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In 2012, the Supreme Court declared that Congress had put “a gun to the head” of states by pressuring them to expand Medicaid, and it said that such “economic dragooning” of the states violated federalism principles embedded in the Constitution. Now, in a separate case, comments by several justices indicate that they could uphold a pillar of the Affordable Care Act — insurance subsidies for millions of lower-income people — by invoking those same principles. (Pear, 3/8)

President Barack Obama's health overhaul remains an all-consuming drama for many, even though millions of people are gaining insurance coverage through a law that's now 5 years old. During oral arguments last week in the latest Supreme Court case brought by the law's opponents, Justice Elena Kagan called it a "never-ending saga." Five reasons why the "Obamacare" epic plays on. (Alonso-Zaldivar, 3/8)

Republicans are under pressure to prove they can avert a massive healthcare meltdown if the party wins its latest ObamaCare battle in the Supreme Court this spring. Some of that pressure is being brought to bear, at least implicitly, by the justices themselves, who appear concerned over whether Congress can create a fully baked alternative plan if the court strikes down ObamaCare subsidies for 8 million people. Skepticism has also been growing within the GOP itself. "This is just going to be ugly no matter what we do," GOP strategist Rick Wilson said. (Ferris, 3/7)

If the challengers win–which seems less likely now, given the tenor of oral argument at the court on Wednesday–some states may seek to quickly establish their own exchanges or to work with the administration to develop a hybrid model under which states control their exchanges but farm out some of the back-end duties to the federal government. A plaintiffs’ victory also could give new momentum to those Republicans who want to replace the Affordable Care Act with another plan (a proposal that could attract a few Senate Democrats up for reelection in 2016 in states where Obamacare continues to be unpopular). (Litan, 3/6)

In the last presidential election, which was dominated with rhetoric about the Affordable Care Act, this community voted roughly 58% to 42% in favor of Mitt Romney. It's a red island in a sea of blue, when you take into account that surrounding Miami-Dade County has gone for a Democratic presidential nominee in every election since 1992. While the national party still lists repealing the health law and replacing it with an alternative, in Hialeah, the business of Obamacare is booming. (De Diego, 3/6)

A bill dissolving Cover Oregon, the state's dysfunctional health insurance exchange, has been signed by Gov. Kate Brown. The measure, which had bipartisan support, transfers responsibilities for the Oregon exchange to the state Department of Consumer and Business Services. ... Cover Oregon was plagued by problems almost from its onset. No Oregonian was ever able to enroll online in a private plan under the Affordable Care Act because the state exchange never had a functioning website, forcing insurance seekers to file paper applications. (Masunaga, 3/7)

New Mexico has pitched CMS a proposal for the state to lease HealthCare.gov to keep enrolling individuals in Obamacare. Ever since federal officials denied a $98 million grant request late last year, New Mexico has been evaluating whether it should move ahead to build its own exchange website or pursue a lease arrangement for the federal site’s technology. (Pradhan, 3/6)

With a potential $1 billion budget hole looming, the Florida Senate is starting to consider whether and how to accept federal funds to expand Medicaid. There are at least two proposed bills floating around the chamber, and lawmakers are also raising the possibility of resurrecting the original plan, dubbed NegronCare. (Hatter, 3/6)

Florida Sen. Bill Nelson says the Obama administration won't back down on cutting off over $1 billion in aid to Florida hospitals if the state doesn't expand its Medicaid program. The Democratic senator said Department of Health and Human Services Secretary Sylvia Burwell told him her position on the aid is firm. (3/9)

A Great Falls Republican lawmaker debuts this week a Medicaid compromise bill that may be the best positioned to win this session’s health care debate. Sen. Ed Buttrey’s Montana HELP (Health and Economic Livelihood Partnership) Plan combines health care with economic development. The plan takes federal money to stretch Medicaid to cover 70,000 Montanans — the equivalent of the populations of Great Falls, Havre and White Sulphur Springs — who make too much money to qualify for Medicaid and too little to be eligible for subsidies on insurance through the health care exchange. That is coupled with opportunities for job training, education and help finding a job match. (Inbody, 3/8)

[Nurse] home visiting programs, paid for through the Affordable Care Act, are at the heart of a sweeping federal effort aimed at one of the nation’s most entrenched social problems: the persistently high rates of infant mortality. The programs have spread to some 800 cities and towns in recent years, and are testing whether successful small-scale efforts to improve children’s health by educating mothers can work on a broad national canvas. Home visiting is an attempt to counter the damaging effects of poverty by changing habits and behaviors that have developed over generations. (Tavernise, 3/8)

Obamacare is a breastfeeding-friendly law. But more than two years in, advocates and doctors are still struggling to educate women about its provisions and to make sure employers and insurance plans comply with them. The list of breastfeeding services that insurers must cover expanded vastly under the Affordable Care Act — a key victory in the ongoing effort to encourage more mothers to nurse their newborns. (Mershon, 3/8)

In their first major test of governing this year, Republicans stumbled, faltered — and nearly shut down the Department of Homeland Security. And that vote may have been the easy one. In April, physicians who treat Medicare patients face a drastic cut in pay. In May, the Highway Trust Fund runs dry. In June, the charter for the federal Export-Import Bank ceases to exist. Then in October, across-the-board spending cuts return, the government runs out of money — and the Treasury bumps up against its borrowing limit. (Parker, 3/8)

Senate Democrats are introducing a bill that would expand Medicaid coverage to include contraception for lower income women, along with strengthening other reproductive health initiatives. (Flores, 3/6)

Eight months after her failed attempt to override a U.S. Supreme Court ruling on contraceptive coverage, U.S. Sen. Patty Murray on Thursday rolled out her latest proposal to protect women’s access to reproductive-health services. The Washington Democrat’s wide-ranging bill would mandate state Medicaid programs to provide full coverage for all forms of birth control, require hospitals and clinics to provide free emergency contraception to patients who have been sexually assaulted and order a study of how states are enacting laws to restrict access to abortions and other family-planning services. (Song, 3/8)

The investigation has focused on the senator’s financial connections to a Florida doctor and close friend, Dr. Salomon Melgen, who is facing a probe into his billing practices. The FBI has examined whether the senator improperly sought to help the doctor in that inquiry and whether Mr. Menendez may have improperly used his influence with the Department of Homeland Security on behalf of the doctor on an unrelated issue, according to people familiar with the investigation. (Barrett and Grossman, 3/6)

A law enforcement official confirmed that criminal charges were expected, but said no action was imminent because prosecutors have been hamstrung by attempts to compel members of the Menendez staff to discuss a series of phone calls the senator allegedly exchanged with federal Medicare and Medicaid officials on behalf of Melgen. At that time in 2012, the doctor was locked in a dispute with government officials who alleged he was overbilling Medicare and Medicaid. Melgen, one of the nation's top-billing ophthalmologists, was paid $21 million from Medicare and Medicaid in 2012, more than any other doctor in the country. He eventually became the subject of a fraud investigation, with the FBI raiding his medical offices in 2013. He has not been charged in that investigation. (Serrano, Tanfani and Memoli, 3/6)

The Food and Drug Administration approved the first copy of a biotechnology drug for the U.S. market, firing the starting gun on a new industry that could help the U.S. curb its $376 billion in yearly drug spending. The drug is a rival version of Neupogen, an Amgen Inc. treatment prescribed to chemotherapy patients. The copycat medicine, Zarxio from Novartis AG , is the first approved under a new regulatory framework designed to introduce competition for costly biotech drugs, which are produced in living cells and typically administered by infusion or injection. (Rockoff and Loftus, 3/6)

The Food and Drug Administration has approved the first so-called biosimilar drug for use in the United States, paving the way for less expensive alternatives to an entire class of complex and costly drugs. The drug, called Zarxio, produced by Sandoz, is used to help prevent infections in cancer patients receiving chemotherapy. It is a close copy of an existing medication called Neupogen, made by Amgen. It was approved in Europe in 2009 as Zarzio but has not been used in the United States, in part because no regulatory pathway existed to bring biosimilars — approximate copies of drugs in a class known as biologics — to market. (Tavernise and Pollack, 3/6)

Federal regulators on Friday approved the sale of the first-ever biosimilar drug in the United States, opening the door to a cheaper class of drugs that could expand patient access to life-saving treatments. The FDA approved Novartis AG's copycat version of Neupogen, a biologic cancer drug that recorded $1.2 billion in worldwide sales last year. Novartis already sells biosimilar versions of the drug in more than 40 countries, but Friday's announcement will allow the company to start selling the drug in the United States. (Millman, 3/6)

Federal health officials on Friday approved the first lower-cost copy of a biotech drug in the U.S., a long-awaited milestone that could save billions for insurers, doctors and patients. Biotech drugs are powerful, injected medicines produced in living cells. They are typically much more expensive than traditional chemical-based pills. (Perrone and Johnson, 3/8)

The Food and Drug Administration on Friday approved the first "biosimilar" drug in the United States, in a move that is expected to increase competition and lower prices in the drug market. A biosimilar drug is the equivalent of a generic drug in that it copies an existing brand-name medication. But unlike generics, biosimilars are not exact copies. They are imitating much more chemically complex drugs that cannot be easily copied and come from living organisms, which makes them more unpredictable. (Sullivan, 3/6)

President Barack Obama, prominent cancer doctors and health insurers are all warning about the need to control the surging prices of new drugs. Drugmakers and their investors aren’t acting worried at all, especially when it comes to cancer medicine. In the wake of AbbVie Inc.’s $21 billion pact to buy the maker of a $100,000-a-year leukemia drug, the pharmaceutical industry and Wall Street are signaling they don’t expect the brakes on pricing any time soon in the oncology field. (Langreth and Koons, 3/9)

Demand for inpatient care is soft. Insurers and the government want to pay less for each service. New payment arrangements ask hospitals to take a degree of financial risk that patient costs exceed expectations. Against that backdrop, the record-setting financial results the Mayo Clinic released last week stand out. (Snowbeck, 3/7)

Price transparency is one of the missing links separating health care from a true market. Hospitals have list prices, cash prices, private insurance prices, Medicare and Medicaid rates, all for the same service. The list price can be 10 times greater than what Medicare pays. When a hospital and insurer reach a deal over prices, they sign a nondisclosure agreement. Insurers say this is necessary because hospitals that learned what their competitors were receiving would want the highest rates for themselves. Within five years, health policy analysts say, the remaining price secrets are likely to be in the open. (Landers, 3/9)

The Department of Veterans Affairs' chief watchdog has not publicly released the findings of 140 health care investigations since 2006, potentially leaving dangerous problems to fester without proper oversight, a USA TODAY analysis of VA documents found. It is impossible to know how many of the investigations uncovered serious problems without seeing the reports, but all concerned VA medical care provided to veterans or complaints of clinical misconduct. (Slack, 3/8)

Sen. Al Franken (D-Minn.) has reintroduced legislation to cut down the backlog for disability claims at the Department of Veterans Affairs. The Quicker Veterans Benefits Delivery Act of 2015 would allow veterans who have backlogged claims — those pending for more than 125 days — to visit local, non-VA doctors for their initial disability exam. (Carney, 3/6)

The charity [Give An Hour] now teams up regularly with technology firms to help veterans. It has worked with the likes of Google to reach more veterans through a series of video chats. It paired with Booz Allen Hamilton to analyze program data to better deliver services. And it is exploring a partnership with Doctor on Demand, an app that gives users 15-minute appointments with doctors, virtually. Technology is critical in overcoming the stigma around mental health issues, said [Barbara] Van Dahlen, who launched a national campaign to raise awareness about the topic in Washington last week. (Jayakumar, 3/8)

More hospitals and doctors are starting to use data from fitness trackers and health apps to help treat patients. But the technology has a lot of potential, but there are key challenges to work out. (Jesdanun, 3/8)

The U.S. Food and Drug Administration this week issued a mobile app specifically for searching for information about drug shortages. App users can identify current drug shortages, resolved shortages, and drug discontinuations. Drug shortages can delay or deny patient care and known shortages may lead doctors to rely on alternatives that may be riskier or less effective. (3/6)

In her Manhattan apartment, Josephina Deltejo is trying to coax her 84-year-old mother Brunhilda Ortiz to get ready to leave the house. As she does most nights, Deltejo makes up a story to get her mother, who has dementia, to cooperate. In Spanish, Deltejo asks her mother if she would rather go to Miami or the Dominican Republic. “She says she wants to go to the Dominican Republic,” Deltejo translates, and then she helps the older woman gather her things and go downstairs to a waiting van. The driver will bring her mother to the Elderserve At Night program at the Hebrew Home At Riverdale in the Bronx. It’s a kind of day camp–but at night, for people like Ortiz who suffer from Alzheimer’s disease. (Gotbaum, 3/9)

Greg and Mary Catherine O'Brien will celebrate their 38th wedding anniversary next month. She knows him better than anyone — his moods and sense of humor, his devotion to their three children and his love of Cape Cod. When Greg was diagnosed with early-onset Alzheimer's five years ago, Mary Catherine had already started to notice little differences in his behavior, she says. Now, as his symptoms continue to worsen, she takes a moment to reflect on how the disease is changing their marriage, sometimes in unexpected ways. (Hersher, 3/7)

Medical aid-in-dying has been approved through a variety of routes. Oregon (the first state where it became legal in 1997) and the state of Washington passed ballot measures. Vermont’s legislature adopted a law. And in New Mexico, as in Montana, it was allowed by the courts. A New Mexico district court judge ruled in January that medically assisted suicide was legal. The state attorney general has appealed the case to the state Court of Appeals and a ruling is expected in a few months. (Ollove, 3/9)

Terminally ill patients would be allowed to try experimental drugs and treatments that have yet to be approved by the federal government under legislation being pushed by several lawmakers in Springfield. A handful of bills before the state legislature dubbed "Right to Try" would give patients with terminal illnesses the chance to use investigational drugs, biological products or devices that have gone through the first phase of clinical trials but have not been approved for general use by the Food and Drug Administration. If the measure is approved, Illinois would join at least four other states with similar laws on the books. Another 20 states are considering related measures. (Hellmann, 3/6)

Terminally ill patients and those who have cared for them asked Maryland lawmakers on Friday to give people facing death the right to end their lives on their own terms. The emotional testimony comes as the Maryland General Assembly weighs a “Death With Dignity” bill, a measure that would allow doctors to prescribe lethal medications to terminally ill patients. (Wiggins, 3/6)

The computer system and county offices that determine whether New Jerseyans are eligible for Medicaid to pay for nursing home are antiquated and making the state the slowest in the region for determining benefits eligibility, according to nursing-home industry representatives. (Kitchenman, 3/6)

Ted Dallas knew he was walking into a crisis the late-January day he accepted the job as Pennsylvania's acting secretary of the Department of Human Services. He knew that, since early December, thousands of Pennsylvanians with alcohol and drug addictions had been locked out of treatment centers. And he understood the seriousness of their situation. (Calandra, 3/8)

The loss of more than half a billion dollars in federal matching funds for Medicaid. Deep cuts at Arizona's three universities. Community colleges in the state's two largest counties losing all of their state funding. Counties and cities losing tax revenue. The budget state lawmakers approved Saturday hits several Arizona constituencies hard, in ways that could have long-term implications for the state's economy. (Nowicki, Pitzl and Wingett Sanchez, 3/7)

Anthie Koromilas' right hand stiffens around the bottle of eye drops as she pulls down her cheek with her left and delicately squeezes the nozzle, just a few inches above her eye. She can't afford, she said, to waste a drop. People with chronic eye conditions like glaucoma would benefit from HB3137. (Hirst, 3/6)

Kathleen Riley has had 14 rounds of chemotherapy and seven surgeries since she first found a lump in one of her breasts in April. It’s a regimen Riley says she wouldn’t have started if it weren’t for the medical team at Memorial Health System of East Texas. Unable to afford a mammogram after discovering the lump, Riley, 47, received a free cancer screening at the system's Livingston facility, a private specialty clinic that participates in the joint state-federal Breast and Cervical Cancer Services program. Doctors there helped her enroll in Medicaid to cover costs related to treating her cancer, including a double mastectomy performed two weeks ago. (Ura, 3/6)

The Republican-controlled West Virginia legislature on Friday banned abortions after 20 weeks of pregnancy, overriding the governor's veto and joining 11 other states in prohibiting abortion at that point. The state Senate voted 27-5 to override the veto by Governor Earl Ray Tomblin, a Democrat. The state House of Delegates had voted to override his veto on Wednesday. (3/6)

The West Virginia legislature on Friday voted to override Gov. Earl Ray Tomblin's (D) veto over banned abortions after 20 weeks of pregnancy. The move comes after Republicans in Congress also tried to pass a 20-week abortion ban but had to drop the effort in January after a revolt from female members and centrists. (Sullivan, 3/6)

During this legislative session, state health regulators have been working to repeal a 2002 law prohibiting the state from regulating mental health drugs used for treating Medicaid patients. The state, however, can regulate other drugs for treating heart disease, high blood pressure or cancer. ... Repealing the law would give the state the ability to limit access to drugs that could pose safety risks or be more expensive by requiring prior authorization for prescriptions. It could potentially save the state about $7 million, a figure hotly contested by mental health advocates. ... Democratic state Sen. Laura Kelly of Topeka urged lawmakers against rushing forward with the proposal until health officials adequately answered the concerns from mental health advocates. (Cooper, 3/8)

Kansas midwives who say they can safely help women deliver babies without formal physician partnerships made their case this week before a legislative committee. In a presentation that noted that midwifery dates back to ancient times, Johnson County midwife Catherine Gordon told the House Health and Human Services Committee that more women nationwide are turning to midwives rather than hospitals to help them during childbirth. (Marso, 3/6)

Iowa Medicaid leaders stress that the main reason they're shifting the $4 billion program to private management is because they hope doing so will improve participants' health. But some people fear the real point is to save serious money by limiting services. At a public hearing in Des Moines Friday, Department of Human Services Director Charles Palmer called the shift "a major venture" and "a journey." The department plans to turn over most of the state's Medicaid program to two to four managed care companies, starting next January. (Leys, 3/6)

Department of Health and Human Services grant funding will be used to provide a 24-hour urgent care and crisis facility for mental health and addiction treatment. (Sisk, 3/9)

Pam Matthews admits she was in denial when she was diagnosed with diabetes in 1997. She didn’t know much about what to do and didn’t want to bother managing it. More than a year ago, she was asked to participate in a pilot project through UnityPoint’s family medicine clinic at Eagle Grove that helped her find ways to better control her blood sugar. She had finally found a doctor she trusted, Dr. Dustin Smith, and his clinic was enrolling patients in a new diabetes management program. (Villanueva-Whitman, 3, 8)

California school districts once viewed lifetime healthcare coverage for employees as a cheap alternative to pay raises. That decision is coming back to haunt school leaders, and districts are scrambling to limit the lucrative benefit promised decades ago. The price tag for retiree healthcare obligations has reached about $20 billion statewide — an amount systems are not prepared to absorb. (Torres, 3/7)

If the Supreme Court rules that no federal tax credit subsidies can be provided to Americans buying insurance on federal health exchanges in 34 states, the economic effects could be devastating. ... State economies would suffer, insurance markets would be disrupted, millions of people would lose coverage, hospitals and insurance plans that have counted on revenues from newly insured people would be left high and dry, and people who continue to hold policies would pay a lot more for them. The health care markets in which individuals and families buy their own policies — on the exchanges and outside them — would fall into chaos. (3/7)

Liberals must be nervous about the Supreme Court’s big ObamaCare subsidy case because last week they decided to throw one last Hail Mary pass to Justice Anthony Kennedy . We hope he or Chief Justice John Roberts don’t fall for it. During a week they hear oral arguments, the Justices typically hold a private conference on Friday morning in which they declare where they are leaning on the cases. Just in time for last week’s Friday conference, liberal scholar Abbe Gluck tried one more state’s rights gambit to pull Justice Kennedy to the side of the four liberals who clearly want to uphold the subsidies delivered through federal exchanges. (3/8)

At t long last, the federalism implications of the Obamacare challenge, King v. Burwell, appear widely understood. This is in no small part thanks to the justices themselves, who at oral argument in the case on Wednesday emphasized the drastic consequences that the challengers’ interpretation of the Affordable Care Act would impose on the states. (Abbe Gluck, 3/5)

The latest GOP plans are ... like the roadside Potemkin villages supposedly erected by Catherine the Great's courtier Grigory Potemkin to give her a false impression of prosperity in the Russian countryside. These contingency plans seem designed chiefly to persuade the Supreme Court that it can safely gut Obamacare via the King case, because there will be an alternative ready to go. Last week's oral arguments suggested that Justice Antonin Scalia, at least, found this argument appealing. (Michael Hiltzik, 3/6)

After Wednesday's oral argument at the U.S. Supreme Court, the odds that Obamacare will survive its latest legal challenge appear slightly better than even. But instead of relief, the law's supporters should take a moment to reflect on the deeper problem for the Affordable Care Act: its persistent and widespread unpopularity. Reversing that will do more to protect the law than any court decision. (Christopher Flavelle, 3/6)

Defenders of the administration’s position in King v. Burwell have recently emphasized two federalism-based arguments in support of their claim that the Affordable Care Act must be interpreted to allow federal subsidies for health insurance purchased in federal government exchanges, as well as in those established by states. (Ilya Somin, 3/7)

A small window of opportunity appears to be opening that may allow consideration of expanding Medicaid in Kansas. The House Vision 2020 Committee, chaired by Rep. Tom Sloan, R-Lawrence, got the ball rolling by holding hearings and drafting legislation outlining a Medicaid expansion plan designed to be politically acceptable to state legislators who oppose the Affordable Care Act. Several other states that initially had opposed Medicaid expansion have taken similar steps; Kansas is one of 14 states that hasn’t found a way to tap into federal Medicaid expansion funds. (3/9)

Fewer than half the low-income kids enrolled in California's dental insurance program see a dentist in any given year. That seems like a problem. Whether it is, though, is impossible to tell because of the state's inadequate oversight of the program, known as Denti-Cal. According to a recent audit, the state doesn't collect the data necessary to determine whether the kids who need care can get it. The state should start measuring the performance of Denti-Cal as if it really cares how well it's working. (3/8)

A little-noticed dental cartel in the U.S. received a long-deserved legal root canal on Feb. 25. In North Carolina State Board of Dental Examiners v. Federal Trade Commission, the Supreme Court affirmed the FTC’s position that state licensing boards controlled by “active market participants”—those who practice the profession—are exempt from antitrust lawsuits only if they are also supervised by the state government. (Rebecca Haw Allensworth and Aaron Edlin, 3/8)

To all parties involved in a trial, the slam of a gavel should indicate that justice has been served. Unfortunately, this is often not the case with Social Security disability appeals. A system designed to serve society’s vulnerable has morphed into a benefit bonanza that costs taxpayers billions of dollars more than it should. The disability trust fund will become insolvent in 2016, and Congress would be wise to begin much needed reform. (Mark J. Warshawsky and Ross A. Marchand, 3/8)

There's a special folder in my email inbox where I keep communications from companies where data breaches have allowed my personal information to be stolen--or maybe it's a special circle of hell. Its volume grows almost month by month. It holds warnings from Target, Home Depot, JP Morgan Chase (two)--and now, Anthem, the health insurance company that somehow allowed hackers to gain access to information it held on as many as 80 million Americans. The victims are current and former members of Anthem health plans, and even some nonmembers, ... Anthem's communication is a pretty standard version of the genre. It's a "don't-blame-us" message masquerading as a mea culpa .... So here's a brief annotation to explain what Anthem is really saying. (Michael Hiltzik, 3/6)

In hindsight, it’s easy to understand why some parents of children with autism want to see conspiracy and evil where none exists. Living with a person with autism can be devastatingly difficult, and learning that truth about vaccines didn’t really help me. Autism seemed to have stolen my son, and he was getting worse. ... I didn’t get a perfect kid or a perfect life. No one does. But when you’re a young, scared parent, you will grasp at anything to make sense of a hardship such as autism. I know that firsthand. But the MMR vaccine does not cause autism. And more important, autism is not the only tough thing that can happen in this life. A return of deadly diseases kept at bay by vaccines would be far worse. (Susan Senator, 3/6)

When it comes to familiar icons, McDonald’s ranks high in symbolism around the nation and the world. McDonald’s is also the world’s largest restaurant chain. The company deserves praise for a decision just announced that cannot have been easy to take but is important: to curtail the use of antibiotics in chicken products sold in the United States. (3/6)

There is certainly reason to celebrate with Beatrice Yardolo, the last known Ebola patient in Liberia. She survived the terrible disease and was released from a hospital on Thursday. Only five months ago, the virus was raging through Monrovia, the Liberian capital, killing thousands, overwhelming the national health system and sparking riots as authorities tried to quarantine entire neighborhoods. (3/8)