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Days before a pivotal vote, House Speaker Paul Ryan said Sunday he will seek changes to a GOP health care bill to provide more help to older people. The new willingness to compromise was a bid for more support from moderate Republicans, who expressed continuing unease about the plan to replace Barack Obama's health law unless significant changes were made. (3/19)

“We think that we should be offering even more assistance than what the bill currently does,” Ryan (R-Wis.) said in a “Fox News Sunday” interview, in which he confirmed that House leaders are eyeing a Thursday vote on its passage. Meanwhile, a key conservative senator said White House officials were continuing to negotiate through the weekend on even more dramatic revisions to the bill in hopes of winning over hard-liners who have threatened to tank the legislation. (DeBonis, 3/19)

House Speaker Paul Ryan on Sunday expressed confidence that the Republican health-care plan will pass the House later this week, saying his party’s lawmakers are working to make changes to the bill to address remaining concerns, including providing more assistance to older Americans. “I feel very good about it. This is exactly where we want to be,” the Wisconsin Republican said in an interview with “Fox News Sunday.” (Hayashi, 3/19)

Ryan's comments came in the wake of a Congressional Budget Office analysis showing that older people could pay higher premiums under the GOP bill. Ryan expressed skepticism about the CBO analysis but said his leadership team is looking at more ways to help older people under the new plan. (Kullgren, 3/19)

Ryan said Sunday the CBO looked at "a little piece of the issue." "When we know the secretary of [Health and Human Services] will help bring market freedom and regulatory relief to the health insurance markets to dramatically lower the price of the plan for the 50- and 60-year-olds," Ryan said. (Savransky, 3/19)

“We have to do something about the fact that the House bill disproportionately affects older, rural Americans,” Republican Senator Susan Collins of Maine said on NBC’s “Meet the Press” on Sunday. Ryan didn’t say whether he had the 218 votes necessary to pass the bill, which would replace President Barack Obama’s signature Affordable Care Act, but he said he feels “very good about where we are.” (Brody and Edney, 3/19)

Among the groups hardest hit by the Republican plan to replace the Affordable Care Act is one that swung for Donald Trump during last year's presidential race — older Americans who have not yet reached Medicare age. Many of those who buy their own health insurance stand to pay a lot more for their coverage. That is especially true for the nearly 3.4 million older Americans who have enrolled through the government marketplaces, many of whom receive generous federal subsidies through the health care law enacted under former President Barack Obama. (3/19)

Just shy of Medicare eligibility, [Erika] Snyder is part of the age 50 to 64 demographic that would face much higher insurance costs under the GOP plan, known as the American Health Care Act. The law would eliminate Obamacare subsidies that 3 million Americans in that age bracket currently rely on to purchase insurance. It would also allow insurers to charge older people up to 5 times as much as younger Americans for individual policies, while providing an age-based tax credit that experts say would fall far short of covering these additional costs. (Ross, 3/17)

President Trump and conservative lawmakers in the House agreed Friday to significant changes to Medicaid that could impose work requirements on able-bodied Medicaid beneficiaries in some states and limit federal funds for the program, as Republican leaders tried to rally balking lawmakers behind legislation to repeal the Affordable Care Act. “I want everyone to know, I’m 100 percent behind this,” Mr. Trump said at the White House, where he met with House members in the conservative Republican Study Committee. (Kaplan and Pear, 3/17)

The House Republican health-care plan picked up an important endorsement on Friday from leaders of a large bloc of conservative lawmakers, after President Donald Trump backed more stringent curbs on funding for Medicaid, as well as work requirements for its low-income beneficiaries. (Radnofsky, Hackman, Peterson, 3/17)

Also, the legislation would give states the option to receive federal Medicaid funding as a block grant. The current legislation calls for giving states a set amount of money per enrollee, known as a per capita cap system. Both would be a major change from the current way Medicaid is funded, which is open-ended federal support tied to state spending on the program. (Luhby, 3/19)

All but one of the 17 RSC Steering Committee members (not counting four ex-officio members) have committed to voting yes on the bill, eight or nine of whom had shifted from a no or leaning no because of the Medicaid changes, RSC Chairman Mark Walker told reporters at the Capitol. (Bennett and McPherson, 3/17)

"I just want to let the world know, I am 100 percent in favor," Trump told reporters brought to the Oval Office to see the tail end of his meeting with about a dozen members of the Republican Study Committee. That group of House members includes some who'd been lukewarm about the bill going into the meeting. (Keith, 3/17)

Many forms of public assistance, including food stamps, require recipients to work, look for work, volunteer or participate in vocational training. The work requirements vary from one program to the next and have varying requirements vary by the program and traits of the recipients, such as their ages and whether they have children. Yet when it comes to health insurance, such requirements would be nearly impossible to enforce, conservative and independent experts on the Medicaid program said Friday. (Ehrenfreund, 3/18)

Its Medicaid recommendations further highlighted the ideological cross-pressures on Ryan — and the Trump administration — in forging a set of Republican health policies that might pass both the House and the Senate. While the committee is trying to nudge the program toward the right, moderate GOP governors and senators are fighting to ward off the loss of millions of dollars in federal aid to the 31 states, plus the District of Columbia, that expanded their Medicaid programs. (Goldstein and Eilperin, 3/17)

House Republicans plan to vote Thursday on a reconciliation bill that would repeal and replace significant parts of the Affordable Care Act, with the House Rules Committee set to mark up the legislation Wednesday. (McIntire, 3/17)

Sen. Tom Cotton (R-Ark.) indicated Sunday the private insurance market provisions in the current GOP healthcare proposal is a larger problem than Medicaid expansion. Cotton told host Jake Tapper on CNN's "State of the Union" that the Medicaid expansion provided a partial solution to health insurance coverage, but the private insurance market would hurt everyday Americans. (Beavers, 3/19)

Four Republican governors have announced their opposition to the House GOP legislation to replace the Affordable Care Act, another sign of the political challenges facing the bill. (Hackman, 3/17)

In a letter Thursday, governors from Ohio, Nevada, Michigan and Arkansas wrote Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan and said the legislation the House is considering “does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states.” They said the bill “does not meet” goals set out by President Donald Trump about state flexibility and making sure people are covered. (Edney and Tracer, 3/17)

The governors for months have cautioned their party about passing legislation that would lead to major coverage losses in their states, and their opposition could present a new challenge for the bill. The letter comes as House Republican leaders are increasingly optimistic their bill could win support from conservatives who've complained the GOP plan doesn't do enough to gut Obamacare. (Pradhan, 3/17)

The future of Medicaid could become a pivotal issue as the health care debate moves to the Senate. Kevin Smith, a spokesman for Sen. Rob Portman, R-Ohio, said his boss "shares (governors') concerns about the need to protect the Medicaid expansion population and give governors more flexibility to ensure they can design programs that meet the needs of their states." (3/18)

During a meeting at Donald Trump’s Mar-a-Lago estate in Florida Saturday, the president’s top advisers told three of the most vocal conservative opponents of the bill — Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) and House Freedom Caucus Chairman Mark Meadows (R-N.C.) — that they agree with some of their demands in principle, according to several sources familiar with the discussions. But it’s also become increasingly apparent to the White House that the conservatives’ requests, which include phasing out Obamacare’s Medicaid expansion earlier and deregulating the insurance industry, are unlikely to pass the Senate. (Bade, Dawsey and Everett, 3/19)

Sen. Ted Cruz said Sunday he spent three hours at the Mar-a-Lago estate of his former rival on Saturday, negotiating with President Donald Trump's team on changes to the Republican health care bill. (Kullgren, 3/19)

Donald Trump likes to move fast. But to this point, for all the bravado, executive actions and tweets, much of Trump's presidency has been showy without a lot of practical effect. For that to change, much of it could depend on the next three weeks. This critical phase could set his ambitious agenda on course or derail it. (Montanaro, 3/20)

Halfway through Congress’s 2013 summer recess, a letter landed on the desks of House Republican leaders demanding a new strategy to fight “one of the largest grievances in our time.” Give Congress the option to defund the Affordable Care Act, it said, or risk shutting down the government. Republican leaders condemned the idea, and the 80 House Republicans who signed the letter acquired a nickname, courtesy of the conservative commentator Charles Krauthammer — the “suicide caucus.” (Huetteman, 3/20)

Congressional Republicans have a lot to say about their new president. Donald Trump's proposed budget is "draconian, careless and counterproductive." The health care plan is a bailout that won't pass. And his administration's suggestion that former President Barack Obama used London's spy agency for surveillance is simply "inexplicable." With friends like these, who needs Democrats? (Lerer, 3/18)

Sen. Rand Paul (R-Ky.) on Sunday said he does not believe proposed Republican healthcare legislation will pass through Congress. "I don't believe so. I think there's enough conservatives that do not want 'ObamaCare lite,' " Paul said on ABC's "This Week." Paul during the interview stressed a clean repeal of ObamaCare. (Shelbourne, 3/19)

Vice President Mike Pence called on Congress to “keep the president’s promise” during an event in Florida to shore up support for a contentious health-care bill, but didn’t address the finding that has moderate Republicans most worried: that 14 million Americans may lose health coverage in a year. “We’re going to continue to work with members of Congress to improve this bill,” Pence said in Jacksonville after meeting with small business owners. He noted a plan that would allow states to include a work requirement for able-bodied adults to receive Medicaid. (Olorunnipa, 3/17)

Health and Human Services Secretary Tom Price on Sunday reaffirmed President Trump’s goal to provide healthcare insurance for all Americans. “The president is committed to that as am I and those of us at the Department of Health and Human Services,” Price told host Jake Tapper on CNN's "State of the Union." Price repeatedly stressed that the Republicans' healthcare proposal is in the first of three phases. (Beavers, 3/19)

Health and Human Services Secretary Tom Price on Sunday shot down a clean repeal of ObamaCare, arguing that doing so would put “vulnerable people at risk.” “What that does is place vulnerable people at risk, and that’s not something that the president’s willing to do, it’s not something that he said he would do,” Price told ABC’s “This Week" when asked what is wrong with a clean repeal. (Shelbourne, 3/19)

When bioethicist and oncologist Ezekiel Emanuel meets with President Trump at the White House on Monday, the session will reveal publicly what has been happening privately for months: A trusted ally of former president Barack Obama and chief architect of the Affordable Care Act is trying to help steer how Republicans rework it. (Eilperin and Goldstein, 3/20)

Republicans intent on scrapping Barack Obama's Affordable Care Act have a budget problem. As it turns out, repealing and replacing the law they hate so much won't save nearly as much money as getting rid of it entirely, the goal they've been campaigning on for seven years. That means trouble for the federal deficit and for Congress' fiscal conservatives who repeatedly warn about leaving their children and grandchildren worse off financially. (Taylor, 3/18)

The Republican-proposed bill to replace Obamacare would be a credit negative for U.S. states, according to Moody's Investors Service, because it would shift a greater share of the cost of Medicaid to the states. The bill, known as the American Health Care Act, aims to replace the Affordable Care Act, commonly known as Obamacare. (Respaut, 3/17)

The Republican-proposed bill to replace Obamacare would hurt the credit ratings for U.S. states, according to Moody's Investors Service, because it would shift a greater share of the cost of Medicaid to the states. That could raise borrowing costs for states and lower the value of bonds already held by investors. (Schoen, 3/18)

One simple way to fix Obamacare is to do something that no one is willing to do: Kick hundreds of thousands of young, mostly healthy Americans off their parents’ coverage. Obamacare allowed young adults to stay on their parents’ plans until they turn 26. It’s a wildly popular feature and a successful one. The uninsured rate for 18- to 25-year-olds has dropped by more than 50 percent since 2010 — a steeper decline than for any other age group. Taking away this provision of the law — even though it might help stabilize the broader health system — is politically toxic to both Democrats and Republicans because it would antagonize millions of middle-class voters. (Demko and Cancryn, 3/19)

Republican plans to scrap Obamacare and roll back its Medicaid expansion are sending tremors through the burgeoning "gig economy" — and nowhere more so than in California. With the Silicon Valley and on-demand companies like Lyft and Uber in its backyard, the Bay Area will be a laboratory for determining whether repeal efforts shift employment away from temporary jobs and startups into more traditional employment — potentially dampening innovation. (Colliver, 3/18)

Planned Parenthood, a major provider of contraception and other preventive health care to poor women in Pennsylvania, is betting that congressional efforts to pull federal funding for those services will backfire. Planned Parenthood is targeting moderate Republicans in the House – including several representing competitive districts in the Philadelphia region – in hopes of stopping a proposal it says could force half of its 2.5 million patients nationwide to go elsewhere for birth control. The agency received about $500 million in federal money last year. (Fitzgerald, 3/19)

When you talk to GOP lawmakers in the Congress about an overhaul of the Obama health law, one of the most mentioned items by Republicans is making it possible for insurance companies to sell health coverage policies across state lines, as the Trump Administration argues that will help promote competition, and bring down prices for consumers. (Dupree, 3/18)

Designing skateboards is just one of Luke Franco's gigs. He has just enough time before his next shift to chat at a café in downtown Providence, R.I. "I work at the YMCA Monday through Friday with kindergartners through fifth graders. It's split shift; seven to nine, two to six daily," he says. "With the rest of my day, I also work at a local pizza place. And in addition to that, I also own and operate a small skateboard company." (Gourlay, 3/19)

In pushing for a repeal of the Affordable Care Act, Republicans have put forth a number of claims about their own bill. (Chakrabarti, 3/17)

Two of Washington’s most influential lobbying groups on Friday announced separate plans to stir up opposition to a House bill that could shrink the number of Americans with health insurance. The efforts from AARP and the American Hospital Association may complicate the already daunting task for GOP leaders of finding enough support for the bill ahead of a Thursday vote, amid continued intra-party squabbles and staunch Democratic opposition. (Young, 3/17)

Feeling unheard in the House, the American Hospital Association is turning to the Senate to stop the American Health Care Act from becoming law. The hospital industry's largest lobbying organization met and shared its concerns with House leadership about provisions of the law it feels will result in millions of people losing coverage, which could ultimately harm the financial stability of many hospitals when their uncompensated-care costs soar. (Dickson, 3/17)

James Waltimire, a police officer on unpaid medical leave, has been going to the hospital in this small city twice a week for physical therapy after leg surgery, all of it paid for by Medicaid. Mr. Waltimire, 54, was able to sign up for the government health insurance program last year because Ohio expanded it to cover more than 700,000 low-income adults under the Affordable Care Act. He voted for President Trump — in part because of Mr. Trump’s support for law enforcement — but is now worried about the Republican plan to effectively end the Medicaid expansion through legislation to repeal the health care law. (Goodnough and Martin, 3/19)

Speaker Paul Ryan and President Donald Trump — those awkward, sometimes reluctant allies — face the biggest test yet of their unusual relationship as the House barrels toward a dramatic vote this week on repealing and replacing Obamacare. The stakes could not be higher for either of them. (Bresnahan and Bade, 3/20)

A group allied with House GOP leaders is targeting Republicans in competitive House districts with an ad campaign ahead of a potential vote this week on legislation to repeal and replace the healthcare law. American Action Network (AAN) is launching digital ads on Monday through video, display ads and landing pages urging lawmakers to support the GOP leadership-backed bill, titled the American Health Care Act. (Marcos, 3/20)

An advocacy group with close ties to House leadership is launching a final push to pressure 29 Republicans to support the GOP health care plan ahead of an expected vote later this week. Some of those lawmakers have indicated they won’s support the bill. The six-figure digital campaign comes from American Action Network, the issue advocacy organization that has already spent more than $10 million in 75 congressional districts in support of Republicans’ plan to repeal and replace the 2010 health care law. (Pathé, 3/20)

If he were still Professor Dave Brat, he’d call the course he might teach about the last couple of months in Washington, “A Primer in Chaos Theory.” But he’s Congressman Dave Brat, and instead he’s been sowing some of that chaos himself. And he’s nowhere near done helping lead the intra-Republican revolt against the Obamacare repeal bill pushed hard by House Speaker Paul Ryan and President Donald Trump. He's already predicting conservative insurgents will primary GOP incumbents over the health care fight. (Dovere, 3/20)

Rep. Jason Chaffetz has strolled to four easy re-election wins in his Republican-friendly Utah congressional district, but now he's facing a surprising challenge from a Democratic political newcomer who raised nearly a half million dollars — by tapping into anger over Chaffetz' recent comment suggesting people should spend their money on health insurance instead of iPhones. Dr. Kathryn Allen has been transformed from a political unknown into a liberal hero for calling out Chaffetz on Twitter, giving her an early boost in name recognition ahead of the November 2018 election. (McCombs, 3/17)

One-size-fits-all was one of the chief criticisms of the Affordable Care Act, also known as Obamacare. It seems the alternative proposed by the Trump administration has taken the same route -- only this time, affecting the poorest and oldest Americans. An AJC analysis of Kaiser Family Foundation data on the proposed American Health Care Act revealed that older Americans with the lowest incomes would be hit the hardest by the Republican replacement plan. (Datar, 3/17)

Massachusetts Republican Gov. Charlie Baker has a way to deal with the uncertainty surrounding his party's efforts to scrap Obamacare: Shift back to the pre-ACA days, when Romneycare reigned supreme. At its core, the system established in 2006 under former Gov. Mitt Romney was proto-Obamacare, mandating free health insurance for residents earning less than 150 percent of the federal poverty level while requiring employers with more than 10 full time workers to offer coverage. The 2010 federal health law superceded the state system, which by then had reduced the uninsured rate in the Bay State to 3 percent without raising health spending. (Dezenski, 3/17)

Illinois stands to lose an estimated $40 billion in federal money over the next decade under the Republican health care proposal being considered in Congress, experts told state lawmakers Thursday. ... The $40 billion projection is based on a report released this week by the Congressional Budget Office that said 24 million Americans would lose coverage by 2026 under the Republican plan, David Gross, senior vice president of government relations for the Illinois Health and Hospital Association, told lawmakers. The report said states could lose out on a possible $880 billion in federal funding over that same period. (BeMiller, 3/17)

Rhode Island may need to spend another $25 million to $30 million to keep 70,000 low-income adults from losing their Medicaid coverage under the House Republicans' plan to replace the Affordable Care Act in 2020, according [to] a preliminary analysis performed by health experts for The Providence Journal. And that's just in the first year. In 2021, the additional cost is projected to run between $65 million and $70 million — an expense, some experts say, the state would likely be unable or unwilling to absorb. (Arditi, 3/17)

Despite a national focus on the individual insurance markets, the Republican health plan being debated in Washington could have far more sweeping impact in Louisiana for other provisions that curb federal spending on Medicaid. That redesign is estimated to come with deep spending cuts. The implications would be major for Louisiana, where more than one-third of residents get health services through the Medicaid program, financed jointly by the state and federal government. (Deslatte, 3/19)

Detroit mother Vanessa Raices, 42, said she doesn’t know the ins and outs of what is happening with health care in Washington, D.C., but she knows enough to be worried. Health care for Raices and one of her four children is covered under Michigan’s Medicaid program. That coverage could change dramatically under the GOP health plan under debate by Congress. ... The program has deep roots in Michigan, where Medicaid provides health coverage for nearly 2.5 million people. The proposed changes would touch every community in the state, from urban centers in the southeast to the rural counties of northern lower Michigan and the Upper Peninsula. (Bouffard, 3/20)

Half of Denver Health’s patients are on Medicaid, meaning government dollars play a major role in the safety-net hospital’s budget. Already this year, Denver Health is trying to trim $48 million from its budget because of expected cuts to the hospital provider fee, a complicated mechanism to pay back hospitals for taking in poor and low-income patients that has also become embroiled in state Capitol budget fights. But the bigger threat, Denver Health leaders say, could come if Congress passes the American Health Care Act, the Republican-backed plan to replace Obamacare and overhaul how Medicaid works. Peg Burnette, Denver Health’s chief financial officer, said the bill could mean a revenue hit in 2020 — when the bill’s more significant Medicaid provisions kick in — of between $50 million and $85 million. (Ingold, 3/18)

How many older Floridians with Affordable Care Act coverage would see their premiums rise under the Republican replacement plan? About 454,000, according to a new analysis by AARP. Low-income people in their 60s would be hardest hit, the analysis found. For some, the proposal under consideration in Congress could mean an annual tax credit reduction of nearly $6,000. (McGrory, 3/17)

As many as a half-million Texans could become uninsured under the Republican plan to replace the Affordable Care Act, wiping out at least half the gains the state has made in reducing the number of uninsured residents in recent years, according to health care analysts. Texas still has the nation's highest percentage of people without health insurance, but that uninsured rate has dropped significantly, falling to about 19 percent from 26 percent over the past four years. About 1 million more Texans gained coverage under the health care overhaul known as Obamacare, which became law in 2010. (Deam, 3/18)

No congressional district in Wisconsin delivered a bigger victory margin for Donald Trump last fall (20 points) than the rural northern one represented by Republican Sean Duffy. But by one key measure, no district in Wisconsin would lose more health care aid under the GOP plan to replace Obamacare. (Gilbert, 3/18)

[Diane] Hughes was among the West Virginia residents gathered at the Robert C. Byrd Health Science Center here on Thursday for a town hall meeting on the Republican plan to overhaul the 2010 health care law. ... She credited the health care law with allowing her to participate in a behavioral health program that has helped her recover [from addiction to pain medication]. ... The Republican plan, which is scheduled for a House floor vote on Thursday, would eliminate a requirement relating to mental health and substance abuse services. Plans offered through the 2010 law’s Medicaid expansion were required to provide those services. (Bowman, 3/20)

Former U.S. Attorney Preet Bharara, who was removed from his post by the Trump administration last week, was overseeing an investigation into stock trades made by the president’s health secretary, according to a person familiar with the office. Tom Price, head of the Department of Health and Human Services, came under scrutiny during his confirmation hearings for investments he made while serving in Congress. The Georgia lawmaker traded hundreds of thousands of dollars worth of shares in health-related companies, even as he voted on and sponsored legislation affecting the industry. (Faturechi, 3/17)

Preet Bharara, a former top federal prosecutor in Manhattan, was investigating stock trades by Health and Human Services Secretary Tom Price prior to Bharara’s ouster last week by President Donald Trump,  ProPublica reported Friday. The report, attributed to an unnamed person familiar with the U.S. Attorney’s Office of the Southern District of New York, revived questions about the propriety of Price’s investments in numerous health care companies that stood to benefit from legislation he voted for and sponsored as a Georgia congressman. Those concerns have dogged the former congressman since Trump nominated him to head HHS last November. (Kopp and Bluth, 3/17)

Cancer researchers and advocacy groups are denouncing President Trump's proposed budget, warning that its 19 percent cut for the National Institutes of Health could cripple or kill former vice president Joe Biden’s cancer “moonshot” initiative and other important biomedical efforts. “Forget about the moonshot. What about everything on the ground?” said George Demetri, an oncologist at Dana-Farber Cancer Institute in Boston. “Fundamentally, this is so extreme that all I can think is that it’s pushing two orders of magnitude off the grid so that when people come back to less extreme positions it looks normal.” (McGinley, 3/17)

Nobody in the United States has ever died from an intercontinental missile strike. Over the past 50 years, hundreds of billions of dollars have been spent on silos, submarines, bombers and satellites to ensure that does not happen. During the same period, nearly 2 million Americans have died from intercontinental virus strikes. The toll includes one American dead of Ebola, 2,000 dead of West Nile virus, 700,000 dead of AIDS, and 1.2 million dead of flu — a virus that returns from abroad each winter. (McNeil, 3/17)

President Donald Trump’s budget proposal deeply rattled the nation's biomedical research enterprise, which was not only dismayed by massive cuts to the National Institutes of Health but also caught off guard by major changes to the Food and Drug Administration's budget. The administration did not specify a topline number for the FDA budget, which was around $4.7 billion in recent years. Normally $2.7 billion comes from discretionary appropriations and the rest from fees paid by regulated industries. The administration seems to want to flip that. The budget plan said it would “recalibrate” medical user fees and increase them by $1 billion in order to “replace the need for new budget authority.” (Siddons, 3/17)

An estimated $5.8 billion in cuts to the National Institutes of Health in President Donald Trump’s proposed budget has California’s top universities and medical institutions sounding the alarm. Trump’s spending plan — running into opposition from Republicans and Democrats alike — would cut about 20 percent of the roughly $30 billion budget of the nation’s medical research agency that supports research on cancer, Alzheimer’s disease, Zika and other conditions. Research institutions nationwide decried the cuts as potentially devastating to their work. (Korry, 3/17)

President Donald Trump's proposed budget includes cuts in public health and medical research funding that would both eliminate jobs and essential services in Northeast Ohio, according to local health and policy experts. Combined with the proposed public health funding cuts in the Republican Obamacare replacement plan, the impact on Ohio state and local health department infrastructure and ability to deliver basic preventive health services would be enormous, said Cuyahoga County Health Commissioner Terry Allan. (Zeltner, 3/17)

President Trump's proposal to slash federal support of medical research would undercut Houston's burgeoning health care and medical technology industries, which are becoming an increasingly important segment of the region's economy. Health care employs more than 560,000 people in the Houston area, a steadily expanding sector that has added about 170,000 jobs over the past 10 years and helped stabilize the local economy during the recent oil bust. Those figures don't include an emerging industry of biotechnology and medical device firms that are growing around Houston's medical complex. (DePillis, 3/17)

One of the casualties of President Donald Trump's proposed budget may be Meals on Wheels, the familiar food delivery program for homebound Americans. The aim is to decrease federal spending, but cuts to the service could backfire by raising health-care costs, the program warned. The spending plan calls for reductions to two grants that Meals on Wheels relies on in some locations, as well as to federal departments that help fund the program, spokeswoman Jenny Bertolette said in a statement. "With a stated 17.9 percent cut to the U.S. Department of Health and Human Services budget," Bertolette said, "it is difficult to imagine a scenario in which these critical services would not be significantly and negatively impacted if enacted into law." (Mosendz, 3/17)

Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents’ medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them. (Jordan, 3/18)

Local leaders and health officials in Contra Costa County, home to four oil refineries, are blasting a part of President Trump’s budget that calls for cutting all money for the federal agency that investigates chemical accidents. Trump’s spending plan aims to eliminate funding for the U.S. Chemical Safety Board (CSB), which has conducted hundreds of probes, including one into the 2010 Deepwater Horizon oil spill. (Goldberg, 3/17)

Facing a possible civil rights investigation, Mayo Clinic’s chief executive is backpedaling from statements he made to employees about prioritizing the care of privately insured patients over those on Medicare and Medicaid. Dr. John Noseworthy issued a press release late Friday saying that he regrets that the wording he used caused confusion about the hospital’s commitment to serving patients with government insurance. He sought to correct the record after Minnesota regulators said they are looking into potential legal violations based on his comments. (Ross, 3/17)

John Noseworthy's comments were made late last year in a videotaped speech to staff but surfaced only this week after a transcript of his speech was obtained by the Star Tribune newspaper. The Mayo Clinic has verified the transcript is accurate. Noseworthy said in a statement Friday that medical need will always be the top factor in scheduling an appointment. (Forliti, 3/17)

A new abortion clinic in the region would be notable enough: Across the Bible Belt, the swath of spiritual states stretching from Texas to North Carolina, the number of abortion clinics has dropped nearly two-thirds over the past three decades, in part due to restrictive laws, constant protests, and sporadic violence. But the activists behind the nonprofit Carafem didn’t just want to quietly open their doors. They embrace an unapologetic brand of women’s health care, which they launched with an in-your-face advertising campaign — in a conservative state where four out of five adults identify as Christian. (Blau, 3/20)

A federal court on Friday permanently blocked Mississippi's law that threatened to close the state's only abortion clinic by setting a hospital-privileges requirement the clinic couldn't fulfill. The ruling comes eight months after the U.S. Supreme Court blocked a similar law in Texas. In a statement, Center for Reproductive Rights President and CEO Nancy Northup called the ruling the latest victory for women's health and rights. (3/17)

As Republicans in Congress move to defund Planned Parenthood, a California state senator is pushing a bill to require student health centers on public university and community college campuses to provide non-surgical abortion services. Sen. Connie Leyva, D-Chino, is expected Friday to introduce Senate Bill 320, which would specifically require student health centers that operate with state funding to provide students with access to medication to abort a pregnancy. (Luna, 3/17)

The phone rings once approximately every 45 minutes — that is how often poison control centers in the United States receive calls about children being exposed to prescription opioids, according to a study published Monday. Over a span of 16 years, from January 2000 until December 2015, about 188,000 calls were placed to poison control centers regarding pediatric and teenage exposure to opioids, the study published in the journal Pediatrics found. Sixty percent of the children exposed to opioids were younger than 5, while teenagers accounted for 30 percent. (Naqvi, 3/20)

The numbers, Casavant said, show that the opioid epidemic "that has been ravaging our adults and our teens has worked its way down to young people as well." Most of the exposures — 60 percent — were among children age 5 or younger. The second-highest percentage — 30 percent — was among those 13 to 19 years old. Findings show that most of the exposures among the youngest children were unintentional and probably occurred when the youngsters found pills that were inappropriately stored, whether in sight or within reach in a purse. (Viviano, 3/20)

The ease of relapsing into opioid addiction has led a growing number of states to help residents make it clear to medical professionals they do not want to be prescribed the powerful painkillers. Connecticut and Alaska are two of the latest considering legislation this year that would create a “non-opioid directive” patients can put in their medical files, formally notifying health care professionals they do not want to be prescribed or administered opioid medications. (Haigh, 3/19)

The first prescription that patients get for opioid painkillers has a large influence on their risk of long-term use, according to a new report published Friday. Prescribing fewer opioids to be taken over a period shorter than three days in the initial prescription decreases the likelihood of chronic use, researchers wrote in the Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention. (Naqvi, 3/17)

Kevin Burnes thinks his school saved his life. He arrived there at 14 years old, just out of rehab, and says it was exactly what he needed: a place where kids with drug and alcohol problems could stay on a path of recovery as they worked toward high school graduation. “I have no question that it changed the course of everything I was doing,” said Burnes, now a music teacher and musician. (St. George, 3/19)

More than 1 million reports of drug side effects were filed with the U.S. Food and Drug Administration in 2015, a fivefold increase since 2004, according to an analysis by the Milwaukee Journal Sentinel and MedPage Today. Numbers aren’t final for 2016, but are expected to match that all-time high. (Wynn and Fauber, 3/17)

Women in their 30s are having babies at the highest rate since the 1960s, providing a rare bright spot in what’s an otherwise stagnating U.S. population. For women in their early 30s, the birthrate in 2015 was the highest it’s been since 1964, according to a Centers for Disease Control and Prevention report this year. And the rate for women age 35 to 39 was the highest since 1962, when families were larger and births hit near all-time highs in the baby-boom years. (Henderson, 3/20)

A score based on common blood tests may someday help people gauge their risk of developing a chronic disease like diabetes or dementia within three years of taking the test. The Intermountain Chronic Disease Risk Score was 77 to 78 percent accurate in predicting whether someone would be diagnosed with diabetes, kidney failure, coronary artery disease and dementia, among other illnesses. It's based on the results of a comprehensive metabolic panel, which includes tests for blood glucose and liver function, and complete blood count, which measures the quantity of different types of blood cells. (Hobson, 3/17)

Intermountain, whose telehealth system is among the most advanced in the country, is using the technology to extend its specialists' skills into the smaller community hospitals and rural locations in its network. These medical outposts rarely have the clinical expertise necessary to handle the more-complex cases that come through their front doors. The system has installed videoconferencing setups in 1,000 rooms across its 22 hospitals. Intermountain's 35 telemedicine programs include specialists providing consultations on stroke, newborn critical care, behavioral health, wound care and cancer care. Intermountain is also using remote monitoring for chronic disease patients with conditions such as hypertension and heart failure. (Livingston, 3/18)

When Kevin Breen first complained about feeling achy and tired, his wife couldn't help but wonder whether he was trying to wiggle out of a busy day of family responsibilities. It was Christmas Day, and Breen — an active 44-year-old whose idea of relaxing is going water skiing on Lake Michigan or playing pickup basketball — is rarely short on energy. But the Grand Rapids, Mich., resident insisted he really was feeling ill. And two days after his vague, flulike symptoms had begun, they'd taken on a strange new form: a razor-sharp stomach pain so powerful that Breen could no longer walk. (Holley, 3/18)

A medical marijuana dispensary plans to open in Hanover this summer next to Friendly’s on busy Route 53, allowing customers to -- if they so choose -- move quickly from a menu featuring THC-infused chocolate bars to one heavy on children’s meals and ice-cream sundaes. Meanwhile in neighboring Norwell, another medical marijuana outlet is breaking ground soon in a far less visible location -- tucked into the far reaches of an industrial park at the edge of town. (Seltz, 3/17)

In the heart of Northern California’s wine country, a civil engineer turned marijuana entrepreneur is adding a new dimension to the art of matching fine wines with gourmet food: cannabis and wine pairing dinners. Sam Edwards, co-founder of the Sonoma Cannabis Company, charges diners $100 to $150 for a meal that experiments with everything from marijuana-leaf pesto sauce to sniffs of cannabis flowers paired with sips of a crisp Russian River chardonnay. (Fuller, 3/18)

For more than 20 years, [Floyd] Huen has counseled thousands of arthritis and insomnia patients to try marijuana. On this night, though, Huen worked to persuade the Sunset group of the benefits of what would be the neighborhood’s first licensed pot shop — one he and his wife, former Oakland mayor Jean Quan, would co-own. (Downs, 3/18)

Dozens of other residents in Ohio nursing homes have died over the past few years in incidents involving their care, a Plain Dealer review of inspection reports shows. A federal statistical measure, meanwhile, rates Ohio's nursing homes among the nation's lowest in quality of care. (Caniglia and Corrigan, 3/19)

The Centers for Medicare and Medicaid Services, which created the rating system to help consumers choose homes wisely, also fined Park East $220,870 for the lapses that preceded the man's death. It was the largest fine levied against Ohio nursing homes in the past three years, out of more than $6.37 million in total fines. (Caniglia and Corrigan, 3/19)

The federal government's Nursing Home Compare system is the only way to evaluate nursing homes nationally, but there's a lively debate over whether it's good enough for families to rely on. Critics, including administrators of some of the lowest-rated nursing homes in Northeast Ohio, say the system is flawed. They noted it penalizes homes for problems that may have occurred years ago, and say it punishes facilities that take in the most seriously ill residents. (Caniglia and Corrigan, 3/19)

After working with the Virginia Department of Health since 1983, James Farrell is preparing to retire from his position as vaccination director — but he leaves with concerns. Vaccination rates in Virginia have plateaued. (Demeria, 3/19)

The Georgia Senate passed SB 201 that would require employers to let workers use their sick days to take care of a child, parent, or any dependent listed on tax returns. State Rep. Brian Strickland (R-McDonough) is sponsoring the bill in the House. (Bandlamudi, 3/17)

Less than three months into Philadelphia's new tax on sweetened drinks, the stakes have escalated: Beverage makers say the measure is hurting sales so much they need to cut jobs, while city officials say the moves are a ploy to get the tax struck down. (3/17)

[Barbara] Sales’ situation goes to the heart of problems that have plagued the Social Security Administration for years: Underfunded and overwhelmed, it operates with a workforce that has remained all but flat for more than 20 years in the face of a rising population and an explosion of disability applications... Some good news came this month when union officials representing federal workers were told that despite a federal hiring freeze, the Social Security Administration would be allowed to hire 100 extra workers to authorize benefits. (Adler, 3/19)

The new program, called ABLEnow, significantly increases the amount of money people receiving certain federal and state benefits may save without jeopardizing those benefits, said Mary Morris, CEO of ABLEnow and Virginia529. Account holders can save up to $100,000 before losing any of their Social Security housing benefits and up to $500,000 total. (Kleiner, 3/19)

The organization [Khmer Health Advocates] provides health care and counseling, and runs a treatment program for torture survivors. It has used a variety of innovative techniques to provide care, including a videoconferencing program that allowed people across the state to communicate with – and receive care from – those in the West Hartford office without having to travel. Another program paired the organization’s community health worker with a pharmacist who helped patients manage their medications. (Levin Becker, 3/19)

Last week the nonpartisan Congressional Budget Office estimated that the new Republican health plan would increase the number of uninsured Americans by 24 million people within a decade, mostly because changes in regulations, subsidies and Medicaid coverage would make insurance too expensive for them. Republican leaders seem unfazed by this, perhaps because, in their minds, deciding not to have health care because it’s too expensive is an exercise of individual free will. (Anu Partanen, 3/18)

The Ryan plan is indeed deeply flawed — not because it obliterates Obamacare, but because it doesn’t.Rather, it’s only the latest turn in a long saga of health care “reforms” that have constricted choice, disempowered consumers, banished price awareness, eliminated competition, and discouraged innovation. The results are all around us: skyrocketing medical costs, mounting economic pressures on employers, employees, doctors, and patients — and a political obsession with providing insurance, rather than with producing good health. (Jeff Jacoby, 3/19)

For more than seven years, Republicans obstructed and rallied their base with the idea that Obamacare was “America slouching toward socialism.” What’s more, Republicans promised they would repeal and replace President Obama’s signature legislation with a better way. Repeal and replace was a great message, but GOP leadership failed to craft serious replacement legislation. And now we’ve learned that their rallying cry was only that — a good campaign mantra. (Harold Ford Jr., 3/20)

It's time to start calling the American Health Care Act by its true name—the Force Older and Poorer Americans to Postpone Health Care Act. That is what the legislation promoted by President Donald Trump and House Speaker Paul Ryan would accomplish. And that, in turn, would wind up costing the federal government and the nation's employers a ton of money, none of which was included in the Congressional Budget Office's score of the bill. (Merrill Goozner, 3/18)

The key problem with the draft House health care bill is that it fails to correct the features of Obamacare that drove up health insurance costs. Instead, it mainly tweaks Obamacare’s financing and subsidy structure. Basically, the bill focuses on protecting those who gained subsidized coverage through the law’s exchange subsidies and Medicaid expansion, while failing to correct Obamacare’s misguided insurance regulations that drove up premiums for Americans buying coverage without government subsidies. (Edmund Haislmaier, 3/18)

The Republican Party is reaping the homogenized “rewards” of its recent push toward ideological purity. The tea party wave has led to a party of extremes and inexperience — it has driven out the nuanced thinkers, the people with institutional knowledge of how to run a government and the actual policy wonks. (Emily Mills, 3/18)

This preventive care, which is the cornerstone of family medicine, reduces long-term complications, such as heart attacks and stroke, which are far more difficult to treat and costly to the U.S. taxpayers. The potential short-term cost savings of repealing the Affordable Care Act will be significantly overturned by the costs of the uninsured receiving their care in ERs and prolonged hospitalizations. Kentucky and Ohio, in particular, need this accessible health care more than ever, as reflected by this region's epidemiology. (Samina Sohail, 3/17)

President Donald Trump is coming to Louisville Monday to tout a plan that doesn’t just roll back access to health care for all the people who gained it in recent years, including 500,000-plus Kentuckians. Trump also is defaulting on a commitment made a half-century ago to care for our most vulnerable: poor people who are elderly, disabled, pregnant or very young. This attack on traditional Medicaid goes far beyond Republican promises to repeal the Affordable Care Act; it is cruel and contrary to what candidate Trump promised when he tweeted “no cuts to Social Security, Medicare & Medicaid.” (3/17)

Purity, apparently, is what some conservative Republicans are demanding in a health insurance bill, which likely will be voted on this week, unless it is held back because Speaker Paul Ryan doesn’t think it has enough votes to pass. Supporters of the evolving House bill emphasize that this is a three-step process designed to get what virtually all conservatives want, a more cost-effective health plan, only they can’t muster enough votes, especially in the Senate. Some conservatives are taking an all-or-nothing approach, which is likely to guarantee they will get nothing. (Cal Thomas, 3/19)

A rare and startling event happened in politics the other day. A well-known conservative Republican spoke out against the GOP’s proposed healthcare plan because of humanitarian concerns, of all things: “Too many of my constituents will lose insurance, and there will be less funds to help the poor and elderly with their healthcare.” (Carl Hiaasen, 3/17)

Last fall when he was winning hearts and minds in the Midwest, Mr. Red Cap promised to remove the curse of Obamacare from the nation and replace it with something beautiful that would cover everybody. Now that Trumpcare is out for previews, he is still upbeat and says he is in a "beautiful negotiation" and will wind up with a "beautiful picture," but it's no longer about everybody. And the picture seems more like a watercolor than a photo. (Garrison Keillor, 3/18)

Health care should be a right for every American. That was an applause line for Sen. Bernie Sanders at a recent town hall in the very deep Trump territory of West Virginia. Sanders is in sync with a decades-long national trend of increasing access to health care. But the party in power is doing something completely different. (Linda Valdez, 3/18)

It’s time to take control of Medicaid before it takes control of us. Unless we act — and there is little evidence that we will — Medicaid increasingly becomes another mechanism by which government skews spending toward the old and away from the young. In the raging debate over the Affordable Care Act (Obamacare), this is a subject that neither Republicans nor Democrats dare touch. It’s an ominous omission that obscures the overhaul Medicaid really needs. (Robert J. Samuelson, 3/19)

The largest threat to children’s health in the new proposal is that it dismantles the Medicaid program, a primary source of health insurance coverage for children. In Virginia, more than 488,000 children and more than 15,000 pregnant women are covered by Medicaid. One in three births are covered by Medicaid. Roughly 30 percent of children with disabilities or special health care needs are insured through Medicaid, as are all children in foster care. (Margaret Nimmo Holland, 3/19)

Over the last few years, big managed care companies like UnitedHealth Group have contributed to the furor over the fate of the Affordable Care Act by saying that important parts of it are fundamentally flawed. But Obamacare hasn’t been a curse for the managed care companies. Over all, based on their share performance, it has been something of a blessing. (Jeff Sommer, 3/18)

The people in our government who oppose universal health care try to scare us by talking about how we’ll lose the personal connection we have with our doctor. Ha. I like my doctor fine, but if we were in an elevator together, I know he’d be trying to place me. “She looks familiar,” he’d be thinking, “but …” If I’m feeling sick, can I reach for the phone and call my doctor? I’d be lucky if I could get an actual person instead of a recording. And as for being seen, well, my doctor is booked for weeks in advance. If I’m sick, it’s Urgent Care where I go. (Carolyn Banks, 3/18)

Illicit drug use is an old phenomenon, and Jeff Sessions has an old solution: Take off the gloves. "We have too much of a tolerance for drug use," the attorney general complained to an audience of law enforcement officials Wednesday, promising more aggressive policing. ... in his prepared remarks, Sessions insisted that cannabis is "only slightly less awful" than heroin. Oh, please. The nation is in the midst of an epidemic of overdose deaths involving heroin and other opioids. In 2015, 32,000 Americans died of such overdoses. Compare that with the number of people who died from ingesting an excess of marijuana: zero. (Steve Chapman, 3/17)

President Trump's FDA appointee Scott Gottlieb wants to speed up the drug approval process to give patients quicker access to life-saving drugs. Luckily for him, President Obama gave him the tools he'll need to do so. In the waning days of his presidency, President Obama signed into law the bipartisan 21st Century Cures Act. The legislation permits the FDA to approve more drugs based on "surrogate endpoints." This move will speed up the drug approval process and improve millions of Americans' chances of beating cancer. (Sandip Shah and Vidya Ramesh, 3/20)

With the issue of prescription drug importation being debated on Capitol Hill again, mark me in the skeptical camp. As a matter of safety and practical policymaking, drug importation simply doesn’t work. It is not by happenstance that our country has the world’s safest drug supply. Counterfeit medicines are proliferating around the world and the people who do this are brilliant at making these products look just like the real deal. (Mike Leavitt, 3/20)

Meals on Wheels has been delivering food to older people in the United States since the 1950s. Last year it served 2.4 million people. This week, after President Trump released his budget proposal, a furor erupted over the program’s future and effectiveness. Let’s look at the evidence. (Aaron E. Carroll, 3/17)

Sadder still, is that so many of these cuts will do damage to so many of the people he persuaded to vote for him: the low-income, the unemployed, the chronically sick and under-housed. Though the president’s increases for training programs for disabled Americans deserve praise, his cutbacks in job training programs for seniors, perhaps unable to retire, but thrust into the job market; disadvantaged youth — and they don’t all live in inner cities, but in rural areas, too; and the out-of-work are headscratchers. Who’s going to fill all those jobs he’s promised to restore? And independent studies show Meals on Wheels, also on the chopping block, is extremely effective at providing isolated seniors nutrition and socialization. (3/18)

Cystic fibrosis is an inherited disorder that affects the lungs, pancreas, intestines and other organs. A genetic mutation leads to secretory glands that don’t work well; lungs can get clogged with thick mucus; the pancreas can become plugged up; and the gut can fail to absorb enough nutrients. Cystic fibrosis has no cure. Over the last few decades, though, we have developed medications, diets and treatments for depredations of the disease. Care has improved so much that people with cystic fibrosis are living on average into their 40s in the United States. In Canada, however, they are living into their 50s. (Aaron E. Carroll, 3/20)

Common sense dictates that Kansas doesn’t want guns in its mental hospitals. But the state is headed precisely in that direction unless lawmakers can rally in the days ahead and agree on exemptions to a gun law passed in 2013. That law gave mental hospitals, other hospitals and the state’s college campuses four years to prepare for the day when firearms would be allowed in their buildings. (3/18)