�鶹Ů��

Government investigators will release a report later this year about multiple cybersecurity “incidents” at HealthCare.gov, a GAO official told lawmakers Wednesday. Gregory Wilshusen, director of Information Security Issues for the Government Accountability Office (GAO), suggested there have been several cyber events at ObamaCare’s online exchange. He did not provide further details. (Viebeck, 4/22)

President Barack Obama's health care law has had a surprising side effect: In some states, it appears to be enticing more Americans to apply for food stamps, even as the economy improves. New, streamlined application systems built for the health care overhaul seem to be making it easier for people to enroll in government benefit programs, including insurance coverage and food stamps. (Johnson and Mercer, 4/22)

While the healthcare law itself is enjoying a boost in popularity, its federal portal seems to be struggling with a branding crisis. A new survey by Forrester Research ranks HealthCare.gov, the federal health insurance exchange portal, dead last among government brands that provide a quality consumer experience. (Ehley, 4/22)

What Cynthia Louis thought would be a fairly straightforward process of finding out what’s wrong with her joints has taken more than a year and a half. She’s had to quit the job she loved so much because she can’t stand up for long periods of time. Because she has no income, though, she does not qualify to get help paying for health plans on HealthCare.gov. She also does not qualify for Medicaid in Florida because she doesn’t have any dependents. She is one of the 850,000 Floridians in the health care “coverage gap.”

States relying on HealthCare.gov need a backup plan if they want to help their residents keep subsidized health insurance. The Supreme Court this summer could rule that subsidies are illegal outside of state-based exchanges. (Infantino, 4/22)

Chaos will befall the health care system if the Supreme Court strikes down Obamacare subsidies, but the law’s obscure requirement that insurers keep non-paying customers on their rolls for 90 days won’t be part of it. (Norman, 4/22)

The IRS' overloaded phone system hung up on more than 8 million taxpayers this filing season as the agency cut millions of dollars from taxpayer services to help pay to enforce President Barack Obama's health law. (4/22)

The Internal Revenue Service triggered many of the taxpayer problems that plagued the 2015 filing season by cutting $134 million from customer-service spending to pay for other activities, House Republicans said in a new report on Wednesday. ... At a hearing Wednesday of the House Ways and Means subcommittee that oversees the agency, IRS Commissioner John Koskinen acknowledged the funding shifts, but defended them as a matter of necessity, given the agency’s growing workload and shrinking budget. The IRS had major new responsibilities placed on it for the 2015 filing season, including implementation of the Obama health-care law, but was given about $346 million less for this year, on top of similar cuts in other recent years. (McKinnon, 4/22)

Senators pushed back Wednesday on threats from Gov. Rick Scott to veto projects or bills, saying they weren’t helpful in resolving the health care spending crisis that has brought the legislative session to a stalemate. Scott met with several senators to urge them to give up their plans to expand Medicaid through a state-run exchange and impose work and co-pay requirements. Expansion, staunchly refused by the House, combined with the imminent loss of $2.2 billion in funds from a separate Medicaid program paying hospitals and other providers for care for the poor and uninsured, has frozen budget negotiations as neither chamber has budged from its position. Senators did not respond well to Scott’s veto threats. (Rohrer, 4/22)

As Gov. Rick Scott threatens lawmakers with a special session and vetoes of their bills, the Florida Chamber of Commerce, one of the governor’s biggest political allies, dropped its support of expanding Medicaid under Obamacare. The chamber’s health care proposal had included drawing down $50 billion in federal money to expand Medicaid if the plan included spending protections proposed by the group. Scott and House Republicans oppose Medicaid expansion. (Dixon, 4/23)

Since the Legislature blew past its adjournment deadline on Sunday, all but one committee meeting scheduled since has been canceled or delayed indefinitely. Now, Gov. Bill Walker is calling on lawmakers to do work on bills for as long as it continues to be in session. In a letter sent to Senate President Kevin Meyer and House Speaker Mike Chenault on Wednesday, the governor urged them to “use this time wisely,” and suggested they continue work on Medicaid reform and expansion. (Gutierrez, 4/22)

As a small group of legislative leaders works on a final budget compromise here, Democrats and Gov. Bill Walker are urging lawmakers to use their spare time for hearings on expansion of the public Medicaid health care program and work on other pending legislation. Both Walker and the Democratic minorities in the Legislature want Medicaid expanded to make about 40,000 low-income Alaskans newly eligible. That’s one of House Democrats’ requests in budget talks with the Republican majorities in both the House and Senate. But lawmakers from both those majorities have opposed expanding the program, saying that their concerns about Medicaid’s costs and problems with the program haven’t been addressed and that Walker’s plan needs more work. (Herz, 4/22)

Federal officials have put Tennessee on alert: Hundreds of millions in federal funds for uncompensated care at state hospitals are under review, a scenario exacerbated by the failure to pass Insure Tennessee. ... Insure Tennessee, Gov. Bill Haslam's insurance expansion plan using federal Medicaid funding, would insure an estimated 280,000 more people, theoretically reducing the amount of uncompensated care at hospitals. Haslam negotiated a waiver with the U.S. Department of Health and Human Services to create Insure Tennessee, which has been defeated by the state Senate twice in committees. (Fletcher, 4/22)

The Ohio House of Representatives on Wednesday approved a two-year, $71.5 billion budget for the state that increases spending on education and Medicaid and also cuts income taxes. The budget now goes to the Senate, then will be taken up in a conference committee before final passage, which is expected in June. ... State Rep. John Barnes (D., Cleveland) broke party ranks to support the bill because Republicans left in the bill the Medicaid expansion that Governor Kasich supported despite many conservative Republicans’ opposition. “The most important aspect of this budget for me is the provision to expand Medicaid,” Mr. Barnes said. (Troy, 4/23)

Despite grumbling by some conservative lawmakers, it also would continue to accept another two years of federal funding for Medicaid expansion. Such federal support is scheduled to start declining in 2017. In total, the House's plan calls for $71.5 billion in general revenue fund spending – more than $770 million less than what the governor sought. However, overall spending would increase in the House version because it would raise the state's hospital franchise fee, resulting in more Medicaid matching funds from the federal government. (Pelzer, 4/22)

Newly insured patients have asked a judge to let them help defend Arizona's Medicaid expansion in a lawsuit challenging the plan. Advocacy groups representing low-income Arizona residents say their clients should be allowed to have a say in court because Republican Gov. Doug Ducey has repeatedly said he opposes President Barack Obama's health care overhaul law, which made the expansion possible. A Ducey administration official is the named defendant in the lawsuit, and the state is represented by outside counsel. (Christie, 4/22)

Most specialized cancer hospitals say they participate in the narrow provider networks of some exchange health plans, but health insurers have not been shy keeping some cancer hospitals out, according to a new survey from consulting firm Avalere Health. The Avalere analysis follows an Associated Press report last year which found that many of America's most prestigious cancer hospitals were getting excluded from health plans sold on the Affordable Care Act exchanges in 2014. (Herman, 4/22)

About 170,000 Washington residents bought insurance through the state health care exchange during open enrollment that ended last week, officials reported Wednesday. That's about 40,000 more people than bought insurance during the first year the exchange was open, but it's still about 40,000 fewer than the goal state officials set this year for Washington Healthplanfinder. (Blankinship, 4/22)

MNsure Board chairperson Brian Beutner and member Thompson Aderinkomi said they will not seek re-appointment when their terms end early next month. The decisions follow the problem-plagued rollout of MNsure, the agency that runs the state's online health insurance marketplace, in 2013 and legislative proposals to eliminate the agency's board. (Zdechlik, 4/22)

A bipartisan bill to help health insurance companies avoid fees under ObamaCare is now backed by a majority of House lawmakers, its sponsors announced Wednesday. The bill would repeal an ObamaCare provision commonly called the “health insurance tax” (HIT), which charges insurers an annual fee to help pay for the healthcare law. (Ferris, 4/22)

One GOP source said negotiators had resolved a sticking point over how to offset a recently enacted bipartisan Medicare overhaul that was not entirely paid for. The source said the agreement is likely to offset the overhaul, often called the “doc fix,” starting next year. But it remained unclear exactly how the agreement would resolve other points of contention, including a multi-billion dollar defense increase and strategies for taking on Obamacare. (Bade, 4/22)

The Senate on Wednesday overwhelmingly approved a bill aimed at curbing sex trafficking after leaders resolved an impasse over abortion, clearing the way for a vote Thursday on confirming Loretta Lynch for attorney general. (Peterson, 4/22)

The unanimous 99-0 vote belied much of the drama behind the legislation, which jammed up the Senate floor amid partisan bickering over whether the bill’s restitution fund for victims should be subject to abortion restrictions. The row over social issues also obscured strong support for the measure’s core provisions aimed at combating sex slavery. (Everett, 4/22)

The House on Wednesday passed a bipartisan cybersecurity bill to make it easier for companies to share cyber-threat information with the government and thwart hacks by criminals, terrorists and rogue nations. It was the first action in the new Congress in response to recent high-profile cyber attacks that have included Sony Pictures, Home Depot, JPMorgan Chase, Target, Anthem health insurance, the State Department and the White House. (Kelly, 4/22)

A few years ago, the drug companies dominating mergers-and-acquisitions headlines were largely household names, from Pfizer Inc. and Merck & Co. to Novartis AG. These days, a new generation of deal makers is making news, with names distinctly less familiar: Actavis PLC, Endo International PLC and Valeant Pharmaceuticals International Inc. Within the past few weeks, two other relatively under-the-radar companies, Mylan NV and Teva Pharmaceutical Industries Ltd., also entered the fray. (Rockoff and Walker, 4/22)

Over the past year, prices for many generic drugs have been climbing, prompting concerns that a low-cost staple of the U.S. health care system might soon strain budgets. And two new reports indicate that prices continued to rise during the first quarter of this year, but not at the same rapid rate that was seen at times in 2014. (Silverman, 4/22)

Novartis AG on Thursday reported a huge rise in first-quarter profit as the proceeds of a series of transactions that overhauled the Swiss drug giant flattered its results. Basel-based Novartis said net profit attributable to shareholders rose more than four times to $13 billion in the quarter ended March 31 as the company recorded one-time gains of $12.8 billion on the sales of businesses to GlaxoSmithKline PLC and Eli Lilly and Co. Novartis reported $2.94 billion in net profit a year earlier. (Morse, 4/23)

Teaching hospitals have long been points of pride for major universities, and in recent years revenue from medical services has served as a lifeline for some schools that have struggled with falling state aid and pressure to slow tuition increases. Now the marriages between universities and their cash-cow clinical operations are starting to fray as changes stemming from the 2010 health-care law threaten to make university hospitals less profitable. (Korn, 4/22)

Privately run Medicare plans, fresh off a lobbying victory that reversed proposed budget cuts, face new scrutiny from government investigators and whistleblowers who allege that plans have overcharged the government for years. Federal court records show at least a half dozen whistleblower lawsuits alleging billing abuses in these Medicare Advantage plans have been filed under the False Claims Act since 2010, including two that just recently surfaced. The suits have named insurers from Columbia, S.C., to Salt Lake City to Seattle, and plans which have together enrolled millions of seniors. Lawyers predict more whistleblower cases will surface. The Justice Department also is investigating Medicare risk scores. (Schulte, 4/23)

Both health-care consumers and providers felt the squeeze of rising health-care costs in 2014 – with out-of-pocket costs for patients rising 11% -- according to a TransUnion Healthcare report released Wednesday. (Helies, 4/22)

A Department of Veterans Affairs medical center in West Virginia put patients at risk by substituting prescribed mental-health medications with older drugs to cut costs, according to a federal investigation. The practice, exposed by an agency whistleblower, violated VA policy and created a “substantial and specific danger to public health and safety,” the department’s Office of Medical Inspector found. (Hicks, 4/23)

Veterans Affairs whistleblowers from two VA regional offices — Philadelphia and Oakland — told a U.S. House committee hearing that management at their benefits claims office “created a hostile work environment” that has left employees “very demoralized,” and they endured psychological abuse after they reported failures to process thousands of claims. (Wax-Thibodeaux, 4/22)

A bill that would require more California children to be vaccinated before they enter school passed a key Senate committee Wednesday as more than 100 parents protested that it would deprive many young people of a public education. The measure cleared the Senate Education Committee on a bipartisan 7-2 vote after its authors agreed to changes that would make it easier for parents to home-school their children if they decided against immunization. (McGreevy, 4/22)

Legislation aimed at reversing the state's liberal vaccine exemption law took a major step forward Wednesday in the state Senate, only a week after support for the bill seemed to be on shaky ground. (Seipel and Calefati, 4/22)

Legislation requiring vaccinations for nearly all California schoolchildren revived Wednesday, winning the approval of a Senate committee that a week earlier looked poised to reject the measure. (White, 4/22)

California's senate education committee approved a bill making it mandatory for children to be vaccinated before starting school despite opposition from “ant-vaxxer” parents who have packed public hearings and flooded lawmakers with calls. The bill, which has already passed the senate health committee, has several more hurdles to clear before becoming law. It next goes to the senate judiciary committee, before going to the state senate, and finally the assembly. (4/22)

The state Senate voted Wednesday to end the philosophical exemption for childhood vaccinations and to make the full range of shots a condition for enrolling in school. The Senate's 18-11 vote came on an amendment to a House bill that now returns to that chamber to see if lawmakers will concur. The House declined to do that when the Senate passed similar legislation in 2012, and the effort failed that year. (4/22)

During Alabama's latest budget crisis, lawmakers often have pointed to out-of-control Medicaid costs as one of the leading culprits. A report released Wednesday by the Pew Charitable Trusts, however, suggests that costs relative to state revenues have been much more manageable in Alabama than most other states over the past decade. (Kirby, 4/22)

Medicaid costs accounted for 11.4 percent of the state’s general revenue budget in 2013, up from 8 percent in 2000, a study released Wednesday by the Pew Charitable Trusts shows. Still, that was below the national average of 16.9 percent in 2013, an average that grew from 12.2 percent in 2000. ... Deputy Revenue Secretary Mark Muchow said Wednesday the results are not surprising, because with the exception of North Dakota, whose economy is buoyed by the oil boom there, health care costs are outpacing growth in the economy nationwide. (Kabler, 4/22)

Rhode Island health-care leaders Wednesday began filling in some of the blanks in Governor Raimondo's proposal to reduce state Medicaid spending by $180 million next fiscal year. In its next-to-last meeting, the working group tasked with identifying half of the $90 million in state Medicaid savings in Raimondo's fiscal 2016 budget proposal — the other $90 million is federal matching — unveiled a list of savings initiatives worth an estimated $85.5 million. The list...includes the large cuts to hospital and nursing home reimbursement rates in Raimondo's proposal plus roughly 30 smaller initiatives it projects to generate savings. (Anderson, 4/22)

Louisiana’s nursing home industry is trying to exempt itself from the final phase of Gov. Bobby Jindal’s Medicaid privatization. The industry’s objection is stalling release of initial steps in the bidding process — called request for proposals or RFP — that would seek a private company to take over management of long-term care programs for the elderly and developmentally disabled. (Shuler, 4/22)

New York's comptroller says $513 million in improper Medicaid payments and missed revenue over four years and another $361 million in questionable transactions were identified by auditors. Comptroller Thomas DiNapoli says Medicaid, insuring nearly 6.4 million low-income New Yorkers, was found with waste throughout the system. It's projected to cost $62 billion this year, with $22.4 billion paid by the state. (4/23)

Maine's attorney general is urging state budget writers to give her more resources to combat Medicaid fraud and elder abuse. Attorney General Janet Mills wants to add a third attorney to the HealthCare Crimes Unit, which investigates and prosecutes Medicaid fraud and patient abuse and neglect in health care facilities. (4/23)

Despite critics who called it patronizing and even “dangerous,” a bill that would extend the waiting period for abortions passed a House committee Wednesday. The Health Committee approved House Bill 465 by a party line vote, with Republicans in favor and Democrats against. It could be voted on by the House as early as Thursday. (Morrill, 4/22)

Less than a year after the region's only abortion clinic closed, Planned Parenthood quietly started performing the procedure Friday. State legislators at the same time moved to increase regulations and expand wait times for women requesting abortion care. (Walton, 4/22)

California's insurance commissioner criticized healthcare giant Anthem Blue Cross for imposing an "excessive" rate increase on nearly 170,000 customers statewide. Dave Jones said Wednesday that Anthem had failed to justify its 9% average rate hike that took effect April 1. Premiums are going up as much as 25% for about 4,000 policyholders. (Terhune, 4/22)

A group of state employees and retirees is asking a judge to reverse changes made to their insurance program that cost many workers more out-of-pocket for lessened benefits. The lawsuit, announced Wednesday, was filed in state district court a day earlier, claiming Gov. Bobby Jindal's administration didn't follow state law in reworking the health insurance plans offered through the Office of Group Benefits. (DeSlatte, 4/22)

A proposed health services budget in the Democratic-controlled Senate has funding to save two state mental health facilities slated to close this year, lawmakers said Wednesday, though it’s unclear whether such a legislative move would garner enough support from either the House or Iowa Gov. Terry Branstad. Sen. Amanda Ragan, D-Mason City and vice chairwoman of the Senate Human Resources Committee, said there is about $11 million in a proposed health and human services budget bill to keep the facilities in Clarinda and Mount Pleasant open. (Rodriguez, 4/22)

A measure requiring physicians to spell out a patient's options even if they're objectionable to the doctor has received Senate approval. It would change a 1977 law that allows health care providers to refuse to perform medical procedures they find morally objectionable. The Biss plan would require that even if a health care provider refuses to treat a patient, it must tell the patient what's wrong, what options exist, and where treatment is available. (4/22)

A measure before Illinois lawmakers would require Roman Catholic hospitals to tell patients they can go elsewhere for birth control, certain medical procedures and other health care choices that violate church teachings. The proposal would amend the state's Health Care Right of Conscience Act, which generally allows workers and institutions to deny services for religious and ethical reasons. And while it would apply to all hospitals in Illinois, it's particularly relevant for Catholic hospitals, which handle more than 1 in 4 admissions statewide. (Pashman, 4/17)

The commissioner of Georgia’s Medicaid agency has written a sharply worded defense of nursing home payments now deemed improper by the federal government. A federal ruling saying Georgia should return more than $100 million in nursing home payments “is factually and legally incorrect,’’ Clyde Reese, commissioner of the Department of Community Health, wrote in a February letter to a Centers for Medicare and Medicaid Services (CMS) official in Atlanta. “Refunding payments previously approved by CMS would be inequitable and would result in unjust enrichment to the federal government,” Reese said. It would probably also lead to the closure of the more than 30 nursing homes involved, he added. (Miller, 4/22)

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state. There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four week programs. (Bebinger, 4/22)

Children's Hospital Colorado in June will relinquish control of its pediatric center at Memorial Hospital Central in Colorado Springs after a federal and state investigation found problems with emergency services. In a joint statement Wednesday, the hospitals said the emergency room has stopped treating severe trauma in pediatric patients. The Colorado Springs hospital will no longer be able to treat the most complex pediatric trauma cases, estimated at fewer than 10 per month. (Draper, 4/22)

Activists held hunger strikes for years and doctors lobbied the state General Assembly before Illinois allowed undocumented immigrants to acquire state-funded kidney transplants last year, a program that is set to be cut under Gov. Bruce Rauner's proposed budget. Immigrant advocates in Chicago expressed dismay at the proposal. (Rodriguez, 4/22)

A number of factors underpin the anti-redistributionist shift in public opinion that I wrote about last week. First, and perhaps most important, is the emergence of significant resistance to downward redistribution among the elderly, a major voting bloc. ... In the zero-sum competition for federal dollars, the cost of major spending programs like the Affordable Care Act has to be made up by spending cuts elsewhere. The Obama administration has reported that the Affordable Care Act will be financed in part by $716 billion in Medicare cuts over 10 years. Somewhat improbably, the administration also contends that cuts of this magnitude will not reduce services to Medicare beneficiaries. (Thomas B. Edsall, 4/22)

The uncomfortable truth (for liberals, at least) is that the ACA case arises from a piece of statutory language that on its face explicitly says that tax subsidies are only available for health insurance purchased on an exchange “established by the state.” Liberals have tried to explain why, correctly interpreted, this language really means “established by the state or the federal government on the state’s behalf.” But their theories seem forced. ... The simplest way for the liberals to win the Obamacare case, King v. Burwell, is to convince [Justice Anthony] Kennedy that the ACA shouldn’t be read literally, as doing so would produce a disastrous and therefore unjust result. (Noah Feldman, 4/22)

Tea Party Senator Ron Johnson has unveiled a new plan to provide temporary help to the millions of people who might lose health coverage if the Supreme Court sides with the King challengers and guts subsidies in three dozen federal-exchange states. Senator Johnson’s fix reportedly has 29 GOP co-sponsors ... and it is fair to assume the eventual GOP post-King contingency plan, if there is any GOP consensus plan, may look something like it. ... The Johnson plan would keep subsidies going ... until September of 2017. ... The idea is to buy time to develop a more comprehensive GOP replacement for Obamacare. As Johnson himself recently put it, this would allow the future of health reform to be litigated in the 2016 presidential race. (Greg Sargent, 4/22)

The Kaiser Family Foundation released a poll Tuesday showing that public opinion is divided on the Affordable Care Act, also known as Obamacare. Forty-three percent of respondents reported that they approve of the health-care law, and 42 percent said they disapprove. That’s a marked improvement from much of the last year. But those of us who believe that the ACA is decent policy that’s working fairly well still need to ask: Why do its polling numbers remain so low? (Stephen Stromberg, 4/22)

On December 17, 2014, Vermont Governor Peter Shumlin publicly ended his administration's 4-year initiative to develop, enact, and implement a single-payer health care system in his state. ... In reality, the Vermont plan was abandoned because of legitimate political considerations. Shumlin was first elected governor in 2010 promising a single-payer system. But in the 2014 election, his Republican opponent campaigned against single payer. Shumlin won the popular vote by a single-percentage-point margin, 46% to 45%, which sent the election to the Democratic-controlled House of Representatives; though the House reelected him easily in January, a clear public mandate for his health care agenda was nowhere in evidence. (John E. McDonough, 4/22)

Gov. Rick Scott and Florida House Republicans are failing our uninsured residents and our hospitals that care for them. They oppose the Senate's plan to accept federal Medicaid expansion money and overhaul the Low Income Pool, which sends hospitals more than $1.5 billion a year in federal, state and local money to treat the uninsured. ... Tell the governor and House Republicans to stop fighting Washington and putting our residents and hospitals at risk. (4/22)

Your humble blogger has been tracking the battle over the Medicaid expansion in Florida, because it’s a really big deal. If the administration can get Governor Rick Scott and state House Republicans to accept the expansion, it could help weaken the blockade against it that conservatives have built in other states, which has slowed down Obamacare’s health coverage expansion after a number of states accepted it last year. Now things are getting truly crazy in Florida. Legislators who oppose the Medicaid expansion are locking reporters out of meetings about the issue. And Republicans who support it are saying this episode is now reflecting badly on the national GOP. (Greg Sargent, 4/22)

The Montana affiliate of the Kochs’ Americans for Prosperity thought it was in a strong position to derail Medicaid expansion in the state, just as AFP activists did in Tennessee in February. ... at this point a year ago, Medicaid expansion in Montana looked like a lost cause, but in early May 2014, [Gov. Steve] Bullock started arranging some “non-publicized” meetings on the issue. The governor saw a possible opportunity to advance the policy, so he started quiet negotiations with state Republicans and private-sector stakeholders. It worked. Assuming the Obama administration signs off on the package, which is likely, Montana will expand health security to tens of thousands of low-income residents, while improving state finances and bolstering state hospitals. (Steve Benen, 4/22)

Let us now praise Newt Gingrich. Yes, Newt Gingrich. There he was, the scourge of Big Government, on the op-ed page of Wednesday’s New York Times calling for a doubling of the National Institutes of Health budget. “It’s irresponsible and shortsighted, not prudent, to let financing for basic research dwindle,” he wrote, noting that government investments in preventing and curing disease could save the government money in direct health-care costs. (E.J. Dionne, 4/22)

The men and women who serve in the military protect both the United States’ security and its values, including political liberty, free enterprise and individual choice. How strange, then, that when their time in uniform ends, we thank them for their service and turn them over to the Department of Veterans Affairs, which epitomizes centralized bureaucracy. (Charles Lane, 4/22)

When the federal government announced last week that youth e-cigarette use tripled in just one year, surpassing the use of traditional cigarettes, the reaction was appropriately strong. “A wake-up call,” said one commentator, echoing others. We agree. But a word that shouldn’t be used to describe it is “surprising.” It’s not. E-cigarettes have so far escaped federal regulation and are being promoted using the same playbook cigarette companies have used to addict generations of teenagers. (David A. Kessler and Matthew L. Myers, 4/23)

Michigan Republican Tim Walberg was a Christian minister before winning election to Congress in 2010 — and he hasn’t entirely changed jobs. In a rare Tuesday-night committee meeting at which House Republicans advanced a bill curtailing reproductive rights, Walberg took the even rarer step of lecturing his colleagues on Scripture. (Dana Milbank, 4/22)

After a second go, and some hasty revision, a controversial bill to end the personal belief exemption for school vaccinations passed through the Senate Education Committee on Wednesday. But it’s far too early for supporters of the bill to raise a celebratory toast. There are plenty of other ways SB 277 by Sens. Richard Pan (D-Sacramento) and Ben Allen (D-Santa Monica) can get held up as it works through the legislative process. (Mariel Garza, 4/22)

Ask most rational people what their No. 1 priority is and, I suspect, they would answer good health. Love, friends, money, freedom, a good education, a productive life — they're all right up there. But none outranks health. So it's pathetic that more legislators aren't fully embracing a bill that essentially would tell parents: Vaccinate your kids against infectious diseases or they won't be allowed in school where they could jeopardize the health of other children. (George Skelton, 4/22)

In most doctor-patient conversations, the doctor leads the way. But when it comes to planning for the end of life, we need a role reversal. The patient — you — may have to take the lead in conducting end-of-life conversations. While this may seem surprising, remember that dying is essentially a social and intimate family event that has become overly medicalized in the past century. (VJ Periyakoil, 4/22)

For the first time, I was present as one of my patients died. I had been working in intensive care all year, and many of the people I’d cared for were dead now. But this patient died with my hand on his forehead. I was with him and saw the monitor the minute his heart quit, its rate dropping from 130 beats a minute to 90, 70, 40, 30, asystole. It was peaceful. He had a do-not-resuscitate order, and the family was expecting it. As far as dying in an intensive care unit goes, it was a good death. (Melissa Beth Behl, 4/22)

The dysfunctional Congress finally appears to be working again as the Founders intended. Lawmakers are negotiating, voting on bills and actually passing legislation. As proof of this, National Journal’s Charlie Cook points to three things: congressional approval of a permanent “doc fix” to prevent cuts to physician reimbursements under Medicare; extension of the Children’s Health Insurance Program; and passage of budget resolutions by the House and Senate. There’s even more evidence. (Karl Rove, 4/22)

Now Congress has scrapped the SGR, replacing it with still-embryonic but promising incentives that could catalyze increased efficiency and greater cost control than the old, flawed formula could ever really have done, in a law that includes many other important provisions. How did such a radical change occur? And why now? The “how” was logrolling — the trading of votes by legislators in order to pass legislation of interest to each of them. Logrolling has become a dirty word, a much-reviled political practice. But the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA), negotiated by House leaders John Boehner (R-OH) and Nancy Pelosi (D-CA) and their staffs, is a reminder that old-time political horse trading has much to be said for it. (Henry J. Aaron, 4/22)

In February 2015, Senators Orrin Hatch (R-UT) and Richard Burr (R-NC), along with Representative Fred Upton (R-MI), unveiled the Patient Choice, Affordability, Responsibility, and Empowerment Act (Patient CARE Act). ...it would fundamentally restructure the program. First, the proposal would eliminate all federal funding for the ACA' s expansion of Medicaid eligibility for adults. Second, it would end Medicaid's historical entitlement to comprehensive coverage for low-income children, pregnant women, and families with dependent children, along with the entitlement to long-term care services and support for elderly or disabled Medicaid beneficiaries. For these groups and services, it would replace Medicaid's open-ended financing structure with a block grant that would allocate a fixed sum to each state .... Such a law would be bad news for beneficiaries and for providers, especially those that serve low-income communities, since under such financing terms few, if any, states could maintain existing coverage for affected populations. (Sara Rosenbaum and Timothy Westmoreland, 4/22)

Early in his career, Louis B. St. Petery Jr, MD, a pediatrician in Tallahassee, Florida, attended the funeral of a young patient from his practice who was shot and killed after the child’s sibling found a loaded gun in a bedside drawer. “It should never happen,” said St. Petery .... With that memory not far from mind, St. Petery, like many physicians across the country, routinely asks his patients’ parents whether they have guns in their home. If they do, he advises them to take safety measures .... But whether St. Petery and colleagues across Florida will be able to continue such routine inquiries without fear of being reported to the state medical board now rests in the hands of the US Court of Appeals 11th Circuit. (Bridget M. Kuehn, 4/22)