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The Obama administration on Friday announced changes to ObamaCare sign-up rules that are intended to cut down on people gaming the system and address a complaint from insurance companies that they say is causing them to lose money. The Centers for Medicare and Medicaid Services (CMS) announced that it is tightening the rules for enrolling in one of ObamaCare’s extra sign-up periods. The extra periods allow people to sign up for insurance outside of the regular enrollment period if they move. The change announced Friday requires that people have coverage at some point in the preceding 60 days, which is intended to prevent people from moving for the sole purpose of becoming eligible to sign up for health insurance. (Sullivan, 5/6)

The CMS unveiled an interim final rule late Friday that could help the Affordable Care Act's struggling co-op plans. The rule also responds to insurers' complaints that people are abusing special enrollments in the exchanges. The CMS tightened the use of special enrollments, specifically making the rules around moving to a new home more restrictive to avoid any gaming of the system. Co-ops also can seek outside funding from investors to build up their capital, something that was outlawed previously. The policies go into effect May 11, and the CMS will accept comments on the rule through July 5. (Herman and Dickson, 5/6)

The Obama administration says it's moving to limit special sign-up periods under the president's health care law after insurers complained of abuses. Under a policy change proposed Friday, people who try to get coverage after moving to a different community will have to show they were insured at their previous address at least some of the time during the previous 60 days. (5/6)

Wyoming’s Democratic Candidate for the U.S. House of Representatives says the Affordable Care Act has helped many citizens in the state, but he adds that it can be improved. (Beck, 5/6)

The Alaska House has given notice that it plans to keep fighting Gov. Bill Walker's authority to expand Medicaid on his own, drawing criticism from minority Democrats who oppose continuing the legal battle. Lawmakers faced a deadline for whether to appeal a judge's decision dismissing a lawsuit initially filed last summer by the Legislative Council, which is made up of House and Senate members. Attorneys representing the council filed a notice of appeal on behalf of the House on Thursday and said they planned to seek an order substituting the House for the Legislative Council in the litigation. (Bohrer, 5/7)

“Given the magnitude of the issues our state is currently facing, we find this very disappointing,” Walker wrote in an email. The Legislative Council, on behalf of the full Legislature, sued Walker’s administration in August to stop him from unilaterally expanding the health care program for low-income Alaskans. The case was dismissed in Superior Court in March. Thursday's move bypasses a vote by the full House and Senate, which would have been necessary to continue the appeal by the Legislative Council. (Andrews, 5/6)

Democratic lawmakers say the House leadership doesn’t have the authority to act on their own in pursuing the appeal. Democrats point to an opinion by the Legislature’s nonpartisan Director of Legal Services, Doug Gardner. Gardner informed Senator Gary Stevens in March that both houses of the Legislature would have to vote to pursue an appeal. Those votes never occurred. (Kitchenman, 5/6)

When it comes to expanding Medicaid, all three Utah candidates for governor have very different views. Democrat Mike Weinholtz wants full expansion, Republican challenger Jonathan Johnson wants to keep medicaid the way it is, and Governor Gary Herbert is in the middle. (Decker, 5/8)

Some of Wyoming’s unemployed energy workers would now be eligible for health coverage if the state had expanded Medicaid to low-income Wyomingites, Gov. Matt Mead said. “As you see these coal miners being laid off, people in oil and gas being laid off, there’s no question some of those people would have been eligible had we expanded Medicaid,” Mead said Thursday evening in Casper. “We’re trying to do our best to find them jobs. But jobs are part of it, health care is part of it. And so I think the state missed an opportunity last time on Medicaid expansion.” (Hancock, 5/9)

Department of Health and Hospitals officials are "highly confident" they'll receive federal approval to use data from food stamp applications to qualify people for Medicaid, the first state in the country to use such a method through what's known as a state plan amendment. Six other states use a similar approach, but they applied through a much longer process known as a waiver. Louisiana will become the first state to use the quicker state plan amendment method. (Litten, 5/6)

A health care program for children of the working poor that had been left out of the budget approved by the Arizona Legislature this week was resuscitated on Friday, after Democrats and moderate Republicans agreed to attach it to a bill expanding disabled students’ eligibility for school vouchers. After blocking a previous stand-alone bill authorizing the program last month, the Senate president, Andy Biggs, allowed the amended measure to come to a vote on Friday. The House of Representatives had already passed it 38 to 21 late Thursday. (Santos, 5/6)

Arizona opted out of the federal Children's Health Insurance Program in 2010 over cost concerns as it grappled with a budget crunch. The program aims to help working families who earn too much to qualify for Medicaid health care coverage for the poor, but who cannot afford private health insurance. To qualify for KidsCare, as it's known in Arizona, a family of four must earn between $33,000 and $49,000 annually. It is estimated to serve about 30,000 children in Arizona. (Schwartz, 5/6)

More than 30,000 Arizona children from low-income families will be eligible for health insurance after a lightning-quick revival of KidsCare, which appeared all but dead earlier this week. (Pitzl, 5/6)

Health insurer Cigna Corp, which announced plans to be bought by larger Anthem Inc 10 months ago, on Friday said the deal may close in 2017 rather than 2016 due to the complexity of the regulatory process, according to a filing with the Securities and Exchange Commission. The U.S. Department of Justice is currently reviewing the Cigna-Anthem deal, which would create the nation's largest health insurer, offering Medicare, Medicaid and commercial health insurance. (Humer, 5/6)

Cigna Corp.’s acquisition by health-insurance rival Anthem Inc. may not be approved this year, Cigna said Friday in a regulatory filing. Shares of both companies declined. An analyst said the delay could be a sign of trouble for the deal, which is one of two pending health-insurance combinations being scrutinized by regulators who have expressed concern about further concentration of the health-care industry. (Tracer, 5/8)

Some people travel long distances to get cheaper medical treatment. United Airlines is testing whether employees will do the same. The airline is encouraging workers across the country and their families to go to Rush University Medical Center in Chicago for hip and knee replacements as well as spinal fusion surgeries. To entice them, United is offering a generous benefit: The expenses for physician visits and the surgery are fully covered by United after employees meet the annual deductible on their insurance policies. (Sachdev, 5/7)

Four out of five emergency-room doctors who responded to an American College of Emergency Physicians survey believe that privately insured patients have skipped needed medical care because of concerns about out-of-pocket costs. (Alltucker, 5/8)

Want to spend more quality time with your doctor? Maybe you should try joining a group. Paradoxical as that may sound, it works remarkably well for Bill Swain, 69, who began going to shared medical appointments several years ago after his doctor suggested the idea. Now he attends quarterly sessions for eight to 15 people that usually last 90 minutes. A digital white board lists group members’ vital signs, such as blood pressure and weight. Mr. Swain, who doesn’t like falling behind his peers, especially likes the accountability and the extra medical attention. (Gustke, 5/6)

The women sat in a circle and bemoaned their sleepless nights. It seemed unfair: Their babies weren’t even born yet. ... These moms-to-be weren’t just commiserating over coffee. They were at a routine prenatal visit — all five of them at once. The women are participating in a unique type of health care: shared medical appointments. As a group, they see nurse midwife Mercedes Taha for 10 two-hour visits throughout their pregnancies. They take turns being examined, learn more about childbirth and parenting, and as their due dates approach, celebrate with a joint baby shower. (Gorman, 5/9)

New medical schools are launching across the country to address a projected physician shortage. They’re promising innovative curriculums that let aspiring doctors spend time doing research, working in community health settings, and following the same patients for months. But they face big obstacles, starting with the challenge of recruiting students and faculty when they’re not yet accredited — and won’t be, even in the best-case scenario, for several years. (Williams, 5/9)

Nursing homes are increasingly evicting their most challenging residents, advocates for the aged and disabled say, testing protections for some of society's most vulnerable. Those targeted for eviction are frequently poor and suffering from dementia, according to residents' allies. They often put up little fight, their families unsure what to do. Removing them makes room for less labor-intensive and more profitable patients, critics of the tactic say, noting it can be shattering. (Sedensky, 5/8)

Farzad Mostashari spent two years leading the White House effort to implement electronic health records. Now that he's running his own company — on the other side of those federal regulations — Mostashari sees numerous problems with how government rulemaking works, he told POLITICO this week. "Regulators really, really, really want to get it right," Mostashari said on POLITICO's "Pulse Check" podcast, but they end up being too cautious and conciliatory. And that's bad for health care, he argues, because it protects underperformers and lets them stick around. (Diamond, 5/6)

When Jarret McCasland and his fiancee decided to celebrate her 19th birthday with heroin, it meant the end of her life and the end of his freedom. Flavia Cardenas, who worked in a nightclub, died of an overdose the next morning in Baton Rouge. After a prosecutor convinced a jury that McCasland administered the fatal dose, the 27-year-old pipe fabrication shop worker was found guilty of second-degree murder. He was sentenced to life in prison in February with no chance for parole. (Kuznia, 5/8)

For more than a decade, doctors, dentists and nurse practitioners have liberally prescribed opioid painkillers despite mounting evidence that people were becoming addicted and overdosing on the powerful pain medications. (Vestal, 5/9)

Across the United States, heroin users have died in alleys behind convenience stores, on city sidewalks and in the bathrooms of fast-food joints — because no one was around to save them when they overdosed. An alarming 47,000 American overdose deaths in 2014 — 60 percent from heroin and related painkillers like fentanyl — has pushed elected leaders from coast to coast to consider what was once unthinkable: government-sanctioned sites where users can shoot up under the supervision of a doctor or nurse who can administer an antidote if necessary. (5/8)

Illinois' heroin and opioid abuse crisis can manifest itself in unexpected, sometimes stunning ways, as U.S. Sen. Dick Durbin himself will tell you. Durbin, D-Ill., for several months has been traveling throughout the state, meeting with political leaders and public health officials to develop strategies for dealing with the situation. That included a stop earlier this week in downstate Carbondale. (Bird, 5/7)

A Kentucky judge said Friday he would rule as soon as next week on a request by STAT to unseal documents related to allegedly illegal marketing of the pain pill OxyContin and what a top executive of the drug’s manufacturer knew about it. (Armstrong, 5/6)

A Kentucky judge says he will decide next week whether to unseal the secret testimony from a former president of the company that markets the powerfully addictive painkiller OxyContin. (Beam, 5/6)

It is a bitter but basic fact in health research: Black Americans die at higher rates than whites from most causes, including AIDS, heart disease, cancer and homicide. But a recent trove of federal data offered some good news. The suicide rate for black men declined from 1999 to 2014, making them the only racial group to experience a drop. Infant mortality is down by more than a fifth among blacks since the late 1990s, double the decline for whites. Births to teenage mothers, which tend to have higher infant mortality rates, have dropped by 64 percent among blacks since 1995, faster than for whites. (Tavernise, 5/8)

When Hee-Soon Juon asked her physician a few years ago whether she needed to be screened for exposure to the Hepatitis B virus, he told her, "You don't need to be. You're in the U.S.A." But Hepatitis B is widespread in Asian and sub-Saharan African countries, including Juon's native South Korea, and many immigrants have brought it with them to the United States. (Jablow, 5/6)

Electronic cigarettes have sickened rising numbers of young children, a study of U.S. poison center calls has found. Most cases involve swallowing liquid nicotine. While most kids weren't seriously harmed, one child died and several had severe complications including comas and seizures. "This is an epidemic by any definition," said lead author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio. (Tanner, 5/9)

Federal and state health officials are bracing for the Zika virus to turn up in the United States. With summer around the corner, federal officials say it's only a matter of time before Zika-carrying mosquitoes appear in this country. So far, it's swept though South and Central America, into Mexico and across the Caribbean. (Terry, 5/6)

The disorder burst into public view this year with international headlines about the Zika virus in Brazil and the birth of several thousand newborns with severely small heads. But little has been reported about their lives. What are the effects of the condition? (Terry, 5/6)

Pending cuts to state funding for mosquito control could pose a problem for the agency that monitors the insects for the Zika virus and other diseases, the director of the Connecticut Agricultural Experiment Station said Friday. (Levin Becker, 5/6)

Alabama will never wipe out its mosquito population. Which bites. And while state officials understand they can’t spray the entire state as a way to even attempt to eliminate the insect, they are aggressively moving forward in educating the public should the Zika virus — which is becoming more and more prevalent in South America, Central America and the American territories, including Puerto Rico — make its way to the Yellowhammer State. (Klass, 7/6)

Bio-tech company Oxitec wants to use genetically modified mosquitos to stop the spread of the Zika virus. Florida Democratic Senator Bill Nelson is calling for support of the plan. (Payne, 5/6)

A pregnant woman shows up at a New York City bar and wants to go in and order a drink despite health warnings against consuming alcohol while expecting. Should the tavern serve her? It's against the law to refuse, under city Human Rights Commission guidelines released Friday. They center on expansive protections for pregnant workers but also say mothers-to-be can't be kept out of bars or denied alcoholic drinks just because they're expecting. "Judgments and stereotypes about how pregnant individuals should behave, their physical capabilities and what is or is not healthy for a fetus are pervasive in our society and cannot be used as pretext for unlawful discriminatory decisions" in public venues, the new guidelines say. (Peltz, 5/8)

For 10 years, Jessica Strom’s biggest dream was to become a mother. But infertility kept that dream just out of reach. She found a silver lining in her work as a photographer, capturing beautiful images of moms and babies in the Kansas City area. She also volunteered to take photos of preemies in the neonatal intensive care units at local hospitals. (Gish, 5/8)

Kimberly Richardson has never gotten a flu shot. Since she's healthy and considers the seasonal vaccines a "best-guess concoction" of the viruses expected to dominate, the northern California gym teacher and mother of two says she didn't want an "injection of something that may or may not keep me healthy in the long run." She's not alone. In an analysis of 245,386 women who delivered babies at Utah and Idaho hospitals over nine flu seasons, 90 percent said they didn't get vaccinated for influenza while pregnant. Those who did reaped benefits — their babies were healthier. (Landhuis, 5/7)

The number of teenage parents in Alaska is continuing its downward trend. Nationwide, the birth rate among teenage women 15-19 years old has declined dramatically since 1991, from 61.8 per 1,000 teens to 24.2 out of every 1,000 by 2014, according to a May 3 bulletin issued by the Alaska Section of Epidemiology. In Alaska, the rate is higher than the national average — 27.8 per 1,000 teens age 15–19 years — but it has fallen significantly from 42.6 per 1,000 in 2008, according to the bulletin. (Earl, 5/7)

A Planned Parenthood attorney says Kansas will not cut off Medicaid funding for the abortion provider until May 24. Attorney Bob Eye said Friday that Planned Parenthood and the state Department of Health and Environment agreed on the timing of the cutoff after Planned Parenthood filed a federal lawsuit. (5/6)

The Missouri House has passed a proposed constitutional amendment that would grant so-called "personhood" status to unborn fetuses at every stage of development. House Joint Resolution 98, if added to the state constitution, would extend the rights of "life, liberty, and the pursuit of happiness" to the unborn. It's sponsored by representative Mike Moon, R-Ash Grove. (Griffin, 5/6)

As they try to beat back new restrictions in Louisiana, abortion rights supporters have keyed into a sensitive issue for lawmakers, the state's ongoing financial problems. (DeSlatte, 5/8)

A plan to require more than 1 million Ohioans on Medicaid to pay a new monthly cost is drawing mostly criticism from health care advocates, Democrats and others who claim the proposal would burden low-income beneficiaries and cause some to drop out of the government-funded program. (Sanner, 5/8)

Erin McCabe was grateful when she got her notice from the state of Ohio that she is eligible for Medicaid. She uses the program to pay for prescriptions, doctors' visits and counseling to help her battle mental health issues of depression, anxiety and attention deficit disorder. Ohio Governor John Kasich made a concerted effort to bring that part of Obamacare to Ohio to expand coverage for Ohio's working poor. "This is what the Lord wants," he said, at the time. But now many Medicaid recipients are concerned about what Republican lawmakers want. Kasich signed legislation that will have the state ask the federal government for permission to start charging able­bodied Medicaid recipients up to $99 in annual premiums. (Beres, 5/6)

Medicaid managers have done little to stem rampant fraud in the massive government health care program for the poor, which totaled more than $29 billion last year, according to a new Government Accountability Office (GAO) report to Congress. (Pianin, 5/8)

Right now hardly any of the nearly 3,500 Tennessee inmates who are known to have hepatitis C are receiving the cure. The cure is costly, but at least one study suggests providing it to inmates could result in stemming the tide of an epidemic affecting the entire country. (Boucher, 5/8)

Tim Leslie still remembers the St. Paul house near Victoria Street and Selby Avenue where he’d regularly respond to calls as a patrol officer from a resident who was convinced there was something landing on the roof. There wasn’t, but police learned how to talk him down anyway. “The first couple calls, it was, ‘We do this, too?’ ” he said. Today he’s the Dakota County Sheriff, responsible for a jail where perhaps a third of the inmates have mental health needs. And like others with a hand in the criminal justice system, he’s trying to manage those needs while navigating the growing, thorny nexus between law enforcement and mental illness. (Eccher, 5/8)

A federal appeals court Friday overturned an order requiring [Washington] state health officials to provide competency evaluations to mentally ill defendants within seven days of a judge’s order, but said there should be limits on the wait times for these defendants. (Bellisle, 5/7)

As soon as the officers on the Kansas City porch announce themselves as the police, the man standing inside the door slams it shut. Bam. The officers in their black bulletproof vests — Ashley McCunniff and Aric Anderson — stand there a moment, exchanging a look. (Robertson, 5/8)

The University of Pennsylvania Health System agreed to pay $75,787 to resolve allegations that its home health unit, Penn Care at Home, submitted claims to Medicare for services not rendered and for services that were not reasonable or necessary, the United States Attorney for the Eastern Disctrict of Pennsylvania said Friday. (Brubaker, 5/6)

Eight Indiana community health centers are sharing in more than $7 million in federal funding that will allow them to serve thousands more patients by renovating or expanding their operations. The funding from the U.S. Department of Health & Human Services is part of $260 million the agency recently awarded to nearly 300 health centers in 45 states. (5/8)

Two California doctors were convicted by a federal jury in Los Angeles on Thursday of falsely certifying that Medicare patients were terminally ill and qualified for hospice care as part of an $8.8 million scheme to defraud government health insurance programs. Sri Wijegoonaratna and Boyao Huang both worked at Covina-based California Hospice Care, which federal prosecutors say billed Medicare and California's Medicaid program for unneeded hospice care between March 2009 and June 2013, when it was shut down. (Pierson, 5/6)

At first, no one seemed to notice the two men sitting on the short wall across from the Marion Transit Center. With eyes shut and heads bobbing, the pair swayed, their limbs twitched. One man, wearing a red shirt bearing the phrase "Southern Muscle," began to have a seizure. This was midmorning on a hot Thursday late last month in downtown Tampa, a few blocks north of the federal courthouse and the posh high-rise apartments at Skypoint and Element. (Sullivan, 5/6)

Over the course of the last year, Linda Rallo has been accused of a lot of things. At one point, she was supposedly trying to steer public funds to abortion providers. Then she was part of a clandestine effort to undercut constitutional protections for stem cell research. She’s been called a shill for big tobacco and an enemy of public schools. (Hancock, 5/8)

Twelve organizations will share more than $500,000 in grants from Healthcare Georgia Foundation that predominantly target rural health, health disparities, and distance learning for health professionals and nonprofits. (Miller, 5/7)

A 16-year-old Central Washington boy is recovering from years of exposure to toxic levels of lead from an unlikely source: two sheepskin rugs he’d slept with since kindergarten. Jake Wood, of Benton City, has posted blood-lead levels at least 12 times higher than the federal level for action, a condition that likely caused irreversible learning disabilities, speech problems and medical issues. (Aleccia, 5/7)

Suicide rates are rising for children and young adults, both nationally and statewide --- and Florida policymakers are trying to reverse the trend. While suicide is increasing for nearly every age group, it's now the second-leading cause of death for Floridians aged 25 to 34, according to the state Department of Health Vital Statistics, and the third-leading cause of death among youths aged 10 to 24. (Menzel, 5/6)

Getting tested for sexually transmitted diseases just got cheaper in Palm Beach County. As STD rates rise dramatically, the County Commission agreed to lower the Health Department's fee for testing from $159 to $58 for self-pay patients. The change was recommended to encourage more people to get tested and treated. (Swisher, 5/6)

Jessica Holloman had no clue what awaited her when she spied lice crawling on her daughter's scalp last year. Holloman turned to an over-the-counter treatment and began picking louse eggs, or nits, from 6-year-old Sydney's hair. When the then-pre-kindergartener went back to class, her mom alerted the teacher. (Kowarski, Paulson and Sangalang, 5/8)

Tallahassee’s Fluoride system needs an upgrade and officials say there’s some state money that could help. Water Resources Engineering Manager John Buss says Tallahassee renovated the buildings associated with the system a few years ago. Now he says the pipes and tanks need attention. “Fluoride is a corrosive material it tends to wear out pumps and tanks and fittings pretty quickly," Buss says. (McCarthy, 5/6)

It was well after dark on Dec. 2, 2009, when a team of government workers, wearing thick gloves and respiratory masks, began to pour 2,200 gallons of milky white liquid into the Chicago Sanitary and Ship Canal in Illinois. Ryan Jackson, then 34, a hydrologist with the U.S. Geological Survey, watched the work begin from the shore, before readying his own boat with a colleague, Kevin Johnson, and heading out onto the water. The men were tasked with tracing the chemical’s path by injecting a pink fluorescent dye into the water where the translucent toxin would be. (Moss, 5/8)

If patients know how much their medical care costs, they’ll shop around for the cheapest option — and over time, health care costs will go down. At least, that’s the idea behind the drive to improve price transparency, a strategy embraced by Donald Trump, among others. But a recent study suggests it’s not so easy to get people to shop. Sunita Desai, a fellow in health care policy at Harvard Medical School, and her co-authors looked at two companies that introduced an online tool that lets employees compare prices for things like lab tests and outpatient surgeries. After a year, only 10 percent of employees had used the tool. And those who had access to it actually had higher out-of-pocket spending on average than comparable employees at other companies who didn’t have the tool. (Anna North, 5/6)

It already looks clear that many Obamacare insurance plans are going to raise their prices significantly. Over the last few years, average premium increases in the Obamacare markets have been lower than the increases for people who bought their own insurance in premiums before the Affordable Care Act. But several trends are coming together that suggest that pattern will break when plan premiums are announced in early November. Many plans may increase prices by 10 percent, or more. Over the last two years, I’ve written articles warning against scary headlines that exaggerate premium increases. Next year, those scary headlines are more likely to be accurate. (Margot Sanger-Katz, 5/6)

A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I'm a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab work? The attending was in her room for less than two minutes and never examined her. But the CT scan and blood work were ordered. My friend received intravenous fluids (about $1 worth), pain meds (about $5 worth of dilaudid), and a $10,000 bill from the hospital. To add insult to injury, the bill from the ER attending was for service at the highest billable level. (Michael Jones, 5/8)

In most presidential election years, the politics of healthcare at least has a nodding acquaintance with reality. This year, the two aren't even on speaking terms. Let's start by correcting some untruths polluting the national conversation. Then I will show what I think is the main reason why millions of Americans are angry about rising healthcare costs: there is a major shift underway in who pays for health insurance. (Merrill Goozner, 5/7)

The prices of oral cancer drugs are rising. This will come as no surprise to anyone who has cancer or who knows someone who has it, but this excellent study documents that fact beyond a shadow of a doubt. Even after introducing a new cancer product at some price, the seller, protected by patents, increased the price by 5% a year on average. This is higher than price growth from economy wide inflation in the same period, while other medical prices also grew excessively, but not by as much, and total drug spending hardly grew at all. (Mark Pauly, 5/6)

Physicians aptly speak of “seeing” patients. After all, medical training is a series of vision lessons. Students look closely at a nameless cadaver and disassemble it until it resembles the pictures in an anatomy text. They watch lectures in which interrelated organ systems are displayed as simple machines. (Abraham M. Nussbaum, 5/8)

Most doctors never forget the paralyzing terror of their first invasive procedure. Dr. Charles Pozner, of Boston’s Brigham and Women’s Hospital, recalls the first time he placed a central line, which involves sticking an eight-inch-long needle into a patient’s jugular vein to place an intravenous line. He had never even seen it done before, but a chief resident offered him the opportunity after a long day working together. (David Scales, 5/6)

The Affordable Care Act’s critics seemed to get a shocking piece of new evidence when UnitedHealth Group, the country’s largest health insurer, announced last month that it would pull out of many ACA markets next year. In fact, the news is not all that shocking, and it is not a sign that the law is failing. Though UnitedHealth is the country’s largest health insurer, it is not a dominant player in the marketplaces that the ACA set up for individual insurance buyers. It covers only about 6 percent of 12.7 million marketplace participants. United does not appear to have been very effective at competing to attract customers. (5/8)

Today the Food and Drug Administration finalized regulations asserting regulatory authority over e-cigarettes and various tobacco products, such as cigars. According to the agency, this rule will help protect public health. Insofar as the rule subjects actual tobacco products to the same regulations as cigarettes, this might be so. But the part of the rule that “deems” e-cigarettes to be tobacco products and subjects them to extensive regulatory requirements is more likely to harm public health than to help it. Big Tobacco, meanwhile, is likely to be pleased with the new regulations. (Jonathan H. Adler, 5/5)

On May 20, cigarette packs in Germany will display images of rotten teeth and blackened lungs. Also this month, cigarette manufacturers in the U.K. are likely to have to switch to plain packaging, without brands or imagery. And the top European court has upheld a 2014 European Commission directive that banned flavored cigarettes, mandated that 65 percent of the surface of packs must be covered with health warnings and imposed restrictions on how much nicotine could be ingested via e-cigarettes. (Leonid Bershidsky, 5/7)

A trio of healthcare information technology experts that includes a vice president of IT from Kaiser Permanente and a senior editor for the Mayo Clinic's website will advise HHS on standards for sharing patient medical information. James “Jamie” Ferguson, vice president of HIT Strategy and Policy at Kaiser; Carolyn Petersen, senior editor for Mayoclinic.org; and Karen van Caulil, president and CEO of the Florida Health Care Coalition, a business coalition on health, will sit on the federally chartered HIT Policy Committee. (Joseph Conn, 5/6)

The federal government has accused South Dakota of unconstitutionally warehousing the mentally ill and disabled in nursing homes. Meanwhile, at least 16 percent of the nation’s jail and prison inmates are estimated to be mentally ill and about 40 percent of the mentally ill have been incarcerated. Many of the homeless are also mentally ill. (5/9)

Johnson & Johnson is an immense pharmaceutical and consumer products company of the type that the public loves to hate. Recently, it's been getting absolutely killed by juries holding its baby powder responsible for causing several women's ovarian cancers. The damage awards levied against Johnson by juries in St. Louis on behalf of two families total $127 million. That sum would suggest that the scientific evidence is clear that Johnson's talcum powder caused the women's cancers. But what does science say? (Michael Hiltzik, 5/6)

Beginning in the late 1990s, pharmaceutical companies selling high-dose opioids seized upon a notion, based on flimsy scientific evidence, that regardless of the length of treatment, patients would not become addicted to opioids. It has proved to be one of the biggest mistakes in modern medicine. An epidemic of prescription drug abuse has swept across the country as a result, and one of the latest victims, according to The New York Times, may have been Prince. (David A. Kessler, 5/6)

This Just in: Overdose deaths in Massachusetts increased 7 percent last year. That figure is significant because the rise in deaths is slower than previous years, an indication that greater awareness and legislation are making a small dent in the epidemic. And the comprehensive opioid legislation signed by Governor Charlie Baker two months ago, including the first law in the nation establishing a seven-day supply limit on first-time opioid prescriptions, should help make a difference over time. (5/6)

My four children were born more than 20 years ago. I had four birth experiences, and I think about those experiences rarely, if ever. In nearly 30 years of motherhood, those acute hours quickly faded into insignificance compared with the reality of my children’s daily lives, their milestones, their achievements, their personalities, their challenges and the growth of our relationship as they changed from infants to school-age children to teenagers to adults. I gave birth vaginally. But it never occurred to me that this was some kind of achievement, since it had nothing to do with me and everything to do with luck. My children, too, do not much care about the specifics of how they were born. This is, I suspect, typical for women of my generation and the ones that preceded us. (Amy Tuteur, 5/6)

A crisis exists right now in nursing-home care, and it has been percolating for some time. Nurses are leaving long-term care — and there is no overflowing pipeline of nursing graduates waiting to care for our elderly. You don’t have to work in long-term care to understand what that means. As anyone with a loved one in a nursing home knows, nurses are the heart and soul of a care facility. They provide care for residents with complex conditions that require consistent attention and regular follow-up. They know their patient’s history and are the first line of defense when a resident’s health declines for any reason. Their patients depend on them, and the comfort from knowing they will see the same nurse at the same time most days goes a long way toward improving the quality of life during a long-term care stay. (Hilary Danklefs, 5/8)

I don’t often get the chance to say these two words about the Arizona Legislature but brace yourself, here they come: Good job. (Laurie Roberts, 5/6)