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The Obama administration is seeking to limit short-term health policies that include features largely banned under the Affordable Care Act, a proposal that could crimp a profitable and growing business for some insurers. Under a proposed rule released Wednesday, insurers would only be able to offer short-term health policies that last less than three months, and the coverage couldn’t be renewed at the end of that period. The proposal seeks to close a gap that has let healthier consumers purchase short-term plans that could last for nearly a year, sometimes using them as a cheaper substitute for ACA plans. (Wilde Mathews, Radnofsky and Armour, 6/8)

The Department of Health and Human Services (HHS) on Wednesday announced a range of steps aimed at improving the health of the ObamaCare marketplaces. The moves are aimed at improving the mix of healthy and sick enrollees, known as the “risk pool.” (Sullivan, 6/8)

The department also announced it will propose a separate rule later this year that would include an adjustment factor for partial-year enrollees as part of the risk adjustment model beginning next January. A third proposed rule the department says is coming this year would include prescription drug utilization data into the risk adjustment model starting during the 2018 benefit year. Such proposed rules would ensure consumers are using temporary insurance plans for when they are intended, typically when someone is in the middle of a transition in their life that would affect their existing coverage, HHS said in a release explaining the rules. (McIntire, 6/8)

The plans, designed for people in between jobs or in need of temporary insurance until they secure a regular policy, are cheaper than regular insurance plans. But they also can lack features that the health law requires for other policies, such as coverage for preexisting medical conditions, maternity care and prescription drugs. In addition, insurers are allowed to refuse to sell short-term plans to people they think will run up large medical costs, and insurers can also cap the maximum amount they will pay. Both practices are banned for regular policies under the health law. (Rau, 6/9)

HHS plans to limit the use of short-term health plans and tweak the Affordable Care Act's risk-adjustment program for health plans to account for people who need coverage for only part of the year. The program will also now track prescription drug usage as a factor in assessing risk. (Dickson, 6/8)

A new study by the Federal Reserve Bank of New York released this week confirms that the expanded Medicaid plan has indeed eased the financial anxiety of millions of poor people, primarily by reducing the size of debts sent to collection agencies. (Pianin, 6/8)

Louisiana's largest health insurer is among a group asking for double-digit rate hikes on individual policies, the latest sign the Affordable Care Act is not preventing jumps in health care prices as hoped. The proposed rate hikes affect many of the more than 214,000 Louisiana residents who got coverage through federal insurance marketplaces this year. (Larino, 6/7)

Wellmark Blue Cross and Blue Shield, which dominates Iowa’s health insurance market, plans to raise premiums by about 6 percent next year for 88,800 Iowa customers who bought individual policies before 2014. That proposed increase, filed with state regulators Wednesday, is much less than the 38 percent to 43 percent increases Wellmark proposed last month for 30,000 Iowa customers who bought newer health insurance policies. (Leys, 6/8)

With public health officials warning of a fast-spreading emergency, House and Senate negotiators will work to reconcile legislation aimed at providing up to $1.1 billion to combat the Zika virus and the mosquitoes that carry it, Senator Mitch McConnell said on Wednesday. The Senate last month approved $1.1 billion — far less than the $1.9 billion sought by the Obama administration — in a regular appropriations measure, after four months of sparring with the White House. The House, in turn, approved $622 million in a stand-alone measure that requires all of the money to be reallocated from existing programs, including efforts to fight Ebola. (Herszenhorn, 6/8)

The Senate voted Wednesday to move ahead with negotiations with the House on a measure to fund the government’s fight against the Zika virus. The 93-2 vote paves the way for potentially tricky talks over how much money to provide to battle Zika and whether to pay for it with cuts elsewhere in the budget as demanded by House GOP conservatives. The virus can cause grave birth defects and can be spread by mosquitoes native to large swathes of the country. (Taylor, 6/8)

Informal discussions between House and Senate leaders and appropriators have been ongoing for weeks, but it remains unclear how the chambers will bridge major differences in their Zika legislation. ... “This is the fight of the month,” said Sen. Amy Klobuchar, D-Minn. “It sure better get done in this work period. What, are they going to go home for six weeks and not have any funding done for Zika as we go into these summer months? That would be atrocious.” Congress is scheduled to leave town July 15 and return Sept. 6, a break of more than seven weeks. (McCrimmon, 6/8)

It has been months since President Obama requested $1.9 billion to fight Zika, and lawmakers are still hashing out how — and how much — to tackle the issue. "We need to act yesterday," [Sen. Patty] Murray said. (Carney, 6/8)

Rep. Hal Rogers, chairman of the House Appropriations Committee who was appointed as a Zika conferee, said the conference committee would start work right away. “The Senate is going to appoint conferees, I think today,” the Kentucky Republican said Wednesday before the Senate vote. “So we will immediately begin work. Our staffs have been discussing generally the matter, so we’re going to try to move it ASAP.” (McIntire, 6/8)

The Zika virus is creeping north toward the continental U.S., and Alberto de la Vega has started to detect its signs. In ultrasounds he gives pregnant women who are infected with the virus in this American territory, he has seen a 22-week-old fetus with serious brain damage and two others with stunted growth. He is bracing for more. ... Zika has blanketed three-quarters of this lush island over the past six months, say health authorities, who expect it to keep spreading now that it is prime mosquito season. More than 1,350 people have tested positive for Zika since the beginning of the epidemic here, including 168 pregnant women. One patient died. (McKay, 6/8)

Zika virus is poised to spread across the U.S. Gulf Coast states this summer, and the human and financial toll could be on the scale of a massive disaster, warns a top public health expert. Peter Hotez, the dean of the National School of Tropical Medicine at Baylor, told POLITICO's "Pulse Check" podcast that the aedes aegypti mosquito could already be spreading Zika virus across the southern United States, but local officials don't have the resources to conduct adequate surveillance because of the monthslong battle over Zika funding in Washington. (Diamond, 6/9)

About 40 men and women attended Zika and Pregnancy: What You Need to Know at the Baptist Health Resource Center to ask questions and listen to presentations from Dr. Michael Jacobs, a reproductive endocrinologist, and Barbara Russell, director of infection control at the hospital. ... Miami-Dade County has the most Zika cases in the state, with 51 cases as of Wednesday. (Cochrane, 6/8)

There’s a fight going on in science right now. Scientists can’t agree on whether the Olympics in Brazil should be canceled. The reason for the argument is Zika – a tiny virus spread by a tiny mosquito. (Yasmin, 8/8)

Professors from the University of Florida have developed a mosquito trap that they say could help prevent the spread of Zika virus. Professor Phil Koehler says the trap is proven to catch and kill mosquitos but the public might not be able use it this summer because it’s awaiting federal approval. (O'Brien, 6/8)

A powerful new technology holds the promise of rapidly altering genes to make malaria-proof mosquitoes, eliminate their Zika-carrying cousins or wipe out an invasive species, but a report Wednesday says these “gene drives” aren’t ready to let loose in the wild just yet. Advisers to the government say lots more research is needed to learn to safely use gene drives and understand the ecological and social consequences of essentially hijacking evolution, spreading genetic changes through populations of insects, animals or certain plants faster than nature. (Neergaard, 6/8)

Doctors would be required to report potentially serious problems with medical devices they use to the U.S. Food and Drug Administration, under a new bill that a pair of lawmakers is expected to introduce in Congress Wednesday. The proposed legislation, known as the “Medical Device Guardian’s Act," is intended to help raise awareness of the possible risks of medical devices that could cause harm to patients. Sponsors of the bill said they were motivated to change the law after the long delay in public awareness of the risks of a women’s surgical tool called the laparoscopic power morcellator. (Levitz, 6/8)

The medical procedure was supposed to help Amy Reed. Instead, it spread cancer through the Bucks County woman's body, and helped spark a national fight that arrived at the Capitol on Wednesday. With Reed and her family looking on, two lawmakers rolled out bills to increase oversight of medical devices like the one that harmed her. (Tamari, 6/9)

Reps. Mike Fitzpatrick (R-Pa.) and Louise Slaughter (D-N.Y.) on Wednesday introduced a pair of bills designed to crack down on the medical device review and approval process. It is not clear whether they will see any action in committee this year. (Owens, 6/8)

Envision Healthcare Holdings Inc. is in talks to merge with AmSurg Corp., a deal that would bring together two big providers of physician and other health-care services with a combined value of more than $9 billion. The companies are in advanced discussions, and a deal could be announced as early as next week, according to people familiar with the matter. It isn’t clear how the deal would be structured and, as always, it is possible the talks could break down before one is reached. (Mattioli and Cimilluca, 6/8)

Nashville-based AmSurg made about $1 billion of acquisitions last year, mostly buying practices of physicians who serve in hospitals in anesthesia, emergency medicine, radiology and neonatology. ... AmsSurg was largely an owner and operator of ambulatory surgery centers until it bought physician staffing giant Sheridan Healthcare in 2014 for more than $2 billion. Greenwood, Colo.-based Envision is a big player in physician staffing as well as ambulance services. (Barkholz, 6/8)

The merger would increase operating efficiency and profit margins for the two companies, the sources said, at a time when consolidation among health insurance companies and hospitals is placing downward pressure on costs throughout the healthcare sector. (O'Donnell and Roumelioti, 6/8)

Less than a month after getting legislative approval to investigate the marketing habits of drug companies, the state attorney general’s office has narrowed its probe to just one, Purdue Pharma, accusing the enterprise of distributing “misleading information” to doctors about its painkiller OxyContin. In a lawsuit filed Friday in Merrimack County Superior Court, the office said preliminary findings suggest that Purdue routinely engages in deceptive marketing, misrepresenting the “risks and benefits of long-term opioid use for chronic pain.” (Blackman, 6/9)

Executive Councilor and Republican candidate for governor Chris Sununu came under fire Wednesday for statements he made about the state and local responses to New Hampshire’s heroin and opioid crisis. After filing to run for governor Wednesday morning, Sununu told reporters he thinks the state needs more money and better leadership to deal with the drug epidemic. (Nilsen, 6/9)

A U.S. advisory panel on Wednesday recommended approval of Pfizer Inc's long-acting opioid painkiller Troxyca ER, saying it dulls pain and its design could deter abuse by addicts in search of a quick high. (Clarke, 6/8)

In response to a spiraling overdose crisis, Ohio health regulators enacted urgent reforms in 2012 to limit the amount of opioids prescribed to patients, cutting the number of doses by 11.5 percent over the next three years. But the quick results collided with a cold reality: Overdose deaths in the state skyrocketed during that same period. (Ross, 6/8)

When DeAndre Levy suffered a hip injury last August that eventually required season-ending surgery, the deep-thinking Detroit Lions linebacker made a conscious decision to rehab himself back to good health without the use of opioid pain-killing pills that are commonly prescribed in the NFL. Levy, like most players, had used such pills at the recommendation of team doctors in the past. (Birkett, 8/8)

The drug that killed Prince has become a favorite of Mexican cartels because it is extremely potent, popular in the United States — and immensely profitable, American officials say. Law enforcement and border authorities in the United States warn that Mexican cartels are using their own labs to produce the drug, fentanyl, as well as receiving shipments from China. Then the cartels distribute the substance through their vast smuggling networks to meet rising American demand for opiates and pharmaceuticals. (Ahmed, 6/9)

Scientists say most antidepressants don't work for children or teenagers with major depression, some may be unsafe, and the quality of evidence about these drugs is so bad the researchers cannot be sure if any are truly effective or safe. In the biggest analysis yet conducted of previously published studies, researchers studied 14 antidepressants and found only one drug that seemed to be useful. (Cheng, 6/9)

The vast majority of antidepressants given to kids and teens are ineffective and potentially dangerous, according to a new study in The Lancet. Of 14 regularly prescribed drugs, only one — Prozac — proved effective enough to justify giving to children and teens, the researchers found. (Weintraub, 6/8)

Most antidepressants on the market are ineffective for children and teens with major depressive disorder, and some may be unsafe for young patients, according to new research published in The Lancet. The findings show that out of 14 antidepressants, only fluoxetine (sold under brand names Prozac and Sarafem) was more effective at relieving symptoms of depression in young people than a placebo pill. In contrast, taking venlafaxine (Effexor) was associated with an increased risk of suicidal thoughts and suicide attempts when compared to a placebo and five other antidepressants. (Welch, 6/9)

For many people a simple blood test is hardly a routine medical event if it involves a big needle. Some adults are squeamish to the point where they avoid giving a blood sample, while young children are often gripped by paroxysms of fear and crying. Now a startup in Medford, Seventh Sense Biosystems, has developed a device the size of a walnut that it says will take the fear, pain, and inconvenience out of drawing blood. Attached to the patient’s arm with an adhesive strip, the device uses an array of tiny needles each about the size of an eyelash to quickly take a blood sample and leave almost no trace. (Christian, 6/8)

One of the most severe form of multiple sclerosis (MS) is sometimes caused by the malfunction of a single gene, NR1H3, a group of researchers from the University of British Columbia reports in the journal Neuron. Some 60-70% of people with a certain type of mutation in this gene will end up with primary-progressive MS (PPMS), a particularly nasty form of the disease. (Starr, 6/8)

A powerful new technique for changing genes in insects, animals and plants holds great promise, according to a report from an influential panel of scientists released Wednesday. But the group also says it's potentially very dangerous. (Stein, 6/8)

Sleep deprivation and an abnormal sleep cycle may increase the risk of heart disease, especially for shift workers, a small study suggests. ... The study results suggest that shift workers "who are chronically exposed to circadian misalignment, might not fully benefit from the restorative cardiovascular effects of nighttime sleep following a shift-work rotation," [study lead author Dr. Daniela Grimaldi] added. (6/8)

Notices that some visits with inmates had been canceled were taped to the front doors of the Federal Detention Center, which holds about 900 inmates and is located a few blocks from Minute Maid Park. ... A more detailed posting on a wall inside the lobby advised visitors that the chickenpox, formally known as varicella zoster virus., posed a "slight risk" of exposure to them. (Schiller, 6/8)

State education and health officials announced Wednesday that the state plans to recommend that all public schools and day care centers test their water for lead this summer. State officials also said the Oregon Health Authority will collect and make public the results of all tests to make it easy for the public too see whether lead is present, and at what levels, in schools and child care centers. (Hammond, 6/8)

Portland Public Schools' senior manager for environmental health and safety, Andy Fridley, resisted testing school water quality and spread false information about the safety of drinking water in schools, email records show. Fridley was the point person charged with protecting students and employees in Oregon's largest school district from environmental hazards for two years. (Hammond, 6/8)

High levels of lead have been found in water at an additional 11 Chicago elementary schools, with results from tests at scores of other buildings yet to come in, Chicago Public Schools said Wednesday. The district expanded lead testing to all of its 600-plus schools after a pilot effort begun in April found that multiple fountains at Tanner Elementary on the South Side spouted water that contained lead levels well above federal standards. (Perez Jr., 6/8)

State environmental regulators announced Wednesday that they will monitor air in Northeast Portland's Cully neighborhood after an analysis of U.S. Forest Service data indicated the area could have high levels of toxic metals in the air. The monitoring should establish if the public is at risk, state officials said. (Zarkhin, 8/8)

As debate swirls around who can use what restroom, the Department of Veterans Affairs is moving to change regulations so VA hospitals can provide gender confirming, or gender reassignment, surgery. ... The Williams Institute, a University of California at Los Angeles think tank on sexual orientation and identity, estimates there are about 134,000 transgender veterans or retirees from the National Guard or the Reserves. There is no estimate on the number that might seek the surgery at the VA. (Davidson, 6/8)

"Somehow I realized he's asking for help," [Kit] Parker says. "It's not being verbalized, but that's why he's calling." Parker would spend the next decade answering that call. He would reset the trajectory of his career. And ultimately, he would make a discovery that changed scientists' understanding of the battlefield brain injuries sustained by hundreds of thousands of troops in Iraq and Afghanistan. (Hamilton, 6/8)

Women who want an abortion in deeply conservative Texas have slightly more choice these days than they had a few months ago. In March, the Food and Drug Administration simplified rules on abortion medication, allowing patients to take the standard regimen of abortion drugs later in a pregnancy. However, the recent spike in the number of women choosing legal, non-surgical abortions in U.S. clinics has not slowed brisk sales of abortion drugs south of the border, in Mexican pharmacies. (Burnett, 6/8)

When Texas abruptly ended its $600,000 HIV prevention contract with Planned Parenthood’s Houston affiliate in late December, state health officials promised that there would be no interruption in services. The Department of State Health Services parceled the money out to three county health departments in the Houston area and insisted at the time that the counties would have the capacity to pick up where Planned Parenthood left off. But the Observer has learned that as of early June, Harris County’s health department has yet to perform a single HIV test with the money. (Garcia-Ditta, 6/8)

This month, the U.S. Supreme Court is expected to rule in the first landmark abortion case in decades, Whole Woman’s Health vs. Hellerstedt. The ruling could have an immediate effect not only in Texas, but in more than half a dozen other states that have recently passed laws restricting access to abortion clinics. (Hennessy-Fiske, 6/9)

California on Thursday becomes the latest state to allow the terminally ill to legally choose to end their lives, raising worries among some people in the state's large Latino and African-American communities that poor people with serious illnesses could be pressured to take lethal drugs as a cheaper option to long-term care. (Watson, 6/8)

Oregon was the first state to allow patients with terminal illnesses to request medications that would end their lives. Though other states have since adopted similar laws, Oregon remains the best guide for what to expect in California when physician-assisted death becomes legal in the state Thursday. Here are some statistics about who has taken advantage of Oregon’s aid-in-dying law since it took effect in 1998. (Karlamangla, 6/9)

Eight months after it was signed into law by Gov. Jerry Brown, California's controversial End of Life Option Act goes into effect Thursday. The law allows mentally capable adults, diagnosed with six months or less to live, to ask doctors for prescriptions to end their lives when they choose. (Seipel, 6/8)

About 5,000 nurses at five Twin Cities hospitals plan to go on strike for a week this month. The nurses voted Monday to reject a contract offer from Allina Health, and Wednesday they followed up by notifying the health care system that they intend to conduct an “unfair labor practice strike” the week of June 19-26. (Delage, 6/8)

Nurses at five Allina Health hospitals plan to conduct a one-week strike, starting June 19 at 7 a.m., amid a contract dispute over health benefits, the Minnesota Nurses Association announced Wednesday evening. The targeted facilities are Abbott Northwestern Hospital and Phillips Eye Institute in Minneapolis, United Hospital in St. Paul, Mercy Hospital in Coon Rapids and Unity Hospital in Fridley. (Olson, 6/8)

The Minnesota Nurses Association said Wednesday it has told Allina Health executives it plans to strike for seven days starting at 7 a.m. Sunday, June 19. The nurses union says the strike involves around 5,000 nurses at Abbott Northwestern, United, Mercy, Unity and Phillips Eye Institute. (Zdechlik, 6/8)

Union leaders representing about 5,000 nurses in the Twin Cities say nurses at five hospitals plan to go on a one-week strike after rejecting the latest contract offer from Allina Health. (6/9)

Ohio Gov. John Kasich signed a medical marijuana legalization bill into law on Wednesday, the Cincinnati Enquirer reported. The former Republican presidential candidate's penmanship makes Ohio the 26th state in the nation to legalize marijuana use for medical purposes. Kasich has said he would like children with certain medical conditions to be able to relieve their pain through cannabis use. (Gurciullo, 6/8)

Republican Gov. John Kasich signed a bill Wednesday legalizing medical marijuana in Ohio, though patients shouldn't expect to get it from dispensaries here anytime soon. The bill lays out a number of steps that must happen first to set up the state's medical marijuana program, which is expected to be fully operational in about two years. (Sanner, 6/9)

A bill authorizing physicians to prescribe marijuana derivatives to treat a host of health conditions was signed into law this afternoon by Ohio Gov. John Kasich. (Ludlow, 6/8)

Republican Ohio Governor John Kasich on Wednesday signed a bill legalizing marijuana use for medical purposes under certain circumstances, his office said. Over the last few years, state legislatures and voters in the United States have been much more receptive to making marijuana legal for medical purposes, and to a lesser extent, recreational use. (6/8)

A New York doctor is headed to prison for his role in a long-running bribes-for-test referrals scheme involving a New Jersey lab company. Federal prosecutors in New Jersey say Bret Ostrager received a 37-month sentence Wednesday. He also must forfeit $101,271. The 51-year-old Woodbury, New York resident had medical practices in Nassau County. He pleaded guilty last December to three counts in an indictment charging him with conspiracy and other counts. (6/8)

A Maryland physician who fled to Panama amid allegations he overprescribed addictive painkillers pleaded guilty Wednesday to a federal charge of health care fraud. Nicola Tauraso, 81, entered the plea in U.S. District Court in Baltimore. He faces up to 10 years in prison at his sentencing Aug. 8. Prosecutors agreed to dismiss 23 other counts, including narcotics conspiracy, in the plea deal. (6/8)

Two former employees are suing CareFlite, a nonprofit air and ground medical service provider, accusing the company of health care fraud for charging the government for services that were “not medically necessary.” (Krause, 6/8)

Missouri Gov. Jay Nixon signed two bills Wednesday aimed at expanding access to cheaper types of certain medicines and ensuring patients can take whatever drug works best for them, no matter the cost. The first bill would allow pharmacists to fill prescriptions for generic biotech drugs, which are similar but not exact copies of biologic medicines produced in living cells. The second bill includes new rules for step therapy. (Ballentine, 6/8)

The number of Arkansans approved for coverage under the state's expanded Medicaid program increased by almost 25,000 from February through April, reaching more than 290,000, the director of the state Department of Human Services told legislators Wednesday. Director Cindy Gillespie also told members of the Health Reform Legislative Task Force that she plans to seek legislative approval to hire a "surge" of about 250 temporary caseworkers to help clear a backlog of work related to 100,000 Medicaid cases, including more than 34,000 applications for coverage that have been pending for more than 45 days. (Davis, 6/9)

Nonprofits that care for thousands of developmentally disabled New Yorkers say their chronic understaffing is reaching a crisis, with nearly 10 percent job vacancies last year. They say they can't fill the jobs because of the low pay for challenging work. A survey of 136 caretaker organizations also shows 23 percent staff turnover last year, another factor forcing other employees to work 6.4 million hours of overtime. (6/8)

The proposal by Rep. Rob Shadoin, R-Ruston, would have raised $117 million to fill gaps in next year's budget by cutting breaks for taxpayers who itemize deductions on their income tax returns. Shadoin said 74 percent of individual taxpayers don't itemize for things like home mortgage interest payments, charitable contributions and medical costs. The change would return Louisiana to where the tax break was in 2007, from allowing 100 percent of those excess itemized deductions to 57.5 percent. Supporters said state government needs the money to keep health, education and other programs from facing steep cuts in the financial year that begins July 1, when Louisiana faces a $600 million shortfall. (DeSlatte, 6/8)

A federal judge has put San Francisco’s planned health warnings for soda and other sugar-added drinks on hold, granting the beverage industry an injunction pending appeal. The law was slated to go into effect July 25 and would require that billboards and other public advertisements include the language: “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” (Esterl, 6/8)

Philadelphia could soon become the first major U.S. city with a sugary drinks tax after a city council committee voted Wednesday to approve an amended version of a soda tax proposal that would set a 1.5 cent-per-ounce tax on sugary and diet drinks. (Whack, 6/8)

City Council gave its initial stamp of approval to a 1.5-cent-per-ounce tax on sweetened drinks and diet beverages Wednesday night, paving the way for Philadelphia to become the first big city in the country to impose a soda tax. ... If the tax gets final approval by the full Council next week, as anticipated, it could have nationwide reverberations - or at least give legislators in other cities another reason for considering it. (Nadolny and Terruso, 6/9)

California lawmakers are lining up in support of a bill that would require health plans to provide information about patient-assistance programs for expensive prescription drugs to enrollees who drop or lose their coverage. The programs are funded by pharmaceutical companies and offer people financial aid for brand-name drugs. They provide the aid to both the uninsured and to people with health coverage, particularly those who are struggling to afford their share of expensive specialty medications. (Feder Ostrov and Terhune, 6/9)

Dozens of mentally ill men and women who have been charged with crimes are languishing in jails across Maryland despite court orders to send them to state hospitals for evaluation and treatment. The state Department of Health and Mental Hygiene, which spurned a consultant's warning four years ago, does not have enough beds or staff to treat new patients, officials say. (Dresser, 6/8)

The Wisconsin Department of Health Services reported two new cases of Elizabethkingia infection on Wednesday. One of the confirmed cases was previously reported as under investigation last week. The other case is new. (Lyon, 6/8)

Fleas from an chipmunk found in the South Lake Tahoe area have tested positive for plague, according to El Dorado County public health officials. The flea sample was from one of three rodents trapped in the Fallen Leaf Campground area during routine plague surveillance May 18, according to a county Public Health Division news release. State test results confirming plague were received June 2. (Locke, 6/8)

Medtronic PLC plans to jump into the market for dependable, lower-priced knee and hip implants next year, after acquiring a Twin Cities start-up company that specializes in selling devices to hospitals in government cost-cutting programs. (Carlson, 6/8)

A state appeals court has rescheduled arguments for June 21 in a dispute about Medicaid payments to hospitals that provide emergency care to undocumented immigrants. A three-judge panel of the 1st District Court of Appeal had been slated to hear arguments Tuesday but approved a two-week delay, according to an online docket. (6/8)

Starting this year Vanderbilt University’s student insurance plan will cover transgender-related surgeries, a move school officials say will make the campus a more inclusive environment for students who previously had gone without necessary care. The change was part of a routine annual review of the university’s health care plan for students. (Tamburin, 6/8)

Gov. John Bel Edwards has agreed to let patients have direct access to physical therapists without needing a doctor's referral. The governor's office said Tuesday that Edwards had signed the bill that does away with a current requirement that patients obtain a referral from a licensed doctor to see a physical therapist. The change, sponsored by Republican Sen. Fred Mills, takes effect immediately.

Andrew Rodriguez was 15 years old when he smoked his first cigarette. He knows how addictive smoking can be and hopes a new California law raising the smoking age will discourage young people from taking up the habit. “I think it’s better,” said the 21-year-old chef-in-training from Los Angeles. “I just hope they don’t raise the drinking age.” Beginning Thursday, smokers have to be at least 21 to buy tobacco products in California. (Chang, 6/8)

David Willett lived in a tent and struggled with drug addiction before coming to Gregory House, a Honolulu shelter that has provided temporary housing for people with HIV and AIDS for more than a decade. But the shelter is among many that face steep federal funding cuts this year, and Willett and other residents worry about its future. The program's daily meetings and supportive atmosphere has helped Willett stay away from drugs for the last two years. (Bussewitz, 6/8)

You don’t expect to go into the hospital and come out sicker than before. But it happens all too often. If the patient who previously used your room was infected with one of many antibiotic-resistant bacteria, those invisible germs could be left behind to transmit illness to you. A lot depends on housekeeping. (Garloch, 6/8)

Clot retrieval is used to treat what are known as ischemic strokes, meaning those caused by a blood clot lodged in a major vessel of the brain, like a boulder in a river, and robbing the brain of oxygen. That procedure, which takes about an hour, uses a catheter snaked through a major artery, usually starting at the thigh and then up into the brain to the clot. (Adler, 6/8)

The public doesn’t have a very high opinion of drug manufacturers for various reasons, and now federal Judge Beth Labson Freeman of San Jose has provided another one. Finding that Merck & Co. lied to a business partner and to the court itself, Freeman this week threw out a patent infringement judgment Merck had won against Gilead Sciences, and overturned a $200-million jury award in the case. This is a big deal, involving one of the most profitable drugs on the market today—Gilead’s blockbuster Sovaldi treatment for the hepatitis C virus—and the world’s fourth-largest drug company Merck. (Michael Hiltzik, 6/8)

Every day, when I am walking to work, or just walking through the streets of downtown Washington, I encounter homeless people on the street. The homeless cover many categories, but prominent among them are those with serious mental illnesses. They know no boundaries of race or education; there was a prominent story last year in the Washington Post of a homeless man with schizophrenia who told a judge that he didn’t need a lawyer, that he was a lawyer. When the judge reacted with bemused skepticism, the man informed the judge—accurately—that they had been in the same class at Harvard Law School. (Norm Ornstein, 6/8)

You’ve got mail. An alert pops up announcing a new message from the portal for my electronic medical record. Previous correspondence had been mundane, but this time I was surprised to receive the results of my recent colonoscopy. I am—or, until that moment, had considered myself to be—a healthy person, in surprisingly good condition considering my age and my distaste for exercise, so I was blindsided to receive the pathology report describing in cold clinical terms the abnormal histology of my tissue fragment. The biopsy results suggested an unexpected benign, but chronic, disease. My mind reeled, my self-image collapsed, and suddenly I was alone on a sea of alarm and confusion. Later that day, I was able to speak to my gastroenterologist on the telephone. I expressed to him my surprise at the findings and my dismay at the way I had received the results. I asked whether this had been sent to me by email because I am a physician and thus presumably more capable of understanding the information (which, it turns out, was a false assumption). “Not at all,” he replied. “It is mandatory that all patients receive biopsy results and lab values within 48 hours.” “Wait,” I replied. “Any abnormal biopsy or lab value? Directly to the patient? In an email?” This seemed implausible. (Ellen M. Friedman, 6/7)

When a friend recently finished her grueling year of breast cancer chemotherapy, she received warm congratulations from her health care team and was invited to ring a special bell set up in her doctor’s office. Another friend, cancer-free for a year, is rewarding herself by taking part in a bike ride fundraising for cancer research. Me? Now that I have been on maintenance chemo for two years, I am celebrating by getting a mammogram. (Marjorie Rosenthal, 6/8)

Whether you make hamburgers, process loans, or take care of patients, fatigue at work leads to errors and mishaps. Among physicians, fatigue can lead to medical errors that may cause great harm. Yet for more than 30 years, the medical profession has been debating limits on how many hours in a row physicians-in-training can work. (Tejal Gandhi and Patricia McGaffigan, 6/8)

More than 1,000 Kentuckians die each year from drug overdoses, more than 200 of them from heroin. Heroin use has surged over the past few years, contributing to drug overdoses becoming a more common cause of death than car accidents in Kentucky. This is a serious public health crisis — one that must be fought on many fronts at once. (Paul Kensicki, 6/8)

It was roughly halfway into a Saturday evening flight from Miami to Boston when I began to wonder if I was going to survive the night. What had started as a sharp pain on the right side of my abdomen now felt as if my gut were being hacked at with a phalanx of rusty chisels. The only explanation I could think of was that my appendix had burst and I was dying of sepsis. (Seth Mnookin, 6/9)

In this issue of JAMA, Flegal and colleagues1 and Ogden and colleagues2 report updated findings related to the prevalence of obesity in the United States. The news is neither good nor surprising. Using 2013-2014 data from 5455 adults who participated in the National Health and Nutrition Examination Survey (NHANES), 35.0% of men were obese (BMI ≥30) and 5.5% were morbidly obese (BMI≥40); among adult women, 40.4% were obese and 9.9% were morbidly obese. These prevalences are unchanged since 2005 among men and represent a slight increase in obesity among women. The data for children are similar. Based on 7017 youth 2 to 19 years old in 2011-2014, the prevalence of obesity was 17.0% and extreme obesity 5.8%. Obesity rates have decreased in children aged 2 to 5 years since 2003-2004, stabilized in 6- to 11-year-olds since 2007-2008, but steadily increased among adolescents since 1988. (Jody W. Zylke and Howard Bauchner, 6/7)

As the 1990s ended, syphilis was on the decline. At least in part due to safer sexual behaviors prompted by the AIDS epidemic,1 the rate of incident syphilis declined to fewer than 4 cases per 100 000 by the year 2000, a historic nadir. Eradication of Treponema pallidum infection in the United States seemed quite possible through concentrated public health efforts in a relatively small number of high-incidence US communities, and the Centers for Disease Control and Prevention (CDC) was developing a national syphilis elimination plan.2 Timing seemed auspicious for eradication efforts to be successful. Now, in 2016, hopes for eradication have long since faded, as have many of the gains realized by the effort. Rates of syphilis have trended steadily upward since 2000, and the CDC’s syphilis elimination efforts officially ended as of December 2013. (Meredith E. Clement and Charles B. Hicks, 6/7)

Growing up in small-town Iowa, I understand the issue of inadequate access to health care and the importance of providing adequate health care to local Iowans. That’s why I encourage Iowans to support the “Pharmacy and Medically Underserved Areas Enhancement Act” backed by Sen. Chuck Grassley and the entire Iowa delegation. (Taylor Monson, 8/8)

On May 10, 2016, Gov Larry Hogan of Maryland signed into law the Maryland Contraceptive Equity Act of 2016 (MCEA). In so doing, he reaffirmed and extended principles laid down in 1998 by his predecessor, Gov Parris Glendening, when Maryland, a trailblazer in women’s health care, became the first state in the nation to enact a contraceptive insurance mandate. (Eli Y. Adashi, 6/8)

What we call "Big Fat Industries" — fast food, soft drink and junk food makers — have been doing this for years. And they got this strategy from the Big Tobacco playbook. For more than a decade of experience and research in teen tobacco use reduction, followed by a decade working in childhood obesity prevention, I've researched how this all goes back to when Big Tobacco funded studies that claimed cigarettes do not cause lung cancer. (Dewey Caruthers, 6/7)

The battle to contain and ultimately defeat the Ebola epidemic of 2014–2015 has been vividly described.1-3 Caught off guard from the start and hindered by myriad coordination, communication, and other problems, a combination of local and international teams fought back with determination, courage, and eventually the deployment of substantial resources to stem the contagion and save lives. Yet more than 11,000 people died, and local economies were brought to a halt. The battle was won, but at immense cost. (Victor J. Dzau and Peter Sands, 6/8)