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Their health care overhaul imperiled from all sides, the White House and top House Republicans acknowledged Wednesday they would make changes to the legislation in hopes of nailing down votes and pushing the party's showpiece legislation through the chamber soon. House Speaker Paul Ryan, R-Wis., declined to commit to bringing the measure to the House floor next week, a fresh indication of uncertainty. (Fram and Alonso-Zaldivar, 3/15)

Speaking after a private meeting of GOP lawmakers, Ryan said that leaders would “incorporate feedback” from the rank-and-file in response to the CBO findings. He did not repeat his previous comments calling support for the bill a “binary choice” for Republican lawmakers. “Now that we have our score we can make some necessary improvements and refinements to the bill,” he said, referring to the CBO’s estimate of the effect on the number of those covered by health insurance and what the GOP proposal would cost. (DeBonis, 3/15)

[Ryan's] comments mark a change in tone from the Wisconsin Republican, who last week presented the bill in a PowerPoint presentation as a “binary choice” between repealing Obamacare and keeping it. He did not describe what types of changes were being considered. Vice President Mike Pence spent much of Wednesday afternoon meeting with House members, including the conservative Republican Study Committee and moderate Tuesday Group. Members said Pence indicated the administration was open to changes, but has not specifically backed certain policies. (McIntire, 3/15)

"This is the plan we ran on all of last year. This is the plan that we've been working — House, Senate, White House — together on," House Speaker Paul Ryan told FOX Business News. "Now as we get closer to finish, going through the committee process, you inevitably make those refinements and improvements as you go through that process. That's exactly where we are right now." (Davis, 3/15)

Meanwhile, members of the hard-right House Freedom Caucus declared that they believed they had enough commitments from their own allies to kill any attempt by Republican leaders to ram through the current bill without significant changes. They said that they intend to present to leadership an amendment on Friday that they say could unite conservatives and moderates. “It’s up for us, moderates and conservatives, to come together,” said Freedom Caucus Chairman Mark Meadows coming out of a Wednesday evening meeting. (Bade, Cheney and Haberkorn, 3/16)

In conversations with House leaders and administration officials, lawmakers focused on proposed changes to Medicaid, with conservative House Republicans pressing for work requirements and an earlier phaseout of the expansion started under the Affordable Care Act, known as Obamacare. Some Senate Republicans also sought to boost the value of tax credits to give more aid to low-income and older people who buy insurance. Others wanted to strike a provision that calls for insurers to charge higher premiums to consumers who let their coverage lapse, a measure intended to encourage people to buy insurance. (Armour, Peterson and Radnofsky, 3/16)

Moderate Republicans are rejecting changes to the health care bill that would more quickly end enrollment in Obamacare's Medicaid expansion program, calling the idea a "nonstarter." The two co-chairmen of the moderate Tuesday Group, Reps. Charlie Dent, R-Pa., and Tom MacArthur, R-N.J., both used that phrase when describing the suggested change. Conservatives, especially in the conservative Republican Study Committee, said earlier on Wednesday they wanted to freeze new enrollment in Medicaid expansion states by 2018, rather than by 2020 as the current package states. (Mershon, 3/15)

The conservative Republican Study Committee (RSC) says it is very close to supporting the House GOP's healthcare plan if changes are made to its Medicaid provisions. Vice President Pence met with members of the Republican Study Committee Wednesday and indicated that the White House is open to accepting some changes to the bill. The 172-member RSC wants to freeze the expansion of Medicaid earlier, in 2018, and put in place work requirements for able-bodied, childless adults. (Hellmann, Sullivan and Wong, 3/15)

A group of conservative House Republicans are pushing for an amendment to the Republican health care bill that would institute work or education requirements for Medicaid, hoping the change would get more conservatives on board and help the legislation move closer to becoming law. (McIntire, 3/15)

House Republican lawmakers from different factions of the caucus say they are open to adding Medicaid work requirements to their ObamaCare replacement bill, a measure that could help bring conservatives on board without alienating moderates. Medicaid work requirements were one of the main additions that the conservative Republican Study Committee asked for in a meeting with Vice President Mike Pence on Wednesday as leadership looks at changes to the bill to help win more votes. (Sullivan and Wong, 3/15)

Republican leaders in Congress may scrap a provision in the House GOP’s Obamacare replacement bill that would require insurers to charge a 30 percent penalty to customers who go without coverage for at least 63 days. ... John Cornyn, the No. 2 Republican senator, confirmed that scrapping the 30 percent surcharge is “being discussed,” but added, “I’m not aware of any decisions.” The Texan said the goal is to craft a bill that can pass the House and Senate. (Kapur and House, 3/15)

“They aren’t thinking only in terms of getting 218 votes in the House,” Grassley said of the officials who came attended the meeting. “How do you get 51 votes in the United States Senate? That’s what they’re looking at.” (Noble, 3/15)

McClatchy surveyed House Republicans and interpreted public statements to see where they stand. The result: Most still don’t support the GOP plan. We'll keep updating this chart. If just 21 vote no, the bill fails. (Daugherty, Walker, Linch and Magness, 3/15)

It's make-or-break time for Republican efforts to repeal and replace the Affordable Care Act. And right now it's looking more like break. Congressional GOP leaders are scrambling to come up with a compromise between conservatives who want to scale back premium subsidies and Medicaid coverage in the already-lean American Health Care Act, and more moderate members and governors who want to see more generous benefits. (Meyer, 3/15)

Republican leaders have been talking about a three-part approach to reworking the U.S. health-care system in recent days. What does that mean and why are they doing it? On Tuesday afternoon alone, White House press secretary Sean Spicer repeatedly described “three prongs” and Vice President Mike Pence talked about a “multi-step process” within minutes of each other. (Radnofsky, 3/15)

A growing number of GOP senators are hoping the House fails to pass its bill to repeal and replace ­ObamaCare so they won’t be blamed for killing it in the upper chamber. Support for the House legislation has “disintegrated” in the Senate, according one Republican senator who requested anonymity to discuss internal conference politics. It will require substantial revisions to win the support of moderate Republicans in the upper chamber — something that will likely make it unacceptable to conservatives. (Bolton, 3/16)

House Speaker Paul Ryan (R-Wis.) accused Sen. Rand Paul (R-Ky.) of "insulting" President Trump, citing the Kentucky senator's recent assertion that Ryan is misleading Trump on the GOP's health care plan. The Wednesday comments on CNN came in response to remarks from Paul on the same network, in which he argued that Ryan is "selling [Trump] a bill of goods that he didn't explain to the president.” (Kamisar, 3/15)

The tribulations now facing Republicans are not hard to understand: The party never set out to revamp the nation’s healthcare system. That was always a Democratic pursuit. Republicans simply wanted to repeal Obamacare, which they saw as a costly government intrusion. Only after they took the White House and it became apparent that millions of Americans would lose their health coverage under a straightforward repeal did Republicans begin to take seriously the “replace” part of their campaign promise. (Mascaro, 3/15)

For four years, Rep. Joe Kennedy III has sought a deliberately low profile as a relatively young member of Congress with a famous last name. But after an epic 27-hour markup last week — and tens of millions of views on social media later — Kennedy has quickly emerged as a national face of resistance to Republicans' health bill and a rising Democrat to watch. (Diamond, 3/15)

American Action Network, the nonprofit aligned with House GOP leadership, is launching a pressure campaign aimed at conservative House members lawmakers who have been reluctant to support the leadership-backed plan to replace Obamacare. (Cheney, 3/16)

U.S. Rep. Raja Krishnamoorthi, who like his Democratic colleagues is dead-set against the repeal of the Affordable Care Act, says he has been bombarded with constituent calls and emails in recent days. The overwhelming majority of messages — 1,098 as of Wednesday — oppose the health care overhaul proposed by House Republicans, while just 11 support it, according to the first-term lawmaker from Schaumburg. (Skiba, 3/15)

Eleven state Republican lawmakers are sending a letter to Tennessee's congressional delegation demanding they keep in mind rural community hospitals as they negotiate the repeal of the Affordable Care Act in Washington. Rep. Jeremy Faison, R-Cosby, is leading the effort and is joined by some of the more conservative members of the legislature who say that rural hospitals might have to pick up $88 billion-worth of care in 2019 as estimates suggest nearly 30 million people could be left uninsured under the plan. (Lowary, 3/15)

For possibly the first time since he came to the U.S. Senate, nobody in Washington is angry with Ted Cruz. Nimble and quick, the junior U.S. senator from Texas is performing a political and rhetorical tap dance of assuaging what would seem like mutually exclusive sides of the ongoing health care debate. GOP leaders are insisting that Speaker Paul Ryan's House bill to overhaul the Affordable Care Act can be salvaged. That position, however, is not in line with most Tea Party backers who want almost nothing short of a clean repeal of President Obama's 2010 health care law. (Livingston, 3/15)

On Tuesday afternoon, Sean Spicer made up a quote from Nancy Pelosi, and nobody complained. In 2010, famously, then-House Speaker Pelosi (D-Calif.) told the National Association of Counties that the Affordable Care Act would become appreciated when it finally became law. “We have to pass the bill so that you can find out what is in it, away from the fog of the controversy,” she said. Spicer remembered it differently. “Anyone in the country and anyone in the world, could read it,” he said of the GOP's American Health Care Act. “That's a vastly different approach than after it's being done, told, after we pass it you can read it, which is what Speaker Pelosi said.” Nobody corrected him, but why would they? (Weigel, 3/15)

House Budget Committee Chairwoman Diane Black (R-Tenn.) says she is confident that ObamaCare repeal legislation will advance out of her committee despite concerns from conservatives. The panel, which is voting Thursday on the GOP healthcare bill, has several conservative members, including Reps. Dave Brat (R-Va.) and Mark Sanford (R-S.C.), who have strong concerns about the bill. The measure would fail if four Republicans join all Democrats in opposing it. (Sullivan, 3/15)

Some Republicans on the House Budget Committee are indicating they're not yet on board with advancing the Obamacare repeal and replace bill when it comes up for a vote in their panel's markup Thursday. It remains unclear and somewhat unlikely that those opposed to the legislative package in its current form would win enough support within the committee to tank the bill. Republican leaders have indicated that their repeal of the 2010 health care law could be altered during its hearing in the House Rules Committee or could be amended on the House floor. (Shutt, 3/15)

Democrats at a House Budget Committee markup Thursday plan to cast doubt on the viability of the GOP’s plan to repeal and replace the health care law, though the panel’s top Democrat believes Republican opponents on the committee will be under tremendous pressure to keep the legislation on track for floor action. “Among the arguments we’re going to make are one, that right now this piece of legislation, the American Health Care Act, is in legislative quicksand. It is sinking of its own weight and every time Republicans try to move one way or another, it is sinking faster,” said Rep. John Yarmuth of Kentucky at a Democratic caucus press conference Wednesday. (Mejdrich, 3/15)

President Trump made a plea on Wednesday for his supporters to unite behind the Republican plan to overhaul Americans’ health care as the only way to squelch Democratic attempts to scuttle the plan. At the same time, facing resistance to the bill from within his own party, House Speaker Paul D. Ryan said it would be refined and improved. (Davis, 3/15)

Trump used campaign-like language in his Wednesday night speech, pledging "to repeal and replace horrible, disastrous Obamacare." Speaking to reporters aboard presidential plane Air Force One after the rally, Trump expressed optimism about his plan's chances in Congress. "We're going to come up with something. We always do," he said. (Cornwell and Stephenson, 3/15)

As a new president who has vowed to keep his campaign promises, Donald Trump knows he'll be judged on whether he can repeal the so-called Obamacare law and replace it with something new. Dealing with skepticism from conservatives and moderates alike, the White House is considering changes to the bill that might reassure conservatives, all in an effort to muscle through the GOP-backed health care plan in the House next week. (Thomas and Lucey, 3/16)

More than 12 million Americans chose health plans for this year through the Affordable Care Act’s insurance marketplaces, according to new federal data that show an increase in the number of returning customers and a significant drop in new participants. The numbers released Wednesday morning, a final report on the most recent enrollment season for ACA coverage, echo preliminary findings last month that the number of people signing up for health plans declined for the first time since the marketplaces opened three years ago. (Goldstein, 3/15)

The 2017 final figure, which updates a preliminary report released last month, was down from 12.7 million in 2016. (Levey, 3/15)

The enrollment total declined slightly from 2016, when 12.7 million people purchased health plans during that year’s open-enrollment period. About 31% of enrollees were buying plans on the exchanges for the first time. The decline, analysts said, was partially due to rising premiums and waning insurer participation in the program, which may have deterred many of the young consumers whom former President Barack Obama was attempting to woo in his final days in office. (Hackman, 3/15)

“I think the discrepancy from last year is almost entirely explained by the lack of a final push in marketing and outreach and promotion,” said Topher Spiro, vice president for health policy at the liberal-leaning Center for American Progress. “We were on track to exceed enrollment,” he said, referring to a late rush to sign up in December for coverage that began Jan. 1. (Rovner, 3/15)

President Donald Trump's administration rolled back emails and ads meant to encourage people to sign up for coverage on HealthCare.gov during the final week of open enrollment, when large numbers of consumers typically choose plans. That pull-back and uncertainty about the future of the exchanges under the new federal administration likely prompted fewer sign-ups. (Livingston, 3/15)

The Obama administration estimated that 13.8 million people would sign up through the law’s online marketplaces, or exchanges. Roughly one-third of the 12.2 million sign-ups were new enrollees, HHS said. (Pradhan, 3/15)

Nationally, 83% — or more than 10 million consumers — of those who selected a plan had premiums reduced by tax credits, and these people on average only saw their premiums jump by $1, the Centers for Medicare and Medicaid Services reported. The average value of the tax credits received was $383 per person per month (O'Donnell, 3/15)

The new data shows 31 percent of the sign-ups were new customers. About 83 percent of consumers relied on the health law's subsidies to help pay for their coverage. About 58 percent relied on the law's cost-sharing subsidies for the lowest-income people in the marketplace, which are at the center of a court case brought by the GOP House of Representatives challenging their constitutionality since Congress did not explicitly authorize them. Whether the Trump administration will fund the subsidies through this year is still up for debate. The report also highlights the importance of those subsidies. (Mershon, 3/15)

The House Republicans’ plan to replace the Affordable Care Act is messy and confusing. No one is sure exactly how Americans will be affected and how much more health insurance will cost them. But there are two certainties. Their health care plan provides a tax cut for the wealthiest Americans. And it will make it easier for Republicans to pass more tax cuts this year. It could also be viewed by some people as a break from some of the populist campaign promises President Trump made to lift up the country’s “forgotten men and women.” (Rappeport, 3/15)

The House Republican health care plan backed by President Donald Trump provides billions of dollars in tax cuts for wealthy families and insurance companies, but it hits older Americans hard with higher insurance premiums and smaller tax credits. In all, the bill provides $883 billion in tax relief by repealing almost all of the taxes enacted under President Barack Obama's Affordable Care Act, according to estimates by the nonpartisan Joint Committee on Taxation, the official tax scorekeeper for Congress. (3/16)

Senate GOP leaders see a silver lining in the contentious House Republican health care legislation: an ambitious tax cut of $883 billion. Majority Whip John Cornyn of Texas was among the senior Senate Republicans who said the Congressional Budget Office projection that taxes would be reduced by nearly $883 billion over 10 years, plus the bill's attempt to curb Medicaid, could attract support for legislation aimed at repealing parts of the 2010 health care overhaul (PL 111-148, PL 111-152). (Ota, 3/15)

The GOP replacement for the Affordable Care Act would repeal most new taxes in the current health-care law, or Obamacare. Among those taxes is the 2.3 percent medical-device tax, which has faced criticism from both Democrats and Republicans. Lawmakers have attributed all sorts of negative impacts to this law, and we’ve fact-checked some of those claims in the past. A two-year moratorium of the tax, which took effect in 2013, started in December 2015. (Lee, 3/16)

Washington state would have to come up with more than $2.5 billion a year to pay for losses in Medicaid coverage expected a decade from now under the GOP health-care plan, said Gov. Jay Inslee in a Wednesday news conference. It’s that or 600,000 Washingtonians would lose insurance they gained under Obamacare, said Inslee, as he and state Insurance Commissioner Mike Kreidler added details to their earlier analyses of the GOP plan. (Young, 3/15)

Arizona could lose $46.8 million in federal public health funding over the next five years via a cut included in the House Republican health bill, likely forcing local health departments to reduce or cut public health programs. While debate over the GOP's American Health Care Act largely focuses on how the bill seeks to remake private-sector insurance and the Medicaid program for low-income and disabled people, a less-publicized provision would eliminate a Centers for Disease Control and Prevention fund of nearly $1 billion that sustains public health programs nationwide. (Alltucker, 3/15)

At least half a million Massachusetts residents are among the 24 million Americans who the nonpartisan Congressional Budget Office (CBO) says would no longer have health insurance by 2026 under the House GOP plan to repeal and replace Obamacare. The plan’s key architect, Speaker Paul Ryan, says many Americans would be choosing to end coverage because they will no longer be forced to buy it. But many Massachusetts residents say they would not have a choice; they'd be forced to drop coverage because it would not be affordable. (Bebinger, 3/15)

Florida's health care future will look a lot like its past — with one of the nation's highest uninsured rates and an underfunded safety net system — if the Congressional Budget Office's projections for the American Health Care Act prove accurate, economists and industry experts said this week. (Chang, 3/15)

Health insurer Anthem Inc. sought changes to the Republican replacement plan for the Affordable Care Act when its chief executive officer talked with President Donald Trump on Tuesday. Anthem CEO Joseph Swedish talked with Trump and Health and Human Services Secretary Tom Price about elements of the GOP plan that he’d like to see “enhanced,” such as making sure that cost-sharing subsidies continue, and that “Medicaid is appropriately funded,” the company’s finance chief, John Gallina, told investors at a conference on Wednesday. Swedish also discussed “some of the things in the bill that we want to ensure stay in the bill, such as the elimination of the taxes,” Gallina said. (Tracer and Olorunnipa, 3/15)

Major hospital and physicians' groups are actively lobbying against the House bill to replace the 2010 health care law ahead of a crucial committee vote on Thursday. Among those mobilizing against the legislation are the American Hospital Association and the American Medical Association, two of the most influential lobbying groups in Washington. The two spent a combined $37 million on lobbying in fiscal 2016. (Williams, 3/15)

What might happen to the "essential health benefits" the Affordable Care Act currently requires insurers to cover if the law is repealed and replaced? Things like maternity benefits, prescription drugs, preventive services and chronic disease management. Here & Now's Robin Young talks with Sarah Kliff, who covers health policy for Vox, about the current benefits that are mandated under Obamacare. (Young, 3/15)

A majority of Colorado voters think it’s a better idea to keep Obamacare than to replace it with a new healthcare plan, according to a new poll out this week. The survey by Keating Research, in partnership with the left-leaning firm OnSight Public Affairs, found that 54 percent of respondents wanted to save or improve the Affordable Care Act, compared to the 41 percent of active Colorado voters who preferred to eliminate or replace the 2010 law, better known as Obamacare. The support tracks with Colorado’s past support of Democrats and the Affordable Care Act. (Matthews, 3/15)

Requiring this “community health needs assessment” was part of a broader package of rules included in the health law to ensure that nonprofit hospitals justify the tax exemption they receive. Another directive was that these facilities establish public, written policies about financial assistance available for medically necessary and emergency care and that they comply with limits on what patients who qualify for the aid can be charged. (Luthra, 3/16)

Dr. Laurie Glimcher has been the CEO of the Dana-Farber Cancer Institute since last October. She came from Cornell University's medical school, but before that had lived and worked many years in Boston. She spoke to us at her office about the GOP health care bill, the latest cancer innovations, and the Mar-a-Lago controversy the institute became embroiled in earlier this year. (Bruzek and Becker, 3/15)

The Department of Health and Human Services would receive $69 billion under the president’s budget proposal, a reduction of 17.9 percent that would send spending in one of the government’s largest and most sprawling departments to its lowest level in nearly two decades. (Goldstein, 3/16)

President Donald Trump is proposing big cuts in federal spending on biomedical research and the elimination of subsidies that help poor people heat their homes as part of a budget that would reduce discretionary spending at the Department of Health and Human Services by 23 percent. The cuts are sure to provoke an outcry from Democrats and Republicans who have long backed a robust budget for the National Institutes of Health, as well as from research universities, advocates for cancer patients, victims of heart disease and other conditions, and lawmakers from northern states dependent on the Low Income Home Energy Assistance Program. (Tracer and Edney, /16)

President Trump’s budget calls for a seismic disruption in government-funded medical and scientific research. The cuts are deep and broad. They also go beyond what many political observers expected. Trump had made clear that he would target the Environmental Protection Agency, but the budget blueprint calls for a startling downsizing of agencies that historically have received steady bipartisan support. The National Institutes of Health, for example, would be cut by nearly $6 billion, about a fifth of the NIH budget. (Achenbach, 3/16)

President Trump's proposed budget takes a cleaver to domestic programs, with many agencies taking percentage spending cuts in the double digits. But for dozens of smaller agencies and programs, the cut is 100%. (Korte, 3/16)

The agency passes out more than 80 percent of its money to more than 300,000 researchers at universities across the country and abroad. It also has hundreds of researchers conducting studies in labs at its sprawling campus in Bethesda, Md. Its world-renowned clinical center treats patients from around the world seeking last-chance cures and volunteers testing cutting-edge therapies. (Bernstein, 3/16)

The Department of Veterans Affairs, the second-largest federal agency with 313,000 civilian employees and a far-flung hospital system, is one of the few corners of the government that would see its budget grow in the next fiscal year — by 6 percent. (Rein, 3/16)

The budget’s main focus is the $54 billion defense boost over budget caps set under current law. It also revisits many themes Mr. Trump set out during the presidential race, including setting aside funding for a southern border wall—and lawyers to obtain land along the border needed for the wall—school choice, the nation’s nuclear arsenal, veterans’ health and treatment of opioid addiction. (Sparshott and Mann, 3/16)

Ever since the Ebola and Zika epidemics, public health officials have advocated for a special emergency fund that would allow the United States to respond rapidly to disease outbreaks. This budget blueprint creates a new Federal Emergency Response Fund, but provides no specifics about how large it would be or where the funds will come from. (Sun, 3/16)

Abortion opponents who've enjoyed a long string of legislative victories in Kansas worry that a legal challenge to a first-in-the-nation ban on a common second-trimester procedure could doom other restrictions they've won in recent years. (3/16)

There's no sign of U.S. abortion law changing anytime soon, but Alabama wants to be ready if it ever does. A proposal in the Republican-controlled Legislature would declare Alabama a "right to life" state by amending the state constitution. The House of Representatives will vote on the bill Thursday, and if it passes the Legislature and is signed by the Republican governor, the constitutional amendment would go before voters in 2018. (3/15)

The Texas Senate gave approval to two abortion-related bills on Wednesday. The upper chamber gave final passage to Senate Bill 8, which would ban what opponents call "partial-birth" abortions and put restrictions on donating fetal tissue, and gave initial approval to Senate Bill 415, which would ban doctors from performing dilation and evacuation abortions. (Alfaro, 3/15)

Under proposed legislation in Texas, before a man receives an elective vasectomy, a colonoscopy or a prescription for Viagra, he would be required to undergo a “medically unnecessary rectal exam and magnetic resonance imagining” and wait at least 24 hours. Rep. Jessica Farrar, an 11-term Democrat, doesn’t expect the bill she introduced last week to go anywhere in the Republican-dominated state Legislature. But that was never the point. (Zavis, 3/15)

A new Johns Hopkins study could fuel ongoing efforts to allow women to get birth control pills without seeing a doctor. Bills pending in each house of the Maryland General Assembly would allow pharmacists to prescribe contraceptives. The study led by researchers at Johns Hopkins' School of Medicine found that oral contraceptives can be sold safely over the counter to all women, including teens. (Cohn, 3/15)

Leigh Ann and John Wilson play back those 42 days in a constant loop. They remember the clinics with lengthy waiting lists; the treatment centers that wouldn’t take Medicaid; the doctors who discouraged Taylor from inpatient treatment, saying she could do without it. They wonder, more than anything, why it’s so hard to get addiction treatment in the state with the nation’s highest drug death rate — 818 deaths last year, most of them from opioids. (Blau, 3/16)

As the national opioid crisis rages, painkiller manufacturers have raked in profits and earned plaudits by reformulating their opioids in an attempt to deter abuse. But on Tuesday, a federal advisory panel delivered an extraordinary rebuke to one such product on the market, suggesting that Endo Pharmaceuticals’ efforts to make Opana ER harder to crush ended up making things worse by enabling addicts to inject it. ... Opana has been blamed by some for spurring a high-profile HIV outbreak in rural Indiana in 2015, and it was also tied to reports of a rare but serious blood disease characterized by clots that can lead to organ damage. (Robbins, 3/14)

A former doctor who at one point prescribed more oxycodone than most Massachusetts hospitals pleaded guilty in federal court Wednesday to fraud charges and is facing more than a decade in prison. Patients allegedly waited in line for hours to see Fathalla Mashali, 62, who saw patients for only minutes at a time in an office at his pain clinics, rather than in an exam room. (Valencia, 3/16)

Michael Botticelli served as President Obama's director of National Drug Control Policy, and pushed Congress to pass a funding measure last year making more money available for the treatment of opioid addiction. Now he's concerned that the proposed Republican health plan will reduce access to health services for people with addiction. (Hersher, 3/15)

Three women suffered severe, permanent eye damage after stem cells were injected into their eyes, in an unproven treatment at a loosely regulated clinic in Florida, doctors reported in an article published Wednesday in The New England Journal of Medicine. One, 72, went completely blind from the injections, and the others, 78 and 88, lost much of their eyesight. Before the procedure, all had some visual impairment but could see well enough to drive. (Grady, 3/15)

Scientists have long studied the use of stem cells, including those taken from a patient’s own body, for treating vision problems and a variety of other diseases. But they and regulators have also issued warnings about clinics that offer unproven stem cell therapies. (Ritter, 3/15)

"One of the big mysteries about this particular case and the mushrooming stem cell clinic industry more generally is why the FDA has chosen to effectively sit itself out on the sidelines even as this situation overall grows increasingly risky to patients," says Paul Knoepfler, a University of California, Davis, stem cell researcher who has studied the proliferation of stem cell clinics. "The inaction by the FDA not only puts many patients at serious risk from unproven stem cell offerings, but also it undermines the agency's credibility," Knoepfler wrote in an email. (Stein, 3/15)

In the current climate, consumer stem cell clinics have flourished. There are roughly a dozen in the Bay Area, where they’re flanked by the locations of some of the nation’s most prominent stem cell scientists, UCSF and Stanford. But the work that’s coming out of academic institutions is usually vastly different from what’s on offer at the clinics, which typically lack federal approval for the treatments they offer, stem cell experts said. And though California hasn’t seen cases of stem cell therapies gone horribly awry in a consumer clinic, it may just be a matter of time. (Allday, 3/15)

Hundreds of stem cell clinics have sprung up across the nation offering therapies. But many of these medical interventions have not been vetted through federal protocols for safety and effectiveness. Because stem cells are harvested from the patient who will receive the treatment, many of these clinicians say they do not need the Food and Drug Administration’s approval, said Karen Maschke, a research scholar at the Hastings Center, a bioethics research institute. (Heredia Rodriguez, 3/15)

Richer countries have higher rates of anxiety in their population than poorer countries and — in a finding that surprised even the researchers — that anxiety also interfered more with daily activities and responsibilities. Specifically, there was a higher proportion of people in higher-income countries with generalized anxiety disorder, or GAD — defined as excessive and uncontrollable worry that affects a person’s life — and with severe GAD. The researchers, who are members of the WHO World Mental Health Survey Consortium, published their findings in JAMA Psychiatry on Wednesday. (Sheridan, 3/15)

Eleven national medical societies representing more than half of the nation's doctors came together today to warn about the ongoing health impacts of climate change and to advocate for a quicker transition to cleaner, renewable energy sources to help protect patients. Most Americans don't realize that climate change is making us sick, these doctors fear, because there has been little public discussion about the connection between the two. Yet extreme weather events, increasing temperatures and air pollution are already affecting us, they say. (Zeltner, 3/15)

Americans who want to ensure they have a say in how they die should examine the lessons of Oregon, a new analysis suggests. Seriously ill people in that state are more likely to have their end-of-life wishes honored — including fewer intensive-care hospitalizations and more home hospice enrollments — than those living in neighboring Washington state or the rest of the country. (Aleccia, 3/15)

Attorney General Jeff Sessions has repeatedly condemned the recreational use of marijuana. On Wednesday he went a step further, casting doubt on medical marijuana use. “I think medical marijuana has been hyped, maybe too much,” he told reporters in Richmond after an event about violent crime. “Dosages can be constructed in a way that might be beneficial, I acknowledge that, but if you smoke marijuana, for example, where you have no idea how much THC you’re getting, it’s probably not a good way to administer a medicinal amount. So forgive me if I’m a bit dubious about that.” (Weiner, 3/15)

Less than two years after the Drug Enforcement Administration officially admitted that “heroin is clearly more dangerous than marijuana,” new Attorney General Jeff Sessions revisited that comparison in remarks today before law enforcement officials in Richmond. (Ingraham, 3/15)

It’s been dubbed the Eyeball Wars: Optometrists want to prescribe more medications and perform surgeries and ophthalmologists are standing firm against them. Optometrists gained some ground Wednesday when a House bill cleared the Health Quality Subcommittee with an 8-7 vote and headed to the House Health Care Appropriations Subcommittee. (Miller, 3/15)

Minnesota Democrats came agonizingly close to scoring an upset victory Wednesday night. During debate over a measure to try to stabilize the individual health insurance market, Democrats in the state Senate offered an amendment to add their preferred program: letting Minnesotans buy in to the state-run MinnesotaCare program. Senate Democrats have one fewer seat than do the majority Republicans, so they were expecting to lose. But then came a shock: Republican Sen. Scott Jensen of Chaska, a medical doctor, spoke out in favor of the DFL plan. It wasn’t perfect, Jensen said, but it might help bring care to residents of greater Minnesota who face dwindling insurance options. (Montgomery, 3/15)

Minnesota Gov. Mark Dayton says he’s interested in passing a “reinsurance” proposal to stabilize the state’s individual health insurance market — if he’s convinced it will actually work. “The insurance industry needs to come forward and tell us, if they get $300 million a year through reinsurance, what effect is that going to have? Are they doing to stay in the market, then? Are they going to lower their rates?” Dayton said last week. “We need to know what we’re getting for this very significant commitment of public funds.” (Montgomery, 3/15)

Through focusing on regular checkups and preventative care, [Alice] Chen says overall health care costs have ticked down over the past decade, due in large part to the system’s ability to divert patients away from costly emergency room visits and catch health complications before they escalate to severe illness and disease. That concept is fundamental to Healthy San Francisco, the city’s universal health care program adopted a decade ago that covers everyone regardless of immigration status or ability to pay. (Hart, 3/16)

Under House Bill 6 — part of a sweeping plan to revamp Texas' child welfare system — the state would slowly create a "community-based care" model, which would allow contracted organizations to monitor children in foster care and adoptive homes and those who have been placed by the state into a relative's home. That would include making sure children are settling into their new homes and their health needs are being met. (Evans, 3/16)

Three months after Gov. Rick Scott stood in Miami Beach and declared that the Zika virus was no longer spreading in Florida, mosquito control experts are warning people not to be complacent. Zika could come back. (Auslen, 3/15)

Bostwick Laboratories filed for Chapter 11 bankruptcy reorganization on Wednesday, two days after telling employees of its intentions to sell its business and assets through a court-supervised auction. Once one of the Richmond region’s fastest-growing companies, Bostwick Laboratories has estimated assets of between $1 million and $10 million and liabilities between $50 million and $100 million, according to the filing. (Demeria, 3/15)

The 94 preschoolers, ages 3 to 5, at Brooksville Head Start, another 146 at Spring Hill Head Start, plus a dozen at Butterfly Wings, a home-based day care in Spring Hill, have put into practice over the past year a quartet of lifestyle suggestions to earn 5210 Healthy Hernando Certification for their schools. The numerals refer to the four daily goals: eat five fruits and vegetables, spend no more than two hours on recreational screen time, engage in one hour of physical activity and consume zero sugary drinks. Based on a nationally recognized child obesity prevention program, 5210 Healthy Hernando was developed as a partnership of the Hernando County Health Department and Mid-Florida Community Services, which sponsors Head Start. (Gray, 3/15)

Texas is trying to take the federal government to task for failing to find a permanent disposal site for thousands of metric tons of radioactive waste piling up at nuclear reactor sites across the country. In a lawsuit filed Tuesday night, Texas Attorney General Ken Paxton accuses U.S. agencies of violating federal law by failing to license a nuclear waste repository in Nevada — a plan delayed for decades amid a highly politicized fight. (Malewitz, 3/15)

A drug epidemic is ravaging the United States, and it’s getting worse, not better. More than 52,000 Americans died from drug overdoses in 2015, more than died from automobile accidents or firearms. That’s far more than died from overdoses in any year during the crack epidemic of the 1980s. (Doyle McManus, 3/15)

House Republicans introduced the American Health Care Act (AHCA), their proposal to repeal and replace the Affordable Care Act (ACA, also known as Obamacare). At a press conference, Speaker Paul Ryan called this bill “an act of mercy.” For the most vulnerable, that characterization is ironic at best. Yes, there are winners in this bill. But those who benefit would be predominantly young, healthy and less likely to need insurance or older, well off and more likely to be able to afford insurance. (Megan Foster Friedman, 3/14)

Markets don’t work unless consumers can compare prices. A health care plan built around free-market principles would force hospitals and doctors to disclose – publicly and clearly – their going rates for that heart bypass, knee replacement, IV drip or Caesarian section. That’s how you know House Majority Leader Kevin McCarthy, Speaker Paul Ryan and other pushers of Trumpcare have zero interest in promoting free markets. (3/15)

Like many of the young Americans who came of age during the Great Recession, I constantly worry about money. It is the governing anxiety of my life. The fiscal obligations of being a “young professional” — paying for groceries and a place to live — are daunting enough. But the questions that really make my palms sweat are far grander in scope: Will I be able to support a family one day? (Miles Howard, 3/16)

Suddenly, there was just blood everywhere. It erupted from my father’s mouth as we sat watching television. I was still struggling to process this horror when my mother, too shaken to drive, asked me — 17 years old and still on my learner’s permit — to get us to the emergency room. Somehow, we made it. But the ER was crowded with folks like us, poor and bearing loved ones in distress. The hospital couldn’t get to my dad right away. They didn’t even have a room to put him in. (Leonard Pitts Jr., 3/14)

Conservatives across the United States pinned a target on the back of Planned Parenthood long before a doctored videotape circulated in 2015 purporting to show the organization’s abortion providers talking about harvesting fetal tissue for research. They didn’t care that the truth is only a fraction of procedures Planned Parenthood performs are abortions and that the video-makers were indicted. None of the $500 million in federal money the organization receives annually can be used for abortions. Most of Planned Parenthood’s procedures — and federal funds — are routine health care for men and women, such as mammograms, Pap smears, birth control, cancer and diabetes screenings. (3/15)

If House Republicans enact their health-care bill, they're screwed. They'll have lost the critical initial dialogue and left opponents salivating. If they fail to pass it, they're screwed, too, having broken a commitment of the past four elections. The Trumpcare debacle confirms the wisdom of the late Republican pollster Bob Teeter, who predicted a couple of decades ago that health care would be a loser for whichever political party owns it. (Albert R. Hunt, 3/15)

Republicans have a historic opportunity to follow through on our promise to repeal ObamaCare. The recent elections that focused on the law’s repeal — 2010, 2014 and 2016 — were massive GOP victories. The American people gave our party unified control of the federal government, and a mandate for meaningful change. (Sen. Ted Cruz (R-Texas) and Rep. Mark Meadows, (R-N.C.) 3/15)

As Republicans in Washington grapple with altering the Affordable Care Act, they have proceeded in a direction that will do little to curb the cost of health care in America. Instead, they are pushing a bill that, according to the Congressional Budget Office, might save the government money, but will end coverage for 24 million people (though several million of those would be willingly giving up coverage the law now requires them to have). If it passes, Republicans will not only own the nation’s health care problems for years, but they will also have violated more than six years of promises. (Erik-Woods Erickson, 3/15)

Recently, President Trump correctly described health care policy making as “unbelievably complex”—although his comment that “nobody knew that” must have been a surprise to the many analysts and lawmakers who for decades have worked on health care reform. Health care policy making is technically complex, of course. But it is also complex in that the president and Republicans seeking to replace the Affordable Care Act (ACA) face very difficult political and philosophical choices. It was evident from the internal backlash to the recent Republican House committee bills that there is a deep divide among Republicans on these choices. (Stuart Butler, 3/15)

Tomorrow the Republicans’ American Health Care Act goes to the Budget Committee. What looked like another rubber stamp for Speaker of the House Paul Ryan’s and President Trump’s bill may instead mean the demise of the bill, at least this version of Republican health care. Moreover, a bombshell dropped in a meeting between Senate Republicans and the White House that would surely doom the AHCA. (Jennifer Rubin, 3/15)

Health and Human Services Secretary Tom Price on Wednesday gave a full-throated defense of the House GOP’s health care overhaul, hours after Speaker Paul Ryan acknowledged changes would need to be made to save the embattled plan. The former Georgia congressman, who has become the face of the White House-backed bill, defended the legislation’s treatment of the Medicaid expansion under Obamacare to a cancer survivor who said his life was saved by the program. He voiced support for the bill’s reversal of an Affordable Care Act provision taxing health insurance CEOs and promised more choice and flexibility for Americans. (Tamar Hallerman, 3/15)

“Well, sure, this hospital would have a foundation to do some charity work. Maybe commissioning portraits of The Donald to hang in the entrance. But let’s drop this bleeding heart nonsense about health care as a human right, and see it as a financial opportunity to reward investors. In this partnership, 62 percent of the benefits would go to the top 0.6 percent — perfect for a health care plan.” Jesus turned to Pious Paul on his left and said: “Be gone! For I was hungry and you gave me no food; I was thirsty, and you gave me no drink; and I was sick, and you did not help me.” “But, Lord,” protested Pious Paul of Ryan, “when did I see you hungry or thirsty or sick and refuse to help you? I drop your name everywhere. And I’m pro-life!” “Truly, I say to you,” Jesus responded, “as you did not help the homeless, the sick — as you did not help the least of these, you did not help me. (Nicholas Kristof, 3/16)

From the start, most Republicans were dead-set against the Medicaid expansion under ObamaCare. More than that, they oppose the program in its current form. “A Better Way,” the 2016 House Republican platform drafted under Speaker Ryan’s leadership, denounced Medicaid as fiscally unsustainable and advocated turning it over to the states as either a block grant or a per capita allotment. It is no surprise that the current Republican bill does just this. Nor should it come as a surprise to anyone that it would lead to a substantial reduction in Medicaid enrollment. This outcome is not a bug in the Republican program; it is a feature. (William Galston, 3/14)

As the saying goes, “It’s tough to make predictions, especially about the future.” But that hasn’t stopped the Congressional Budget Office (CBO) from trying. The CBO has forecast the effects of the House Republicans’ health care reform plan, the American Health Care Act (AHCA), which will repeal and replace much of President Barack Obama’s 2010 Affordable Care Act. (Joel Zinberg, 3/16)

Maybe in politics, genes really are destiny. Under pressure from a CBO “score,” the genetic disposition of Republican politicians is to go wobbly. The disposition of movement conservatives is to get out the long knives and start carving up other conservatives. The result will be guaranteed political defeat for years if congressional Republicans choke at the chance to repeal and replace ObamaCare. (Daniel Henninger, 3/15)

Three of Virginia’s GOP congressmen have expressed opposition to or skepticism about the House leadership’s plan to replace Obamacare — and the other four are uncommitted. Not an auspicious start for the bill. Although Republicans spoke for years of health care reform, they did not grow serious until Obamacare’s enactment. (3/15)

A Republican-dominated House committee approved HR 1313 last week along partisan lines. Businesses argue that the popular programs need the information to help keep employees and their insured family members healthy and reduce health care costs. Two problems with the bill: Genes are not destiny, but that may not stop employers from discriminating against workers. Critics also argue that third party vendors who run the wellness programs have weak privacy rules. Kill this bill. (3/16)

Some things should be simple. However, a few obstructionists in Missouri’s Senate make issues more complex than needed. I am a father, a businessman from Kansas City, a board member of the nonprofit Shatterproof and an advocate for a prescription drug monitoring program in Missouri. I am an advocate for Senate Bill 314. (3/16)

As clergy and as women, we oppose any action by the Iowa Legislature to restrict a woman’s ability to make her own health care and reproductive decisions or to access health care services. Additionally, we support Planned Parenthood of the Heartland and the excellent care it provides for any woman who chooses its health care services. (Rev. LeAnn Stubbs, 3/15)

Attorney General Jeff Sessions once again took aim at marijuana in remarks Wednesday, forcefully attacking the idea of recreational use and even deriding the growing consensus around the possible use of marijuana to counter America’s rapidly-growing opioid crisis. Speaking before law enforcement officials in Richmond, Va., Sessions said that “we need to focus on … preventing people from ever taking drugs in the first place,” according to prepared remarks provided by the Department of Justice. (Daniel M. Jimenez, 3/15)

The political power brokers behind Arizona’s anti-abortion money machine know that they can’t get elected officials to simply write a bill declaring abortion illegal. That would be unconstitutional. So, they’ve determined instead to employ a strategy of death by a thousand cuts. Each year there are anti-abortion bills filed in the State Legislature with the intent to make it more and more difficult to find, receive, provide or afford a legal abortion. (EJ Montini, 3/15)

Immunization remains our best defense against this illness that can swoop in to upend our health, home and workplace. For those with pre-existing conditions, though, contracting the flu is particularly serious business, because it can lead to pneumonia. That’s why some providers are now recommending people ages 18-64 with these conditions and chronic diseases also consider getting vaccinated against pneumonia while getting their flu shot. (Linda Witucki, 3/15)

Preterm birth is one of the leading health indicators among nations, as it is the most frequent cause of neonatal death and the second most frequent cause of death in children younger than 5 years worldwide. In the United States alone, complications related to preterm birth account for approximately two-thirds of all infant deaths. Infants born preterm who do survive have significantly higher risks of long-term morbidity, including serious neurologic and developmental disabilities. In 2005, the Institute of Medicine estimated that the annual societal cost of preterm birth in the United States was $26 billion. (Steven L. Bloom and Kenneth J. Leveno, 3/ 14)