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A year and a half after the Affordable Care Act brought widespread reforms to the U.S. healthcare system, Chicago's Cook County Health & Hospitals System has made its first profit in 180 years. Seven hundred miles south, the fortunes of Atlanta's primary public hospital, Grady Health System, haven't improved, and it remains as dependent as ever on philanthropy and county funding to stay afloat. The disparity between the two "safety net" hospitals, both of which serve a disproportionate share of their communities' poorest patients, illustrates a growing divide nationwide. (Respaut, 7/23)

Gov. Steve Bullock will discuss with a federal official Montana's plan to expand Medicaid that recently entered a public-comment period. The Democratic governor traveled with his health policy adviser and deputy chief of staff to Washington, D.C., Wednesday morning to meet with U.S. Secretary of Health and Human Services Sylvia Burwell .... They will discuss the premiums and copays that are expected to receive particular scrutiny before the federal government's decision to support or deny the state's waiver for expanding government-subsidized health insurance. (7/22)

They have no power to stop Gov. Bill Walker’s plan to unilaterally expand Medicaid by the end of the summer, but some members of the Legislative Budget and Audit Committee would still like to hold a meeting about it. The committee met in Anchorage on Wednesday to discuss a number of issues related to education but held a brief discussion at the end about holding a meeting on Medicaid expansion. ... Ultimately the decision rests with committee chairman Rep. Mike Hawker, an Anchorage Republican who supports Medicaid expansion. He told the committee that he asked for legal opinions on the matter and that everything confirmed the governor’s ability to act alone in expanding Medicaid. (Buxton, 7/22)

North Dakota's costs for the Medicaid expansion under the Affordable Care Act have increased since the original estimate during the 2013 legislative session. The North Dakota Department of Human Services' initial estimate of $2.9 million to $8.2 million for the 2017 fiscal year. "We knew when we prepared those estimates that it was an estimate," said Maggie Anderson, executive director of the the Department of Human Services. "You have to start somewhere." (Magee, 7/22)

Officials at Connecticut’s health insurance exchange say they’re trying to limit any coverage gaps for the 1,300 people who will no longer be eligible for Medicaid starting September 1. James Michele, director of operations at Access Health CT, said Wednesday that letters will be sent to recipients later this week, followed by robo-calls informing people about how to get replacement, private insurance coverage through the exchange. The state’s new two-year, $40.3 billion budget reduced the income levels for certain people to qualify for Medicaid. The group includes parents and caregivers of children in the HUSKY insurance program. About 18,000 more will lose coverage next year. (Haigh, 7/22)

More than 100,000 people bought private health plans through the state’s health insurance exchange for this year, but a survey of customers found that more than one in three haven’t used their coverage and more than one in four don’t have a primary care physician. (Levin Becker, 7/22)

Some analysts who have looked at health insurers’ proposed premiums for next year predict major increases for policies sold on state and federal health exchanges. Others say it’s too soon to tell. One thing is clear: There’s a battle brewing behind the scenes to keep plans affordable for consumers. Now the Obama administration is weighing in, asking state insurance regulators to take a closer look at rate requests before granting them. Under the Affordable Care Act, state agencies largely retain the right to regulate premiums in their states. So far only a handful have finalized premiums for the coming year, for which enrollment begins in November. (Rovner, 7/22)

Small-business owners are descending on Washington this week to lobby Congress to roll back an ObamaCare rule that could hit companies with thousands of dollars’ worth of penalties. About 150 small-business owners, organized by the National Federation of Independent Business (NFIB), will head to Capitol Hill on Thursday to make the case to members from their states on legislation that would change the rule. (Sullivan, 7/23)

The American health insurance market might soon become even smaller. Anthem, one of the country’s biggest health insurers, is closing in on a deal to buy Cigna after slightly sweetening its previous takeover offer, people briefed on the matter said on Wednesday. (de la Merced, 7/22)

Shares of Cigna Corp. soared late Wednesday on a report that rival Anthem Inc. was nearing a deal for the health insurer after a months-long pursuit. Cigna's stock shot up 6% during extended trading after the Wall Street Journal reported that a merger could be announced as early as Thursday. (Terhune, 7/22)

Anthem Inc. is nearing a deal to buy Cigna Corp. for more than $48 billion in a transaction that along with a previously proposed combination of rivals would shrink the five largest U.S. health insurers to just three. Anthem, based in Indianapolis, is expected to pay about $188 a share for Cigna, of Bloomfield, Conn., according to people familiar with the matter. A deal between the two companies could be announced as soon as Thursday afternoon, one of the people said. The agreement hasn’t been signed, and it is possible that the timing could be delayed or deal terms changed. (Mattioli, Hoffman and Wilde Mathews, 7/22)

Health insurers have been in a race to consolidate, arguing that being larger would help them negotiate better prices with doctors and hospitals as well as cut administrative costs following President Barack Obama's signature healthcare law that was passed in 2010. Many healthcare providers are concerned, however, that further consolidation will decrease competition in the insurance industry. (Roumeliotis, 7/22)

A merged company would serve 53 million people and is part of a dramatic, long-predicted reshaping of the health insurance landscape as a result of the Affordable Care Act. UnitedHealthcare has 45 million members, and Humana and Aetna announced they would merge in July, creating a company serving 33 million people. (Johnson, 7/22)

As complaints grow about exorbitant drug prices, pharmaceutical companies are coming under pressure to disclose the development costs and profits of those medicines and the rationale for charging what they do. So-called pharmaceutical cost transparency bills have been introduced in at least six state legislatures in the last year, aiming to make drug companies justify their prices, which are often attributed to high research and development costs. (Pollack, 7/23)

More than 100 oncologists from top cancer hospitals around the U.S. have issued a harsh rebuke over soaring cancer-drug prices and called for new regulations to control them. The physicians are the latest in a growing roster of objectors to drug prices. Critics from doctors to insurers to state Medicaid officials have voiced alarm about prescription drug prices, which rose more than 12% last year in the U.S., the biggest annual increase in a decade, according to the nation’s largest pharmacy-benefit manager. (Whalen, 7/23)

Top cancer experts called Thursday for steps to curb the rapidly escalating price of oncology drugs, warning that the current trajectory “will affect millions of Americans and their immediate families, often repeatedly.” The commentary in the journal Mayo Clinic Proceedings, signed by 118 physicians from cancer centers across the country, cited startling, if now familiar, evidence of the dramatic rise in cancer-drug prices. (Bernstein, 7/23)

A group of 118 leading cancer experts have developed a list of proposals designed to reduce the cost of cancer drugs, and support a grassroots patient protest movement to pressure drug companies to charge what they deem a fair value for treatments. The experts include former presidents of the American Society of Clinical Oncology and the American Society of Hematology. (Steenhuysen, 7/23)

More than 100 of the country’s most prominent cancer doctors are calling for a mass mobilization of patients to fight the escalating cost of new cancer drugs, which are routinely topping $100,000 a year. (Norman, 7/23)

Republican presidential candidates and lawmakers are calling for Planned Parenthood to be investigated and its federal funding eliminated after two videos that critics said showed the reproductive health care group is involved in the illegal sale of aborted fetal tissue. White House hopeful Senator Rand Paul introduced an amendment to a highway bill Wednesday that would cut the nearly $500 million in taxpayer funding that goes annually to Planned Parenthood. (Cassella, 7/23)

Congressional Republicans began working Wednesday to defund Planned Parenthood as House Democrats called for Attorney General Loretta Lynch and the California attorney general to investigate the group that produced the undercover sting videos at the center of the controversy. (Ehley, 7/22)

House Republicans are threatening to subpoena a top Planned Parenthood official unless the group voluntarily makes her available for an interview about alleged sales of fetal tissue from abortions. But the women’s health group is ramping up its own efforts to contain political damage from the controversy. The dispute over Dr. Deborah Nucatola and her comments in a video secretly taped by anti-abortion activists means abortion - not a dominant issue in American politics for several years - could move front and center this fall as Republican lawmakers try to score political points on Planned Parenthood. Several Republican presidential candidates have already attacked the organization, meaning abortion rights could be part of the struggle for the White House as well. (Palmer and Bresnahan, 7/22)

Senate Democrats pulled a bill from a scheduled committee markup Wednesday after Republicans threatened to force a vote on prohibiting the Veterans Administration from “harvesting” or “selling” fetal tissue. (Haberkorn, 7/22)

With partisan battling over abortion on the rise, a Democratic senator withdrew a bill Wednesday expanding government fertility services for wounded veterans and blamed what she said was a Republican attack on women's health care. A GOP senator said the changes he was pushing were designed to set priorities for an overburdened Department of Veterans Affairs. Meanwhile, the White House went further than it had since the uproar began last week over secretly recorded videos of Planned Parenthood officials discussing how they provide organs from aborted fetuses for research. White House spokesman Josh Earnest suggested President Barack Obama would veto legislation erasing federal funds for Planned Parenthood, as many Republicans want to do, and said the videos could have been "selectively edited to distort" Planned Parenthood's procedures, as the group has claimed. (Fram, 7/22)

Lawmakers from both parties Wednesday accused the Department of Veterans Affairs of hiding details of a budget crisis that could force the shutdown of some VA hospitals next month. The VA last week said it may shutter hospitals unless Congress closes a $2.5 billion shortfall caused by a sharp increase in demand by veterans for health care, including costly treatments for the deadly hepatitis C virus. Rep. Jeff Miller, R-Fla., the chairman of the House Veterans Affairs committee, said he was shocked at the magnitude of the VA's problems and outraged that Congress was not notified until nearly 10 months into the budget year. The possible closure of hospitals was not mentioned as recently as last month, when the VA first told Congress about the potential budget shortfall, Miller said. (Daly, 7/23)

Pharmaceutical researchers on Wednesday presented new data from the clinical trials of three drugs that, the scientists said, show promise for slowing the progression of Alzheimer’s disease. (Kunkle, 7/22)

Eli Lilly & Co. on Wednesday reported that an experimental medication might slow mild Alzheimer's if people take it early enough, one of a handful of drugs in late-stage testing in the frustrating hunt for a better treatment. The new findings don't prove that Lilly's solanezumab really works; a larger study is underway that won't end until late 2016. On Wednesday, researchers at the Alzheimer's Association International Conference updated ongoing research into Lilly's effort, and those of two competitors, that aims to fight Alzheimer's with injections targeting a sticky protein that clogs the brain. (Neergaard, 7/23)

Dr. Maria Carrillo, chief scientific officer at the Alzheimer’s Association, which paid for research on Medicare projections that was released Monday at a major conference for Alzheimer's researchers and health policy experts, talked with Kaiser Health News staff writer Lisa Gillespie about what the growth of Alzheimer’s will mean for the nation. (7/23)

The face of Alzheimer's isn't always old. Sometimes it belongs to someone like Giedre Cohen, who is 37, yet struggles to remember her own name. Until about a year ago, Giedre was a "young, healthy, beautiful" woman just starting her life, says her husband, Tal Cohen, a real estate developer in Los Angeles. Now, he says, "her mind is slowly wasting away." People like Giedre have a rare gene mutation that causes symptoms of Alzheimer's to appear before they turn 60. (Hamilton, 7/23)

More than 1 million emergency room visits and more than 70,000 of hospital admissions in Minnesota possibly could have been prevented, according to a new Minnesota Department of Health Study. (Zdechlik, 7/23)

Minnesotans receive as much as $2 billion in hospital care a year that could be avoided, according to a new analysis that also estimates two of every three emergency room visits in the state are potentially preventable. (Olson, 7/23)

Most rural Georgia residents in a new survey say they have experienced problems with the affordability of health insurance and the cost of health care. When asked the biggest problem facing local health care, 68 percent named cost, with quality of care and access to care trailing far behind, according to the survey of 491 people. It was conducted by Opinion Savvy and commissioned by Healthcare Georgia Foundation. (Miller, 7/22)

A spokesman for the U.S. Department of Justice said Tuesday that the department is still investigating complaints about Medicaid waiting lists for disability services in Kansas. The services are daily living supports in home and community-based settings that people with disabilities would normally receive Medicaid coverage for if they were in assisted living facilities. In 2012, the U.S. Department of Health and Human Services, which partners with states to administer Medicaid, referred complaints about long waits for the services in Kansas to the Justice Department, the legal arm of the federal government. (Marso, 7/22)

A federal whistleblower lawsuit alleging that one of the companies running KanCare ordered employees to shift KanCare patients away from high-cost health care providers has been dismissed. A one-sentence document filed Tuesday in federal court in Kansas City, Kan., said that the plaintiff, Jacqueline Leary, and the defendants — Sunflower State Health Plan Inc., its parent company Centene Corp. and three other parties — had stipulated to the dismissal. Each party was to bear its own costs and attorneys’ fees. (Margolies, 7/22)

Mental health system leaders hope a new computerized registry of psychiatric beds will make what happened to Cynthia Shouse a bit less common. Shouse, 22, recalls spending more than two days in a Cedar Rapids emergency department, suffering a mental health crisis a few years ago. The staff determined that Shouse, who has been diagnosed with schizophrenia, should be admitted to a psychiatric unit. But their unit was full, as usual, and their repeated calls to other hospitals couldn't locate any openings. (Leys, 7/22)

Even going to prison doesn’t spare patients from having to pay medical copays. In response to the rapidly rising cost of providing health care, states are increasingly authorizing the collection of fees from prisoners for medical services they receive while in state prisons or local jails. At least 38 states now do it, according to the Brennan Center for Justice at New York University School of Law and Stateline reporting. The fees are typically small, $20 or less. And states must waive them when a prisoner is unable to pay but still needs care, in keeping with a U.S. Supreme Court ruling that prisoners have a constitutional right to “adequate” health care. (Ollove, 7/22)

When choosing retirement locales, a few factors pop to mind: climate, amenities, proximity to grandchildren, access to quality healthcare. Chris Cooper had something else to consider - marijuana laws. The investment adviser from Toledo had long struggled with back pain due to a fractured vertebra and crushed disc from a fall. He hated powerful prescription drugs like Vicodin, but one thing did help ease the pain and spasms: marijuana. (Taylor, 7/22)

Cutting the number of mentally ill inmates in Los Angeles County's jail system would require spending tens of millions of dollars on new treatment facilities and housing for offenders who would otherwise be released into homelessness, a long-awaited report concludes. A task force of public officials and mental health advocates convened by Los Angeles County Dist. Atty. Jackie Lacey issued the report after spending more than a year studying how to divert mentally ill people from the criminal justice system. (Sewell and Gerber, 7/23)

King County could be one of the nation’s first metropolitan areas to adopt a wide-reaching plan to curb public-health problems through services for pregnant women, infants and children. Voters in November will decide on a proposal to raise property taxes to boost aid for early intervention programs, following the Metropolitan King County Council’s vote of approval on Wednesday. (Lee, 7/22)

Washington state health officials are appealing a federal court order to pay $1.3 million in attorney’s fees to lawyers of mentally ill defendants who sued the state for warehousing them in jails. U.S. District Judge Marsha Pechman ruled in April that the state was violating the constitutional rights “of its most vulnerable citizens” by forcing them to wait for weeks or months in jails for competency services. (7/22)

Law enforcement agencies said Tuesday they are stepping up efforts to stop a surge of heroin sales by dealers in Detroit’s Woodward Corridor mainly to suburban customers, many of them from Oakland County. In Pontiac, Oakland County officials announced they are launching several initiatives aimed at stemming the supply of prescription pain relievers, whose addictive lure is widely thought to underlie southeast Michigan’s spiraling problem with heroin. Countless abusers of the pain pills ultimately turn to stronger, cheaper heroin, said officials on both sides of 8 Mile Road. (Allen and Laitner, 7/22)

A federal appeals court has struck down the earliest state ban on abortion in the country, a move that could invite the Supreme Court to weigh in on one of the nation’s most controversial social issues in the middle of a presidential election year. (Haberkorn, 7/22)

Three Bon Secours locations — St. Mary’s Hospital, St. Francis Medical Center and Memorial Regional Medical Center — and the VCU Medical Center are using TRU-D to disinfect rooms using ultraviolet radiation technology. When humans clean an operating room, they eliminate only about 50 percent of surface bacteria, according to Khiet Trinh, chief medical officer at St. Mary’s, which purchased one TRU-D system in 2013 and another last year. The TRU-D system is placed in a room after hospital employees manually wipe and scrub surfaces. It scans the room’s dimensions and bacteria concentration and emits UV light which eliminates 99.99 percent of bacteria, according to Trinh and TRU-D SmartUVC President Chuck Dunn. (McQuilkin, 7/22)

There has never been a welcome mat for abortion service providers in the Flathead Valley, a vast area that stretches over 5,000 square miles in the northwest corner of Montana. Susan Cahill began providing abortions in 1976 in the first clinic to offer the service in the Flathead. (Cates-Carney, 7/23)

Democratic lawmakers are proposing legislation they say is aimed at preventing unintended pregnancies in Michigan. Bills unveiled Wednesday in the Republican-controlled state Capitol would require employers to inform workers and job applicants about reproductive health care coverage. Other measures would require the state to distribute information about emergency contraception and health facilities to make emergency contraception available to rape victims. (7/22)

A former compliance officer for Georgia-based Primrose Pharmacy has accused it of operating a multistate scheme to defraud the Medicare Advantage program by billing for diabetes testing supplies that patients never ordered. In a False Claims Act lawsuit unsealed on Tuesday in U.S. District Court in Atlanta, Rosa Siler said Primrose, a mail-order pharmacy operating in 31 states and specializing in diabetes testing supplies, and consulting firm Diabetic Pharmacy Solutions, tricked the patients and doctors with the help of "lead generators" - outside sources that supplied patients' names, medical information, doctors, insurance providers and sometimes Social Security numbers. (Grzincic, 7/22)

The [Social Security] trustees moved the projected exhaustion date for the combined trust funds of the program's old-age and disability segments one year further out, to 2034, from the 2033 date in last year's report. But this masks the dire condition of the disability program: Its trust fund, taken on its own, will run out of money at the end of next year. The trustees urged Congress ... to take the short-term action of reallocating payroll tax income from the old-age program to disability to keep it fully funded; that would keep both trust funds solvent through 2033. Conservatives in Congress have been resisting this obvious fix, last done in 1994, in favor of concocting some broader Social Security reform--which, given the tenor of the current Congress, undoubtedly would involve benefit cuts to retirees and the disabled. But the new report underscores that no comprehensive change to Social Security is necessary. (Michael Hiltzik, 7/22)

Now the post-Hobby Lobby cases have, inevitably, arrived at the Supreme Court’s door. Three appeals have been filed so far, and the justices will decide shortly after the new term begins in October whether to accept any of them. At that point, the spotlight will return to the court, along with the heated rhetoric about the Obama administration’s supposed “war on religion.” Not only is there no such “war,” but the administration has bent over backward to accommodate religious claims that are by any measure extreme. The problem is that the religious groups pressing these claims refuse to take yes for an answer. The question is whether their arguments go too far, even for the Roberts court. (Linda Greenhouse, 7/23)

Debate about the Iran nuclear deal shows that issues besides the Affordable Care Act can suck up partisan oxygen, at least for a time. But the respite for the ACA is likely to be fairly short-lived. ... The Affordable Care Act escaped a political and policy crisis last month when the Supreme Court ruled for the government in King v. Burwell–and the ACA may catch a second break if conservative ire focuses on the Iran deal for the immediate future. But the health-care law is not likely to disappear for long as a political issue, and the politics of the ACA are not likely to change significantly until after the next election cycle. (Drew Altman, 7/23)

Last week, Alaska Governor Bill Walker announced that he will bypass the legislative process and implement Obamacare’s Medicaid expansion by executive fiat. ... expansion may come as a shock to Alaska’s legislative leadership, who last month brokered an informal arrangement with the governor to put Medicaid expansion on hold until 2016. The press conference Walker held last week was heavy on promises, but light on specifics. ... Despite promises that Medicaid expansion will jumpstart the Alaskan economy, the governor’s Obamacare plan will actually discourage work and shrink the economy. (Josh Archambault and Christie Herrera, 7/23)

Expansion will bring in hundreds of millions of dollars of federal funds, which is cash flow that Alaska very much needs right now. ... Medicaid expansion will also allow the state to use Medicaid money to cover health care costs for prison inmates, which the state currently pays, resulting in millions of dollars in savings. It will also provide care for many recently released prisoners, some of whom can only receive health care if they’re incarcerated. Many prisoners are more in need of mental health care than prison and can receive this with Medicaid expansion. ... Expansion will also add jobs to the economy; not just well-paying health care jobs, but also spinoff jobs created by the boost that these health care jobs create. (Alaska State Rep. Adam Wool, D-Fairbanks, 7/22)

Liberals should rethink their absolutist position on abortion. In the past, its biggest losses — on “partial-birth” abortion, for example — have come when pro-life advocates forced them to defend extreme, even gruesome conduct. Unlike gay marriage, opposition to unfettered abortion on demand has remained high, perhaps because scientific breakthroughs allow us to see and treat the unborn baby. By once again going into attack mode, pro-abortion advocates are doing themselves no good. For Republicans, the challenge will be to keep the country with them and not overstep so as to lose valuable allies. (Jennifer Rubin, 7/22)

A friend Jim DeBrosse recently posted a Facebook message about the experience he and his wife, Kathy, had at a Cincinnati hospital, where she was getting checked after suddenly losing vision in her left eye. Tests ruled out a retinal detachment or a stroke. But the experience reminded him to be alert to mistakes when you’re in the hospital. (Karen Garloch, 7/22)