump-Pence administration rejects these quintessentially American values and is substituting instead a regime that actively hides information from patients and silences their nurses and physicians. (R. Atla Charo, 6/1)

Addressing issues related to poverty, an underlying and arguably the most important risk factor for disease, can make a difference. High-quality early childhood programs that support parenting lead to increased educational achievement, higher incomes and better health. One study showed that increasing the minimum wage was associated with a decrease in low birth weight babies and infant mortality. Another study showed that raising the minimum wage in New York in 2008 would have prevented thousands of deaths over the next 5 years. (Jessica Schorr Saxe, 6/1)

Across the country, Democrats are winning primaries by promoting policies like universal health insurance and guaranteed income — ideas once laughed off as things that work only on the “Left Coast. ”At the same time, national politicians from both sides are finally putting front and center issues that California has been grappling with for years: immigration, clean energy, police reform, suburban sprawl. And the state is home to a crop of politicians to watch, from Kevin McCarthy on the right to Gavin Newsom and Kamala Harris on the left, part of a wave that is likely to dominate American politics for the next generation. California, which holds its primaries on Tuesday, has long set the national agenda on the economy, culture and technology. (Steve Kettmann, 6/2)

The pharmaceutical industry believes that the lucrative future of cancer treatment lies in combining immune-boosting medicines with other drugs to boost their effectiveness. But that future is still a ways off, and the present is pretty ugly. It’s something to keep in mind as one of the year’s biggest cancer conferences gets underway in Chicago. (Max Nisen, 6/1)

As the International Bio Conference opens here in Boston, I’ve been thinking a lot about the impossible. The annual convention of biopharma leaders celebrates innovation — and there’s a lot to toast this year. Cancer patients can now be treated with custom-built therapies that rewire immune cells to attack their tumors. Children on the brink of losing their vision can get a gene therapy to treat a genetic form of blindness. Just this month, the US Food and Drug Administration approved the first preventive treatment for migraines. These accomplishments are inspiring. But my particular field — neurodegenerative diseases — has had little cause to celebrate. To some, it’s starting to feel like an impossible quest. I disagree. (Adam Rosenberg, 6/4)

Boston’s rise as the biotech capital of the world has been well-chronicled. Many factors make the city — in fact, the entire region around Boston — attractive to those seeking to create the next pharmaceutical breakthroughs. The area is home to some of the finest academic institutions, hospitals, and venture capital firms; has a highly educated and diverse workforce; and its location provides relatively easy access to Europe and the world beyond. (Bill Sibold, 6/3)

Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called nonnutritive sweeteners, these can be synthetic, such as saccharin and aspartame, or naturally derived, such as stevia. To date, the Food and Drug Administration has approved six types of artificial and two types of natural nonnutritive sweeteners for use in food. That’s been great news for those working hard to curb their sugar consumption. Aspartame, for example, is found in more than 6,000 foods worldwide, and about 5,000 to 5,500 tons are consumed every year in the United States alone. (Eunice Zhang, 6/3)

Dermatologists in a recent Bloomberg article have recently claimed that Americans are using inferior sunscreens compared to the ones available in Europe, Japan, Australia, and Canada. However, that is a gross misrepresentation of the true situation. While it is true that new and innovative sunscreen ingredients are available for consumer use in these countries; and while it is also true that the U.S. has been slow to adopt these sunscreen ingredients; it is objectively false to claim that U.S. sunscreens are outdated and needlessly expose you to cancer risk. (Janet Hill Prystowsky, 6/2)

Assisted suicide is becoming more popular throughout the developed world. The New Zealand Parliament is currently debating its legalization. A legalization proposal in Guernsey in the United Kingdom was recently voted down, but in nearby Jersey a majority of politicians up for election support legalization. Assisted suicide and in some cases outright euthanasia are legal in a number of Western European countries: Switzerland, Belgium, Luxembourg, the Netherlands. In America, meanwhile, assisted suicide is legal in several states and the District of Columbia. (Daniel Payne, 6/1)

When President Trump mused that the mass shooting at a high school in Parkland, Fla., in February might have been prevented if the United States had more mental institutions, he revived a not-quite-dormant debate: Should the country bring back asylums?Psychiatric facilities are unlikely to prevent crimes similar to the Parkland shooting because people are typically not committed until after a serious incident. Still, a string of news articles, editorials and policy forums have noted that plenty of mental health experts agree with the president’s broader point. (6/2)

In conclusion, most agree that the "transition" to value-based payment needs to accelerate dramatically, as Secretary Azar stated in the same March speech. Once just a small number of the long-term payers successfully implement recurring provider payments for chronically ill patient outcomes, they will set off a private market firestorm and get this done. (Alain C. Enthoven, Russell J. Mueller and Charles Weller, 6/3)

We have argued that any approach to reducing gun violence involves an increased focus on mental health counseling. Mental health issues were discussed in the Yoder meeting, including so-called “red flag” laws that allow judges to prevent weapons from falling into the hands of the mentally ill. (6/1)

The newly appointed Judicial Commission on Mental Health has its work cut out. There are simply not enough beds at the state hospital level to accommodate all the people who need that level of service. The state is working to address the problem by adding more beds, but its pace is not fast enough to meet the demand. (6/2)

There’s a good chance medical marijuana won’t be available to those who need it by the Sept. 8 deadline, and that’s not OK. Ohio became the 25th state to legalize medical marijuana in 2016 and set the deadline for when patients 21 or older suffering from 21 severe medical conditions — including cancer, Alzheimer’s and Parkinson’s — can purchase and possess up to a 90-day supply with authorization of a certified doctor. (6/2)

At some point, almost all of us will seek treatment at a hospital. And it is hard to decide which one to choose. Do not expect an unbiased opinion from your health-care provider, since most are now employees of the facility. To find the best care, you must shop for both quality and price. If your hospital admission is planned, it is best to negotiate payment on the front end. Do not expect accrediting agencies to assure hospital quality. Currently, the U.S. Congress is holding hearings because 39 percent of hospital accreditation surveys did not detect serious problems. Thus, you need to do your own research. (Kevin Kavanagh, 6/1)