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President Barack Obama nominated federal appeals court judge Merrick Garland to the Supreme Court, unleashing a showdown with the Republican-controlled Senate over the court’s first vacancy in six years. Wednesday’s nomination of Judge Garland, a veteran jurist with a reputation for consensus-building, landed in the middle of a heated election battle and at a time when the nation’s highest court is bitterly divided on hot-button issues that include abortion, campaign finance and gun rights. (Lee and Peterson, 3/16)

Planned Parenthood President Cecile Richards headed into the West Wing right after Merrick Garland’s Supreme Court nomination was announced — and she seems to like what she heard. "Judge Garland seems like a responsible and qualified nominee,” Richards said in a statement Wednesday afternoon, throwing her support behind giving the D.C. Circuit Court of Appeals chief judge a hearing. Abortion rights, of course, are the perennial major issue in Supreme Court politics — and on the frontburner for the Supreme Court this year, with a big case challenging Texas state restrictions in front of the justices. (Dovere, 3/16)

Lawmakers will almost certainly spend coming months digging through Garland's judicial record to see where he stands politically. As chief justice of the U.S. Court of Appeals in Washington, Garland, who is viewed as moderate, has been involved in a number of healthcare-related cases, sometimes siding with hospitals and other times with HHS. Garland was part of a three-judge panel in May that partially sided with hospitals in a case over Medicare outlier payments. ... Also, in December, Garland was part of a three-judge panel that sided with HHS in a case brought by Fayetteville City Hospital in Arkansas, which was reportedly closed by Washington Regional Medical Center in 2012. ... A few years earlier, in 2011, Garland was part of a three-judge panel that sided with Beverly Hospital in Massachusetts after it challenged reimbursements it received from HHS for services it provided to low-income beneficiaries. ... Garland's court has also dealt with several challenges to the Affordable Care Act. (Schencker, 3/16)

Supreme Court nominee Merrick Garland’s nearly two-decade tenure as a judge on the D.C. Circuit holds few seminal opinions that capture his legal philosophy—and, for those rooting for his confirmation, that may be a good thing. ... A former prosecutor, Garland often split with his liberal colleagues on criminal justice issues, while broadly approving of federal government regulatory actions in areas like health and the environment. On the First Amendment, he has leaned towards free speech rights, while his stances in other areas like abortion rights and church-state issues are uncharted. (Gerstein, 3/16)

A bill that would prevent states from requiring food labels to note the presence of genetically engineered ingredients failed to pass the Senate on Wednesday. Republicans in Congress, led in the Senate by Pat Roberts of Kansas, had been scrambling to come up with a bill that would head off mandatory labeling in Vermont, which goes into effect on July 1. Many food companies have already gotten approval for the language they will use on packaging there, but they worry that other states will pass similar laws, creating a patchwork of requirements that will add to the cost of compliance. (Strom, 3/16)

The procedural vote is a setback for many big players in the food industry who had lobbied to block Vermont’s law. The industry argues that genetically modified organisms, or GMOs, are safe and the labels could be costly for agriculture, food companies and consumers. Congressional Republicans have opposed a patchwork of state laws and worked to find a solution on the issue before Vermont’s law kicks in. The food industry says about 75 percent to 80 percent of foods contain genetically modified ingredients. (3/16)

A closely divided Senate may revisit legislation to bar states from imposing mandatory labeling of genetically modified foods after lawmakers on Wednesday rejected a procedural move to limit debate and advance the measure. The amendment attached to an unrelated bill (S 764) sought to block states from writing mandatory labeling laws and establish a federal voluntary labeling process created and administered by the Agriculture Department. (Ferguson, 3/16)

Vermont's law requiring most genetically modified food to be labeled as such remains on schedule to take effect July 1, after the U.S. Senate on Wednesday voted not to advance a bill that would have blocked such state laws. On a 48-49 procedural vote — short of the 60 votes needed for passage — the Senate decided not to go ahead with legislation similar to a bill passed by the U.S. House last year. The decision was hailed by U.S. Sen. Patrick Leahy and Gov. Peter Shumlin, both Democrats, and independent U.S. Sen. Bernie Sanders. It was sharply criticized by industry groups, which vowed to continue fighting for the legislation and are also seeking to have Vermont's law overturned in Federal court. (Gram, 3/16)

The Michigan Department of Environmental Quality repeatedly gave assurances that water from the Flint River was safe, when in reality it had dangerous levels of lead, Michigan Gov. Rick Snyder says. Snyder tells Congress that he did not learn that Flint's water was contaminated until Oct. 1, 2015 — nearly 18 months after the city began drawing its water from the Flint River in April 2014 to save money. Snyder said he took immediate action, reconnecting the city with Detroit's water supply and distributing water filters and testing residents — especially children — for elevated lead levels. (3/17)

Gov. Rick Snyder said Wednesday he's disappointed the federal government has rejected his appeal of an earlier denial of certain funding requests to assist the state in addressing the Flint drinking water crisis. Snyder, in a March 3 letter to the Federal Emergency Management Agency, had requested funding under programs related to emergency protective measures and the Individuals and Households Program. (Egan, 3/16)

Federal prosecutors in Manhattan are investigating health and safety conditions, including lead problems, in New York City’s public-housing system, according to court documents and city officials. Prosecutors in U.S. Attorney Preet Bharara’s office are investigating whether the New York City Housing Authority, the largest public-housing agency in the country, made false claims for payment to the federal government related to safety conditions at city housing complexes, according to court filings. The investigation began last fall, court records show. (O'Brien, 3/16)

Federal prosecutors in Manhattan are conducting a sweeping investigation of environmental health and safety conditions, including cases of elevated blood lead levels, in public housing and homeless shelters and the possibility that the New York City housing and homeless agencies filed false claims to federal housing officials for payment related to the conditions. (Navarro and Rashbaum, 3/16)

Standing glumly behind the screen door of the brick house she has called home since 1971, Mary Schell shares the bad news: "We have it." "It" is confirmation that the water in her home contains high levels of lead. Schell and her husband tested their water in the fall after town officials discovered in October that 11 homes in their neighborhood had high levels. A subsequent round of testing in December found six homes exceeding federal limits. (Hughes, 3/16)

A key House panel on Wednesday approved a GOP plan to eliminate the federal budget deficit without tax increases demanded by Democrats, relying on sharp cuts to federal health care programs, government aid to the poor, and hundreds of domestic programs supported by lawmakers in both parties. The 20-16 Budget Committee vote could be the high point for the GOP blueprint, which is short of the majority votes needed to advance through the GOP-controlled House. Two tea party Republicans defected on the otherwise party-line vote. (3/16)

A key committee on Wednesday voted unanimously to send a mental health bill sponsored by Sen. Chris Murphy to the Senate floor, but not until certain provisions were dropped. The Mental Health Reform Act, which is co-sponsored by Sen. Bill Cassidy, R-La., would establish a new a new assistant secretary for mental health and substance abuse and establish a new grant program for early intervention aimed at helping children and young adults. (Radelat, 3/16)

A bipartisan bill designed to improve the health and safety of babies born to mothers who used heroin or other opioids during pregnancy was approved by a U.S. Senate committee on Wednesday. The bill, which will now move to the Senate floor, was prompted by a Reuters investigation last year. Reuters found 110 cases of children who were exposed to opioids while in the womb and who later died preventable deaths at home. No more than nine states comply with a 2003 law that calls on hospitals to alert social workers whenever a baby is born dependent on drugs, Reuters found. (Shiffman and Wilson, 3/16)

Lawmakers, health policy experts and the chief executive of one of the nation's largest insurers believe Medicare Advantage could help keep the Medicare program solvent. On Wednesday, the House Ways and Means Committee's Health Subcommittee held a hearing on Medicare's future. The Medicare board of trustees said in its most recent annual report that Medicare will be able to cover its costs until 2030, but suggested congressional action to strengthen the program's future. (Muchmore and Herman, 3/16)

House appropriators at a hearing on the National Institutes of Health budget flatly rejected the Obama administration’s proposal to use mandatory spending, rather than discretionary appropriations, to fund part of the biomedical research agency. President Barack Obama’s proposed fiscal 2017 budget designates $33.1 billion for NIH, including new funds for the “moonshot” initiative to cure cancer being spearheaded by Vice President Joseph R. Biden Jr. The fiscal 2016 omnibus boosted the agency’s budget by $2 billion, bringing it to $32.1 billion. (Zanona, 3/15)

Four of the 11 remaining health cooperatives set up under the Affordable Care Act are still seeing tepid enrollment, according to a report by federal investigators, in another sign such insurance startups are on shaky footing despite more than $1 billion in federal loans. The cooperatives were launched under the health law to provide affordable insurance and infuse competition into the market. Twelve of the 23 co-ops that got off the ground have closed as a result of financial troubles. The Obama administration is seeking to recoup about $1.2 billion in federal loans to the co-ops that have closed. (Armour, 3/16)

State officials and consumer advocates are reminding Massachusetts residents with subsidized health insurance coverage to file their tax returns before April 19 -- or risk losing their federal tax credits. For the first time this year, 174,000 people in Massachusetts who receive tax credits to offset the cost of their health insurance must file a tax form to prove they were eligible for the credits. Those who don’t file could be forced to pay back their tax credits or lose eligibility for credits in future years. Tax credits are available to help individuals and families with low or moderate income pay for health coverage. (Dayal McCluskey, 3/16)

Health insurance is no guarantee against financial hardship, according to a national poll by NPR, the Robert Wood Johnson Foundation and the Harvard T. H. Chan School of Public Health. "People are financially overwhelmed in lives that are working OK — they have financing for everything else in their life but they can't deal with this large medical bill," says Robert Blendon, a professor of health policy and political analysis at the Harvard Chan School. (Mack, 3/17)

Susan Kubicka-Welander, a short-order cook, went to her pain checkup appointment straight from the lunch-rush shift. “We were really busy,” she told Dr. Robert L. Wergin, trying to smile through deeply etched lines of exhaustion. “Thursdays, it’s Philly cheesesteaks.” Her back ached from a compression fracture; a shattered elbow was still mending; her left-hip sciatica was screaming louder than usual. She takes a lot of medication for chronic pain, but today it was just not enough. Yet rather than increasing her dose, Dr. Wergin was tapering her down. “Susan, we’ve got to get you to five pills a day,” he said gently. She winced. (Hoffman, 3/16)

Americans broadly support new Obama administration guidelines urging physicians to prescribe fewer powerful painkillers, according to the latest STAT-Harvard poll. They blame doctors for the nation’s epidemic of opioid addiction about as much as they hold individuals responsible for abusing the drugs. (Scott, 3/16)

The World Health Organization has put a number on the people estimated to have died as a result of living or working in an unhealthy environment and it's big -- 12.6 million. That number represents one in four of all deaths globally and underscores the devastating impact of the chemicals and waste we've been putting into the air, water and earth since the end of World War II. The WHO said deaths due to non-communicable diseases -- which include heart disease and cancer and are related to exposure to pollution -- now make up 8.2 million or nearly two-thirds of the total deaths. Deaths from infectious diseases -- such as malaria and diarrhea -- due to unsafe water and lack of sanitation represent one-third and are on the decline. (Cha, 3/16)

Exposure to air pollution for just a month or two may still be enough to increase the risk of developing diabetes, especially for obese people, a recent U.S. study suggests. Researchers studied more than 1,000 Mexican-Americans living in southern California and found short-term exposure to contaminated air was linked to an increased risk of high cholesterol and impaired processing of blood sugar – risk factors for diabetes. (Rapaport, 3/16)

Scientists reported on Wednesday that they think they have found the "final puzzle piece" for a dengue vaccine that might, at last, be able to stop the deadly mosquito-borne virus that has infected billions since the early 19th century. The experimental vaccine, developed by the National Institutes of Health, was tested in a small, randomized, double-blind trial on 41 healthy volunteers. Each participant received either a single shot of an experimental vaccine or a placebo and were then infected with a mild form of the virus six months later. All of the 20 people in the placebo group came down with rashes, low white blood cell count and other symptoms of the disease, while none of the 21 vaccinated volunteers became sick and did not have evidence of infection in their blood. (Cha, 3/16)

People suspected of carrying the Zika virus can wait weeks for test results from a federal lab. The wait can be nerve-racking for patients, especially pregnant women, and frustrating for local health officials who can't take precautions to stem potential spreading. (Somerson, 3/16)

The Ohio Department of Health can now test blood samples of people who show symptoms of Zika virus to detect the mosquito-borne illness. "By conducting our own initial Zika virus testing on patients within seven days of symptom onset, we can significantly speed up initial test results for patients who are anxiously waiting on them," ODH Medical Director Dr. Mary DiOrio said in a news release. (Zeltner, 3/16)

State and local law enforcement officials spoke out Tuesday against part of a bill aimed at making it easier for drug addicts to exchange dirty needles for clean ones, but they oppose the measure for different reasons. Under current law, hypodermic needles and syringes can be dispensed only by pharmacists, and possessing a used syringe with heroin residue on it is a felony. But a bill before the House Criminal Justice and Public Safety Committee would legalize residual amounts of heroin on used syringes and would allow nonprofit and community groups to create needle exchange programs. (Ramer, 3/16)

Terminally ill patients with only six months left to live could be prescribed life-ending medication under a bill moving through the Minnesota Legislature. The Minnesota Compassionate Care Act would make the state the sixth in the nation to enact so-called "Right to Die" legislation. Hundreds of people packed into a Senate hearing room on Wednesday afternoon with many opponents donning red shirts and stickers and bill proponents dressed in bright yellow. (3/16)

Medicaid officials from the Iowa Department of Human Services shared with state senators on Wednesday how the department plans to make sure Medicaid recipients are safe and receive necessary services, once the Iowa's Medicaid system is privatized on April 1. (Boden, 3/16)

About 75 disabled New Yorkers and their caregivers are lobbying legislators to cover higher reimbursements should they enact a $15 state minimum wage. Gov. Andrew Cuomo and the Assembly are pushing to raise the wage over three years in the New York City area and five years statewide. (3/17)

Michigan's tax on health insurance will continue under legislation signed by Gov. Rick Snyder. The bill enacted Tuesday extends the health insurance claims assessment, which helps pay for Medicaid for low-income residents, until July 2020. The tax would have gone away in two years if the legislation were not adopted. (3/17)

A bill to help anguished parents get a child seizure treatment failed to get a vote amid a hastily adjourned Senate session, even though a majority of senators support the proposal. (Stein and Spivak, 3/16)

The state Supreme Court plans to decide whether the mere smell of marijuana is enough to justify a search by police in the wake of Arizona's legalization of medical marijuana. The justices agreed Tuesday to consider appeals of contradictory rulings by the Phoenix and Tucson divisions of the state Court of Appeals. (3/16)

Disease-trackers from the Centers for Disease Control and Prevention arrived in Boston Wednesday to study the spread of a deadly bacterial infection among homeless people. Dr. Anita Barry, director of the Infectious Disease Bureau at the Boston Public Health Commission, said the CDC is interested in the city’s experience because the federal agency is updating guidelines for handling clusters of meningococcal disease, the infection that killed two homeless people in Boston and sickened three others. (Freyer, 3/16)

Seventeen people with infections caused by Elizabethkingia bacteria have died since the outbreak began in Wisconsin in November, an increase of two from last week, the state Department of Health Services reported Wednesday. The number of cases, which are spread across 12 counties, also increased, from 48 to 54. (Stephenson and Rutledge, 3/16)

Low-income adults in Minnesota are much more likely to develop diabetes than people with higher incomes, according to the Minnesota Department of Health. New research shows that 13 percent of working-age Minnesotans who earn less than $35,000 annually have diabetes. That compares to a diabetes rate of just 5 percent for earners who make more than $35,000. (Benson, 3/16)

A hospital in North Dakota's capital on Wednesday rescinded its decision to close its pediatric inpatient unit, two days after the closure was announced. CHI St. Alexius Health in Bismarck said in a statement that the unit will remain open, but the health system will still go ahead with its plans to lay off 23 employees, reassign others and close the inpatient rehabilitation unit for adults. (3/16)

Monument must pay a methadone provider $350,000 under a settlement that would keep the company from opening a facility there, the town's manager said Wednesday. The figure offered the first glimpse at how much taxpayers must pay to settle with Colonial Management Group - which sued Monument last year after town officials denied the company a business license and issued a moratorium on clinics opening in or around downtown. (Rodgers, 3/16)

The Centers for Disease Control and Prevention this week released well-reasoned guidelines for how doctors should prescribe opioid painkillers. The voluntary standards could make a difference in curbing the alarming increase in prescription drug deaths. ... To reduce this high toll, the C.D.C. is advising doctors not to prescribe opioids for chronic pain in most situations. Studies have found no evidence that the long-term use of opioids is beneficial, and in fact, exercise, physical therapy and over-the-counter drugs like acetaminophen can be more effective. The guidelines do not apply to cancer treatment, palliative care and end-of-life care, situations in which opioids are often the only way to reduce pain. (3/17)

Valeant analysts are leading from behind. Sell-side analysts, many of whom have been Valeant's staunchest defenders, belatedly started to sour on the company Wednesday. It's akin to pouring a dixie cup on the remains of a bonfire. But after the spit-roasting of Valeant's stock -- down 50 percent -- and the company's shambolic earnings call on Tuesday, some analysts finally came to terms with exactly how broken this company is. (Max Nisen, 3/16)

Back when it was a hedge fund, one thing that SAC Capital did was learn some negative results of a clinical trial of a drug about two weeks before those results were publicly announced, and then sell its stock in the drug company before the announcement. In a narrow sense this was a good trade, and SAC avoided several hundred million dollars of losses by getting out of the stock before the announcement. In a broader sense, this trade led to the end of SAC, which had to pay $600 million to the Securities and Exchange Commission, plead guilty to insider trading, and stop being a hedge fund because of it. Also the analyst responsible for the trade went to prison for nine years. (Matt Levine, 3/16)

On November 23, 2015, Pfizer announced that it would merge with Ireland-based Allergan. The resulting organization, valued at about $160 billion, will be the largest pharmaceutical company in the world. The chief motive for the merger is financial: to avoid paying higher corporate taxes, U.S. companies have started to merge with smaller companies based in countries with lower tax rates to effectively become foreign companies. This strategy is known as “corporate inversion” or “tax inversion,” and it’s become particularly attractive for health care companies. (Haider Javed Warraich and Kevin A. Schulman, 3/17)

In 2014, Americans reacted with outrage to reports that personnel at Veterans Health Administration (VA) medical centers had schemed to feign compliance with targeted waiting times for appointments. Whistle-blowers outed miscreants, alleging that clinical delays had caused scores of avoidable deaths. Political leaders blamed bad actors — and each other. Investigations led to firings — and congressional fury that not enough heads were rolling. The prevailing narrative was one of breakdowns of character and culture: dishonesty, callousness, and ineptitude. (M. Gregg Bloche, 3/17)

When former Apple CEO John Sculley first joined that seminal company, he was struck by co-founder Steve Jobs’ vision of changing the world through the “noble cause” of personal computing. Now, he said, he’s “totally excited and passionate about” a new noble cause – using high-level technology to transform health care. (Laura Ungar, 3/17)

Overhauling the health care system for Americans who answered the call of duty by serving in the military is a national priority. In the spring of 2014, the Veterans Health Administration (VA) faced a crisis with regard to veterans’ access to care. Systemic problems in scheduling processes had been exacerbated by leadership failures and ethical lapses. Demand for services was outstripping capacity. The result was that veterans did not have timely access to the health care they had earned. (David J. Shulkin, 3/17)

Ironies abound whenever the General Assembly meets, but Sen. Ralph Alvarado, R-Winchester, has provided one of the most profound and disturbing of this session. Alvarado, a physician, assured that more dirty hypodermic needles will be in circulation, spreading deadly blood-borne infections. He did this by attaching a noxious amendment in the Senate to a simple bill that had easily passed the House. (Timothy D. Easley, 3/16)