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President Obama's health-care reform law made government health insurance available to more people living in poverty or near poverty by expanding Medicaid. The hope was to improve people's physical health, but new research shows an important effect on financial health: The law has helped many poor Americans pay off the collection agent. The analysis, conducted by a team of university researchers and members of the Federal Reserve Bank of Chicago, estimates that those who signed up for Medicaid under the law reduced their collection balances by $600 to $1,000 each. (Ehrenfreund, 4/20)

State Medicaid expansions under Obamacare have improved low-income Americans' insurance coverage, increased their doctor visits and enhanced detection of chronic health conditions, which could lead to improvements in health, a new study suggests. (Pallarito, 4/20)

The Obama administration and religiously affiliated employers in a final round of legal briefs Wednesday moved no closer to a compromise for covering contraception in workers’ insurance plans, likely leaving it to the eight-member Supreme Court to settle the dispute. The justices in an unusual step had requested supplemental briefs from both sides on a potential solution as they sought a way to avoid a potential 4-4 split following the February death of the court’s ninth justice, Antonin Scalia. The high court is reviewing a dispute over the 2010 health-care law requirement that employers provide birth-control coverage for workers. (Radnofsky, 4/20)

The Arkansas Senate approved a plan Wednesday allowing Gov. Asa Hutchinson to continue the state's hybrid Medicaid expansion despite lawmakers voting to end it, though opponents warned the tactic opens the door for lawsuits. (DeMillo, 4/20)

A budget bill containing funding for the governor’s Medicaid expansion plan cleared the Senate on Wednesday, thanks to an unconventional strategy that involved asking supporters of the plan to vote to kill it in order to save it. Senate Bill 121 by the Joint Budget Committee passed in a 27-2 vote, receiving exactly the number of votes the appropriation bill needed to reach the required three-fourths majority in the 35-member Senate. The bill goes next to the House, which is expected to vote on it Thursday. (Lyon, 4/20)

The Arkansas Senate has approved funding for the state’s hybrid Medicaid expansion, with an amendment that the expansion come to a stop by the end of this year. ... Considered a workaround plan, the amended legislation grants Gov. Asa Hutchinson the opportunity to veto the amendment, thus allowing for the reinstatement of the expansion. Hutchinson has said he intends to use that authority. (Riddle, 4/20)

Thus far, the push for Medicaid expansion in Kansas has been fruitless. An expansion bill proposed more than two months ago has not reached the Statehouse floor. Hospitals and health groups, who have long pushed for expansion, remain frustrated by the lack of progress. “What we’re most concerned about is the future,” said Bill Voloch, CEO of Wesley Healthcare. (Dunn, 4/20)

It’s been a busy week for health insurers. First, UnitedHealth announced plans to pull out of most Obamacare exchanges. Cigna talked about taking a completely different tack, by expanding in those same exchanges. And we’ve learned that Anthem is teaming up with 15 hospitals in Wisconsin to form a new insurance company. (Gorenstein, 4/20)

UnitedHealth Group, the nation’s biggest health insurer, recently said it will drop out of the Obamacare individual insurance market in all but “a handful of states,” raising concerns that other insurers could follow. ... But that doesn’t mean UnitedHealth UNH 2.63% is ditching the individual exchange market altogether—and it’s not a sure signal that other large insurers will also ditch their Obamacare plans anytime soon. “This is one company that never made a serious play for this market from the get-go, and it may not really be abandoning it,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. (Lorenzetti, 4/20)

Roughly 18 months after Anthem rocked the healthcare business community with a new provider-insurance alliance in California, the health insurer has formulated another similar project. Anthem and Aurora Health Care will co-own a new health insurance company. (Herman, 4/20)

Marilyn Tavenner, a premier spokeswoman for insurers, is concerned about 2017 health care premiums. As president and CEO of America’s Health Insurance Programs, she says the culmination of market shifts that insurers have faced over several years will cause a stark rise in health insurance rates on Obamacare exchanges. “I’ve been asked, what are the premiums going to look like? I don’t know, because it also varies by state, market, even within markets. But I think the overall trend is going to be higher than we saw previous years. That’s my big prediction,” she said in a recent interview with Morning Consult. (Owens, 4/20)

Evidence continues to pile up that federal health care programs are working to reduce dramatically the number of uninsured Americans -- especially children and low-income families. (Pianin, 4/20)

Here’s how a congressional committee created to investigate fetal tissue research is spending its time: They’re bickering back and forth about whether they’re breaking new ground, or just recycling material from the Planned Parenthood “sting” videos. (Kaplan, 4/20)

House Republicans targeting Planned Parenthood released documents that they say may point to businesses profiting from the sale of fetal tissue for research. Democrats said the documents showed no direct evidence of profiteering. (Jalonick, 4/20)

Democrats say top GOP lawmakers are proposing to partially fund President Barack Obama’s request for money to fight the Zika virus. The $1.1 billion measure circulating Wednesday comes in advance of an Appropriations panel meeting on Thursday and was being worked on with Democrats in hopes of winning their support. The measure has not been finalized and is part of continuing negotiations. The money would be used to try to slow the spread of the Zika virus and develop a vaccine against it. (Taylor, 4/20)

Senator Patty Murray of Washington, the top Democrat on the Health and Human Services appropriations subcommittee who has been involved in the discussions, said lawmakers were working to reach an agreement that would address Zika, which has been linked to serious birth defects. “Protecting women and families from the serious risks the Zika virus poses should not be a partisan issue, so I’m glad that Republicans are now working with us to put much-needed resources into this effort,” she said in a statement. “Negotiations are continuing and I’m very hopeful we’ll be able to reach a final agreement.” (Huetteman, 4/20)

Senate GOP leaders are in talks to advance a major funding package to fight the Zika virus, marking the end of a months-long battle between the GOP and the White House. (Ferris, 4/20)

It’s 7:30 a.m. and the hallway outside the neurosurgeon’s office at the Pedro I Municipal Hospital is filling with mothers and their babies. The women arrive with questions: Will their children ever learn to walk? Will they ever speak? The doctor, Alba Batista, wishes she had answers. She used to see two, maybe three cases of microcephaly a year. But since December, more than 40 newborns with the condition — an abnormally small skull, often with an underdeveloped brain — have shown up at Pedro I. (Zavis, 4/21)

Zika virus is causing birth defects rarely seen before, including collapsed brains and skulls, according to Dr. William Dobyns, a Seattle Children’s hospital expert in genetics and pediatric neurology. (Aleccia, 4/20)

South Dakota will soon require doctors to tell women that they can change their minds after taking the abortion pill and potentially halt an abortion in progress. Arizona and Arkansas passed similar laws last year. And an antiabortion group is promoting model legislation to inform women they can “reverse” medication abortions. Yet that claim has no solid science behind it — just an anecdotal case report written by a physician who invented a protocol and arranged to have it tested on a half-dozen patients who regretted swallowing the abortion pill. (Graham, 4/21)

A commonly used second-trimester abortion procedure would be illegal under a new bill debated in the Alabama legislature on Wednesday. The House Health Committee held a public hearing on a bill that supporters say would prohibit a medical procedure called dilation and evacuation, or "D&E." The bill would allow the procedure, which it describes as "dismemberment abortion," in the event of a "serious health risk to the mother." (Brown, 4/20)

House Republican leaders are not planning to include new funding in their legislative response to the national opioid epidemic, a leadership aide confirmed to The Hill on Wednesday. (Ferris, 4/20)

A second Yolo County death related to illicit fentanyl painkillers was announced Wednesday, bringing the region’s total number of fentanyl cases to 13 deaths among 54 overdoses. Yolo County spokeswoman Beth Gabor said the deaths were among three overdoses that occurred in Davis, West Sacramento and Woodland in recent weeks. “This is concerning that it’s so widespread in Yolo and in Sacramento,” said Gabor. “It’s not just in one community.” (Buck, 4/20)

Gov. Jack Markell is signing legislation to create a state commission that will review drug overdose deaths in Delaware. The Drug Overdose Fatality Review Commission being established with Thursday's bill signing is similar to commissions the state already has in place to review child deaths and deaths of domestic violence victims. (4/21)

The day Jim O'Neill died, he and his wife Cindy fought about how many prescription drugs he was taking. Cindy left their Wildwood house to get a bite to eat and received a text from Jim: "I'm so sorry." "I just figured — he's on my side of the story," she said. "And I get home later that evening and I can't find him anywhere. Searched everywhere. Found him on our porch swing with a shotgun between his knees." (Sunthrup, 4/20)

Three government workers were charged with crimes on Wednesday for their roles in this city’s water crisis, accused in part of covering up evidence of lead contamination. The workers — an employee of Flint and two state workers assigned to monitor water quality in cities — are the first to face criminal charges in connection with the failures that left residents of this city drinking foul and unsafe water for many months. (Davey and Perez-Pena, 4/20)

The first criminal charges have been filed in Flint’s lead-tainted water crisis, including allegations that two state regulators and a Flint water plant supervisor tampered with evidence and that the state regulators knowingly misled U.S. Environmental Protection Agency officials and the county health department. The Michigan city switched from Detroit’s drinking water system to the Flint River in April 2014 as a cost-saving measure, but failed to treat river water with corrosion-control chemicals — an omission that allowed lead to leach from aging pipes and fixtures and contaminate tap water for 18 months. Here’s who was charged Wednesday and their connections to the crisis. (Webber, 4/20)

Michigan Attorney General Bill Schuette announced charges against Stephen Busch, who was a district supervisor in the Michigan Department of Environmental Quality’s Office of Drinking Water and Municipal Assistance during the water crisis; Michael Prysby, a former district engineer with the DEQ; and Michael Glasgow, a supervisor at Flint’s water-treatment plant. Messrs. Busch and Prysby were each charged with three felony counts, including for allegedly misleading federal environmental officials and tampering with evidence related to lead testing of Flint’s water. Mr. Prysby faces an additional felony count for authorizing the operation of the Flint water-treatment plant when he allegedly knew it couldn’t provide safe drinking water. The men also face two misdemeanor counts. (Maher, 4/20)

The Alabama Medicaid Agency, facing about $85 million less in funding than it says it needs to function, started laying out a case for more money to legislators Wednesday. ... The Legislature formed the committee as a way to gather data and learn more about the functions of the agency. Medicaid consumes about 38 percent of the General Fund budget, and legislators – unwilling or unable to create new revenue for the troubled budget – have accused the program of “cannibalizing” other state agencies in its needs. (Lyman, 4/20)

Medicaid Commissioner Stephanie Azar talked to state legislators today about the agency's need for more money and about who uses the massive federal-state healthcare program. ... Gov. Robert Bentley requested a General Fund appropriation of $785 million for Medicaid next year, $100 million more than this year. The Legislature overrode Bentley's veto and passed a budget giving Medicaid $700 million from the General Fund, a $15 million increase and more than a third of the $1.85 billion General Fund. (Cason, 4/20)

The chairman of the panel said he didn't expect the hearings to fix the Medicaid Agency's projected $85 million shortfall. "These impacts have to be felt," said Sen. Trip Pittman, R-Daphne, chairman of the Joint Medicaid Study Group. Pittman convened the group as supporters and Medicaid critics continue to stare each other down over the cost of the agency, which provides health care for approximately 1 million Alabamians below the poverty line. (Lockette, 4/21)

State senators said Wednesday that they have heard complaints about Iowa's Medicaid program under private management and that state officials providing information on the new system should stop telling the public the transition has been smooth. (Rodriguez, 4/20)

U.S. Sen. Sherrod Brown on Wednesday sharply criticized a plan to require Medicaid recipients to help pay for their care, calling it a cynical political play that would throw people off their insurance and increase costs for all Ohioans. (Ross, 4/20)

State officials are holding a public hearing on a proposal to require more than 1 million low-income Ohioans to pay a new monthly cost for Medicaid. House Republicans inserted plans for the so-called Healthy Ohio Program into the state budget last year. The idea requires federal approval. (4/21)

As Oklahoma is on the brink of a healthcare disaster, some metro hospitals fear this could create new challenges when it comes to recruiting doctors. Hospital officials with OU Medical System said the demand for more doctors, nurses and therapists is huge. ... But as the Oklahoma Health Care Authority proposes to cut Medicaid reimbursement rates for providers by 25 percent, hospital officials said attracting out-of-state doctors to Oklahoma won’t be easy. (Price, 4/20)

Home to more immigrants than any other state, California will be the largest in the nation to cover undocumented low-income children, joining Washington, Illinois, New York, Massachusetts and Washington, D.C. The expansion, effective next month, was approved by Gov. Jerry Brown in the October 2015 state budget. (Caiola, 4/20)

An Oklahoma bill that allows judges to take into consideration a diagnosis of PTSD for veterans unanimously passed the state Senate on Tuesday, adding to a series of U.S. laws seeking to address mental illness among military veterans. Oklahoma House Bill 2595 allows judges to take into account a diagnosis of post-traumatic stress disorder (PTSD) as a mitigating factor when sentencing veterans who have been diagnosed with the illness. (Brandes, 4/20)

Patients are getting fewer infections and suffering fewer injuries, though some snags remain, while the hiring of additional medical staff, technological upgrades and extensive renovations have begun to attract more insured patients to Jackson Health System, according to reports presented on Wednesday to the Public Health Trust that governs Miami-Dade's $1.8 billion-a-year public hospital network. (Chang, 4/20)

When Connecticut lawmakers raised the annual licensing fee for health care professionals by $5 last year, they assigned the additional money to go to a confidential assistance program for health care practitioners whose medical, mental health or substance abuse issues could prevent them from practicing safely. (Levin Becker, 4/21)

Six people have died in Illinois with infections caused by Elizabethkingiaanophelis, though the strain of the bacteria that sickened them is different from the Elizabethkingia anophelis linked to 19 deaths in Wisconsin, health officials said Wednesday. (Stephenson, 4/20)

Metro Denver ranked eighth most-polluted with ozone and Fort Collins 10th among U.S. cities in an American Lung Association report Wednesday — due to persistent emissions from cars and industry. (Finley, 4/20)

A Bettendorf chiropractor has agreed to retire to settle allegations that he exaggerated his healing abilities. The Iowa Board of Chiropractic filed administrative charges last July against James P. Woods. The licensing board said Woods “claimed to be able to ‘cure almost everything,’ including ear conditions, eye conditions, stroke, kidney stones, hernia, tremors, blindness and high blood pressure.” (Leys, 4/20)

Hundreds of companies have agreed to spend around $78 million on cleaning up groundwater contaminated by toxic chemicals from a Southern California Superfund site, it was announced Wednesday. (Jablon, 4/20)

It once billed an insurance company $66,000 for a bunion repair, but a South Bay surgical company now faces another eye-popping dollar figure: a $37.4 million judgment for defrauding insurance giant Aetna. A civil jury last week found that Bay Area Surgical Management, based in Saratoga, recruited dozens of doctors to refer their patients for out-of-network procedures at inflated prices, fraudulently billing millions of dollars. (Seipel, 4/20)

On a recent Friday morning, Dawn Russell wheeled into a therapy room in a Lakewood office building, still stiff and sore from a pain-laced night. In a relaxing environment of exposed brick, soft light and soothing music amid plants and statues, massage therapist Joby Siciliano gently lifted Russell out of her wheelchair and placed her on a massage table, wedging pillows under her feet and knees. (Briggs, 4/21)

Virginia's Republican-controlled General Assembly approved a proposal backed by Gov. Terry McAuliffe on Wednesday that will allow the state to obtain execution drugs from pharmacies whose identities will remain secret. (Richer, 4/20)

Even if you lack health insurance, you’ll probably be able to get treatment at a hospital in the event of a catastrophe — if you’re struck by a car, say. But having insurance can mean the difference between financial security and financial ruin. A new study is showing that, by giving health insurance to low-income people, Obamacare seems to have cut down on their debt substantially. It estimates that medical debt held by people newly covered by Medicaid since 2014 has been reduced by about $600 to $1,000 each year. (Margot Sanger-Katz, 4/20)

Congress and President Obama are engaged in a needless spat over the president’s Feb. 8 request for about $1.9 billion to fight the growing danger of the Zika virus. For two months, the Republican-controlled House and Senate have not acted. Further delay will degrade preparedness for a virus that carries a greater punch than was first believed . The dispute is one that White House and legislative staff could easily resolve in an hour — and ought to get done tomorrow. (4/20)

Public reporting of the quality of care delivered by physicians, hospitals, and other health care organizations has been around for a while. Some of the earliest efforts began in the 1990s, when the New York State Department of Health began reporting risk-adjusted mortality rates for surgeons performing cardiac surgery in that state. The early reports could be obtained by mailing a request to the Department of Health, which would send along a paper copy of the latest data. (Ashish Jha, 4/20)

It's not surprising that UnitedHealthcare is high-tailing it out of Arizona's health-insurance marketplace. The exchanges -- a major part of the Affordable Care Act -- are money losers. Not enough young, healthy people have signed up in Arizona and elsewhere to use the plans. Which means those enrolled in plans have needed -- or at least are using -- more care than people who get insurance through their employers. (Joanna Allhands, 4/20)

Imagine a full year, or two, during which a nation’s old people die but no new people are born. Picture an elementary school with empty first- and second-grade classrooms. Look further ahead to the years no new workers join the labor pool. How would a two-year collapse in the birth rate rattle a nation? We might be about to find out. (Karin Klein, 4/20)

When the director-general of the World Health Organization (WHO) declared that the recently reported clusters of microcephaly and other neurologic disorders represent a Public Health Emergency of International Concern (PHEIC), she called for increased research into their cause, including the question of whether the Zika virus is the source of the problem.1 The declaration provides an opportunity to step up the pace of research in order to find the answer to some important questions more quickly. It could not only facilitate the accumulation of knowledge about the relationship between the Zika virus and microcephaly, but also accelerate the study of newer technologies for mosquito control, which could have far-reaching effects on global health security beyond controlling Zika infections. (David L. Heymann, Joanne Liu and Louis Lillywhite, 4/21)

Marsha Blackburn isn’t one to worry about appearances. The Tennessee Republican didn’t make any pretense this week of being impartial with the committee she chairs, the House Select Investigative Panel on Infant Lives, commonly known as the Planned Parenthood committee. (Dana Milbank, 4/20)

It is time, at last, for a reckoning. Will Massachusetts continue to live with the moral stain that is Bridgewater State Hospital? Or will we finally end the decades of torture and misery inflicted there in our name? (Yvonne Abraham, 4/20)

Deaths from prescription-opioid overdose have increased dramatically in the United States, quadrupling in the past 15 years. Efforts to improve pain management resulted in quadrupled rates of opioid prescribing, which propelled a tightly correlated epidemic of addiction, overdose, and death from prescription opioids that is now further evolving to include increasing use and overdoses of heroin and illicitly produced fentanyl. (Thomas R. Frieden and Debra Houry, 4/21)