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The Montana House of Representatives voted Wednesday to blast a Republican lawmaker's Medicaid expansion bill to the floor after two hours of back and forth over procedural rules as conservative Republicans attempted to derail the measure. Eleven Republicans joined all 41 Democrats to bring the measure out of the House Human Services Committee by a 52-48 vote. (Baumann, 4/9)

After two days of maneuvers aimed at killing the bill, the last Medicaid expansion measure still alive will come to the House floor for debate Thursday. The House voted 52-48 on Wednesday to blast Sen. Ed Buttrey's Medicaid expansion bill out of committee after tense discussion on rules, on deals and even on the meaning of the word "and." ... 11 Republicans ... joined 41 Democrats to bring up the bill for debate. ... Senate Bill 405 would help close the gap between those covered by Medicaid and those eligible for subsidized insurance coverage by raising the income threshold for Medicaid. The bill makes use of federal funds and calls for payments from plan users. (Inbody, 4/8)

Republican state Rep. Art Wittich, R-Bozeman, called it “law of the jungle.” Democratic House Minority Leader Chuck Hunter said it’s just a matter of interpreting the House rules. Hunter, however, was able to muster 52 House members who agreed with him, so he won the argument Wednesday, as 41 Democrats and 11 Republicans used -- and interpreted -- the rules to their advantage to advance one of the biggest bills of the 2015 Legislature. The bill is Senate Bill 405, which would expand Medicaid in Montana to offer government-funded health coverage to an estimated 45,000 low-income citizens over the next four years. (Dennison, 4/8)

In a rare display of raw political power at the Montana Legislature, all House Democrats and 11 House Republicans Wednesday muscled a Medicaid-expansion bill to the House floor, where it will be debated and voted on Thursday. Through a half-dozen votes spread over two hours, the bipartisan voting bloc repeatedly formed a 52-vote majority to overturn actions of House Speaker Austin Knudsen, R-Culbertson, and force the decisive vote that removed Senate Bill 405 from the House committee that voted Tuesday to kill the measure. House Minority Leader Chuck Hunter, D-Helena, led the effort, saying it’s time for the House to have a “good debate (on this bill) and vote it up or down.” (Dennison, 4/9)

Moderate Republicans have outmaneuvered conservatives in the Montana legislature to give a Medicaid expansion bill here a real chance of passing. Its prospects have been in doubt since the legislative session began in January. The bill faces a crucial debate and vote on the state House floor Thursday. If the Republicans who joined with Democrats to overcome attempts to kill it don’t stray, it has the votes to pass. Pending the governor’s signature and approval from the federal government, the bill would make Montana the 29th state – plus the District of Columbia — to expand Medicaid. (Whitney, 4/9)

A third attempt to expand Nebraska Medicaid coverage under the federal health care law was defeated Wednesday by conservative lawmakers who cast it as an unaffordable expansion of government. Lawmakers voted 28-16 to send the bill to the bottom of the Legislature's agenda, effectively killing it for the rest of this year. (Shulte, 4/8)

Nebraskans who may have depended on state senators this year to expand Medicaid saw a swift end Wednesday to their hopes. Supporters of expansion couldn’t even hang on for an eight-hour filibuster. The Medicaid Redesign Act (LB472) essentially died after senators failed to adopt an amendment on a 22-24 vote. The amendment was necessary to change the makeup of the proposed Medicaid Redesign Task Force and ensure the bill was constitutional. (Young, 4/8)

In another sign of growing tension about a Senate plan to expand health coverage for low-income Floridians, a Senate committee Tuesday tabled the confirmation of state Surgeon General John Armstrong after questioning him about the issue. The move by the Senate Health Policy Committee came a day after Gov. Rick Scott --- Armstrong's boss --- opposed the plan to use federal money to provide health coverage to an estimated 800,000 Floridians through a private insurance system. (Saunders, 4/8)

The main national organization promoting Obamacare enrollment is cutting 100 jobs amid a major retrenchment as key funders turn to other health care priorities. It’s the beginning of the end for Enroll America, which was set up by liberal advocates of the Affordable Care Act to run a sophisticated, political-style campaign to persuade Americans to get covered. The group, led by veterans of President Barack Obama’s campaigns and administration, was never intended to last forever, but a precipitous drop in funding forced it to scale back to half of its peak size after only two seasons of Obamacare sign-up. That’s a far more rapid throttling back than its founders anticipated. (Norman, 4/9)

One week before the 2014 tax deadline, Affordable Care Act advocates and tax preparers in Charlotte are making a push to get people covered for 2015. The act, which offered subsidized health insurance for the first time last year, has complicated tax filing. Many people who were uninsured for all or part of 2014 owe a penalty, but they can sign up now to get covered and reduce the 2015 penalty. (Helms, 4/8)

Democratic Rep. Lois Capps, in her 10th term representing a congressional district along California's Central Coast, said Wednesday that she will not run for re-election. ... A former nurse, the 77-year-old Capps has served on the influential House Energy and Commerce Committee. Over the years, she has often focused on health issues with legislation that included increasing the availability of emergency defibrillators, expanding opportunities for people to get into nursing and improving Medicare coverage for patients suffering from Lou Gehrig's disease. (4/8)

The Santa Barbara Democrat was elected to Congress in a 1998 special election to replace her husband, Walter, after his death. She said in a video that “it is time for me to return home, back to the community and family that I love so much.” ... Capps’ most notable work has been in healthcare and nursing. For example, she wrote a provision in 2000 giving grants for children’s dental care and a 2002 law providing scholarships and grants designed to train more nurses. (Bierman, 4/8)

One Democrat quickly jumped into the race Wednesday afternoon. Santa Barbara Mayor Helene Schneider praised Capps and said she plans “to pursue an agenda that focuses on helping Californians reach their full potential by creating more good paying jobs, growing the middle class, advancing more progressive environmental protection policies, investing in our infrastructure and education, defending Medicare and Social Security, and ensuring equal pay for equal work for all Americans.” (Schneider, 4/8)

He is neither the first, nor certainly the last, to hold out the hope for a balanced budget — while at the same time glossing over what happens if the government is truly made to live within its means. Some combination of Social Security, Medicare, the armed forces, domestic security, roads, medical research and much more wouldn’t look the same if that happened. (Woodward and Elliott, 4/9)

Rand Paul and Debbie Wasserman Schultz spent the Kentucky senator’s first day on the presidential campaign trail fighting about abortion. Early Wednesday, Paul refused to tell the Associated Press whether he would support exceptions for abortions in instances of rape, incest or if the birth of a child would risk the mother’s life. (Breitman, 4/8)

Kentucky Sen. Rand Paul, a newly declared Republican presidential candidate, is dodging a central question about abortion: What exceptions, if any, should be made if the procedure were to be banned? In an interview with The Associated Press on Wednesday, Paul would not say if his opposition to abortion rights includes an exception in cases of rape, incest or risk to the life of the mother. (Elliott, 4/8)

A pricey pill made by Gilead Sciences Inc. caused Medicaid spending on hepatitis C treatments to soar last year, even as most states restricted access to the drug, leaving many low-income patients untreated. State Medicaid programs spent $1.33 billion on hepatitis C therapies through the third quarter of last year, or nearly as much as the states spent in the previous three years combined, a Wall Street Journal analysis of federal data shows. (Walker, 4/8)

Rite Aid Corp reported a better-than-expected quarterly profit on Wednesday, and expected a renewed distribution agreement with McKesson Corp along with the remodeling of its wellness stores to benefit fiscal 2016 earnings. Rite Aid said its outlook accounts for planned wage and benefit increases, the introduction of certain new generics and a reimbursement rate environment which will remain challenging this year. (Bose and Sharma, 4/8)

John Hancock Financial is the first insurer in the U.S. to offer discounts to policyholders who wear wireless fitness trackers. Sign up for a new life policy today, and the company will send you a Fitbit, one of those bracelets that tracks your steps. The more exercise you get, the bigger discount you get on your insurance premium, up to 15 percent. (Nickish, 4/8)

John Hancock announced a new program promising discounts for policyholders who wear a fitness tracker, exercise more and go to the doctor. The life insurance company says that if people live longer healthier lives, everybody wins. But privacy advocates worry about all the electronic monitoring. (Arnold, 4/8)

Andrew Thomas’s life insurer knows exactly when he arrives at his local gym. The company is notified when he swipes his membership card, and 30 minutes later, it checks that he is still there, tracking his location through his smartphone. The insurance company has a vested interest in keeping Mr. Thomas alive and well. In return for sharing his exercise habits, his cholesterol level and other medical information, Mr. Thomas, a 51-year-old medical publisher who lives in Johannesburg, earns points, which translate into premium savings and other perks. By staying in good shape, it is less likely that Discovery, his insurer, will have to pay out his life and disability policies. (Tara Siegel Bernard, 4/8)

Hooked up to machines and a breathing tube, Joseph Mox, 55, can’t talk to the doctors and nurses bustling around a Johns Hopkins intensive care unit. But they know he likes to be called Joe, enjoys “NCIS” and relied on his Catholic faith through bouts of colon and esophageal cancer. ... Such questions aren’t normally asked in ICUs, where nurses and doctors are often rushing to keep desperately ill patients alive. But the questions are part of an ambitious experiment at Hopkins and three other hospitals to retool the ICU not only to make it safer but also to make it more humane. The goal is to redesign the workflow, culture and behavior to reduce “preventable harms” to patients. (Sun, 4/8)

A year after Americans recoiled at new revelations that sick veterans were getting sicker while languishing on waiting lists — and months after the Department of Veterans Affairs instituted major reforms costing billions of dollars — government data shows that the number of patients facing long waits at VA facilities has not dropped at all. No one expected that the VA mess could be fixed overnight. But The Associated Press has found that since the summer, the number of vets waiting more than 30 or 60 days for non-emergency care has largely stayed flat. The number of medical appointments that take longer than 90 days to complete has nearly doubled. (Caruso, 4/9)

As medical care for veterans continues to raise concerns across the country, new data show that thousands of former service members still face significant delays when they seek treatment at Veterans Affairs medical centers in Maryland. The longest delays among Maryland's VA centers were at the Glen Burnie VA Outpatient Clinic, where nearly 8 percent of appointments were not scheduled within 30 days, the goal set by the U.S. Department of Veterans Affairs, according to data for the six-month period ending Feb. 28. The center's so-called failure rate topped the statewide rate of 2.9 percent and the national rate of 2.8 percent. (Puente and Donovan, 4/9)

The Atlanta VA Medical Center ranks near the bottom nationally in providing timely appointments to vets needing care and has made little progress toward fixing the problem. (Schneider, 4/9)

In the eight months since Congress passed a law pumping billions of dollars into a Veterans Affairs healthcare system plagued by long patient delays and controversy, Miami veterans are seeing improvements in their wait times to see a doctor. According to VA data released last week, about 98.6 percent of appointments completed in Miami’s VA Healthcare system during February — the most recent month for which data is available — were scheduled within 30 days of the patient’s preferred date to see a doctor. (Herrera, 4/9)

While Sen. Rand Paul (R., Ky.) was formally launching his 2016 presidential campaign Tuesday, still-not-a-candidate Jeb Bush was in Colorado, where he called for privatizing some parts of veterans’ health care. Mr. Bush, sitting in front of an untouched breakfast at an IHOP in Colorado Springs, told a group of veterans that he favors transferring some elements of veterans’ care to private hospitals from government-run Veterans Affairs facilities. (Epstein, 4/8)

Arkansas has joined Arizona in requiring doctors to tell pregnant women they can reverse the effects of abortion medication, a controversial mandate that adds to the state’s lead in enacting anti-abortion legislation this session and continues what abortion-rights advocates say is a trend in other states to tighten access to the procedure. Republican Arkansas Gov. Asa Hutchinson signed a bill Monday that forces doctors to tell patients that hormone medication could reverse the effect of abortion pills. Arizona became the first state to enact this law on March 30. (Evans, 4/8)

A new Kansas law banning a common second-term abortion procedure is the first of its kind in the United States. The law, signed by Kansas Gov. Sam Brownback on Tuesday, bans what it describes as "dismemberment abortion" and defines as "knowingly dismembering a living unborn child and extracting such unborn child one piece at a time from the uterus." (Shoichet, 4/8)

The Oklahoma Senate on Wednesday passed a ban on the main procedure used for second trimester abortions, a day after neighboring Kansas became the first state to ban the practice that its critics call "dismemberment abortions." The "Dismemberment Abortion Act" passed easily in both houses of the Republican-dominated Oklahoma legislature and should soon head to Governor Mary Fallin, a Republican, who has been a staunch supporter of abortion restrictions. (Herskovitz, 4/8)

Oklahoma would ban a common second-trimester abortion procedure that critics describe as dismembering a fetus under a measure that lawmakers overwhelmingly approved Wednesday, a day after Kansas became the first state to prohibit the same procedure. (4/8)

Unswayed by a relentless parade of opposition, a key Senate panel on Wednesday passed a bill that would strengthen California's vaccination requirements, capping an emotional hearing that marked the beginning of a battle over what has become Sacramento's most contentious issue this year. (Seipel, 4/8)

A bill that would make childhood vaccinations harder to avoid survived its first legislative test Wednesday, after a three-hour hearing marked by raw emotion on both sides of the issue and a packed rally at which Robert F. Kennedy Jr. denounced the measure. The measure, which would end parents' ability to obtain vaccination waivers for their children based on personal beliefs, passed the state Senate Health Committee on a 6-2 vote. (McGreevy, 4/8)

States are stepping in to enforce a little-known federal law that’s supposed to improve insurance coverage of mental health care for millions of Americans. The parity law has been on the books since 2008, but mental health advocates say the federal government has been slow to make sure it’s been put into practice. (Villacorta, 4/8)

D.C. home health-care workers filed a class action lawsuit against four agencies Wednesday, alleging that they were cheated out of wages and denied overtime and sick pay. The suit against four local agencies — Capitol View Home Health Agency, Human Touch, T&N Nursing and VMT Home Health — comes a week before home health-care workers and other low-wage workers across the country are expected to rally for a $15 wage on April 15 as part of the “Fight for 15 movement.” (Stein, 4/8)

A group of home health workers in Washington, D.C., are suing several staffing agencies in the district for allegedly stealing their wages. In a class action lawsuit, filed in the D.C. Superior Court, the workers claim they were not paid the hourly wage they were entitled to and were denied overtime and sick days in violation of the law. It's the second in a series of lawsuits against home care agencies. (Rooney, 4/8)

Workers at 27 nursing homes [in Conn.] have voted to go on strike April 24, a move aimed at both their employers and state lawmakers wrangling over a state budget that has significant implications for nursing homes. (Levin Becker, 4/8)

Former executive at Blue Shield of California has sued the health insurance giant, claiming he was wrongly fired right before he was due a $450,000 bonus. Aaron Kaufman, the insurer's chief technology officer since 2013, sued Blue Shield on Monday in Los Angeles County Superior Court for wrongful termination and breach of contract. (Terhune, 4/8)

Supporters say a measure requiring hospitals to disclose whether a person is being admitted is needed to protect consumers. The Missouri House on Tuesday gave first-round approval to a bill that would require written notices when a patient is admitted or placed on observational status by a hospital. (4/8)

A federal judge has approved a $3 million settlement in a class-action lawsuit by patients at a former state-licensed mental health facility in Putnam County alleging abuse. The suit filed in 2007 alleges patients were illegally restrained, assaulted, punished and isolated by SLS Residential staff, while the facility falsely advertised compassionate care and effective treatment and received up to $900 a day from patients' insurance companies. (4/8)

More than a half-million adults who said they wanted help with their serious mental conditions last year couldn’t get it because they lacked the resources and weren’t eligible for Medicaid to pay for treatment, a new study finds. Those people — an estimated 568,886 adults ages 18 through 64 diagnosed with a serious mental illness, serious psychological stress or substance use disorder at the start of last year — lived in 24 states that didn’t expand Medicaid eligibility under the Affordable Care Act in 2014, according to a study published this week from the American Mental Health Counselors Association (AMHCA). (Ollove, 4/8)

Prisoners in the Oregon State Penitentiary unit reserved for inmates with the most severe mental illnesses spend months, sometimes years in small cells with no natural light or outdoor access and rarely get to speak with others, according to an investigation by Disability Rights Oregon. (Bernstein, 4/8)

One of the nation's largest suppliers of HIV and AIDS medical care is accused of bilking Medicare and Medicaid in an elaborate $20 million dollar scam that spanned 12 states, according to a lawsuit filed in South Florida federal court. Three former managers of the AIDS Healthcare Foundation filed a suit last week alleging the company paid employees and patients kickbacks for patient referrals in an effort to boost funding from federal health programs. Employees were paid $100 bonuses for referring patients with positive test results to its clinics and pharmacies. (Kennedy, 4/9)

Shortly before 4 a.m. Wednesday, after a six-hour filibuster and bipartisan resistance nearly derailed the process, the Missouri Senate finished its work on the state’s $26 billion budget. Perhaps. Major differences in how the state will fund its social welfare programs, as well as how much money should be divvied out to public schools and colleges, must be worked out with the Missouri House. The debate is complicated by a dramatic proposal to turn over most management of Medicaid to private companies. Meanwhile, Gov. Jay Nixon has expressed serious concerns, setting the table for potential budget battles between the Democratic governor and a Republican-dominated General Assembly. (Hancock, 4/8)

A recent U.S. Supreme Court ruling about teeth-whitening services may have long-term implications for health care professionals and their practices across the country. The dispute involves the right of dental hygienists to perform such services in North Carolina. The Federal Trade Commission brought a major anti-competition case on the matter. The high court did not settle the case, but rejected the state dental board’s claim that its actions were immune from FTC scrutiny. (Kanne, 4/8)

A cancer diagnosis is often the beginning of a life-or-death struggle. Patients want to go into that fight armed with the most powerful weapons available. In many cases, that involves treatments still in their experimental stages that are only available through clinical trials, which are typically found at academic medical centers. But the University of Kansas Cancer Center has created a partnership to bring those options closer to home for rural Kansans. (Thompson, 4/8)

A battle over the Medicaid expansion has erupted among Republicans in Florida, and it has created a strange situation: Republican legislators are urging GOP Governor Rick Scott to accept the expansion, but he is reluctant to do so, even though it is imperiling his drive for tax cuts. Scott can’t seem to decide which priority is more important: Turning away federal money to expand health care for hundreds thousands of his own constituents; or cutting taxes. (Sargent, 4/8)

We are morons for allowing a handful of selfish, egotistical, politically driven hucksters to waste billions of our tax dollars while also playing games with people's lives. ... In this case, the buck has to stop with us. It is our responsibility to shout so loud and so long that it becomes impossible for the reverse populists in Tallahassee to continue to ignore reality. And the reality is by failing to address Medicaid expansion, our elected leaders are guilty of political malfeasance. You might have heard Gov. Rick Scott has changed direction — once again — on this issue. He's back to singing the same tired tune as the sock puppets in the state House. (John Romano, 4/8)

There's nothing — nothing — that irritates people more about the department they otherwise love than watching a 50-foot firetruck with a crew of fully suited firefighters show up to a 911 call for a heart attack or bee sting. Inevitably, someone watching the drama will gripe, "Why can't they just send an ambulance?" It's a valid question. The answer is an unnecessarily complex one that dates to a time when fighting fires was still the main mission of most fire departments. But times have changed. "Structure fires" are fewer and farther between. Today, nearly 90% of the calls to the Los Angeles Fire Department are for medical service. (4/8)

A farsighted food safety law enacted in 2011 has faced obstacles to meaningful enforcement ever since, including delays in issuing necessary rules and a shortage of money. Now, in what may become the latest shameful chapter, Congress seems unwilling to provide enough money to effectively carry out regulations that are about to be issued. The losers, of course, will continue to be consumers, who live with the hazards of an unsafe food supply. (4/9)

I don’t quite understand Robert Kennedy Jr., smart and dedicated environmental lawyer, scion of a revered political family—and opponent of required vaccinations. Look, there are plenty of anti-vaxxers—though Kennedy doesn’t quite fit in that category, having had his own kids vaccinated—but I can understand their reasoning, even if it isn’t grounded in science. ... Kennedy is going in logical circles on the question of childhood vaccines. He’s making great shows, but so far he’s not making great sense. (Karin Klein, 4/8)

Someday soon, Big Brother may be watching you. Only his name will be "John Hancock." The insurer is rolling out a program in the U.S. similar to ones already deployed in other parts of the world, where your life insurer tracks your fitness levels, then gives you rebates depending on how active you are. ... I'm sure this makes sound business sense in an industry that isn't exactly experiencing roaring demand growth. But if it becomes common, I'd expect some pushback. After all, this is exactly the sort of sound underwriting we just outlawed in the health insurance market. (Megan McArdle, 4/9)

In the United States, patients make 1 billion visits to physicians’ offices every year. These visits are the principal way patients access health care and are the building blocks of the patient-physician relationship, at an estimated annual cost of nearly $600 billion. Payment system changes are fueling growth in alternatives to the traditional office visit, raising the question of how often patients should visit and interact with their clinicians. The large variation in practice, the paucity of research on the subject, and the emergence of accountable care organizations (ACOs), in which health systems uphold quality standards and assume a share of financial risk for patient costs, present new impetus to examine this question from an individual and a population health perspective. (Ishani Ganguli, Jason H. Wasfy and Timothy G. Ferris, 4/6)