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Democratic presidential candidates leveled a stark critique of President Trump’s immigration policies and the condition of the American working class in the first primary debate on Wednesday, but split in unmistakable terms over just how aggressively the next president should seek to transform the country along more liberal lines. (Martin and Bruns, 6/26)

Health care and immigration, more than any other issues, led the debate. And Massachusetts Sen. Elizabeth Warren, more than anyone else, stood out — on her own at times — in calling for “fundamental change” across the nation’s economy and government to address a widening gap between the rich and the middle class. “I think of it this way. Who is this economy really working for? It’s doing great for a thinner and thinner slice at the top,” Warren declared shortly before raising her hand as one of the only Democrats on stage willing to abolish her own private health insurance in favor of a government-run plan. “Health care is a basic human right, and I will fight for basic human rights.” (Summers and Peoples, 6/27)

Senator Elizabeth Warren, the only person on the stage Wednesday polling in double digits, was expected to be the star of the first Democratic debate — and for the first half-hour, she was. But by the end, several lower-polling candidates had taken the spotlight: Senators Cory Booker and Amy Klobuchar, and especially Julián Castro. Twitter is a bad gauge for public opinion, but a decent source for the assessments of political experts, including those who know the stakes of debates best: veteran campaign strategists and consultants from both parties. Here is a sampling of their responses. (Astor, 6/27)

Two candidates raised their hands when asked whether they supported abolishing private health insurance in favor of a government-run plan, often called “Medicare for all”: Senator Elizabeth Warren of Massachusetts and Mr. de Blasio. Other candidates expressed support for a public option, in which everyone would have the option to buy a government-run health care plan, while still giving people the option to buy private insurance, at least in the immediate future. (6/26)

"I'm with Bernie on 'Medicare for all,' " Warren said. Her answer further narrowed the political distance between Warren and Sanders, who will be on the debate stage Thursday night. (Bradner, Krieg and Merica, 6/27)

‘Medicare for all’ is politically messy. The candidates all like to vow their support for it, but the debate laid bare how starkly different their approaches are. Only two of the candidates onstage, Warren and New York Mayor Bill de Blasio, said they want to end private insurance. They argued intensely over the merits of scrapping the entire insurance system, with the more moderate candidates warning such a move could destabilize the entire healthcare system. (Halper, 6/26)

[Warren] characterized commercial health plans as a central part of a broken medical system, taking a more vigorous line of attack than in the past on a subject that has become a litmus test for many progressive voters. “Look at the business model of an insurance company,” Warren said. “It's to bring in as many dollars as they can in premiums and to pay out as few dollars as possible for your health care. That leaves families with rising premiums, rising copays and fighting with insurance companies to try to get the health care that their doctors say that they and their children need. Medicare for All solves that problem.” (Roubein, 6/26)

Warren rejected politicians who call such proposals impossible. "What they're really telling you is they just won't fight for it," she said. "Well, healthcare is a basic human right, and I will fight for basic human rights." When former Texas Congressman Beto O'Rourke said he would not eliminate private insurance, de Blasio interrupted: "How can you defend a system that is not working?" Former Congressman John Delaney of Maryland, a little-known candidate, muscled his way into the conversation to defend the position of the party's moderate wing. He pointed out that his father enjoyed the private health benefits negotiated through his union. "Why do we have to stand for taking away something from people?" (Stein and Gibson, 6/27)

Some of the more centrist candidates, including Sen. Amy Klobuchar and former Maryland Rep. John Delaney, pushed back on Ms. Warren’s stance. “I think we should be the party that keeps what’s working and fixes what’s broken,” Mr. Delaney said. All the hopefuls seemed to agree they would go further than President Obama did in widening access to health care. (Thomas, Jamerson and Day, 6/27)

After pushing back on the idea of taking something away from Americans that most are reasonably happy with, Delaney said this: "Also it’s bad policy. If you go to every hospital in this country and you ask them one question, which is how would it have been for you last year if every one of your bills were paid at the Medicare rate? Every single hospital administrator said they would close." .... As an argument inside the Democratic Party, where "Medicare for All” is a rallying cry, this may not resonate. But once there's a general election, it's a new landscape, and if Warren—or Bernie Sanders, who shares the “no private insurance” view—makes it to that stage, it could be a much bigger deal. (Greenfield, 6/27)

John Delaney, a former congressman from Maryland, has proposed a universal health care system based on a combination of government coverage and private insurance. (Astor, 6/26)

Kaiser Health News/PolitiFact: ‘Medicare For All’ Emerges As Early Divide In First Democratic Debate
During Wednesday night’s Democratic presidential primary debate — the first in a two-night event viewed as the de facto launch of the primary season — health policies,  ranging from “Medicare for All” to efforts to curb skyrocketing drug prices, were among the key issues the 10 hopeful candidates onstage used to help differentiate themselves from the pack. Health care dominated early, with Sens. Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums. (Luthra and Greenberg, 6/27)

Here is how the candidates’ remarks stacked up against the truth.... Sen. Amy Klobuchar: “I am just simply concerned about kicking half of America off of their health insurance in four years, which is exactly what this bill says.” Mostly true. Ms. Klobuchar was referring to Senator Bernie Sanders’s bill that would put a Medicare-for-all national health insurance program into effect over a four-year period. His bill would create a universal Medicare program that would cover all Americans — including the roughly half who are currently covered by employer plans — with generous benefits and minimal out-of-pocket costs. Private insurers could offer coverage only for services not covered by the public program, such as cosmetic surgery. (6/26)

It took 30 minutes or so for Senator Elizabeth Warren to wind toward well-worn territory for her: a riff on the evils of insurance companies. “It’s not working for families,” she said, “But it’s sure as heck working for them. It’s time for us to make families come first.” It took barely a moment more for another familiar scene: a male peer cutting in as she spoke. “It should not be an option in the United States of America for any insurance company to deny women coverage for their exercise of their right of choice,” Gov. Jay Inslee of Washington interjected, pounding the air with his fist. “And I am the only candidate here who has passed a law protecting a woman’s right of reproductive health in health insurance.” (Flegenheimer, 6/26)

Washington Gov. Jay Inslee boasted of his executive standing, contrasting it with the many congressional lawmakers on stage, saying he had done more than any other to protect a woman's legal right to abortion — which drew a tart rejoinder from Minnesota Sen. Amy Klobuchar. "There's three women up here who have fought pretty hard for a woman's right to choose," she dryly noted, drawing cheers and applause from the studio audience. (Barabak and Mason, 6/26)

Democratic candidates split over one of the biggest issues in the race to find a 2020 presidential nominee: whether or not to replace the U.S.’s system of largely private health insurance with government-run health-care known as Medicare for All. Expanding a Medicare-like program to all Americans is popular with the party’s progressive wing, including Senator Elizabeth Warren and Senator Bernie Sanders. But the questions candidates faced on Wednesday night, and the split among Democrats, reflected the mixed support voters give to the idea when they consider the details. (Kapur and Edney, 6/26)

Democrats demonized the pharmaceutical industry throughout the first primary debate of the 2020 presidential election, racing to prove their status as the candidate most willing to “take on pharma.” ...The bombastic remarks, collectively, speak to the continuing political appeal both of promising to lower drug prices and of demonizing the pharmaceutical industry. The issue has enjoyed bipartisan attention in Washington in the nearly three years since Donald Trump was elected president. On Wednesday, however, Democrats escalated their rhetoric far beyond the tone employed by their Republican colleagues in Congress and even, in many cases, by Trump. (Facher, 6/26)

The 2020 Democratic presidential candidates see abortion as a winning issue in the next election. That was clear from the first night of the party’s primary debates, where the politicians onstage vied to show how emphatically they support abortion rights. The candidates focused on fear: of the state-level abortion bans recently passed in places such as Alabama, Missouri, and Georgia; of the threat to Roe v. Wade, the 1973 Supreme Court decision that established a constitutional right to abortion. Multiple candidates affirmed their support for expansive abortion rights, citing widespread support among Americans. (Green, 6/26)

Julian Castro, who served as secretary of housing and urban development under President Obama, offered a vigorous defense of abortion rights for transgender Americans during the first Democratic primary debate on Wednesday night. Asked if his health-care platform would provide public funding for abortion, Castro replied emphatically in the affirmative and emphasized the importance of facilitating access to abortion for transgender women, or biological males incapable of baring children. He presumably intended to refer to transgender men, or biological women who have transitioned. (Crowe, 6/26)

Warren: “Seven children will die today from gun violence — children and teenagers.” The average for firearms-related deaths was 7.15 per day when looking at people ages 0 to 19, according to data from the Centers for Disease Control and Prevention’s fatal injury report. The data covers 2013 to 2015. It’s worth noting that about one-third of the deaths are suicides — and that 18- and 19-year-olds are legal adults, though technically still “teenagers.” ... O'Rourke: “Despite what Purdue Pharma has done, their connection to the opioid crisis and the overdose deaths that we’re seeing throughout this country, they have been able to act with complete impunity and pay no consequences.” In terms of money, O’Rourke is wrong. Purdue Pharma, the maker of OxyContin, in March agreed to pay a $270 million civil settlement in Oklahoma and faces lawsuits around the country. In 2007, three executives were spared prison time and sentenced to probation after agreeing to plead guilty to charges that they misled federal regulators about the addiction risks of the drug. (Kessler, Rizzo, Lee and Kelly, 6/27)

Immigration dominated the first Democratic debate of the 2020 White House race as the candidates staked out concrete policy proposals on the border crisis, their discussion charged with emotion in the wake of a widely circulated photo of a father and daughter who drowned trying to cross the Rio Grande. Several of the 10 presidential contenders onstage Wednesday addressed the Miami audience with statements in Spanish, and immigration topics triggered some of the most contentious exchanges of the evening. (Miroff, 6/27)

Warren and Klobuchar are among the Democratic candidates who visited a detention center in Florida on Wednesday to highlight the wrenching conditions for migrants, including children, as Congress debates different versions of an aid bill that must be reconciled. (Niquette and Epstein, 6/26)

Former Obama HUD Secretary Julián Castro ... had a heated exchanged with O'Rourke, a fellow Texan. Castro argued that candidates should be calling for the repeal of the federal law that makes “illegal entry” into the U.S. a misdemeanor. Instead, he said such a violation should only be a civil offense, adding that U.S. law should "not criminalize desperation." (Morin, 6/27)

The party’s leftward push has been apparent to insiders and political junkies, particularly since the beginning of the 2020 presidential primary, but was in full view Wednesday night in front of a national television audience. (Stein, 6/27)

The two-hour session Wednesday evening was more contentious than many expected, even though the Democratic National Committee decided against putting the highest-polling candidates on stage together as was done with the crowded Republican field four years ago. Mr. Biden, 76, will be at the center of the stage Thursday and will be flanked by the oldest and youngest candidates in the race, 77-year-old Mr. Sanders and 37-year-old Mayor Pete Buttigieg of South Bend, Ind. (McCormick, 6/27)

Senator Bernie Sanders of Vermont has started highlighting his policy differences with former Vice President Joseph R. Biden Jr. He’ll get a big chance in the second night of the Democratic primary debates on Thursday. To the extent that the two end up hogging the spotlight, it could draw airtime from Mayor Pete Buttigieg of South Bend, Ind., and Senator Kamala Harris of California, the other two candidates receiving strong support in polls. Here are the political dynamics to watch. (Goldmacher, Parlapiano and Ramic, 6/27)

Joe Biden wasn't in Wednesday night's debate, but he wanted a turn to answer a question on health care. After a question was posed on health care, Biden's campaign immediately replied with the former vice president's position on the issue. "Let's be clear: We shouldn't tear the Affordable Care Act down: We should build on it," the tweet said on the "Team Joe" account. "The Biden administration will give every American the right to choose a public option like Medicare to ensure everyone has access to the quality, affordable health care they deserve." (Parnes, 6/26)

A slate of 10 Democrats vying to become their party’s nominee for president faced one another on Wednesday in Miami, the first of two nights of debate among the 2020 candidates. (6/27)

If there was any doubt that gun control will be a big issue in the 2020 Democratic primary, the first round of debates helped put that to rest. For 15 minutes, led with a question by moderator Chuck Todd referencing the shooting at Marjory Stoneman Douglas High School in Parkland, Florida, the candidates spoke extensively about gun control. The candidates even tried to one-up each other — Cory Booker, for one, brought up his plan to require a license to buy and own a firearm. (Lopez, 6/26)

The question from Chuck Todd to Senator Elizabeth Warren was direct: “What do you do about the hundreds of millions of guns already out there, and does the federal government have to play a role in dealing with them?” It was an effective query, one that, arguably, cuts to the heart of America’s gun problem, which claimed nearly forty thousand lives last year. A 2017 study estimated that there are three hundred and ninety-three million civilian-owned firearms in the United States, a rate of 120.5 guns for every hundred residents, twice that of the second-highest nation, Yemen. Yet Warren, who has been battling with Senator Bernie Sanders to win over the Democratic Party’s left wing, sidestepped the question. She offered up a quotable sound bite—“Gun violence is a national health emergency in this country, and we need to treat it like that”—and talked about the need to “double down on research,” an allusion to how the N.R.A. succeeded, during the mid-nineteen-nineties, in effectively cutting off federal funding for gun-violence research. (Luo, 6/26)

Overall, [Booker's] performance struck a balance of introducing himself to a broader audience and leaning into race issues, while detailing his policies, including on guns. “If you need a license to drive a car, you should need a license to buy and own a firearm,” Booker said to big applause. (Siders and Korecki, 6/27)

Senator Cory Booker of New Jersey introduced a 14-part plan earlier this year to address gun violence, and it is one of the most progressive gun-control measures suggested by a candidate seeking the Democratic presidential nomination. (Corasaniti, 6/26)

A federal appeals court on Wednesday requested written arguments on whether the House of Representatives and numerous Democratic-leaning states can step in to appeal a federal judge’s ruling that struck down President Barack Obama’s health care law. The question posed to lawyers on both sides of the “Obamacare” legal battle is significant because President Donald Trump’s administration isn’t defending the Affordable Care Act. The filing at the 5th U.S. Circuit Court of Appeals in New Orleans also raises the question of whether there is a legitimate “live case or controversy” to be decided, and what the “appropriate conclusion” of the case should be if nobody involved can legally appeal the December ruling by Texas-based U.S. District Judge Reed O’Connor striking down the law. (McGill, 6/26)

One law professor, Nicholas Bagley of the University of Michigan, said in a tweet that the notice from the court was an "ominous sign." "If neither the blue states nor the House has standing, it would mean that no one has standing to appeal the decision," Bagley wrote in the tweet. "That would effectively leave the lower court decision unappealable." This isn’t the first time the federal courts have faced such a dilemma. When the Obama administration wouldn’t defend a federal law that allowed states to refuse to recognize same-sex marriage, the Republican-led House of Representatives was allowed to step in to advocate for the law. (Larson, 6/26)

The panel also asked if there is even a controversy left to decide in the case if the House and the states can’t participate, given the Justice Department’s position that it now agrees with the lower court ruling in the case. If neither the Democratic-led states nor the House has standing, that would effectively leave no party in the case to appeal the lower court decision from U.S. District Court Judge Reed O’Connor in Texas, Bagley wrote. (Ruger, 6/26)

The implications of such a decision for the future of the Affordable Care Act are difficult to parse without more information, legal experts said. But most suggested that it wouldn't bode well for supporters of Obamacare. “The odds that the Fifth Circuit does something nasty to the health-reform law have gone up,” Nicholas Bagley, a professor at the University of Michigan Law School who has followed the case closely, wrote on Twitter. (Demko, 6/26)

If the 5th Circuit upholds the lower-court ruling — which would almost certainly put it back in front of the Supreme Court — it would create a political and logistical mess for the Trump administration and Congress. Republicans repeatedly failed to repeal and replace Obamacare while they controlled both the House and the Senate in 2017 and have little appetite to revisit health reform. “If a court decision came down quickly overturning the ACA, it would immediately catapult health care into the primary issue in the election,” said Larry Levitt, a senior vice president with the Kaiser Family Foundation, a nonpartisan health policy organization. “The issue is now almost 10 years old and has so many legal tentacles that it would take a long time and probably many additional lawsuits to figure out how to unwind it.” (6/26)

Legal experts have long thought that the case will not ultimately succeed, that even if the 5th Circuit affirms the lower court ruling striking down the health law from a conservative judge, that the Supreme Court — which has twice upheld ObamaCare already in different cases — would not strike down the law this time either. (Sullivan, 6/26)

Congress is at a standoff over a $4.6 billion aid package for the southern border as House Democrats say a Senate-passed measure doesn't go far enough to care for thousands of migrant families and children. Speaker Nancy Pelosi is considering a fresh vote Thursday. Democrats want to add more protections for the children — including medical and hygiene standards at facilities, and a requirement that any death of a minor be reported within 24 hours. Democratic leaders will convene early Thursday and Pelosi's spokesman says they plan to push the amended measure through the House quickly. (Taylor and Fram, 6/27)

The Senate vote was 84-8 and came after an emotional debate highlighted Wednesday morning by Senate Minority Leader Chuck Schumer's display of a blown-up image on the Senate floor depicting a shocking photo of a Salvadoran father and his daughter who drowned trying to cross the Rio Grande. (Sullivan, Barrett and Fox, 6/26)

Earlier in the day, the Senate voted 37-55 to reject the House's emergency border funding bill, which would have appropriated $4.5 billion for emergency funding, as well as stronger protections for migrants and children. The House had passed its version of the border funding bill on Tuesday evening. In a legislative quirk, Sen. Richard Shelby, R-Ala. introduced an amendment that struck out the text of the House bill and replaced it with the text of the Senate bill (S. 1900). The Senate bill is the version that ultimately passed. (Wu and Hayes, 6/26)

The action set up a stalemate over the border spending, even as tragic images of the migrant crisis and reports of children and families in squalid and overcrowded detention centers fueled an urgent push to reach an agreement. Speaker Nancy Pelosi of California rejected the Senate’s bill even before the vote was taken, setting up a clash over immigration policy just days before Congress leaves Washington for a weeklong July 4 recess. Ms. Pelosi on Wednesday afternoon called Mr. Trump, who has threatened to veto the House bill, to discuss how to reconcile the dueling measures. “They pass their bill; we respect that,” she said. “We passed our bill; we hope they would respect that. And there are some improvements that we think can be reconciled.” (Cochrane and Hirschfeld Davis, 6/26)

Trump himself sounded notes of optimism as he spoke about the legislation outside the White House prior to departing for Japan. “What they’re working on is aid, humanitarian aid for the children. It seems that the Senate is very close,” Trump said. “I think that Nancy wants to get something done, and the Senate and the House will get together. I think they’ll be able to do something very good.” (Werner and DeBonis, 6/26)

Meanwhile, officials say cities on both sides of the U.S.-Mexico border are overwhelmed by migrants. Politicians are arguing about responsibility for the death of a Salvadoran father and toddler daughter, captured in a photograph from Matamoros, Mexico, and U.S. immigration officials say they need new funds to process the large number of asylum seekers fleeing violence and poverty in Central America. (Duehren, Radnofsky and Montes, 6/26)

The House is expected to vote on the package Thursday, teeing up another potential showdown with the Senate if Republicans across the Capitol refuse to take up the amended bill. House Democrats already proposed some of those changes earlier in the day but Senate Republicans seemed unlikely to support them, according to Sen. John Thune of South Dakota, the GOP whip. "I don't think people want to go home not having solved this. Unless they have tweaks that are things that could pass here, I think it's going to be pretty much our bill or bust," Thune said. "The list [of changes] I've seen are the kind of things that people over here would have a pretty big problem with." (Everett and Caygle, 6/26)

Hard-liners inside and outside the Trump administration are pressing for the removal of President Donald Trump’s acting Homeland Security secretary amid a rolling leadership purge that began in April and shows no signs of ending, according to five people in the Trump administration and four former Department of Homeland Security officials. Kevin McAleenan, who took over the post less than three months ago, is under heavy criticism from prominent Trump allies, including former Immigration and Customs Enforcement Director Thomas Homan, who may become the administration’s immigration czar. (Hesson and Cook, 6/26)

Immigrant rights attorneys filed suit against the Trump administration, claiming that the federal government is holding children in unhealthy and unsafe conditions along the southwest border in violation of a settlement dictating the detention of minors. The suit, filed in U.S. District Court in Los Angeles on Wednesday, asked for an emergency injunction allowing immediate inspections by a public health expert of all Customs and Border Protection facilities in Texas’ El Paso and Rio Grande Valley sectors. The suit also sought access for medical professionals to these facilities. (Lazo and Gershman, 6/27)

Immigrant advocates are asking a federal judge to immediately require inspections and let doctors into border detention facilities where they say sleep-deprived, flu-stricken children are languishing in filthy conditions. Doctors and lawyers who visited the facilities in recent weeks outlined several damning examples in a court filing late Wednesday that puts more pressure on the Trump administration to improve conditions for immigrant children. Lawyers are also asking for the prompt release of children to parents and close relatives and for the government to be found in contempt of court. (Attanasio and Taxin, 6/27)

The temporary restraining order “further demands immediate, unfettered access of medical experts to the facilities, to evaluate and treat the children,” according to the statement. The motion, which cites detention facilities in the Border Patrol’s El Paso and Rio Grande Valley sectors, also asks the court to hold the U.S. government in contempt for failing to comply with basic child welfare standards. Those standards were agreed upon in a 1997 court settlement known as the Flores agreement, which set legal requirements for the housing of children seeking asylum or in the country illegally. (Carcamo, 6/26)

Children as young as 3 pressed their faces against the windows of one crowded cell holding nearly 20 migrant girls, some sprawled on the floor. Boys gazed through the fencing of a containment zone exposed to the 101-degree heat. Customs and Border Protection authorities on Wednesday allowed a group of journalists on a brief, highly controlled tour of the border station in Clint, a farming town near El Paso, hitting back at reports of filthy and abusive conditions for the children detained inside. Agents claimed that they were supplying soap and toothbrushes for the children, pointing to shelves with those items in a supply room. (Romero, 6/26)

U.S. authorities did not allow cameras on the tour, and reporters were barred from talking to children. Some of the children in the holding cells pressed up against windows to watch the entourage. Border Patrol agents and other government workers wore surgical masks to protect them from contagious diseases. Approximately 90 children were in the holding cells Wednesday. The rest — all teenage boys — were housed in a fenced-in area of an adjacent sally port that has been converted into a holding area with triple-decker bunk beds and mats. It can accommodate up to 200 children for sleeping. (Moore, 6/26)

As more than 200 children languished in troubling conditions in a remote Border Patrol station, the government's system of child detention facilities had at least 500 beds available. Records obtained by The Associated Press show that the U.S. Department of Health and Human Services had beds available in facilities across the U.S., which when tallied up numbered 512 last week. Under federal law, the department is responsible for sheltering migrant children until they are placed with family sponsors. (6/27)

The harrowing photo of a drowned toddler and her father along the Rio Grande has illustrated the risks migrants are willing to take to reach the U.S. in the face of increasingly hardline Trump administration policies aimed at keeping them out. For many people trying to enter the country, it's a matter of waiting, waiting and waiting some more for the OK to come across — unless they try to force the issue and slip over the border, a dangerous and sometimes lethal undertaking that involves trekking through the scorching desert and fording the deceptively tricky Rio Grande. (Galvan, 6/26)

And in other news —

About half of the roughly 2,300 children confined in a privately run Florida facility intended as a temporary shelter for migrant teenagers have been there for more than 20 days and many of them for months, despite legal standards that require children who cross the border to be speedily released or sent to state-licensed shelters that are equipped to offer longer-term care. (Jordan, 6/26)

Wayfair will donate $100,000 to the American Red Cross after an employee backlash over the sale of bedroom furniture for use in a migrant detention facility. In a letter to employees, Wayfair cofounders Steve Conine and Niraj Shah said the company will donate the money to support the American Red Cross "in their effort to help those in dire need of basic necessities at the border." CNN obtained the letter. The company didn't say whether the funds for the donation come from the proceeds or profits as a result of the use of its furniture in a detention facility. (Alesci, Meyersohn and Trafecante, 6/26)

Employees of Wayfair Inc. walked out of the company’s Boston headquarters on Wednesday in protest of the online retailer’s sale of $200,000 worth of bedroom furniture to a southern border facility for migrant children seeking asylum in the U.S. The walkout evolved into a demonstration that swelled to hundreds of people as employees were joined by human-rights and other groups in Copley Square, a public space just minutes away from the Wayfair workplace. (McGee and Levitz, 6/26)

The harrowing image of Salvadoran migrant Óscar Alberto Martínez Ramírez and his 23-month-old daughter, who drowned in the Rio Grande after reportedly being unable to request asylum, has returned attention to the U.S. government's controversial policy of forcing migrants to wait in Mexico before allowing them to cross the border to claim asylum. Known as “metering,” the policy is meant to address a record surge of migrants, mainly families from Central America, making the trek through Mexico to the U.S. (Roldan, 6/26)

The Senate health committee approved a package of bills on Wednesday aimed at lowering the cost of medical care, from ending surprise medical bills to curbing prescription drug price surges, with a rare bipartisan vote that could vault it toward final passage. Still, even some Democrats who supported the legislation couched it as cold comfort as the Trump administration prepares to argue before a federal appeals court next month that the entire Affordable Care Act should be struck down as unconstitutional. (Goodnough, 6/26)

Committee Chairman Lamar Alexander, R-Tenn., hopes to bring the bill (S 1895) to the Senate floor for a vote in mid-to-late July, which will likely set up a flurry of lobbying and debate among lawmakers over changes to it. Senate Majority Leader Mitch McConnell told CQ Roll Call that the package was on the priority list for floor time. "We haven't made a decision on exact timing yet, but it's for early consideration," the Kentucky Republican said. Two of the three committee members who voted against the bill — Sens. Bernie Sanders, I-Vt., and Elizabeth Warren, D-Mass. — did so by proxy, likely because they are seeking the Democratic party’s presidential nomination and participating in the Miami debates on Wednesday and Thursday. Kentucky Republican Sen. Rand Paul also opposed the bill. (McIntire, 6/26)

The Senate health committee approved its major healthcare package on Wednesday, but with one change to the proposed ban on surprise medical billing and potentially more to come ahead of a full Senate vote expected later this month. As it stands, the provision on surprise medical bills would cap out-of-network physician or hospital charges at a rate already negotiated by insurers. An amendment to that provision came from Sen. Bill Cassidy (R-La.) and would make insurers post all the physician and hospital options in their networks so patients could see their choices of doctor before deciding on a plan. (Luthi, 6/26)

A key Senate committee on Wednesday voted to require drug companies to justify price hikes to the federal government if they exceed 10% in a year or 25% in a three-year span, advancing a proposal that also enjoys bipartisan support in the House. The measure, spearheaded by Sen. Tammy Baldwin (D-Wis.), was offered as an amendment to a broader health care bill being considered by the Senate’s Health, Education, Labor, and Pensions Committee. Three other senators — two Republicans and one Democrat — co-sponsored the legislation, which the committee voted to include by a 16-7 margin. (Facher, 6/26)

Warren said that while the bill had "important provisions" it failed to address GOP "sabotage" of ObamaCare or soaring drug costs. Sen. Rand Paul (R-Ky.), a strong conservative, also voted "no." Otherwise, the committee was remarkably united. Alexander purposely steered the bill to avoid the polarizing issue of ObamaCare and to focus on other areas. (Sullivan, 6/26)

In other news from Capitol Hill —

The leaders of the Senate Finance Committee are in bipartisan talks on a potentially sweeping deal to limit drug price increases in Medicare, according to sources familiar with the negotiations. Sen. Ron Wyden (Ore.), the top Democrat on the panel, is pushing to make drug companies pay back rebates to Medicare’s prescription drug program, called Part D, if their prices rise faster than inflation. Another measure would force drug companies to pay money back to Medicare if they launch a new drug with a high price.  (Sullivan, 6/26)

Rep. Susan Wild (D-Penn.) opened up about the death of her life partner Monday evening on the House floor to draw attention to the "national emergency" of suicide. Monday was the one-month anniversary of Kerry Acker's death, Wild said. "What most people don't know is that Kerry's death was a suicide," she said in a tearful floor speech. (Hellmann, 6/26)

Sen. Joe Manchin (D-W.Va.) on Wednesday embraced the GOP’s line of attack on “Medicare for All” proposals, arguing that the government can’t even pay for the program it has now. “We can’t even pay for Medicare for some and to go Medicare for All, we can’t take care of those who are depending on it right now,” Manchin said at The Hill’s Future of Healthcare Summit. (Hellmann, 6/26)

Kaiser Health News: Five Things We Found In The FDA’s Hidden Device Database
After two decades of keeping the public in the dark about millions of medical device malfunctions and injuries, the Food and Drug Administration has published the once hidden database online, revealing 5.7 million incidents publicly for the first time. The newfound transparency follows a Kaiser Health News investigation that revealed device manufacturers, for the past two decades, had been sending reports of injuries or malfunctions to the little-known database, bypassing the public FDA database that’s pored over by doctors, researchers and patients. Millions of reports, related to everything from breast implants to surgical staplers, were sent to the agency as “alternative summary” reports instead. (Lupkin, 6/27)

The former utility lawyer who led much of President Donald Trump’s rollback of pollution regulations will leave the Environmental Protection Agency — a move that comes after he provided conflicting information to Congress about his connections to the industry, three sources knowledgeable about the matter told POLITICO. EPA air pollution chief Bill Wehrum’s ties to his old law firm and especially the Utility Air Regulatory Group, an influential collection of coal-heavy utilities that lobbied against climate regulations, drew scrutiny from House Democrats, who launched an investigation in April. (Guillen and Colman, 6/26)

While much of the attention this week from the Trump administration's executive order on transparency focused on prices, there's also a section of it that calls for alignment of quality measures across all federal healthcare programs. Provider stakeholders and quality researchers support the effort but say it will be a heavy lift. Tucked within the executive order, the administration notes that HHS, the Defense Department and the Veterans Affairs Department in the next six months will develop a strategy, called the Health Quality Roadmap, that will detail plans to consolidate quality measures publicly reported across Medicare, Medicaid, the Children's Health Insurance Program, the health insurance marketplace, the Military Health System and the VA health system. (Castellucci, 6/26)

Add one more group to the long list of industries working to block new tariffs on Chinese imports: medical-supply companies. Trade officials have left the pharmaceutical industry and other pockets within the health-care sector out of the trade conflict, but dozens of medical supplies—tongue depressors, exam gloves, surgical gowns and the like— used in everyday patient encounters are among the $300 billion in Chinese imports facing 25% tariffs under the Trump administration’s latest proposal. (Ferek, 6/26)

A federal public health advisory panel said Wednesday that some people through age 45 could benefit from getting an HPV vaccine and should discuss the possibility with their doctors. The recommendation, which came during a two-day meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, could expand the pool of people whose insurance providers may cover the HPV vaccine. (Bever, 6/26)

In a 10-4 vote, the committee also recommended adults ages 27 through 45 who had not been adequately vaccinated make shared decisions with their doctors about getting vaccinated. Adults older than 45 who had not been vaccinated are not advised to do so, since HPV vaccines are not licensed for use in that age group. The ACIP recommendations won't be official until they're approved by the CDC director. (Howard, 6/26)

The CDC estimates that roughly half of Americans ages 18 to 59 had some form of genital HPV. Vaccinations against it first became available in 2006 and each dose now costs $216. The vaccine is approved for people up to age 45, but the same panel declined a proposal to recommend it for people older than 26. Instead, it settled on a weak endorsement for adults between 26 and age 45, meaning patients and doctors can make the decision together. (Stobbe, 6/26)

An expert group that provides guidance on U.S. vaccine policy on Wednesday recommended that decisions on the use of two vaccines — one against bacteria that cause pneumonia and one against human papillomavirus — be left to patients and their doctors, stopping short of blanket recommendations from the panel itself. The decisions by the Advisory Committee on Immunization Practices came as a disappointment to the vaccine manufacturers. But they also keep both products on the official vaccine schedule and covered by health insurance. (Branswell, 6/26)

As the Trump administration moves to make confidential hospital prices public, New Hampshire’s dozen years of experience with price transparency suggests what it may—and may not—accomplish. New Hampshire has one of the most comprehensive and oldest hospital price-transparency laws in the U.S. (Evans, 6/26)

In July 2007, Carrie Barrett went to the emergency room at Methodist University Hospital, complaining of shortness of breath and tightness in her chest. Her leg was swollen, she’d later recall, and her toes were turning black. Given her family history, high blood pressure and newly diagnosed congestive heart failure, doctors performed a heart catheterization, threading a long tube through her groin and into her heart. Her share of the two-night stay: $12,109. (Thomas, 6/27)

Drug shortages cost providers nearly $360 million a year in labor expenses, a new survey has found. Hospitals and affiliated facilities dedicate more than 8.6 million hours per year working around persistent drug shortages, according to a new Vizient survey of 365 health system employees polled from July to December 2018. The distraction resulted in at least one medication error for 38% of the organizations surveyed by the group purchasing and consulting organization. (Kacik, 6/26)

There’s a hospital in the middle of the state that’s about to go under, and it has a lot of people concerned. Some of them are at the General Assembly, where the Senate leader introduced a bill late in this session to establish a state-funded loan program for struggling rural hospitals. The budget compromise released Tuesday night includes about $20 million over two years in one-time money to fund the Rural Health Care Stabilization Act, pending approval of the bill. And the old Randolph Hospital in Asheboro, surrounded by shuttered textile mills, would likely be the first beneficiary. (Knopf and Hoban, 6/27)

Louisiana officials announced a deal Wednesday with Asegua Therapeutics, a subsidiary of Gilead Sciences, that would allow the state to provide hepatitis C treatment to its Medicaid and prison populations. They also secured the necessary clearance from the federal government Wednesday for a novel approach to paying for the drugs and expect the program to start July 15. In Louisiana, at least 39,000 people either on Medicaid or in the prison system have hepatitis C, a viral infection that attacks the liver. (Simmons-Duffin and Kodjak, 6/26)

Health Secretary Rebekah Gee celebrated the deal's signing with Gov. John Bel Edwards at a New Orleans health clinic. She said Louisiana hopes to treat 31,000 of the estimated 39,000 Medicaid patients and prisoners with the disease by the end of 2024. By comparison, the state treated about 1,100 people last year, Edwards said. "It just was unacceptable. We knew we had to do better," said the Democratic governor. (DeSlatte, 6/26)

Louisiana is the first state in the nation to start plotting a subscription model like this one, dubbed the "Netflix model," based on the unlimited-access, single-price approach, Gov. John Bel Edwards said at a news conference. “It is time that Louisiana lead,” Edwards said to applause from a roomful of Louisiana health care providers and policymakers. “And we are leading.” (Woodruff, 6/26)

In other pharmaceutical news —

A rush of acquisitions this year is reshaping the drug industry. But investors haven’t universally welcomed the deal-making. AbbVie’s agreement on Tuesday to buy Allergan, in a deal valued at $63 billion, provided the latest evidence: AbbVie’s shares fell 16 percent, their worst day in six years. Months earlier, investors pushed the stock of Bristol-Myers Squibb down 14 percent after the announcement that it would buy Celgene for $74 billion, the year’s biggest pharmaceutical deal. (Grocer, 6/27)

A congressional committee is asking Gilead Sciences (GILD) to explain its pricing policies for the Truvada HIV prevention pill, the latest effort to pressure the drug maker over a medicine that has stirred controversy thanks to its high cost and federally funded research support. In a letter sent on Wednesday to the company, the House Committee on Oversight and Reform asked for explanations for Truvada price hikes over the past decade, as well as correspondence with federal agencies about donations to the U.S. government and patents related to HIV prevention. The committee also wants data on the cost to manufacture Truvada and a forthcoming follow-up pill called Descovy. (Silverman, 6/27)

Kaiser Health News: How Black Pharmacists Are Closing The Cultural Gap In Health Care
After a health insurance change forced Bernard Macon to cut ties with his black doctor, he struggled to find another African American physician online. Then, he realized two health advocates were hiding in plain sight. At a nearby drugstore here in the suburbs outside of St. Louis, a pair of pharmacists became the unexpected allies of Macon and his wife, Brandy. Much like the Macons, the pharmacists were energetic young parents who were married — and unapologetically black. (Anthony, 6/27)

A Missouri commission charged with determining the fate of the state’s last abortion clinic will hear the case in August, weeks after the expiration, set for Friday evening, of the injunction that has kept the clinic operating.Lawyers representing the Reproductive Health Services of Planned Parenthood of the St. Louis Region filed a motion to the state’s Administrative Hearing Commission Tuesday asking it to allow the clinic to continue operating as an abortion provider, as the commission considers the case. (Calfas, 6/26)

Texas lawmakers' latest move to block public money from going to abortion providers and their affiliates is creating a murky picture for the future of women’s health care and some community health programs in Texas. That includes some services unrelated to abortion and reproductive health, like sharing information about sexual health on college campuses or helping local governments prevent disease outbreaks. Senate Bill 22, which goes into effect Sept. 1, prohibits government entities from providing anything of value to an abortion clinic or an affiliate, even if the money isn’t explicitly for abortions or the clinic doesn’t perform the procedure. (Korte, 6/27)

Abortion rights supporters on Wednesday challenged an Arkansas law banning the procedure 18 weeks into a woman's pregnancy and another requirement that they say would likely force the closure of the state's only surgical abortion clinic. In all, the lawsuit filed by the American Civil Liberties Union and Planned Parenthood targets three abortion restrictions and asks a federal judge to block them before they take effect July 24. (6/26)

A new Kentucky law takes effect Thursday that requires doctors to tell patients that some abortions can be reversed, a claim disputed by the medical establishment, even as a similar law in another state faces a legal challenge from two national organizations. Senate Bill 50, which passed in Kentucky's 2019 legislative session, requires doctors to counsel patients seeking to terminate an early-stage pregnancy with medication that the process can be reversed by a different medication. (6/26)

When the University of Chicago Medical Center announced a partnership to share patient data with Google in 2017, the alliance was promoted as a way to unlock information trapped in electronic health records and improve predictive analysis in medicine. On Wednesday, the University of Chicago, the medical center and Google were sued in a potential class-action lawsuit accusing the hospital of sharing hundreds of thousands of patients’ records with the technology giant without stripping identifiable date stamps or doctor’s notes. (Wakabayashi, 6/26)

Two years later, a law firm alleged Wednesday that the hospital handed vast amounts of data over to the tech giant without removing potentially identifying information like physicians’ notes or date stamps of when patients checked in and out of the hospital. The suit was filed on behalf of a single patient, with the goal of expanding it to a class action suit if more patients come forward. The suit underscores rising concern about patient privacy as companies seek to mine the reams of health data stored in hospitals’ medical records systems to fine-tune their algorithms. If the suit can attract more plaintiffs, it could open up a new front in the debate over when and whether patient data can be truly de-identified. (Robbins, 6/26)

In other health and technology news —

Health IT groups were generally supportive of revised information technology provisions proposed in the CMS' annual update to the inpatient prospective payment system, but urged the agency to slow potential requirements related to integrating outside programs with electronic health record systems. The public comment period for the CMS' IPPS proposal, which the agency released in April, closed Monday. Now the CMS is tasked with sifting through more than 2,000 comments from providers, vendors and trade groups offering feedback on the agency's plan to update inpatient hospital reimbursements for federal fiscal 2020. (Cohen, 6/26)

The state of Oklahoma on Wednesday wrapped up most of its case against Johnson & Johnson, in a historic trial that is testing whether a state can make a pharmaceutical company pay for the opioid epidemic impacting its residents. After 22 days, the state's case came close to concluding with fiery and emotional testimony from Oklahoma mental health commissioner Terri White, who said Johnson & Johnson's claim it bears zero responsibility for the state's opioid crisis "offends my decency." (Drash, 6/26)

The fate of thousands of lawsuits seeking to hold drugmakers responsible for fuelling the U.S. opioid epidemic hinges in part on a thorny legal question: Can a company use a bankruptcy to stop lawsuits from cities and states? U.S. Bankruptcy Judge Kevin Gross is expected in July to decide whether to halt more than 160 active lawsuits brought by state attorneys general, cities and counties against opioid manufacturer Insys Therapeutics Inc. When it filed for Chapter 11 protection in Delaware earlier this month, Insys requested the cases be paused. (6/26)

Federal health officials issued warnings Tuesday to two companies they say make unproven claims about the potential health benefits of the herbal supplement kratom. Cali Botanicals of Folsom, California, and Kratom NC of Wilmington, North Carolina, illegally sold product containing kratom that claimed to treat or cure opioid addiction and withdrawal symptoms as well as other health conditions the supplement is not proven to treat, the U.S. Food and Drug Administration says. (Miller, 6/26)

Fentanyl is a deadly part of the opioid crisis.  The synthetic drug can be up to 100-times more potent than morphine. Now researchers at Virginia Commonwealth University in Richmond have not only tested a promising vaccine, but they’ve also developed a method to test other new treatments. (Noe-Payne, 6/21)

It was never a secret in my house that I was conceived with the help of an anonymous sperm donor. For a majority of my childhood, I never really thought about him. But when I was around 11, I went through a period of having questions. My parents — I have two mothers — gave me a photo copy of a questionnaire that was sent to them from the sperm bank they used, California Cryobank. The donor filled it out in 1996, two years before I was born. I remember carrying the form with me in my backpack, taking it to school and studying it occasionally when I remembered I had it. (Baden-Lasar, 6/26)

To be the biological child of an anonymous sperm donor today is to live in a state of perpetual anticipation. Having never imagined a world in which donors could be tracked down by DNA, in their early years sperm banks did not limit the number of families to whom one donor’s sperm would be sold — means that many of the children conceived have half-siblings in the dozens. There are hundreds of biological half-sibling groups that number more than 20, according to the Donor Sibling Registry, where siblings can find one another, using their donor number. Groups larger than 100, the registry reports, are far from rare. (Dominus, 6/26)

Doctors have known for years that some patients who become unresponsive after a severe brain injury nonetheless retain a “covert consciousness,” a degree of cognitive function that is important to recovery but is not detectable by standard bedside exams. As a result, a profound uncertainty often haunts the wrenching decisions that families must make when an unresponsive loved one needs life support, an uncertainty that also amplifies national debates over how to determine when a patient in this condition can be declared beyond help. (Carey, 6/26)

Antoinette Catholdi-Dow, a 30-year-old mother of two, first started noticing little bite marks on the window sills in 2015, when her son was about two and a half years old. The window sills were the perfect height to help her toddler pull himself up to stand and walk. Eventually, Catholdi-Dow would enter the room and catch her son nibbling along their edges. By this point, her son had already been diagnosed with both autism and pica, which is an eating disorder that causes a person to crave and eat non-food items. (Almendrala, 6/26)

Burgers, fries, pizza and high energy drinks impact testicular function in young men, new research suggests. Specifically, the sperm counts for men who typically eat "Western" meals of high fat foods were 25.6 million lower, on average, than the counts of men noshing on fish, chicken, fruits, vegetables and other more "prudent" foods, a new Harvard study found. (Scutti, 6/26)

Today, antiretroviral medicines allow people with HIV, the virus that causes AIDS, to live long, productive lives. But at the onset of the AIDS epidemic in the early 1980s, the disease was considered a death sentence. No one was sure what caused it or how it was spread. Some doctors and nurses refused to treat patients with the disease; others protected themselves by wearing full body suits. (Gross, 6/26)

Sleep traits could be a risk factor for breast cancer, new research suggests. Women who said they preferred to get out of bed early were found to have a lower risk of breast cancer than those who stay up late. However, experts cautioned that other breast cancer risk factors such as alcohol consumption and being overweight have a greater impact than sleep and said there was no reason to change your sleep patterns. (Avramova, 6/26)

For most of our 200,000 years of existence as a species, humans have walked the planet barefoot. It’s only in the last 40,000 years that shoes have come into style. We evolved to feel the ground under our feet and to develop thickened skin, known as calluses, that protected us from heat, cold and abrasion. Now, many of us walk on cushioned soles that take the place of calluses. (Stein, 6/20)

Many people would be surprised to hear that grilling carries potential cancer risks. But each year, the American Institute for Cancer Research publishes guidance for “cancer-safe grilling,” cautioning consumers to avoid two types of compounds that have been tied to cancer. These compounds, called polycyclic aromatic hydrocarbons and heterocyclic amines, get generated when food, especially meat, is cooked on a grill. They have not been proven to cause cancer in people, but lab studies have shown they alter DNA in a way that could lead to cancer. (Egan, 6/27)

Scabies can be controlled with a pill or two, and the protective effect lasts for years, scientists reported on Wednesday. At present, the standard remedy is a skin cream with an insecticide that does not provide long-term protection. In poor countries, pills can be distributed throughout a village, ridding whole communities of the parasite. While not fatal, scabies causes profound misery; many people find even the thought of it repulsive. (McNeil, 6/26)

There’s not nearly as much science behind those products as with a typical prescription medicine. On the other hand, there is one FDA-approved drug based on CBD, fully cleared based on the agency’s rules for safety and efficacy, with dosing information at least for the patients who have the two types of epilepsy it treats. ...More than half a dozen neurologists and other physicians around the country spoke with STAT about the difficult decisions and even headaches that CBD — sometimes a supplement, sometimes a drug — and its booming popularity have created for the medical community. (Florko, 6/27)

Hollywood has produced quite a few fictionalized depictions of dramatic climate change. Scores of people die after Manhattan freezes in 2004’s “The Day After Tomorrow.” In “Geostorm,” released in 2017, the weather goes haywire after satellites malfunction. Realistic scenarios, though, have been less frequent. Yet Sunday’s episode of “Big Little Lies,” the HBO show about five women living in Monterey, Calif., included a second grader who had an anxiety attack after discussing climate change with a teacher. The girl worried the world was going to end. (Holson, 6/27)

Kaiser Health News: More Seniors Are Dying In Falls. Doctors Could Do More To Reduce The Risk.
Older adults worried about falling typically receive general advice: Take an exercise class. Get your vision checked. Stop taking medications for sleep. Install grab bars in the bathroom. A new study suggests that sort of advice hasn’t proved to be very effective: Nearly three times more adults age 75 and older died from falls in 2016 than in 2000, according to a recent report in the Journal of the American Medical Association. (Graham, 6/27)

Eva Freund first came to the nation’s capital in the early 1960s, when the law allowed the federal government to fire anyone suspected of being gay. When sodomy laws allowed men and women to be arrested for having sex with someone of the same gender. When there was only one place in town someone like Freund could go and feel somewhat at ease — the city’s sole lesbian bar. But even there, safety wasn’t guaranteed. (Schmidt, 6/26)

In May 2018, Perelandra, a natural foods store and juice bar in Brooklyn Heights, sold 698 pounds of celery; in May 2019, they sold 1,245 pounds of it, according to Roland Auer, the store’s co-owner. He’s seen these patterns before. “A couple years ago cilantro shot up in popularity like this,” he said. “Last summer it was turmeric.” (Meltzer, 6/27)

Scroll through Lisa A. Olivera’s Instagram grid and you’ll find a distinctly 2019 tableau: a desert palette of blush, mauve and slate backgrounds with cream sans serif text. Her logo, a line drawing of a hand grasping desert poppies and wild grass, appears on many of the squares. These colors and icons are trademarks of influence in the age of peak wellness, the trappings of nonexperts who assert that drinking warm lemon water, de-puffing your face with a jade roller and bathing in rose petals will make you a better person. (June, 6/26)

When Kate Lacroix was driving alone from Seattle to Vancouver for a funeral, she called AT&T to get an international wireless plan. By the time she arrived, not only did she have a new phone plan, she also had a refreshed outlook on life and death. “I was feeling lonely and wistful,” she said, “so I shared, ‘I’m headed to a funeral for a person who was a stranger but became a friend.’” The customer service agent said, “Well, everyone’s a stranger before they’re a friend.” (Parker, 6/27)

A former campus gynecologist at the University of Southern California was charged Wednesday in the sexual assaults of 16 patients at the campus student health center, authorities said. Dr. George Tyndall has been the subject of a Los Angeles police investigation for more than a year after patients claimed sexual abuse or harassment by the gynecologist. (6/26)

The physician was taken into custody at 7:45 a.m. as he exited his apartment in a high-rise near Lafayette Park. Los Angeles police said he was carrying a loaded .38-caliber handgun, a concealed weapon for which they said he did not have a permit. Immediately after detectives approached him, the 72-year-old began complaining of chest pains and was driven to L.A. County-USC Medical Center for treatment. He remained there Wednesday evening. (Winton and Ryan, 6/26)

Hundreds of women said that Dr. George Tyndall, who was the longtime head gynecologist of the university’s health center, sexually abused them and that school officials did not adequately address their concerns. The Los Angeles District Attorney’s Office said that Dr. Tyndall faces charges of sexually assaulting 16 young women who had gone to the university’s health center for annual exams or other treatment between 2009 and 2016. (Cowan, 6/26)

Tyndall, 71, resigned from the prestigious private university in 2017, after an internal investigation by USC, and last year authorities suspended his medical license. He was arrested early on Wednesday at his home in Los Angeles, Flier said. Flier said he believes the arrest results from criminal grand jury proceedings in the case. (Dobuzinskis, 6/26)

Michigan officials on Wednesday began raising public awareness of tougher sampling rules they expect to result in more drinking water systems exceeding limits for lead, a byproduct of new regulations enacted after Flint's crisis. Samples now have to be taken not only from the first liter drawn from a house with exterior or interior lead plumbing, but also the fifth liter. (6/26)

As the federal government tries to compel Mississippi to give mentally ill people more options to get the treatment they need in their own communities, the experiences of Harold Biggs and Pamela Kirby offer a sharp contrast. Biggs, 75, has tried for decades to get help for his adult daughter, who has borderline personality disorder, bipolar disorder with schizoid affect and intellectual disabilities. For most of that time, he's felt that his only option was to ask a judge to confine her to a state mental hospital, where she's spent 12 of the last 24 years. And during her time on the outside, Biggs says she often doesn't get adequate treatment or supervision. (6/26)

Gov. Ralph Northam (D) is taking his crusade for gun control to the people of Virginia, and the people are sending back mixed messages. In community forums around the state ahead of a special legislative session on gun violence set for July 9, some of the public response has been predictable. Legions of gun advocates - many of them white men wearing orange “Guns Save Lives” stickers - have angrily invoked the Second Amendment while tearful parents have demanded laws to protect their children. (Schneider, 6/26)

Lyft is now a covered option for some Medicaid beneficiaries in Arizona, the on-demand transportation company said Wednesday. That means eligible Medicaid beneficiaries in the state will be able to use ride-sharing services from Lyft to travel to and from medical appointments. Lyft's new Medicaid provider status in Arizona is the result of a policy change the state's Medicaid agency finalized in May. (Cohen, 6/26)

Stem cell scientists at three California universities will receive an infusion of cash as the state’s publicly funded research program gets ready to dole out the last of its grant money. The Broad Foundation announced Wednesday it would give a total of $30 million to UCLA, USC and UC San Francisco. The funds will support research programs aimed at finding treatments for developmental disorders that affect patients even before they are born and age-related diseases that arise late in life. Some of the money will also be used to recruit and train scientists in the field. (Kaplan, 6/26)

California lawmakers agreed this month to hand over $650 million to big cities, counties and regional agencies to help fight homelessness. Now some Los Angeles officials say they want more. Much more.At a news conference Wednesday, City Councilman Mitch O’Farrell urged the state to match the $1.2-billion bond measure that L.A. voters approved in 2016 to build homeless housing, contending that the additional money could be pulled from the state’s reserves. (Reyes and Oreskes, 6/26)

Even as the city and county of Sacramento pour millions of dollars into ending homelessness, a count this year found 1,905 more people living on the streets, in cars or in shelter beds since 2017, raising the estimated number of homeless people countywide to 5,570. The federally mandated count, conducted every two years and released Wednesday by homeless nonprofit Sacramento Steps Forward, is the highest ever recorded number of people living without permanent housing in Sacramento County. (Yoon-Hendricks and Clift, 6/26)

The owner of Hahnemann University Hospital in Philadelphia announced its closure in September because of what the company called "continuing, unsustainable financial losses." Philadelphia Academic Health System, a subsidiary of American Academic Health System, said Wednesday that Hahnemann will immediately begin an "orderly wind down of its inpatient and outpatient treatment services" at the 496-bed Level 1 trauma center that has about 2,500 employees. (6/26)

Piedmont Healthcare is taking a bold approach in its fight against bad debt: The not-for-profit health system now requires patients who'll be on the hook for the entirety of their bill to pay one-quarter of it before they can receive non-emergent services. Atlanta-based Piedmont launched the advance payment policy this month. It requires uninsured, self-pay patients and those with high-deductible commercial policies to pay 25% of their bill before they can receive services. (Bannow, 6/26)

Companies have embraced health surveys, biometric screenings and other wellness offerings, as a way to keep employees healthy and lower their overall medical costs. But studies are finding that most traditional workplace wellness programs do not work, and large employers aren’t reporting a reduction in their health-related spending, which is now at a record high.One of California’s largest health insurers has had enough. (Farr, 6/25)

The Navajo Nation has opened a cancer treatment center on the reservation that it says will significantly cut down on travel time for patients. The Tuba City Regional Health Care Corp. in northeastern Arizona recently welcomed its first patient. It is funding the new center with hospital profits, grants and donations. (6/27)

The state's individual health insurance market got even smaller last year, according to a new state report, but the annual rate of decline slowed significantly. The figures are another hint of relative stability in a market that has undergone big changes with the federal Affordable Care Act (ACA), including a period of premium spikes and plummeting enrollment followed by rate declines the past two years. (Snowbeck, 6/26)

Tens of thousands of Californians have come off the Social Security disability payroll and gone back to work, part of a national trend that reflects a surging U.S. economy, a shift toward less conventional work and tighter supervision of what qualifies a worker for disability benefits. The number of adults in California collecting Social Security disability benefits fell by nearly 50,000, or 7%, from 2013 to 2017, with the biggest decline coming between 2016 and 2017, according to the latest federal statistics. The drop follows years of steep increases nationally and statewide as workers left the labor market amid a brutal recession and started drawing disability benefits. (Reese, 6/26)

In another example of a health insurer moving into the primary-care provider space, Blue Cross and Blue Shield of Minnesota and Minneapolis-based health system North Memorial Health will jointly own 20 outpatient clinics throughout the Twin Cities. The value of the deal has not been disclosed. Under the joint venture that kicks off in January, North Memorial Health will own a 51% stake in its existing clinics that will operate under the health system's brand. The Blues will own a 49% stake. (Johnson, 6/26)

Paid home care can significantly improve the lives of older adults with disabilities and their families, but recipients often incur substantial out-of-pocket spending. We simulated the financial burden of paid home care for a nationally representative sample of non-Medicaid community-dwelling adults ages sixty-five and older. (Johnson and Wang, 6/3)

With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. (Foster, Agrawal and Davis, 6/3)

In this case-control study, prior opioid dispensing to family members was associated with 2.89-fold higher odds of individual overdose, which persisted in young children and increased with greater quantities of opioid medications dispensed to family members. (Khan et al, 6/24)

Although potentially dangerous, little is known about outpatient opioid exposure (OE) in children and youth with special health care needs (CYSHCN). We assessed the prevalence and types of OE and the diagnoses and health care encounters proximal to OE in CYSHCN. (Feinstein, 6/3)

Since the passage of the Affordable Care Act (ACA) in 2010, many studies have used national Medicare data to examine associations between national hospital pay-for-performance programs and quality and costs of care. In January 2011, as the ACA was being implemented, the Centers for Medicare & Medicaid Services increased the number of available diagnosis billing codes from a maximum of 9 diagnosis codes (the primary diagnosis plus 8 comorbidities; a tenth code was reserved for coding external causes of injury and usually left blank) to 25 diagnosis codes (the primary diagnosis plus 24 comorbidities). (Tsugawa et al, 6/26)

“America will never be a socialist country,” President Trump said as he launched his bid for re-election last week.That declaration was an effort to frighten Americans and undermine growing support for expanding Medicare and Social Security—two popular programs that have long been derided as “socialist.” Mr. Trump’s declaration hypocritically ignores that he and his Republican colleagues are the nation’s leading purveyors of an insidious form of corporate socialism, which uses government power and taxpayer resources to enrich Mr. Trump and his billionaire friends. (Sen. Bernie Sanders, 6/26)

Elizabeth Warren came into Wednesday night’s debate as the candidate to watch most closely, the only one of the 10 onstage who had double-digit support in polls, with an apparent momentum that none of those rivals could claim. Her performance over two hours in Miami probably strengthened that position. During the first hour, Warren was crisper than most of her peers. She was clearer. I didn’t always like what she said — or how she said it. But she said it well, leaving no doubt about the direction in which she’d pull the country and giving voters a fair amount of detail, within the crushing constraints of time, about the map that she’d use to travel there. (Frank Bruni, 6/27)

On a range of issues, including immigration, climate change, health care, the economy and more, the Democratic candidates were unabashed in their enthusiasm for more government activism, signaling not only differences with President Trump but also with a more cautious approach by Democratic politicians of the past two decades. Whether the Democrats put their best face forward was another question, however. The debate was often marred by squabbling, interruptions, and candidates talking over one another and ignoring time limits. The often fractious tone highlighted the stakes for many of those on the stage who have struggled for attention during the first months of the campaign. (Dan Balz, 6/27)

A moderator joked that Warren has “a plan” for just about everything. That’s good. And viewers heard many of them but they already knew of her liberal-minded campaign promises: Medicare for all, breaking up giant tech companies, addressing climate change. They already know she is a bit of a Bernie Sanders. We know what she stands for. Warren didn’t move the needle much, but no one else did either Wednesday night. (6/26)

The United States needs an immigration policy that combines border security, justice and humanity. No one with a conscience can look at the photo of an asylum seeker and his 23-month-old daughter lying dead on the bank of the Rio Grande and accept the status quo. That single tragedy, reminiscent of the photo of a drowned Syrian boy washed up on a Turkish beach in 2015, has the power to clarify a vast, long-running problem that has already claimed many lives. What it should also do is prompt urgent action from the country’s elected representatives to compromise over their many differences and resolve a stalemate that is no longer tolerable. (6/24)

If you had the power to eliminate several common cancers and prevent your children from developing them, you’d use it, wouldn’t you? We have that power today for cancers caused by the human papillomavirus (HPV), but we aren’t fully using our available resources, including vaccination for primary prevention and screening and treatment for precancerous changes in the cervix. HPV causes six different kinds of cancer: cervical, oropharyngeal (throat), anal, penile, vaginal, and vulvar cancers. Shockingly, most of them are on the rise in the United States. Our best prevention tool — the HPV vaccine — hasn’t been fully utilized. (Anna R. Giuliano and Gilbert S. Omenn, 6/27)

In recent years, one promising Alzheimer’s drug after another has failed to produce results in clinical trials. At the same time, the growing number of older adults with cognitive problems is reaching a crisis point. In 2018, there were 5.7 million people in the United States living with Alzheimer's disease. That number is projected to grow to 13.8 million by 2050, threatening to overwhelm the U.S. healthcare system. (Gary Rosenberg, 6/26)

Reporters and editors at mainstream media outlets should be on their best behavior these days, after years of accusations of “fake news.” But there’s a type of misleading reporting that many are finding hard to avoid: the creation of phony health scares, usually mixed up with manners and morals. Last week, the Washington Post fell into the trap with a claim that looking down at smartphones was causing young people’s skulls to sprout “horns.” Other news outlets followed. (Faye Flam, 2/26)

A recent study in the New England Journal of Medicine found “vaping” to be twice as effective as Food and Drug Administration-approved nicotine replacements (patches, gum, lozenges) in helping smokers quit cigarettes. Even more absurd is the fact that regular, combustible cigarettes remain untouched on the shelves of convenience stores. "We’re basically saying that we only care about the risks of kids vaping, but we don’t care about whether they smoke or not," Michael Siegel, a professor at Boston University who studies tobacco regulation, told Wired magazine. This is harm maximization: Banning sale of e-cigarettes virtually guarantees that many vapers will go back to their Marlboros. It also puts teen vapers — the very impetus for the ban — at increased risk for smoking. (Sally Satel and Erica Sandberg, 6/26)