�鶹Ů��

Republicans, struggling to figure out their next steps after their health-care bill’s collapse, delivered mixed signals on Wednesday about how they will contend with the 2010 law, with a Trump administration official promising to uphold the law and others saying they will continue working on its repeal. Health and Human Services Secretary Tom Price said on Wednesday he is obligated to uphold the Affordable Care Act as long it is in place, but he didn’t commit to specific actions, including implementing the requirement that most Americans pay a penalty if they don’t have health coverage. (Armour, Peterson and Radnofsky, 3/29)

President Donald Trump's top health official got strong pushback Wednesday from lawmakers of both parties about deep cuts the White House is pressing in medical research, public health and social service programs. Health and Human Services Secretary Tom Price also dodged repeated attempts by Democrats to flush out the administration's next move on the Obama-era health insurance law. President Donald Trump's push to repeal the health care law failed last week because of disagreement among Republicans. (Alonso-Zaldivar, 3/29)

[U]nder intense questioning from Democrats, Price outlined how his department could make insurance plans cheaper by scaling back several federal mandates, including what the ACA currently defines as “essential benefits” in coverage. And he refused to say whether the administration will keep providing cost-sharing subsidies for insurers participating in the federal marketplace. The multibillion-dollar infusion is critical to maintaining the system’s stability, insurers say. (Eilperin and DeBonis, 3/29)

Pressed by Representative Mark Pocan, a Democrat from Wisconsin, on whether the administration still wants to repeal the law, Price said: “What we’re trying to do is make sure individuals have access to coverage and care.” (Edney and Tracer, 3/29)

He did note that he will enforce the law, including ObamaCare's mandate for people to have coverage. "So long as the law is on the books, we at the department are obliged to uphold the law," Price said. (Sullivan, 3/29)

As a member of Congress, Price was adamant: He spent years vowing to destroy the law, and addressing House appropriators on Wednesday, he railed against Obamacare for restricting Americans’ health care freedoms and vowed to do whatever he could to expand choice and lower premiums. But he left both lawmakers and the health care industry with several big, unanswered questions. (Cancryn, 3/29)

Nine senators are pushing U.S. Attorney General Jeff Sessions to reveal what he knows about a reported investigation into Health and Human Services Secretary Tom Price’s stock trades that a top federal prosecutor might have begun before being fired by the Trump administration this month. In a letter Wednesday, seven senators — six Democrats plus Vermont independent Bernie Sanders — called on Sessions to assure them that any investigation of Price — or others connected to the Trump administration — would be “allowed to continue unimpeded.” (Kopp and Bluth, 3/29)

Secretary of Health and Human Services Tom Price on Wednesday defended the Trump administration’s proposed cuts to medical research, saying that the National Institutes of Health budget is plagued by unnecessary expenses. ... Price also noted that given across-the-board HHS spending cuts, the NIH next year will continue to receive roughly one-third of total department funding. The remarks came a day after reports that the administration had proposed an additional $1.2 billion cut to the NIH for the current fiscal year, on top of a suggested $5.8 billion cut for 2018. The NIH’s 2016 budget totaled $32.3 billion. (Facher, 3/29)

A bipartisan group of lawmakers blasted President Donald Trump's proposed HHS budget cuts on Wednesday, saying patient lives could be at risk if the plan turns into reality. Republicans and Democrats on the House Appropriations Committee's Labor, Health and Human Services, Education and Related Agencies Subcommittee raised grave concerns to HHS Secretary Tom Price during a hearing Wednesday about Trump's proposed 16% cut to HHS' budget. The deep slashes would amount to a $12.6 billion loss to the agency, but there are few specifics about those cuts. Price said the changes would come to light in mid-May, when the full budget is slated for release. (Dickson, 3/29)

After Chairman Tom Cole (R-Okla.) said he was “extremely concerned” about the proposed $5.8 billion spending cut (which makes up about 19 percent of the NIH’s discretionary budget), Price responded that it is aimed at increasing efficiency. He noted about 30 percent of the NIH’s grant funding is used for purposes not directly associated with research. (Reid, 3/29)

The House appropriator who oversees the National Institutes of Health’s budget on Wednesday said in a hearing he expects further debate on administrative expenses at universities and other organizations that are funded through federal medical research grants. This could emerge as a flashpoint as Republicans and Democrats tussle over funding for the agency in fiscal 2018 and later years. Labor-HHS-Education Appropriations Chairman Tom Cole, R-Okla., told reporters after a Wednesday hearing that his panel would examine these so-called indirect costs funded by NIH grants. This could open a debate over how much funding for medical research ends up supporting more general expenses at universities such as rent and overhead, a topic that’s concerned lawmakers for years. (Young, 3/29)

George Yancopoulos, the Regeneron Pharmaceuticals Inc. co-founder who became a billionaire by turning scientific discoveries into medical treatments, warned that deep cuts to science budgets proposed by President Donald Trump would jeopardize the health of future generations. Failure to invest in biomedical research and basic science undermines the ability of firms to discover new therapies that can change or even save patients’ lives, said Yancopoulos, Regeneron’s president and chief scientific officer, in an interview. Without that investment, he said, bright minds would focus on developing apps and gadgets. (Tracer and Chen, 3/30)

The Agency for Healthcare Research and Quality has made enemies because it takes a hard look at whether popular — and often expensive — treatments like spinal surgery actually help patients. Supporters say it plays a key role in controlling health care costs and ensuring that medical practice is dictated by evidence, not the financial interests of doctors and insurers in a $3.4 trillion industry...But Republicans have long dismissed the agency as duplicative and wasteful. (Ross, 3/30)

Secretary of Veterans Affairs David Shulkin says the Department of Veterans Affairs "is on a path toward recovery." "We have a clear mandate to do better, [and] to make sure that we're honoring our mission to serve our veterans," Shulkin told NPR's Morning Edition. (Hersher, 3/30)

In its quest to merge with Cigna Corp., national insurer Anthem has suffered more than a few setbacks. But just days after defending the $54 billion merger in federal appeals court, Anthem finally got some good news. President Donald Trump said he will nominate former Anthem lobbyist Makan Delrahim to the top post in the Justice Department's antitrust division. The nod to Delrahim could be a boon for the Anthem-Cigna merger, which was blocked by a U.S. District Court judge for threatening to harm competition in the national employer market. Indianapolis-based Anthem has been holding out hope that its beleaguered deal will close under a new U.S. Justice Department led by the Trump administration. (Livingston, 3/28)

President Donald Trump is vowing to step up efforts to combat the nation's opioid addiction crisis, and he's tapped New Jersey Gov. Chris Christie to lead the fight. Trump convened an emotional roundtable Wednesday with Christie, members of his Cabinet, law enforcement chiefs, recovering addicts and advocates. It was the first public event tied to the launch of a new addiction commission that Christie, a longtime Trump friend and formal rival, will chair. (3/29)

As a candidate, Donald Trump promised rural towns and states hit hard by opioid addiction that he'd solve the epidemic ravaging their communities. "We will give people struggling with addiction access to the help they need," Trump vowed in October. Trump won many of those communities — often overwhelmingly. But as president, he's proposing deep cuts to research and treatment in favor of funding a border wall to stop drug traffic, while hinting at bringing back policies like criminalization of drug misuse — and announcing Wednesday yet another big presidential commission to study the problem. (Diamond and Karlin-Smith, 3/29)

Governor Charlie Baker, increasingly defined by his uncomfortable political relationship with President Trump, was in line Wednesday for a presidential appointment to a panel aimed at fighting opioid addiction, individuals in Boston and Washington familiar with the matter said. The appointment would put Baker at the center of national efforts to combat the opioid crisis, which has killed thousands of people in Massachusetts — and thousands more across the country. (O'Sullivan, 3/29)

Calling the recent surge in opioid-related overdoses one of “the biggest public health and law-enforcement crises of our time,” prosecutors in Brooklyn announced the indictment on Wednesday of 34 people charged with running a sprawling drug ring that sold a potent new designer narcotic never before seen in New York City — furanyl fentanyl. (Feuer, 3/29)

Sarah [Fuller] was given Subsys, a fast-acting opioid that is 50 times more potent than heroin. Fifteen months later, Sarah's fiance found her dead in their home. Now a lawsuit places ultimate responsibility for her death on Insys Therapeutics Inc., which makes Subsys, a brand-name version of fentanyl...Deaths from fentanyl have been surging, but nearly all of them are tied to illicit versions of the drug, which is cooked up by cartels overseas and mixed with heroin sold on the street. (Sapatkin, 3/30)

House Republicans are considering making another run next week at passing the health-care bill they abruptly pulled from the floor in an embarrassing setback to their efforts to repeal Obamacare. Two Republican lawmakers say that leaders are discussing holding a vote, even staying into the weekend if necessary, but it’s unclear what changes would be made to the GOP’s health bill. They described the discussions on condition of anonymity. (House and Kapur, 3/29)

House Republicans insist they aren’t leaving for dead their effort to repeal ObamaCare. But days after failing to move the American Health Care Act forward, there are no discernible signs of progress in bridging the differences within the Republican conference that led to an embarrassing retreat last week. Some centrist GOP lawmakers are pushing back on reviving the House bill, which GOP leaders and President Trump moved to the right in a bid to win over the conservative House Freedom Caucus. (Sullivan, 3/30)

Leadership has yet to make any concrete decisions on the path forward for health care after pulling a bill last week (HR 1628) that would have partially repealed and replaced the 2010 health care law. The House Energy and Commerce Committee, however, has set up a members-only meeting for Thursday to discuss the path forward for the effort to repeal and replace the law, aides and lobbyists told CQ. (McPherson, 3/29)

Colorado Republican U.S. Rep. Ken Buck on Wednesday said he wants to see the GOP’s left-for-dead health care overhaul resuscitated for a vote within the next month, while a health care consultant warned that the lingering uncertainty around national health policy will probably scare even more insurers away from the coverage exchanges. The comments are a sign that the storm clouds looming above the Affordable Care Act won’t be blowing over anytime soon, despite the failure of congressional Republicans to move forward last week with their national health care plan. (Ingold, 3/29)

The bill's failure was a blow to President Donald Trump's legislative agenda and set off days of finger-pointing, including at conservative Republicans for, as some critics viewed it, doing Democrats a favor by withholding support for the bill. The White House and Ryan indicated they hope for another shot at the issue. But Senate Majority Leader Mitch McConnell said his chamber isn't planning to tackle it. (Hansen and Nowicki, 3/29)

One of the House Republican rebels, Kentucky Rep. Tom Massie, wasn't just "no" on the GOP health care bill to replace Barack Obama's Affordable Care Act. Massie was "hell no." That won over Mary Broecker, president of the Oldham County Republican Women's Club and a strong proponent of a full-blown repeal of the 2010 law. "When he came out against this bill, I thought, 'I trust him so this must be the right way,'" the 76-year-old retired teacher said of Massie this week as she sat at a coffee shop near her LaGrange home. (Beaumont and Lovan, 3/30)

Note to President Donald Trump and House Republicans: People really don't like your approach to overhauling America's health care. If you're hoping to revive the effort, you may want to try something different. Sixty-two percent of Americans turned thumbs down on Trump's handling of health care during the initial weeks of his presidency, according to a poll by The Associated Press-NORC Center for Public Affairs Research released Wednesday. It was his worst rating among seven issues the poll tested, including the economy, foreign policy and immigration. (Fram and Swanson, 3/30)

Of six changes the GOP bill would have made to health care, five drew more opposition than support. Those included allowing insurers to charge older customers higher premiums than is now allowed (80 percent opposed), surcharges for people whose insurance coverage lapses (70 percent opposed), reducing funding for Medicaid (64 percent opposed) and denying federal funding to Planned Parenthood (56 percent opposed). In addition, more oppose than favor replacing income-based subsidies with age-based subsidies for people buying insurance, 48 percent to 16 percent. (Swanson, 3/30)

A growing majority of Americans – including a sharply increasing number of Republicans – oppose an outright repeal of Obamacare, according to a new McClatchy-Marist Poll, signaling trouble for Republicans still hoping to dismantle the 2010 health care law. Efforts to repeal and replace the law collapsed last week, after GOP lawmakers couldn’t agree on an alternative health care system. (Magness, 3/30)

President Trump’s approval rating is falling in the wake of the GOP's failed effort to repeal and replace ObamaCare, according to a new poll. Trump's numbers have dropped 4 points in a Morning Consult/Politico survey out Wednesday. Forty-six percent approve of Trump after the American Health Care Act’s (AHCA) demise, down from 50 percent in the same poll last week. (Hensch, 3/29)

Republican voters are mostly blaming the failure of the GOP's healthcare bill on Congress, instead of pointing the finger at President Trump or Speaker Paul Ryan (R-Wis.), according to a Reuters/Ipsos poll out Wednesday. Among Republicans in the survey, 26 percent blame the bill's defeat on House Democrats, while another 23 percent say House Republicans are at fault. Only 13 percent blame Trump for the failure, and even fewer, 10 percent, say it's Ryan's fault. (Greenwood, 3/29)

Liberals are pushing in from the left with their own health-care solutions, looking to gain new ground after last week’s Republican meltdown over an Obamacare replacement. The Progressive Change Campaign Committee, a political action committee that aims to represent the “Elizabeth Warren wing of the Democratic Party,” began circulating a petition Wednesday calling for every person to have access to a Medicare-type plan — an idea supported by the party’s left wing but viewed with some skepticism by moderates. (Cunningham and Weigel, 3/29)

If at first he didn't succeed in Congress, President Trump may nevertheless be poised to undercut the Affordable Care Act. After a stinging defeat on health care in Congress last week, Trump said Tuesday night that cutting a deal with Democrats will be "such an easy one." Yet House and Senate Democrats say there's been no outreach while the White House clarifies it remains committed to repealing Obamacare. Meantime Trump could use a pending lawsuit and agency directives to help short-circuit the current health care law. (Przybyla, 3/29)

House Republicans flew through ObamaCare repeal and replace solo, attempting to pass the legislation quickly this year without a single Democratic vote. Now some, including those who helped kill the bill, are calling for bipartisanship. But Democrats feel burned in the process and before lending a helping hand say they need to first see clear signals Republicans are committed to working across the aisle. (Roubein, 3/29)

Senate Democrats are pressing President Trump to drop the GOP effort to repeal ObamaCare and work with them to fix it. Forty-four Democratic senators signed a letter to Trump, sent Wednesday, stating that they "remain ready and willing to work with him."...Wednesday's letter comes at a time when some House Republicans are eyeing a second run at their legislation to nix the Obama-era law, though Senate GOP leadership is signaling they want to move on to other policy fights, including the Supreme Court and funding the government. (Carney, 3/29)

The fallout from Friday’s Republican health care bill collapse is still trying to be understood. Right after the bill was pulled, President Trump teased that he wanted to work with Democrats and believed a bipartisan bill would be possible. But it wasn’t clear if that was just talk. On Tuesday night, he may have taken the first step to trying to reach across the aisle. (Montanaro, 3/29)

We’re still sifting through the fallout of Republicans’ failure to repeal and replace the Affordable Care Act last week. One consequence: It’s reignited the debate in some states about whether to expand Medicaid. First out of the gate, the Kansas Legislature. Yesterday, state lawmakers sent the governor a bill to do just that. Nineteen states yet to expand may also begin to re-evaluate their options. (Gorenstein, 3/29)

After years of a proposed Medicaid expansion going nowhere in Kansas, the conservative state legislature has just voted to approve it. This comes after federal lawmakers dropped their bid to repeal and replace the Affordable Care Act, which gives states money to expand their Medicaid programs. (Young, 3/29)

The national health care landscape has shifted so dramatically over the past month that earlier this week, the Republican-dominated Kansas Legislature did what many in that state long thought impossible: voted to expand Medicaid. ... the news of further Medicaid expansion hasn’t sat well with many Republicans in Washington. “My concern is I want the Medicaid dollars to be used the best way they can be, and I think they should be emphasized for those people with disabilities and the elderly and children,” Congressman Roger Marshall of Kansas, a Republican, told STAT. “I think that I would still try to emphasize spending money on federally qualified clinics. … Mental illness needs some specific monies probably spent on it as well. We’re not doing a great job with it right now.” (Facher, 3/29)

An effort to keep Arkansas' hybrid Medicaid expansion for another year fell short in the state House days after an attempt by congressional Republicans to repeal the federal health law that created the program failed. The House voted 73-17 Wednesday for the budget for the state Medicaid program, including the expansion, falling two votes short of the 75 needed to send the measure to the governor. House leaders did not indicate when they would try another vote on the bill. (3/29)

Senate Bill 196 by the Joint Budget Committee, which would appropriate funding for both the Medicaid expansion program and traditional Medicaid, received 73 votes in support and 17 against. As an appropriation bill it requires a three-fourths vote, or at least 75 votes in the 100-member House. ... House Speaker Jeremy Gillam, R-Judsonia, told reporters Wednesday he was confident the House would pass the bill later in the week. (Lyon, 3/29)

Missouri's Republican-led House has squashed an attempt by Democrats to expand Medicaid eligibility. Members voted 102-41 against a proposal by Columbia Democratic Rep. Kip Kendrick to broaden eligibility under former President Barack Obama's federal health care law. (3/29)

After seven years of trying, Republicans failed to repeal and replace the Affordable Care Act last week. That doesn't mean the health care drama is over, though. House Speaker Paul Ryan this week told donors that the party is "going to keep getting at this thing," according to The Washington Post. But whatever Ryan and his colleagues manage to do, plenty could still change in the Affordable Care Act. Last week's failed bill, after all, was only one part of the GOP's plan. (Kurtzleben, 3/29)

A looming push to overhaul the U.S. tax code could include the repeal of Obamacare taxes left intact by last week's collapse of the Republican healthcare bill, the Senate's top Republican on tax policy said on Wednesday. (Morgan, 3/29)

Two key Republican senators on Wednesday unveiled legislation intended to help individuals who live in areas with no insurers participating in the insurance market created by the 2010 health law. The draft bill, by Tennessee Sens. Lamar Alexander and Bob Corker, would give individuals in counties with no insurance options in the individual marketplace the ability to use subsidies provided under the health law for any state-approved plan, regardless of whether the insurance was offered through the marketplace, according to a summary. (Williams, 3/29)

With the GOP effort to replace the Affordable Care Act in tatters, two Senate Republicans are seeking an emergency patch to help people who could find themselves with no options to buy health insurance through exchanges next year. The legislation, which would run through 2019, would help people affected by insurers leaving the individual market, as Republicans seek to limit the fallout from what they see as the failures of Obamacare in the absence of broader legislation to overhaul the health insurance system. (Reid, 3/29)

Buoyed by Congress’ failed attempt last week to replace the Affordable Care Act, California officials, health advocates and insurance executives are pressing forward on a new phase of resistance against GOP efforts to weaken the health care law. California Insurance Commissioner Dave Jones sent a letter Wednesday to the White House and Health and Human Services Secretary Tom Price, urging the administration to enforce the law. (Ho, 3/29)

Ohio health insurers are owed more than $100 million by the federal government, which was supposed to protect them from losses during Obamacare's startup, according to a cleveland.com review of records. They may never get it, thanks to a Republican provision. The provision slipped into a spending bill in late 2014, after the Affordable Care Act was under way, restricted the government in making payments. (Koff, 3/29)

A new Missouri law cuts off a line of funding to all organizations that provide abortions in the state, including hospitals. For years, Missouri has helped low-income women pay for family planning under a Medicaid program called Extended Women's Health Services, which is funded by both the state and the federal governments. (Bouscaren, 3/29)

The collapse of the Republican health care overhaul was a sharp setback for anti-abortion leaders, whose hopes of halting federal funding to Planned Parenthood were derailed. But they continue to pursue that goal and also are pushing for a federal ban on most abortions after 20 weeks of pregnancy. (3/29)

Arkansas Gov. Asa Hutchinson on Wednesday signed into law a measure that would impose fines and prison time on doctors who perform abortions that are based solely on whether the mother wants to have a boy or girl. Under the new law sponsored by Republican Rep. Charlie Collins, a physician performing the abortion would ask the patient if she knows the sex of the child. If she does, the doctor must let her know that it's illegal to have an abortion based solely on gender. (Mukunyadzi, 3/29)

The Arizona Legislature has passed a bill regulating how doctors must care for a baby born alive during an abortion. Opponents say the bill would force doctors to perform pointless procedures during what could be an infant's final few minutes of life. During the final votes Wednesday, backers added an amendment they say will mitigate the effect on babies born early with fatal fetal defects, while still assuring doctors give babies every chance of survival. (Beard Rau, 3/29)

Gov. Matt Bevin's administration is seeking to shut down Kentucky's only abortion provider, prompting a federal lawsuit by the clinic to block the move it says would have “a devastating impact on women.” Bevin’s administration has ordered the EMW Women’s Surgical Center in Louisville to stop providing abortions starting Monday, claiming it lacks proper agreements for patient care in the event of a medical emergency. (Yetter, 3/29)

Kentucky’s only remaining clinic that performs abortions is challenging a state order that would shut it down. The complaint was filed Wednesday in federal court by the American Civil Liberties Union on behalf of the EMW Women’s Surgical Center in Louisville. (Lovan, 3/29)

Barely 24 hours after introducing legislation that would ban abortions once a fetal heartbeat is detected, Iowa Republicans reversed course Wednesday and instead took steps to advance a less restrictive bill that would ban abortions after 20 weeks into a pregnancy. (Pfannenstiel, 3/29)

Legislation that would require medical centers to bury or cremate the remains of aborted fetuses won initial approval in the Texas Senate on Wednesday. Because Senate Bill 258 by Sen. Don Huffines, R-Dallas, did not have enough votes to be finally approved, a follow-up vote will be needed before it goes to the House. (Ward, 3/29)

Doctors are on the cusp of launching the first new male contraceptive in more than a century. But rather than a Big Pharma lab, the breakthrough is emerging from a university startup in the heart of rural India. Years of human trials on the injectable, sperm-zapping product are coming to an end, and researchers are preparing to submit it for regulatory approval. Results so far show it’s safe, effective and easy to use—but gaining little traction with drugmakers. That’s frustrating its inventor, who says his technique could play a crucial role in condom-averse populations. (Altstedter, 3/29)

Climate change is not only harmful to our physical health — it can be debilitating for our mental health as well, according to a report published Wednesday. Severe weather events and natural disasters linked to climate change have the most dramatic impact on mental health, according to the report by the American Psychological Association and EcoAmerica: Natural disasters cause intense negative emotions in people who are exposed to them, primarily fear and grief. Anxiety, depression and unhealthy behavior are also common responses. (Naqvi, 3/29)

For more than a decade, growing numbers of women diagnosed with cancer in one breast have been opting to get both removed. Experts have been trying to discourage this radical approach, because for most women, it adds to surgical risks and medical costs without improving survival. It also defies decades of advances, such as lumpectomy, that have made surgery less aggressive. Now, the first study to look at the double mastectomy trend state by state finds wide geographic  variation, with startlingly high rates among younger women. (McCullough, 3/29)

A baby born recently in San Diego County is the first in the region to suffer birth defects after the infant’s mother contracted the Zika virus while traveling abroad. Public health officials said the case, announced Tuesday by the county government, is a reminder that the risk of Zika infection continues in warmer climates even though mosquitoes are dormant in San Diego. (Sisson, 3/29)

Saying they cannot afford to wait for a congressional rewrite of the nation's health laws, House and Senate negotiators announced a deal on a bill that aims to rein in soaring health insurance costs in Minnesota. The proposal would prop up the individual insurance market by creating a reinsurance program to help insurers cover expensive medical claims. (Bakst, 3/29)

Minnesota lawmakers have adopted a plan to try to stabilize the state’s individual health insurance market — but it’s uncertain whether Gov. Mark Dayton will sign it. The measure, called “reinsurance,” would spend $542 million in state money over two years to try to lower premiums in the individual market. That covers roughly 4 percent of Minnesotans who have neither employer-sponsored insurance nor a government health plan such as Medicare or Medical Assistance. If implemented, the $271 million per year would pay for some high-cost claims borne by the state’s HMOs. (Montgomery, 3/29)

A handful of rural Colorado hospitals are facing the risk of closure from the spending cuts embedded in the $26.8 billion state budget bill that won preliminary approval Wednesday in the state Senate. The budget package cuts more than $500 million in payments to the state’s hospitals for uncompensated care in part of an effort to balance a spending bill in a year mired by fiscal constraints and increasing demands. (Frank, 3/29)

Just one day after the Texas Senate passed its two-year budget, a key House committee sent their own spending proposal to the full House – but not before cutting $2.4 billion from the state’s largest health care program for the poor and disabled. Emboldened by the election of President Donald Trump, Texas House budget writers voted to cut $1 billion in state funding for Medicaid, the federal-state insurance program that mostly serves children, pregnant women and people with disabilities. (Walters, 3/29)

A longstanding fight over the use of telemedicine in Texas appeared to end Wednesday, as the Texas Senate unanimously approved legislation to legalize online doctoring on a wide scale for the first time. Sen. Charles Schwertner, the Senate's health and human services chairman who authored the measure, said Senate Bill 1107 will allow doctors to see patients electronically in what will benefit patients, especially in rural areas. (Ward, 3/29)

A measure to create a commission to monitor federal actions that could affect health care in Maryland has cleared the General Assembly. The Senate voted 32-14 on Wednesday for the bill, sending it to Gov. Larry Hogan. (3/29)

A bill before the Senate Health Committee today attempts to crack down on the more than 550 chronic dialysis clinics in California. The centers serve roughly 63,000 patients with end-stage kidney failure, according to the state. Patients sit at stations for hours as machines clean and filter the blood back into the body, taking on the role of a healthy kidney. (Luna, 3/29)

Michigan and the city of Flint have agreed to spend the next several years replacing roughly 18,000 aging underground pipes as part of a far-reaching legal settlement over the city’s ongoing crisis involving lead-tainted water. A settlement approved by a federal judge Tuesday will require the state to fund Flint’s efforts to replace the lead and galvanized water service lines by 2020. (Dennis, 3/28)

The joint venture between UCF medical school and the for-profit hospital chain HCA took another step on Wednesday toward building a 100-bed hospital in Lake Nona. The Facilities Committee of the Florida Board of Governors unanimously approved the deal. The public-private venture will go in front of the full board on Thursday for a final vote. (Miller, 3/29)

It’s a test the Massachusetts health care system has failed two years in a row: restraining growth in medical spending to 3.6 percent. But undeterred, the state’s health care watchdog agency on Wednesday approved a more aggressive target, saying doctors and hospitals must do more to slash unnecessary costs. The Health Policy Commission reset the limit to 3.1 percent a year, starting in 2018. (Dayal McCluskey, 3/29)

Massachusetts will aim to hold health care spending increases to 3.1 percent next year, a drop from this year's target of 3.6 percent. Both targets were set in a 2012 state law that aimed to keep the growth of health care costs in line with other sectors of the economy. The state's Health Policy Commission could have voted against the lower benchmark for the coming year, but it did not. (Bebinger, 3/29)

Though it has made strides in some health measurements, Petersburg remains one of the unhealthiest municipalities in Virginia as poverty continues to plague the city. The Robert Wood Johnson Foundation’s annual County Health Rankings report places Petersburg at 132 on the list of Virginia counties and cities, followed only by Emporia. (Demeria, 3/29)

Forsyth County, northeast of Atlanta, is the healthiest in Georgia for the fifth straight year, according to the 2017 County Health Rankings. The list was released Wednesday by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The rest of the top 10 are: Oconee, Fayette, Gwinnett, Cherokee, Columbia, Cobb, Harris, Coweta and Paulding. Those were the same as last year, though in a different order. (Miller, 3/29)

The country's largest advocacy group for gay, lesbian, bisexual and transgender people has criticized Johns Hopkins Medicine in its latest health index for not taking a tough stance on the controversial views of two of its psychologists who believe there is virtually no scientific evidence that people are born gay or transgender. The Human Rights Campaign deducted 25 points from the medical institution's final score under the "responsible citizenship" clause. The clause focuses on activity that would undermine the care or equality of LGBTQ patients. (McDaniels, 3/29)

The first drug to treat an aggressive form of multiple sclerosis has won approval from the Food and Drug Administration, a significant medical development with ties to the Tampa Bay area. Local patients helped test the safety and effectiveness of the drug in clinical trials at the University of South Florida's Multiple Sclerosis Center, said Dr. Derrick Robertson, the center's director. (McGrory, 3/30)

Replacing the aging twin towers at the MetroHealth System main campus will dramatically improve patient care and sustain the future of Cuyahoga County's hospital, officials say. MetroHealth's board of trustees voted March 22 to self-issue $1.3 billion in bonds for the project, including a parking garage, central utility plant and 12-story hospital. The building is expected to open in 2022 with 150 adult acute care beds, 96 perinatal care beds and 24 specialty unit beds. (Farkas, 3/29)

Sixteen years ago, city and school officials in San Francisco came together with dentists to figure out how to improve oral health in students. The program screens all San Francisco public school kindergartners for tooth decay.A new report shows it’s working. (Klivans, 2/39)

More than 150 parents came out to a Tuesday night school board meeting to oppose a controversial new sexual health education curriculum that many said was “too graphic” and “not age appropriate” for their Cupertino Union School District seventh-graders. At the March 28 meeting, the school board voted 2-2, with Phyllis Vogel and Anjali Kausar in favor, Liang Chao and Kristen Lyn voting against and Soma McCandless recusing herself. (Myllenbeck, 3/29)

As some states and cities around the nation look to ease criminal punishment for marijuana possession, Tennessee’s conservative Republican legislature is blocking that trend in Nashville and Memphis. As a result, police in those cities could soon lose their option of giving minor citations for carrying small amounts of marijuana. (Mattise, 3/29)

President Trump has discovered that trying to work with Republicans, like trying to work on health care policy, is complicated. So with all his big campaign pledges in limbo following last week’s Obamacare fiasco, he reportedly is contemplating overtures to a party that actually wants to govern: the Democrats. This new tack comes, mind you, after Mr. Trump blamed Democrats for refusing to help him and House Speaker Paul Ryan eviscerate Obamacare. With zero support from Democrats, the pair had no margin for error as Republicans started to defect and were forced to pull their bill. (Will Marshall, 3/30)

President Trump is now claiming he really, really wants to make a big deal with Democrats, striking a rhetorically conciliatory pose after previously suggesting that Democrats would come to him on their knees begging him to bail them out once Obamacare collapsed all around them. ABC News reports that Trump told senators at a White House reception Tuesday night that a deal is “going to happen,” because “we’ve all been promising — Democrat, Republican — we’ve all been promising that to the American people.” (Greg Sargent, 3/29)

House Speaker Paul D. Ryan (R-Wis.) told GOP donors Monday that he had not abandoned his effort to pass a major health-care reform bill. But he sounded a more realistic note last Friday: “We’re going to be living with Obamacare for the foreseeable future,” he admitted after House Republicans failed to unite around a repeal-and-replace bill. The real question facing Republicans is one Mr. Ryan fielded Friday: “Do we try to prop it up?” His answer: “It is so fundamentally flawed, I don’t know if that is possible.” (3/29)

There’s no better time for Congress to prove that it can still do the tough stuff. Members should lay down their swords and figure this out. Watching the slow-motion death of the Affordable Care Act may be the choice of politicians seeking an electoral advantage in 2018. But it’s no way to govern the world’s leading democracy when so many other countries have health care systems that work. (3/29)

If the GOP is going to be a governing party, and not just the raucous opposition, it has an opportunity and a duty to repair the flaws in the Affordable Care Act, aka Obamacare. Contrary to the hot talk from Trump, it is not exploding. But it needs work. Premiums on the individual market are rising faster than they should in some parts of the nation — although less so in Washington — and insurers are skittish about the future. (3/28)

House Republicans are suing to pare back Obamacare subsidies, and President Trump implied he will revisit the insurance issue, because Obamacare is “exploding right now.” Here’s what you need to know going forward. While Republicans marketed their dumber-than-dirt plan as a conservative replacement for the Affordable Care Act, they were wrong. We already have a conservative health plan. (Rich Barlow, 3/30)

The Trump administration, working with governors and state legislatures, could make dramatic state by state changes to Medicaid and the ACA marketplaces using waivers that are allowed by federal law. Because waivers are enacted at the state level, they generally don’t garner the attention from the national press as federal health care bills in Congress. With less press and public scrutiny, reforms unpopular in Congress can still become policy. The Trump administration has already signaled its intention to push state health reform forward using waivers by sending letters to governors. (Rachel Gershon, 3/29)

As House Republicans discuss how to reboot their effort to repeal and replace Obamacare, President Trump’s favorite idea has been curiously absent: buying insurance across state lines. But a new approach to replacing Obamacare could make it easier for Republicans to enact this idea under Senate rules. It has long been a favorite concept among Republicans. ... Sometimes, interstate insurance sales are brought up as an idea that can singlehandedly eliminate the health cost problem in America. That’s not true, but what is true is that interstate insurance—especially in metropolitan areas that cross state lines, like New York City or St. Louis, a regional multi-state plan could do a better job of playing cross-state hospitals against each other. (Avik Roy, 3/29)

Fee for service, the dominant payment model in health care today, relies on an elaborate fee schedule for every identifiable procedure. Unfortunately, it has created incentives for doing more tests and surgeries than may be necessary. The concept of population health stands in contrast to the fee-for-service model. It focuses on managing the health of a population by providing the right interventions for patients at the least costly point in the care continuum — from preventive care programs to post-acute services. Population health management means paying providers or health systems on a per-patient, per-month basis rather than sticking with the fee-for-service system of paying for each service rendered. With quality reporting and guarantees built in, this change provides incentives to keep people healthy — not just treat them when they are injured or sick. (Rita E. Numerof and David B. Nash, 3/29)

Health policy in this country is, in fact, really challenging, not simply because of all the systems involved, but also because of our conflicting principles and feelings. We are very worried about who is sick now and not always clear about how to keep others from getting sick. As we consider health care policy, we would do well to think about how and why we allocate our resources the way we do. (Ryan Holmes, 3/29)

Republicans’ seven-year “repeal and replace” effort died in a fiery legislative crash two months into the Trump administration last week. Various tactical missteps helped produce this legislative failure, but the most fundamental reason the Affordable Care Act (ACA) prevailed has nothing to with the legislative tick-tock: In its own imperfect way, the ACA has insured 20 million people who would otherwise have gone uncovered. It has helped tens of millions of others who face financial or health challenges. And in doing so, it has quietly embedded itself within the fabric of American life — and has become very difficult for politicians to kill. (Harold Pollack, 3/29)

One common fear after President Donald Trump's inauguration was that the agenda of the following four years would be driven by fake news -- an administration of "alternative facts." In his first press conference, White House press secretary Sean Spicer doubled down on President Trump's inaccurate claim that the crowd for his inauguration was the largest in history. The president has also repeated his unsubstantiated (and roundly debunked) claim that, were it not for millions of fraudulent votes, he would have won the popular vote in the election. That kind of talk works, as far as it goes. It gets attention. It stokes emotion. It distracts from the administration's substantive failures. But that kind of talk doesn't get any work done. When it came time to generate an actual bill, which could pass both chambers of Congress and hold up to judicial review … well, that's when bluster sputters out and the gears of lawmaking grind into action. (Conor Sen, 3/29)

[W]hile the quality of "strong leadership" was something Trump sought to reinforce throughout his campaign, a new poll finds that the number who see it in him appears to be dropping. Following his stinging defeat on the health care bill, 50 percent of the 1,500 U.S. adults in a poll released Wednesday said Trump was either a "very strong" or "somewhat strong" leader in a question about leadership qualities. That's down from 54 percent last week; in the first results after his inauguration, 61 percent said Trump was a strong leader. (Jena McGregor, 3/29)

It has become a tired, familiar act. Members of the House Freedom Caucus say they are the only true conservatives, while other congressional Republicans are RINOs, “Republicans in Name Only.” In the latest episode, the Freedom Caucus and its outside allies—including Heritage Action and FreedomWorks—denounced the GOP health-care bill as “ObamaCare Lite.” (Karl Rove, 3/29)

The Republicans in the House Freedom Caucus are getting more than their fair share of the lumps. When it comes to threatening to shutter the federal government in a budget showdown over impossible political demands, this group has been a menace to good governance. But in this case, they were right. (Robert Robb, 3/29)

According to the cynical old saw, apocryphally attributed to Joseph Stalin, a single death is a tragedy but a million deaths is a statistic. I’ve been pondering that line lately, apropos the 183,000 deaths related to prescription opioid overdoses between 1999 and 2015 — a figure sure to rise when 2016 data come out. ... Prescription opioid overdose deaths were rare before the 1990s, suggesting the current wave could have been avoided, and that one or more persons or institutions can and should be held accountable. (Charles Lane, 3/29)

In a Wednesday press briefing following a meeting of this White House commission, the White House press secretary, Sean Spicer, blamed the crisis on "cheap heroin" flooding the market, and he credited President Donald Trump with already taking action against drug cartels. He framed the battle against the epidemic as one for the Drug Enforcement Administration and law enforcement. If that's what the White House is focused on, it has the situation all wrong. (Linette Lopez, 3/29)

Opioid abuse has turned into a killer drug epidemic across the nation, but especially so in Ohio, where more than 3,000 people died of overdoses in 2015. The toll of the crisis plays out daily in our homes — in poor and affluent communities alike — and is placing an enormous burden on families, law enforcement and community safety nets. (3/30)

Two years ago, Princeton University economists Anne Case and Angus Deaton disclosed a shocking finding: Between 1999 and 2014, middle-aged (45-54) white Americans with a high school education or less died at a rate never before seen in a modern industrialized society. Alone among every other demographic group they studied, this group’s life expectancy was shrinking. The group’s annual mortality rate jumped from 281 per 100,000 to 415 per 100,000 during the 15 years studied. Big reasons: Striking increases in the number of suicides, drug overdoses and liver disease caused by alcohol poisoning. Case and Deaton called them “deaths by despair.” (3/29)

When it comes to the right to die in the face of terminal illness, Congress has previously deferred to the states. Indeed, the liberty to relinquish life has thus far garnered limited congressional attention. Whether or not this will continue is uncertain. After all, the right to die is closely aligned with the right to choose to terminate a pregnancy, wherein the sanctity of life features just as prominently. Both constitute leading moral issues of our time, comprising 2 sides of the same proverbial coin. (Eli Y. Adashi, 3/29)

Bet you thought the mess that was Trumpcare was about as horrible a piece of legislation that could be concocted for ruining a lot of people's health. Nope. A bill called the Preserving Employee Wellness Programs Act, currently under enthusiastic review by Congress, will allow employers to charge their employees a higher insurance premium if they refuse to provide them with their personal genetic information. It is hard to think of a worse idea. (Arthur L. Caplan, 2/29)

The discovery that the water in Flint, Michigan, was contaminated with lead shows that excessive exposure to this toxic metal remains a threat to human health. The episode resulted from a series of poor decisions by politicians that allowed lead to leach from pipes and fixtures into the water flowing into residents’ homes. But Flint is by no means unique with regard to lead hazards. A 2016 report identified 3000 US communities in which the percentage of children with a blood lead concentration greater than 5 μg/dL, the current Centers for Disease Control and Prevention (CDC) reference value, exceeded that among affected children in Flint. (David C. Bellinger, 3/28)

A major study of the grocery-buying habits of millions of Americans released late last year found that people using food stamps generally make the same unhealthy food choices as everyone else in America. Too many sweets, salty snacks and prepared desserts. Junk food, in other words. But when it came to soda and its sugary ilk, the results were more surprising, and not in a good way. (3/29)

Republicans have waited a long time to make numerous changes to Iowa law. Now that they hold majorities in the Iowa Legislature, they’re moving as fast as possible. On their list is limiting the amount of money an injured patient can collect after being victimized by medical malpractice or nursing home negligence. (3/29)

A leaked draft of a Trump administration executive order proposed a sweeping interpretation of “religious freedom” that would allow organizations and businesses to circumvent legal protections against discrimination. This proposal echoes a controversial plan in Indiana signed by now-Vice President Pence. Discrimination for any reason is antithetical to true religious liberty, and it’s time for people of faith to raise their voices in opposition. (Sheila Briggs, 3/29)

There’s no question that anti-abortion activist David Daleiden surreptitiously recorded healthcare and biomedical services employees across the state of California with the intent of discrediting the healthcare provider, Planned Parenthood — something his heavily edited videos failed to do. There’s also no question that it’s against state law to record confidential conversations without the consent of all the parties involved. But that doesn’t mean that California Atty. Gen. Xavier Becerra should have charged Daleiden and his co-conspirator, Susan Merritt, with 15 felony counts. (3/30)

The Founding Fathers were all too aware of the death and destruction across centuries driven by the intent to impose particular religious beliefs and practices on those with different convictions. Hence, the Establishment Clause of the Constitution. Thus, Hobby Lobby was excused from something no more burdensome than the ACA requirement to submit a form testifying that they were opposed to contraception on religious grounds — if they were to omit contraceptive care from their health insurance. However, many of the people and organizations who lauded the Hobby Lobby decision do not recognize that government interference with abortion-rights they propose is a more severe violation of the same amendment to which Hobby Lobby appealed. (Thomas W. Allen, 3/30)

A little-noticed cut in President Trump’s proposed “budget blueprint to make American great again” would eliminate the Fogarty International Center, which is part of the National Institutes of Health. That would be a big mistake for the United States and the rest of the world. The center ... has initiated and sustained research around the globe aimed at fighting polio, tuberculosis, AIDS, and other infectious diseases, as well as focusing on global environmental health, bioethics, noncommunicable diseases, and more. Through more than 400 research and training projects, the center has trained well over 5,000 scientists worldwide. (Arthur L. Reingold and Madhukar Pai, 3/29)

Kansas City voters will be asked Tuesday to reduce the penalties for minor marijuana possession in the city. The proposal — Question 5 on the ballot — is fraught with potential complications and unintended consequences. Voters should reject it. The plan came to the ballot through an initiative petition. It would limit fines in Municipal Court to no more than $25 for possession of 35 grams of marijuana or less — about an ounce and a quarter. (3/29)