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The Trump administration on Wednesday proposed changes to the Obamacare individual insurance market that insurers welcomed as a good start but that raised the possibility of higher out-of-pocket cost for consumers. (Humer and Abutaleb, 2/15)

A proposed rule released Wednesday aims to give health insurers greater certainty and financial benefits, making it more appealing for them to stay in Affordable Care Act’s insurance exchanges. Some health-care advocates, however, say the changes would hurt consumers. (Armour, 2/15)

The proposed rules, backed by insurance companies, would tighten certain enrollment procedures and cut the health law’s open enrollment period in half, in hopes that a smaller but healthier consumer base will put the marketplaces on sounder financial footing and attract more insurance companies in states with limited choices. But part of the market’s problem stems from President Trump’s determination to repeal the health law while the White House and Congress struggle to find a politically acceptable replacement. Even as the Department of Health and Human Services worked to answer insurance company concerns, the Internal Revenue Service and Congress were taking steps that could add uncertainty to the jittery insurance economy. (Pear, 2/15)

For consumers, the proposed HHS rules mean tighter scrutiny of anyone trying to sign up for coverage outside of open enrollment by claiming a "special enrollment period" due to a change in life circumstances such as the birth of a child, marriage, or the loss of job-based insurance. Also, sign-up season will be 45 days, shortened from three months currently. (2/15)

The proposed regulations also set the stage for potential reductions in government aid to low- and moderate-income consumers, another policy favored by GOP leaders, including Trump’s new Health and Human Services secretary, Tom Price, a fierce advocate for reduced federal healthcare spending. (Levey, 2/15)

HHS will also require people who want to sign up for coverage during so-called special enrollment periods to first prove they qualify because of a life change like losing a job or getting divorced. "The overall effect of many of the policies here would actually, over time, I think, actually shrink enrollment, not grow enrollment," says Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. (Kodjak, 2/15)

Notably, the rule doesn’t address age-rating bands that set how much more insurers can charge older people compared to younger participants. Some insurer and consumer groups want to see the current three-to-one ratio loosened to lower premiums for younger people. (McIntire, 2/15)

“This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options,” said Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services. “They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.” (Tracer and Armstrong, 2/15)

While it addressed a number of insurers’ requests, industry executives said it didn’t resolve all their concerns and stopped short of answering some of the most important questions surrounding the future of the health law’s exchanges. Most of those major issues will likely involve action by Congress—including the fate of ACA subsidies that help low-income consumers pay for premiums and reduce their out-of-pocket costs for care. (Armour and Wilde Mathews, 2/15)

“These are initial steps in advance of a broader effort to reverse the harmful effects of Obamacare, promote positive solutions to improve access to quality, affordable care and ensure we have a health system that best serves the needs of all Americans,” Tom Price, secretary of the Department of Health and Human Services said in a Twitter message. But the new rule, which had been widely expected, was actually begun by the outgoing Obama administration. (Rovner, 2/15)

The IRS says it's following President Donald Trump's executive order on health care by easing enforcement of the unpopular Obama-era requirement for people to have coverage or risk fines. Trump directed federal agencies to ease the health law's rules after he took office. (2/15)

The Internal Revenue Service has revoked an Obama-era instruction to taxpayers that was taking effect during the current filing season as a way to further compliance with the ACA’s requirement that most Americans carry health insurance or pay a tax penalty. Under the instruction, the IRS had announced that it would no longer process tax returns for people who fail to send a notice with their returns that they have insurance, are exempt from the requirement or are paying the fine. (Goldstein, 2/15)

Since the formal launching of the health care program in 2014, taxpayers have been given the option of checking a box on line 61 of their 1040 federal tax returns declaring whether or not they or members of their family have qualified health insurance -- and providing documentation to prove it. Even with this voluntary approach, the IRS collected individual mandate payments from 8.1 million tax returns in 2015 averaging $210 for a total of $1.7 billion, according to an analysis of IRS data by Investor’s Business Daily. (Pianin, 2/15)

It is unclear how much of an effect the decision will have. The mandate remains the law, and people are still supposed to pay a penalty for lacking coverage. Insurers are worried that the Trump administration could ease up on the mandate or create more exemptions to it. The mandate helps bring in healthy enrollees to balance out the sick ones and prevent premiums from spiking. (Sullivan, 2/15)

Seema Verma, the Indiana health care consultant who has been tapped to head the Centers for Medicare and Medicaid Services, will face senators’ questions Thursday on how she would approach the job if confirmed. Exhibit A is likely to be Indiana’s alternative Medicaid program, which Verma designed, and which has been praised by Health and Human Services Secretary Tom Price as a national model. (Groppe, 2/15)

The businesswoman President Donald Trump selected to oversee Medicaid, the health care program for 74 million low-income Americans, has said the program is structurally flawed by policies that burden states and foster dependency among the poor. ... Her proposed solutions can be seen most dramatically in Indiana, where Medicaid enrollees pay fees and a missed payment means a six-month lockout from the program. ... Democrats in Washington are concerned Verma's methods may become a favored model as Republicans work to repeal the Affordable Care Act, making it harder for non-disabled adults to get access to health care. (Johnson, 2/16)

If confirmed, she would take over CMS at a moment of particular uncertainty for the health care industry as Republicans seek to dismantle Obamacare but haven't settled on a replacement plan. That makes Verma's work in Indiana and other states especially notable since it could provide a roadmap for what she could do in Washington. (Bradner, 2/16)

Seema Verma's claim to fame has been as the conservative health wonk who made Obamacare's expansion of Medicaid work in red states. Then, she was tapped to be the Trump administration's point person for dismantling the health law. (Pradhan, 2/15)

Seema Verma will need clearance from the HHS office of ethics before she can weigh in on any decisions involving states that paid her to help tweak their Medicaid programs. ... From Indiana alone, Verma's Indianapolis-based firm, SVC Inc. collected more than $6.6 million in consulting fees. The firm helped the state expand Medicaid .... That and other contracts led Verma to inform the HHS' ethics office that she will request written authorization before hearing matters involving states she worked for. That also includes Arkansas, South Carolina, and Virginia. (Dickson, 2/14)

House conservatives, frustrated by GOP leadership’s slow and tentative approach to replacing the Affordable Care Act, have gotten behind legislation by Rep. Mark Sanford (R-S.C.) and Sen. Rand Paul (R-Ky.) that would repeal most of the law and move millions of Americans Health Savings Accounts (HSAs). “We were tired of waiting,” said Rep. Jim Jordan (R-Ohio) at a Wednesday press conference on the legislation, “and that’s why we said: Let’s go. Let’s go now.” (Weigel, 2/15)

Conservative Republicans on Wednesday staked out their position on a proposed replacement to the 2010 health care law. But their views are likely to muddle the path toward GOP consensus. The House Freedom Caucus endorsed legislation authored by one of its members, Rep. Mark Sanford of South Carolina, and Kentucky Sen. Rand Paul. “Conservatives have come together to say that this is the replacement plan that we not only want to promote but debate and hopefully fine-tune,” said North Carolina Rep. Mark Meadows, the caucus chairman. (McPherson, 2/15)

The plan would include a tax credit of up to $5,000 per person to fund part of a Health Savings Account to pay for medical care, as well as a provision to allow insurers to sell policies across state lines. Rep. Mark Sanford (R-S.C.) will introduce a companion of Paul's bill in the House. Rep. Mark Meadows (R-N.C.), chairman of the 40-member House Freedom Caucus, said the replacement proposal will fix a shattered healthcare system. "It will finally be able to address many of the concerns that we're hearing whether it's at town halls or personal calls," Meadows said. (Hellmann, 2/15)

A key House Republican in the healthcare fight said Wednesday that lawmakers are considering a way to deal with their dilemma on ObamaCare’s Medicaid expansion by increasing payments to states that rejected the expansion. Rep. Brett Guthrie (R-Ky.), the vice chairman of the House Energy and Commerce subcommittee on health, told reporters that one option under consideration is to freeze new enrollment in the 31 states that expanded the program, while increasing certain payments to the 19 states that did not expand. (Sullivan, 2/15)

House GOP leaders are offering rank-and-file lawmakers options for replacing President Barack Obama's health care law. Lawmakers, aides and lobbyists say the proposals take a conservative approach dominated by tax breaks and a transition away from today's Medicaid program. House Speaker Paul Ryan and other House leaders planned to discuss details of their plans with lawmakers Thursday and gauge their receptiveness. (Fram, 2/16)

House Majority Leader Kevin McCarthy (R-Calif.) told reporters Wednesday that committee leaders will brief GOP lawmakers on some specific proposals at a closed-door meeting scheduled for Thursday morning. The meeting comes as leaders are working to rally sharply divided GOP members around a single plan to remake the health-care law. Asked whether leaders planned to announce specific elements of the repeal-and-replace plan that will be included in upcoming legislation McCarthy said, “Yes.” McCarthy did not say which elements of the plan would be detailed at the meeting. (Snell, Weigel and DeBonis, 2/15)

Divisions sharpened Wednesday between hard-right and more pragmatic Republicans over a strategy for repealing and replacing the Affordable Care Act. One of their biggest disagreements is over the future of the ACA's expansion of Medicaid coverage to more than 10 million low-income adults. Those differences -- along with the apparently slow progress in drafting actual legislation that could be scored by the Congressional Budget Office on cost and coverage impact -- underscore the struggle Republicans face while dismantling Obamacare and establishing an alternative system. House GOP leaders promise, however, that they'll soon have a bill they can pass before the Easter recess. (Meyer, 2/15)

HHS Secretary Tom Price failed to give Republican senators clear direction on how to repeal Obamacare but acknowledged problems facing the GOP, including delicate Medicaid politics, according to several lawmakers who attended a closed-door gathering Wednesday. (Haberkorn, Pradhan and Cancryn, 2/15)

Newly installed Health and Human Services Secretary Tom Price offered Senate Republicans few concrete details about the administration's specific goals for repealing and replacing the health care law, lawmakers who attended the meeting told CQ Roll Call. Lawmakers said they did not expect that Price or the Trump administration would roll out their own legislative blueprint. President Donald Trump had suggested at a news conference earlier this year that he would unveil his own plan after Price's confirmation. (Mershon, 2/15)

About 18,000 callers participated in a telephone town hall hosted by U.S. Rep. Peter Roskam, a suburban Chicago Republican who has been criticized for canceling smaller in-person meetings and declining debates. ... Roskam abruptly canceled a smaller meeting with constituents this month to hear concerns about repealing the Affordable Care Act. Protesters have since shown up to his events. The League of Women Voters has also invited him to debates and town halls, which he has declined. (2/15)

Rep. Andy Harris said the people who are showing up at town hall meetings held by Republican members of Congress to voice concern over the repeal of Obamacare are "organized" and funded by out-of-district interest groups, and said he will not conduct such a meeting until Republicans announce a plan to replace the law. Harris, an anesthesiologist who made opposition to the health care law a central component of his 2010 campaign for Congress, described the angry confrontations his fellow Republicans have faced in constituent meetings as "George Soros-funded," referring to the prominent Democratic donor. The claim has been made by GOP lawmakers in other states as well. (Fritze, 2/15)

Rep. Mia Love, R-Utah, is getting criticism from constituents over new rules she set for meeting with them. ... “I was told that we could do a meeting with four to five people at a time, in the office,” [Terry] Mitchell said, adding that Love’s office informed her no recording devices or media would be allowed. ... Republican lawmakers have faced rowdy crowds at some meetings in their districts. Fellow Utah Rep. Jason Chaffetz, head of the House Oversight Committee, had several tense exchanges with the audience at a meeting in his district last week. (Chuang, 2/15)

When Congress enacted the Affordable Care Act in 2010, some small firms worried that the cost of covering their workers would drive them out of business. But many of them now say they plan to keep offering health-insurance coverage, even if the requirement that they do so is eliminated. Some entrepreneurs have changed their tune after realizing that the benefit helps them attract and retain workers in a tight labor market, while others say that complying with the requirement to offer health insurance coverage to certain employees hasn’t been the financial strain they feared—in part because fewer workers than expected signed up. (Simon, 2/15)

Humana Inc.’s decision to withdraw from the Affordable Care Act exchanges next year adds to the pressure on Republicans to bolster the marketplaces even as they promise to unwind the health law. ... Republicans may find themselves in a tough position politically if insurer withdrawals or sharp rate markups affect marketplace consumers in 2018, when federal health policy will have been under their control for about a year. ... Insurers have been ratcheting up the pressure on Republicans to prop up the marketplaces, with increasingly public threats about the consequences if they don’t see such efforts. Insurers must begin filing rates for their 2018 exchange plans with state regulators this spring. (Wilde Mathews and Armour, 2/15)

Humana’s decision to exit the ObamaCare exchanges at the end of the year could trigger a “domino effect” among insurers, with companies abandoning the marketplace and potentially leaving thousands with diminished or zero coverage options in 2018. Humana became the first insurance company to pull out of the exchanges for 2018 on Tuesday, amid uncertainty from Congress and the Trump administration about what an ObamaCare replacement will look like and when it might be implemented. (Hellmann, 2/15)

Humana's decision to stop selling insurance on Obamacare exchanges in 2018 will impact Tennesseans who live in the state's three major metro areas. Humana is currently the only insurer on the exchange in the greater Knoxville area — meaning if another insurance company does not enter the market, there will be no Obamacare exchange in that area. The insurance giant announced the decision on Feb. 14 during an analyst call after its $34 billion deal with Aetna was terminated following a ruling by a federal judge. (Fletcher, 2/15)

Humana’s planned pullout from Georgia’s insurance exchange at the end of 2017 would subtract yet another health insurer from the state’s marketplace. The company, based in Louisville, Ky., is one of just five insurers offering plans this year in the Georgia exchange, which was created by the Affordable Care Act. UnitedHealthcare and Aetna were two heavyweights that bowed out of Georgia’s and other exchanges in 2017. (Miller, 2/15)

Aetna chief executive Mark Bertolini said Wednesday that the Affordable Care Act's exchanges — the marketplaces where consumers can buy individual health coverage under President Barack Obama's signature health-care law  — are in a “death spiral.” Bertolini's remarks at the Wall Street Journal's the Future of Healthcare event came a day after the official end of his company's proposed merger with the health insurer Humana — a divorce that will cost Aetna a $1 billion breakup fee. (Johnson, 2/15)

Bertolini’s doomsday prophesy: More insurers will pull out of the government-run marketplaces in the coming weeks and many areas will have no insurers to provide Affordable Care Act coverage in 2018. “It’s not going to get any better; it’s getting worse,” Bertolini said in an interview at a Wall Street Journal event. But he declined to say whether Aetna would completely pull out of Obamacare markets next year, though he said the population of covered people in the marketplaces has skewed older and sicker than expected. (Demko, 2/15)

Bertolini has been saying for months that the ACA’s markets are deteriorating. In October, he said that rising rates would push healthy people away from Obamacare, leaving insurers with sicker customers, and forcing premiums even higher. The increasing burden of medical costs as fewer and fewer healthy customers enroll are among the conditions that create an insurance death spiral. (Tracer and Greifeld, 2/15)

Another U.S. health insurer is threatening to drop out of Obamacare after posting massive financial losses related to the program, just hours after an insurance CEO said the law’s markets were entering a “death spiral.” Molina Healthcare Inc., one of the few big insurers that’s stuck with the exchanges created by the Affordable Care Act, said Wednesday that it could pull out of some markets next year after losing $110 million in 2016. Chief Executive Officer J. Mario Molina said he’s going to wait to see what President Donald Trump’s administration does to shore up the program. (Tracer, 2/15)

Obamacare’s health insurance markets are flirting with financial disaster — and that’s before Republicans have had a chance to lay their hands on the law they’ve vowed for seven years to repeal. (Demko, 2/15)

Health insurers Anthem and Cigna are now trading lawsuits instead of working together to salvage a shaky $48-billion buyout agreement. The Blue Cross-Blue Shield carrier Anthem said Wednesday that it is seeking a restraining order to block its smaller rival from terminating their deal, which has already been blocked by a federal judge. (2/15)

In its suit, filed like Cigna’s in the Delaware Court of Chancery, Anthem said it sought a temporary restraining order to block Cigna from ending their pact. It also sought to force Cigna to adhere to the terms of their deal and requested damages. Anthem said it was reacting to “Cigna’s campaign to sabotage the merger and to try to deflect attention from its repeated willful breaches of the merger agreement.” (Wilde Mathews, 2/15)

The messy divorce between Anthem and Cigna took another turn Wednesday in a Delaware court that will be the scene of further expensive legal battling over the insurers’ merger attempt. Anthem on Wednesday filed a temporary restraining order in Delaware’s chancery court against a lawsuit Cigna lawsuit filed Tuesday aimed at ending the merger agreement, collecting a $1.85 billion breakup fee and seeking at least $13 billion in damages from Anthem. (Radelat, 2/15)

Last year saw slower growth in Medicaid, a federal-state program for low-income individuals, as well as in prescription drug spending. Both factors likely contributed to the reduced growth in overall health spending. Prescription drug spending grew 5% in 2016, compared with 9% in 2015, a shift largely be attributed to a decrease in the use of specialty drugs to treat hepatitis C. At the same time, the growth of Medicaid slowed last year as the impact of an expansion of the program under the Affordable Care Act began to wane. (Hackman, 2/15)

The cost of medical care in the United States is expected to grow at a faster clip over the next decade and overall health spending growth will outpace that of the gross domestic product, a U.S. government health agency said on Wednesday. A report by the U.S. Centers for Medicare and Medicaid Services (CMS) cited the aging of the enormous baby boom generation and overall economic inflation as prime contributors to the projected increase in healthcare spending. (Abutaleb, 2/15)

The projections are based on an assumption that the legislative status quo will prevail — an unlikely scenario given President Trump and Republicans' plan to repeal and replace the Affordable Care Act. The spending projections are similar to previous estimates, putting health care on track to make up about a fifth of the economy by 2025. (Johnson, 2/15)

But the CMS analysis found that healthcare spending growth between 2016 to 2025 will be largely influenced by changes in the economy and population as opposed to coverage expansion under the ACA. The healthcare law greatly influenced the average 5.5% spending growth experienced in 2014 and 2015 as more people enrolled on the exchanges and gained Medicaid coverage, but those numbers are expected to stabilize. (Castellucci, 2/15)

Wednesday's report from nonpartisan experts at Health and Human Services concludes that health care spending will claim a growing share of national resources for the foreseeable future, regardless of what President Donald Trump and Congress do with the Obama-era health law. Health care will grow at an annual average of 5.6 percent from 2016-2025, outpacing expected economic growth. Now $3.5 trillion, the nation's health care tab will increase to nearly $5.5 trillion in 2025, accounting for about one-fifth of the economy. That puts a squeeze on other priorities, such as infrastructure improvement. (2/15)

In its last report in July, CMS projected health spending would grow an average of 5.8 percent by 2025. They noted at the time that the figure remains below the average over the previous two decades before 2008, which was nearly 8 percent. (McIntire, 2/15)

The Broad Institute in Cambridge, Mass., will retain potentially lucrative rights to a powerful gene-editing technique that could lead to major advances in medicine and agriculture, the federal Patent and Trademark Office ruled on Wednesday. The decision, in a bitterly fought dispute closely watched by scientists and the biotechnology industry, was a blow to the University of California, often said to be the birthplace of the technique, which is known as Crispr-Cas9. (Pollack, 2/15)

UC Berkeley biochemist Jennifer Doudna and her European collaborator, Emmanuelle Charpentier, have racked up a slew of awards for their work, which makes it very easy to alter the DNA of living things. But their efforts to patent their discovery have been hung up by a competing claim from Feng Zhang at the Broad Institute of MIT and Harvard. (Netburn, 2/15)

The CRISPR patent fight appears to be over, at least for the moment. A ruling by the U.S. Patent Trial and Appeal Board found no “interference” in patents awarded to Feng Zhang at the Broad Institute of MIT and Harvard. The loser, pending appeals, is the University of California, and the much-heralded biochemist  Jennifer Doudna, who, along with Emmanuelle Charpentier, in 2012 published a groundbreaking paper showing how to exploit a natural bacterial gene-editing system known as CRISPR. The patent office determined that Zhang's later innovations, which used CRISPR to edit mammalian cells, were not simply elaborations of what Doudna and Charpentier had already discovered. (Achenbach and Johnson, 2/15)

The proceedings aren't entirely settled, but as Sherkow sees the situation, the Broad Institute — a joint venture of Harvard University and MIT — will hold the patent for using CRISPR in human beings, other animals, and plants. Sherkow told Shots he believes Cal's patent, which has not yet been issued, could be limited to bacteria. (Harris, 2/15)

The financial implications are huge, since CRISPR may lead to many lucrative products in medicine, agriculture and elsewhere. One company that has licensed Broad’s technology, Editas Medicine Inc., saw its shares jump by 29 percent Wednesday. (Ritter, 2/15)

In a brief order, the Patent Trial and Appeal Board of the U.S. Patent and Trademark Office sided with Broad, ruling there is “no interference in fact” — meaning that the universities’ discoveries accomplish different things. The ruling neither cancels nor refuses either parties’ claims, but leaves in place patents previously issued to the Broad Institute. (Krieger, 2/15)

“As the legal dispute moves forward, my team will continue to focus on using CRISPR to deliver advances and solutions that can help solve our greatest challenges across human health, agriculture and the environment,” said Doudna, in a statement Wednesday. (Perlman, 2/15)

Republicans who dominate legislatures in at least 15 states are moving to cut tens of millions of dollars Planned Parenthood chapters receive under the federal Medicaid program for reproductive health care. Planned Parenthood is fighting to protect its funding from the prospective cuts. (Moritz, 2/15)

An Indiana House panel clashed Wednesday over the science behind a disputed method to purportedly stop drug-induced abortions, then narrowly approved a requirement for women to receive information about it before undergoing the procedure. (2/15)

A proposal from an Arizona lawmaker to require doctors to do everything possible to save the life of a baby born alive during an abortion could have far broader implications. Senate Bill 1367 would require hospitals and clinics providing abortions at 20 weeks or beyond to have medical equipment on site to care for a fetus delivered alive. If the delivered baby is breathing, has a heartbeat and is moving, doctors must use all available means and medical skills to save its life. But there are concerns that it also would require doctors to perform fruitless medical procedures on a fetus born early due to fatal abnormalities. (Beard Rau, 2/15)

Senate Health and Human Services Committee members heard emotional testimony from reproductive rights and anti-abortion advocates on Wednesday over Senate Bill 8, Senate Bill 415 and Senate Bill 258. SB 8 and SB 258 would change how providers handle fetal tissue, while SB 415 would ban "dismemberment abortions," a procedure anti-abortion advocates say involves removing an unborn baby from the womb limb by limb. (Evans, 2/15)

Some emergency room doctors are far more likely than others even within their own department to prescribe opioids to treat pain in older people, and their patients are at greater risk of using the powerful drugs chronically than those who saw doctors who prescribe them less frequently, according to a large new study. The research was published Wednesday in The New England Journal of Medicine. (Hoffman, 2/15)

The study also found a remarkable difference in opioid prescribing habits by doctors in the very same emergency rooms: “High-intensity prescribers” doled out narcotics during 24.1 percent of patient visits, on average, while “low-intensity prescribers” called for them only 7.3 percent of the time. In addition, patients who received a large dose of opioids at their initial visit were more likely to end up as long-term users. (Bernstein, 2/15)

“Physicians are just doing things all over the map,” says Dr. Michael Barnett, an assistant professor at the Harvard T. H. Chan School of Public Health and one of the study’s authors. “This is a call to arms for people to start paying a lot more attention to having a unified approach.” (Gold, 2/15)

The study suggests that about 1 of every 48 people newly prescribed an opioid will become a long-term user – a number that constitutes a significant potential risk given nearly 300 million opioid prescriptions are written each year in the United States. The huge disparity in prescribing points to another problem. Despite intense scrutiny in recent years of physician prescribing of opioids, detailed clinical guidance on when to prescribe opioids, for what conditions, and in what amounts are lacking in many areas of health care. (Armstrong, 2/15)

New Jersey Gov. Chris Christie signed legislation Wednesday curtailing the quantity of opioid pills doctors can prescribe for acute pain, a restriction he said is necessary to curb the state’s addiction crisis. The new law lowers the limit on initial prescriptions for opioids to a maximum five-day supply from 30 days for acute pain and directs practitioners to prescribe the lowest effective dose of immediate-release opioid drugs. Mr. Christie, a Republican, has pledged to spend his final year as governor battling the state’s heroin and opioid epidemic. (King, 2/15)

Seeking to stem the growing opioid abuse crisis, a California state senator is proposing to prohibit prescriptions of the painkiller oxycodone for anyone under the age of 21. Sen. Anthony Portantino (D-La Cañada Flintridge) said his measure, SB 419, would stop younger people from getting early exposure to the highly addictive pain drug, commonly known by its brand name, OxyContin. (Mason, 2/15)

More than 272,000 Texans could lose access to mental health and substance abuse treatment if one of the lesser known guarantees of the Affordable Care Act goes away with the law's repeal and is not replaced. In Texas alone, 65,559 people with the most serious types of debilitating mental illnesses, such as bipolar disorder or schizophrenia, are now covered by individual plans offered under the health care law, according to a data analysis released this week by the Harvard Medical School and New York University. (Deam, 2/15)

Repealing the Affordable Care Act would result in more than 61,400 Kentuckians with mental illness or substance use disorder losing coverage. That's according to an analysis by two researchers from Harvard Medical School and New York University that also estimates that more than 133,500 Hoosiers would lose coverage for such behavioral health issues. (Carter, 2/15)

In the past six years, dozens of rural hospitals around the United States have discharged their final patients and turned out the lights, including three in North Carolina. The nation’s crisis of opiate addiction and overdose has been playing out most strongly in rural towns, where family and community ties are strong and overdose deaths hit hard. And research shows there’s a persistent gap in life expectancy between rural and urban communities,  with data showing that rural areas experience poorer health on almost every measure and have less healthcare infrastructure to support residents. (Hoban, 2/15)

The city's top health official told some council members Wednesday that "Louisville needs to grow up" and offer more medication-assisted treatment since abstinence-based programs don't work for everyone. Some treatment programs don't allow methadone, Suboxone and Subutex to try to wean addicts off stronger drugs, said Dr. Joann Schulte, who heads the Metro Department of Public Health and Wellness. Critics of using drugs in treatment say this method can merely substitute one addiction for another. (Warren, 2/15)

Children with autism tend to be diagnosed around age 4, after a child begins to socialize and speak. But the earlier a child is diagnosed, the better. Early-intervention speech and behavioral therapy programs have shown promise at reducing symptoms. Now, new research shows such a diagnosis could be predicted as early as one year old — based on scans of infants’ brains. Still, the study’s findings need to be repeated with a larger sample size before they could be used in a clinical setting, the researchers noted. (Sheridan, 2/15)

Tracking the brain growth of infants can predict the likelihood that they will be diagnosed with autism in their toddler years, according to new research that could give doctors a head start on treating the developmental disorder. The study, published Wednesday in the prestigious journal Nature, took place at four U.S. hospitals and was co-authored by two University of Minnesota researchers. (Olson, 2/15)

New research from the University of Minnesota could lead to early autism detection in children at high risk of developing the disorder. Using MRI brain scans, researchers across the country, including the U of M, were able to pinpoint changes in the brains of children who later developed autism. And they were able to predict that diagnosis with 80 percent accuracy. (Enger, 2/15)

In a meeting with educators, Trump asked the principal of a center that serves students with disabilities about the prevalence of autism. The principal, Jane Quenneville, spoke about the increasing number of students with autism at the Kilmer Center, a Fairfax County public school. But Trump then claimed that there was a “tremendous amount of increase” in autism in general — “really a horrible thing to watch.” This exchange is especially noteworthy, because Trump wants to create a vaccine safety commission that could roll back vaccine laws based on the widely discredited theory that vaccines cause autism. (Lee, 2/16)

Prominent vaccine skeptic Robert F. Kennedy Jr. said Wednesday that he expects the Trump administration to move forward with a vaccine safety commission and that President Trump pledged that he was “not going to back down” if the drug industry objected to the commission. Kennedy said he had spoken with presidential aides three times since his January meeting with Trump. His understanding is that a commission is still being developed, he said. “Why would anybody not want a vaccine safety commission?” he said at an event with actor Robert De Niro at the National Press Club in Washington. (Scott, 2/15)

Critics of annual mammograms point to the issue of overtreatment. Just last month, for example, a report in the Annals of Internal Medicine showed that screening mammograms (those done for women without signs of breast cancer) often lead to unnecessary treatments. One in three women in the study whose breast cancer was identified by a screening mammogram had a potentially harmless disease that may not require treatment. That work has raised questions about the benefits of screening mammograms. The findings of screening studies, including mammography, can be influenced by certain biases in the study design. (Citrin, 2/16)

Current testing for lead contamination does not accurately measure exposure, according to a new report. That could mean providers are facing a whole generation of patients with long-term health effects. An analysis of lead levels in school water fountains across 16 states showed many schools had levels that exceeded the federal threshold of 15 parts per billion. Water from school drinking fountains has increasingly been tested for lead since the contamination crisis in Flint, Mich., sparked municipalities across the country to test their own water supplies. (Johnson, 2/15)

A new study suggests at least half of men who have been infected with Zika will emit traces of the virus in their semen, but in most cases that viral shedding stops after about three months. The research, conducted in Puerto Rico, found that 56 percent of men who had been infected had traces of virus in their semen but about half of them stopped emitting those viral traces by about a month after they first became ill. And by three months after the onset of symptoms, only 5 percent still had virus in their semen. (Branswell, 2/15)

Remember how CDC officials abruptly cancelled their long-planned climate and health summit right before President Donald Trump took office? Well, an unofficial version featuring many of the same speakers will happen Thursday in Atlanta. After word spread last month of the summit’s cancellation, a group of advocates — led by former Vice President Al Gore — scrambled to put on an one-day version of the original three-day conference so experts in public health, public policy, and climate science could gather to talk about global warming and its impact on public health. (Blau, 2/15)

It's long been known that Vitamin D helps protect our bones, but the question of whether taking Vitamin D supplements can help guard immunity has been more controversial. An analysis published online Wednesday in the British journal the BMJ suggests supplements of the sunshine vitamin can indeed help reduce the risk of respiratory infections — especially among people who don't get enough of the vitamin from diet or exposure to sunlight. (Aubrey, 2/16)

New dads are at risk of experiencing the same symptoms of postpartum depression as women who’ve just given birth — despite the fact that their bodies don’t go through the same sort of changes. A paper published Wednesday in JAMA Psychiatry finds that just over four percent of new fathers experience elevated symptoms of depression after their children are born. The idea of postpartum depression among new dads is a relatively new one, and the study’s authors say raising awareness about the issue is a critical first step. That, combined with screenings, could help catch symptoms of depression among new fathers and treat them early. (Thielking, 2/15)

In the near future, there will be many millions more like him, and the cost of their care could threaten to “bankrupt” the country if changes aren’t made, American Heart Association President Steven Houser said. Its new findings could have important implications for health care reform. (Corwin, 2/15)

For the first time, scientists can point to substantial empirical evidence that people with attention-deficit/hyperactivity disorder have brain structures that differ from those of people without ADHD. The common disorder, they conclude, should be considered a problem of delayed brain maturation and not, as it is often portrayed, a problem of motivation or parenting. (Nutt, 2/15)

Survival rates for very early preterm infants have improved slightly, according to a study published in the New England Journal of Medicine on Wednesday. Those who survive are also somewhat less likely to suffer from neurodevelopmental impairments, the study found. Researchers gathered survival and neurodevelopmental impairment data for 4,000 extremely premature infants by analyzing records from a National Institutes of Health research network. The infants were born between 22 and 24 weeks of gestation, rather than after a normal 40-week pregnancy. (Naqvi, 2/15)

For premature babies born at the edge of viability, the chance of survival without serious health problems has gotten slightly better, at least at the nation’s top neonatal care centers — a small change with potential implications for the bitter abortion debate in  Pennsylvania and other states. Researchers from the 11 centers analyzed the records of more than 4,200 babies born at 22 to 24 weeks of pregnancy between 2000 and 2011. While the grim picture at 22 weeks did not change — 96 percent of newborns died — the outlook for the rest of the “periviable” infants improved over the 12-year period. (McCullough, 2/15)

The Cleveland Clinic suffered a nearly 50 percent decrease in operating income in 2016, falling to $243 million from a record high of $481 million the year before, according to a report released Wednesday. During his annual State of the Clinic address to employees, Clinic CEO Toby Cosgrove said the decrease was expected and was driven by falling reimbursement brought about by the Affordable Care Act as well as rising drug costs. (Zeltner, 2/15)

When someone wants to build a new hospital or nursing home in Florida or add beds in an existing facility, the state has to agree that their community has a need for expanded health care. It's a regulation meant to ensure that poor and rich communities alike have equal access to hospitals, hospices and other health facilities. But at $10,000 to $50,000 per facility application, it's also costly and can lead to lengthy, even pricier lawsuits. (Auslen, 2/15)

A Kansas House committee narrowly rejected a bill Wednesday that would have allowed the University of Kansas Health System to continue banning concealed firearms. It failed to advance on an 11-11 vote. The chairman of the House Federal and State Affairs Committee, Republican Rep. John Barker of Abilene, chose not to vote to break the tie. A state law set to take effect in July will allow concealed weapons on university campuses and in public hospitals and government buildings unless security is in place to keep out guns. The bill would have exempted the KU Health System. (Koranda, 2/15)

Nemours Children’s Hospital will find out on Friday if the state is going to give initial approval to its application for a new heart and lung transplant program, which would be Central Florida’s first and the fifth in the state. This is good news to parents such as Kelly Green, an Orlando resident whose 9-year-old son has congenital heart disease and might one day need a heart transplant. (Miller, 2/15)

Health-care consumers who have been stung by surprise medical bills might soon find some relief from an unexpected source: the Arizona Legislature. The problem occurs when a consumer seeks care after checking to be sure a doctor, clinic or hospital is part of their insurance company's network — only to be billed later by out-of-network providers such as anesthesiologists or surgical assistants who were part of the chain of care. That can sometimes result in a whopping medical tab, with the consumer caught between an insurance company that doesn't want to pay more and a medical provider who refuses to accept less. (Alltucker, 2/15)

Connecticut had one of the lowest rates of uninsured residents in the country last year, according to estimates from a federal survey released this week. The estimates from the National Health Interview Survey, released by the National Center for Health Statistics, pegged Connecticut’s uninsured rate at 3.5 percent – but the authors warned that that figure should be used with caution because the potential for error “does not meet standards of reliability or precision.” (Levin Becker, 2/16)

When the wind kicks up in the town of Coalinga, dust devils whirl over almond orchards and pumpjacks. You can even see the narrow brown funnels from the grounds of Pleasant Valley State Prison, on the outskirts of town.But at the prison itself, there’s hardly any dust. That’s evidence of years of work by the California Department of Corrections and Rehabilitation to reduce and control the San Joaquin Valley’s ubiquitous wind-borne dust. The dust carries the spores of the debilitating fungal disease known as coccidioidomycosis, or “valley fever.” (Klein, 2/15)

President Donald Trump's executive order last month reduced the cap of refugees allowed into the United States from 110,000 to 50,000. That means that fewer refugees will be resettled into areas like St. Louis. But the cap also is curtailing disease research across the country. To understand diseases that are widespread in poor, war-torn countries, scientists study refugees from those nations that are infected with those diseases. (Chen, 2/15)

A distracted aide at an Eden Prairie assisted-living center failed to plug in a resident’s heart pump at bedtime, and the man didn’t live through the night, according to a state investigation released Wednesday. The state Health Department found the facility, Aging Joyfully, at fault in the July 10 death because it had no procedure to ensure the pump would keep operating when switched every night from batteries to electricity from an outlet. (Walsh, 2/15)

For many parents, San Miguel Elementary School is not just a place to fill their children’s minds but their stomachs as well. Since 2015 the school has participated in the Weekend School Food Program organized by Sunnyvale Community Services in partnership with the Sunnyvale School District. The program allows parents and other residents to pick up 32 pounds of donated food twice a month on Fridays. (Kezra, 2/15)

In the 15 minutes after firefighters and a nurse knocked at Thelma Lee’s Maryland townhouse, they checked her blood pressure, told her what foods would keep her blood sugar from skyrocketing and set up an appointment — and a ride — to visit her primary-care physician. They also changed the battery in her chirping fire alarm and put a scale in her bathroom so she could monitor her weight. Then they rolled out in an SUV to their next house call. (Bui and Williams, 2/15)

Palo Alto’s flood basin and nearby areas will be sprayed Thursday, Feb. 23 with a pesticide in an effort to reduce the growth of salt marsh mosquitoes, which are known for being “very vicious biters.” Russ Parman, assistant manager of the Santa Clara County Vector Control District, said the day-biting salt marsh mosquitoes are not known to transmit diseases such as West Nile or Zika. Officials are concerned, however, that treatment delays caused by winter storms will result in a “big cohort of mosquitoes,” Parman said. (Lee, 2/15)

A 7-year-old Columbiana County boy who died on Saturday of flu-related illness marked the fourth such death in the state so far this flu season, coming only two days after the death of a Rocky River 6 year old. Eva Harris of Rocky River died February 9th after being admitted to the Cleveland Clinic with a high fever two days earlier. The Columbiana County child was the second from that county to die of flu-related illness since the January 25th death of a 6-year-old Salem boy. (Zeltner, 2/15)

A dentist who practiced in Gwinnett and DeKalb counties is headed to federal prison for Medicaid fraud. Dr. Oluwatoyin Solarin was sentenced to a year and six months for filing false claims worth nearly $1 million, the U.S. Attorney’s Office in Atlanta announced Wednesday. (Sharpe, 2/15)

The burgeoning crisis over President Trump’s and former national security adviser Michael Flynn’s connections to Russia makes the already difficult task of repealing and replacing the Affordable Care Act even more confounding for Republicans, who won the White House and both houses of Congress based on unrealistic expectations about an as-yet-unidentified replacement plan. (Jennifer Rubin, 2/15)

The last 24 hours have been one long string of bad news for Obamacare. Tuesday, the insurer Humana announced that it would be pulling out of the exchanges for next year. Then we found out that the IRS had responded to Trump’s executive order on Obamacare by quietly rolling back a new rule planned for this year, which would have required filers to indicate whether they had maintained coverage in 2016 or to pay a penalty. And on Wednesday, word came that Mark Bertolini, the CEO of Aetna, had told a Wall Street Journal conference that Obamacare was in a death spiral. This stands in pretty stark contrast to claims by Andy Slavitt, who ran the Center for Medicare and Medicaid Services under President Barack Obama, that things were shaping up splendidly for 2018, so long as Republicans didn’t screw anything up. (Megan McArdle, 2/15)

The Internal Revenue Service has become the first agency to follow President Trump’s directive to start undermining the Affordable Care Act. In a quiet rule change, but an important one, the IRS has told tax preparers and software firms that it won’t automatically reject tax returns that fail to state whether the tax filer had health insurance during the year. That effectively loosens enforcement of the ACA’s individual mandate. It appears to be a direct response to Trump’s Jan. 20 executive order requiring federal agencies “minimize ... the economic and regulatory burdens of the Act.” (Michael Hiltzik, 2/15)

If you want to keep your health insurance status a secret from the I.R.S., the Trump administration just made it a little easier. The policy change, confirmed by the I.R.S. on Wednesday after elements were reported by the libertarian magazine Reason, does not do away with the Affordable Care Act’s requirement that all Americans who can afford it obtain health insurance or pay a fine. But it might make it a little harder for the I.R.S. to figure out who is breaking the rules. (Margot Sanger-Katz, 2/15)

Now that Tom Price has been confirmed as Secretary of Health and Human Services, it's time to examine what he has in store for Medicare. He backs "premium support," which is the GOP's backdoor plan to privatize the system. Although GOP leaders such as House Speaker Paul Ryan have said that privatization is the only way to save Medicare -- it's not -- there are some dangerous drawbacks for retirees. (John Wasik, 2/15)

One reason health insurance premiums exploded under the Affordable Care Act is the law’s requirement that health insurers accept anyone who applied for individual coverage, known as guaranteed issue. The provision destroys an insurance market because it allows people to wait until a medical incident has occurred to get coverage. (Merrill Matthews and Mark Litow, 2/16)

The election of President Donald Trump and a Republican-controlled US Congress may once again thrust medical liability reform into the health care debate. One likely policy solution to be advocated for is to place a cap on noneconomic damages that plaintiffs can recover through lawsuits. This policy proposal is part of the GOP’s A Better Way health care platform and has been part of previous Republican proposals to limit medical malpractice torts despite concerns that federal medical liability reform, by preempting state laws, may potentially weaken successful state regulation in some cases. (Anand Parekh and G. William Hoagland, 2/15)

If the U.S. Supreme Court were to reverse Roe v. Wade, individual states could still permit abortion. But, in theory, the Supreme Court could go further, and rule that laws permitting abortion violate the equal protection rights of unborn fetuses. That may seem far-fetched -- but in his book on assisted suicide and euthanasia, Judge Neil Gorsuch lays out an argument that could easily be used to this end. (Noah Feldman, 2/16)

In 1948 the World Health Organization officially defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition has remained unchanged for more than 60 years. When it was adopted, tools to measure health did not exist. Indeed, it was decades before a comprehensive set of tools to measure physical, mental, and social well-being were developed. (Robert H. Brook, 2/14)

For all their dysfunction, the Republican Senate and House have managed to act with lightning speed in striking down a sensible Obama administration rule designed to stop people with severe mental problems from buying guns. President Trump, who championed the National Rifle Association agenda as a candidate, is expected to sign the regressive measure. This, despite the Republican mantra that tighter control of mentally troubled individuals — not stronger gun control — is the better way to deal with the mass shootings and gun carnage that regularly afflict the nation. (2/15)

One promising idea in a state efficiency study was having school districts join a statewide health insurance plan. But as a new audit found, such a move is complicated and would not save as much money as previously suggested. What’s more, a big share of the potential savings would be cost shifts to schoolteachers, especially in Wichita. In fact, 40 percent of the projected savings would come from shifting costs to teachers and other district employees. And of the $25 million in net cost shifts statewide, nearly $24 million would come from Wichita school district employees. (2/16)