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House Speaker Paul Ryan has a lower job approval rating than President Donald Trump in a new survey released Monday by the Pew Research Center. Less than a month since the collapse of the House GOP health-care bill, only 29% of those surveyed by Pew approved of Mr. Ryan’s job performance, compared to 39% for Mr. Trump — itself a historically low rating for a new president. (Peterson and Ballhaus, 4/17)

A Republican congressman who in 2010 lost both legs after stepping on a roadside bomb in Afghanistan told an occasionally raucous town hall meeting here that he supports his party’s push to repeal the Affordable Care Act because Americans should be free to go without health care if they so choose. “There are positives and negatives” in the health law known as Obamacare, said Rep. Brian Mast, who noted he gets his health care from the Veterans Health Administration. “I’m not going to pretend this is the easiest thing to work through. (Galewitz, 4/17)

Rep. Joe Barton, a vocal Obamacare opponent, is trying to thread the needle. Now given the chance to blow up Obamacare, Barton is telling constituents back home about how he would like to fix problems with the health care law that — despite its unpopularity in deep red Texas — has quietly helped people in his district. (Rayasam, 4/17)

Irate voters, worried that the health care reform efforts of President Trump and House Speaker Paul Ryan (R-WI) would jeopardize their health care coverage, complained at town hall meetings during the current two-week recess that their representatives were leaving them in the lurch. Some resentful voters have also demanded to know who is paying for the health care insurance of members of Congress and their families and whether they stand to lose benefits if the current health insurance laws are dismantled by the GOP. (Pianin, 4/17)

A pro-Trump group is airing ads in a dozen Republican-held House districts aimed at drumming up support for the White House's wounded drive to repeal President Barack Obama's health care law. The $3 million campaign comes during a two-week congressional recess in which GOP lawmakers' town hall meetings have been rocked by liberal supporters of Obama's 2010 statute. Underscoring the challenges Republicans face, one poll showed Monday that the public trusts Democrats over the GOP on health care by their biggest margin in nearly a decade. (4/17)

Political groups aligned with President Donald Trump and Speaker Paul Ryan are doling out millions of dollars to defend House Republicans who are taking heat at home for supporting the GOP’s now-stalled plan to replace the Affordable Care Act. The moves show a shift in the groups’ focus, from targeting skeptics of the health care plan to focusing on its supporters, which have faced pressure from both the political right and left. (Reid, 4/17)

Health insurers, facing fast-approaching deadlines to file plans for next year’s Affordable Care Act marketplaces amid uncertainty about the law’s fate, are putting off key business decisions as they scour for clues on social media and in the hallways of Washington. A group of insurers meets Tuesday with Trump administration officials, seeking reassurance and greater clarity about the future of the exchanges. Some companies have just weeks to file proposed 2018 rates with state regulators. (Wilde Mathews, 4/17)

Obamacare is stuck in limbo, and insurers and state regulators are struggling to set their plans for what’s increasingly shaping up as a chaotic year for the health-care program. After the failure of Republicans’ first attempt to repeal and replace the Affordable Care Act and President Donald Trump’s subsequent threats to let the program “explode,” more health insurers are threatening to pull out next year, while others may sharply raise the premiums they charge. They’ll start to declare in the next few weeks whether they’re in or out. (Tracer and Edney, 4/17)

A new survey finds that insurers have a “cautious commitment” to remaining in the ObamaCare marketplaces next year, despite uncertainty from the Trump administration. The survey from consulting firm Oliver Wyman finds that 96 percent of insurers surveyed said they plan to remain in the Affordable Care Act (ACA) marketplaces next year. The research “reveals that the vast majority of health insurers remain committed to the ACA exchanges, but with some adjustments in strategy and continued watchfulness,” according to the report. Still, Republicans’ pending decision on ObamaCare payments known as cost-sharing reductions creates a major source of uncertainty for the market. (Sullivan, 4/17)

Sen. Dean Heller (R-Nev.) said Monday during a combative town hall that he supports federal funding for Planned Parenthood. "I have no problems with federal funding for Planned Parenthood," Heller said when asked about his support for the health organization. The GOP senator was booed when he initially appeared to hedge his answer on whether or not he supports federal funding for Planned Parenthood. (Carney, 4/17)

Heller is a key swing vote on Planned Parenthood funding because the Senate vote margin is razor thin on the issue. His comments suggest he may be open to keeping federal funding. “The question is whether federal funding should cover some of the activities that occur in Planned Parenthood,” Heller said to boos from the crowd. “I don’t know if we’re going to agree on everything here, but a lot of my constituents called my office and said they don’t want federal funding at Planned Parenthood to be used for…” he said, appearing to trail off. (Haberkorn, 4/17)

State Rep. Candice Keller, R-Middletown, posted an image comparing the Planned Parenthood logo to a swastika on her public page. Keller, who serves as executive director of the Community Pregnancy Center in Middletown, is unabashedly anti-abortion and opposes Planned Parenthood, which provides abortions along with other health care services. (Balmert, 4/17)

Theranos Inc. and its founder pledged to stay out of the blood-testing business for at least two years in exchange for reduced penalties from federal health authorities, in an agreement that resolves a year-long regulatory impasse. The main lab regulator first had proposed barring Elizabeth Holmes from the medical-lab business for two years in March 2016 after the company failed to correct testing problems at its main lab in Newark, Calif., ones that inspectors earlier had said put patients in “immediate jeopardy. (Weaver, 4/17)

It is unclear whether the settlement has any bearing on investigations into the company by the Department of Justice and U.S. Securities and Exchange Commission. The company faces lawsuits from investors and Walgreens, its ex-partner that had been using Theranos blood-testing technology in dozens of stores before terminating the relationship. (Ho, 4/17)

Court documents unsealed in the investigation into Prince’s death paint a picture of a man struggling with an addiction to prescription opioids and withdrawal, with various pills stashed in bottles around the pop superstar’s suburban Minneapolis studio and estate. But the search warrants and affidavits unsealed Monday shed no new light on how Prince got the fentanyl that killed him. (Forliti, 4/18)

Before his death, Prince abused opioid pain pills, suffered withdrawal symptoms and received at least one opioid prescription under his bodyguard’s name, according to search warrants and affidavits unsealed Monday. Prince was 57 when he was found alone and unresponsive in an elevator at Paisley Park on April 21. Nearly a year after his accidental overdose death at his suburban Minneapolis studio and estate, investigators still don’t know how he got the fentanyl that killed him. The newly unsealed documents give the clearest picture yet of Prince’s struggle with opioid painkillers. (Johnson, 4/18)

At the time of Prince’s death, his Paisley Park home and recording compound in Minnesota were strewn with “a sizable amount” of narcotic painkillers for which he did not have prescriptions, including some hidden in over-the-counter vitamin and aspirin bottles and others issued in the name of a close aide, according to newly released court documents related to the investigation into the accidental opioid overdose that killed Prince last year. (Coscarelli and Kovaleski, 4/17)

Investigators’ records say Prince got his painkillers through others, most recently with the help of a local doctor, Michael Schulenberg, who had started treating Prince in the month before his death. (Pearce, 4/17)

Some fishermen link that reputation to a rugged cowboy culture; others to the pain medication taken by men and women whose bodies are battered by the job. But now, as opioid deaths rise relentlessly in Massachusetts, fishing captains from Cape Ann to Buzzards Bay are beginning to stock their boats with naloxone, a drug that reverses overdoses and is commonly sold under the trademark Narcan. (MacQuarrie, 4/17)

By the end of May, Las Vegas will have debuted three new vending machines that dispense clean needles. They hope to keep drug users who get their fix via syringe from contracting diseases by reusing needles that could carry bloodborne infections. (Welsh, 4/17)

An Ohio man who sold heroin laced with an elephant tranquilizer that caused more than two dozen overdoses in West Virginia was sentenced to more than 18 years in federal prison Monday. Bruce Lamar Griggs, of Akron, was "in this just for the money" when he sold the heroin mixture that sickened 28 people on Aug. 15 in Huntington, U.S. District Judge Robert Chambers said. (4/17)

Hannah Berkowitz is 20 years old. When she was a senior in high school her life flew off the rails. She was getting high on whatever drugs she could get her hands on. She was suicidal. Berkowitz moved into a therapeutic boarding school to get sober, but could only stay sober while she was on campus during the week. (Rodolico, 4/17)

Americans think it’s safer to use marijuana than opioids to relieve pain, but they were less comfortable with children and pregnant women using pot to treat medical conditions, according to a new Yahoo/Marist poll released Monday. Two-thirds of the respondents in the telephone survey said opioid drugs such as Vicodin or OxyContin are “riskier” to use than pot, even when the pain pills are prescribed by a doctor. (Wyatt, 4/17)

With the approval this month of two drugs to treat hepatitis C in children, these often overlooked victims of the opioid epidemic have a better chance at a cure. Kids may have an easier time than adults getting treatment approved, some experts say. Medicaid programs and private insurers have often balked at paying for the pricey drugs for adults, but stricter Medicaid guidelines for kids may make coverage more routine. (Andrews, 4/18)

For decades, scientists here at NASA’s Jet Propulsion Laboratory have sent spacecraft deep into the solar system. Now, they’re exploring another mysterious terrain: the human breast. The lab’s primary mission, of course, is to dream up and create robotic spacecraft to look for water on Mars or peer below the dense clouds that shroud Jupiter. But in recent years, top scientists here have realized that JPL’s powerful technology for exploring the cosmos might also help solve daunting medical questions here on Earth. (McFarling, 4/18)

With so many vaccines being required for young children today, some parents are asking their doctors whether they can space out or delay the vaccine schedule. They’re concerned that too many vaccines might overwhelm their child's immune system. Parents also worry that getting more than one shot at a time increases the pain and stress. (Sun, 4/17)

A new pilot program in Washington hopes to boost vaccination rates by having parents who support vaccines talk to parents in the neighborhood who might be unsure. A study released this week by Kaiser Permanente and published in the journal Health Promotion Practice shows the model is already working. (Caiola, 4/17)

Federal health officials writing in a medical journal on Monday urged doctors to be on the lookout for Zika-related seizures and epilepsy among infants born to mothers infected with the virus while pregnant. Citing recent studies that found seizures and epilepsy reported in some infants exposed to Zika while in the womb, the Centers for Disease Control and Prevention warned that cases of epilepsy caused by the virus may be misdiagnosed or under reported. (Chang, 4/17)

Biochemists may have discovered a type of antibiotic that sounds like something out of a fairy tale: It is based on dragon blood. Scientists from George Mason University recently isolated a substance in the blood of a Komodo dragon that appeared to have powerful germ-killing abilities. Inspired by the discovery, they created a similar chemical in the lab and dubbed it DRGN-1. (McNeil, 4/17)

Michael Miller, 44, does what most smokers do to protect his sons and daughter from the fumes of his Marlboro Ultra Lights. He takes it outside. After his 7 a.m. coffee, he walks out of his home in Cincinnati to smoke his first cigarette of the day. Then, as a branch manager of a road safety construction company, he smokes dozens more on street curbs. (Heredia Rodriguez, 4/18)

Inspired by social media, some people are turning to rubber bands, fishing line and paper clips to perfect their own pearly whites – a practice that orthodontists warn could lead to gum irritation, misalignment and tooth loss. A quick search on YouTube reveals thousands of tutorials about how to straighten teeth without braces, many posted by users who appear to be teenagers. (Caiola, 4/17)

While breast cancer rates have plateaued or declined in some racial groups, they have been steadily rising among Asian-Americans since 1988. The new findings, released last week by the Fremont-based Cancer Prevention Institute of California, show the largest increase in breast cancer rates in the Golden State is occurring among Koreans and Southeast Asians. (Seipel, 4/17)

A federal lawsuit filed Monday alleges the U.S. Army has issued less-than-honorable discharges for potentially thousands of service members without adequately considering the effects of post-traumatic stress disorder and other mental health conditions. (4/17)

President Donald Trump plans to sign legislation to extend temporarily a program that gives veterans access to private-sector health care. White House spokesman Sean Spicer says Trump will sign the bill Wednesday at the White House. (4/17)

Upset that people with schizophrenia and other mental disorders have been put to death after murder convictions, lawmakers in a handful of states want to bar the use of the death penalty for people with a serious mental illness. People accused of murder who are found not guilty by reason of insanity can serve time in a mental hospital and avoid the death penalty. But many states have a narrow legal definition of insanity — not knowing what one did was wrong. And critics say that leaves many people with mental disorders to be found guilty of capital crimes and sentenced to death. (Beitsch, 4/17)

Two members of MNsure’s board of directors will get another four years leading the state-run health insurance marketplace — provided it continues to exist. Minnesota Gov. Mark Dayton on Monday reappointed MNsure board chair Pete Benner and board member Phil Norrgard to new four-year terms. Their terms were previously scheduled to expire next month. Dayton appointed the original six members of MNsure’s board in 2013. (The seventh spot is automatically filled by the state’s Human Services Commissioner.) Four of the original six have since left the board, replaced by new appointees as their terms expired. Benner and Norrgard are the first board members Dayton has reappointed. (Montgomery, 4/17)

California’s program to provide in-home care for its low-income elderly and disabled residents finds itself once again at the heart of a state budget standoff. It is familiar territory for the workers, advocates and administrators of the In-Home Supportive Services program. The current flare-up — between the state and county governments over how to divvy up IHSS costs — is the latest example of how California’s signature program, meant to keep people in their communities and out of nursing homes, has continually been the source of budget friction in recent years. (Mason, 4/18)

With about a month to go before a critical revenue forecast, Oregon’s budget writers released a more detailed list of cuts Monday to address the state’s approximately $1.6 billion budget gap if new revenue isn’t raised. The cuts are across the board and intended to show what it would take to balance the state’s budget. For example, about 350,000 Oregonians would no longer be eligible for coverage under the recent Affordable Care Act Medicaid expansion, and a ballot measure to require the state to pay dropout prevention, college readiness, and career and technical education for high school students would only be partially funded. (Withycombe, 4/17)

The federal government agreed to revive the Low Income Pool at $1.5 billion last week after it was set to end. Though it is clear that the money will be funded mostly by the federal government with the remainder coming from state or local governments, the full terms of the agreement are not yet clear. (Auslen, 4/18)

A jury in Sacramento, California, last week awarded more than $11 million to the family of a 16-year-old-boy who had been sexually assaulted by a peer at his group home in Davis. The jury found that operators of the group home failed to look after the boy as the facility for troubled youngsters descended into a prolonged period of chaos and violence. (Sapien, 4/17)

Is the nonprofit Northside Hospital Inc. subject to the state’s open records law? The Georgia Supreme Court on Monday heard arguments on the high-profile case, which involves Northside’s rejection of requests for information about financial documents and other matters. (Miller, 4/17)

Minnesota health officials have confirmed a ninth case of measles in the Hennepin County outbreak that began last week, and they expect the count to rise as additional lab specimens are tested. The patients, all children, were not vaccinated. Most of the cases have occurred in the Twin Cities Somali-American community, where vaccination rates have been relatively low. (Howatt, 4/18)

Researchers have long known that the adolescent brain is continually rewiring itself, making new connections and pruning unnecessary neurons as it matures. Only recently has it become clear that the process stretches well into early adulthood. Buried in that research is an uncomfortable legal question: If their brains have not fully matured, how responsible are adults ages 18 to 24 for their crimes? (Requarth, 4/17)

For Vanderbilt University School of Medicine, 2016 was a banner year: It netted its largest ever amount of grant funding from the National Institutes of Health. The medical school received $340 million in 2016 — placing it eighth in the country for grants awarded to a medical school. The school moved up two spots on the ranking from the year prior in part because it received a five-year $71.6 million grant to establish in Nashville a key component of the national initiative to further research and use of precision medicine. (Fletcher, 4/17)

A federal judge has ordered the U.S. government to contribute half of Temple University Hospital’s $8 million settlement of a birth injury lawsuit. The hospital sued the government seeking exemption from legal responsibility, or indemnity, arguing that the obstetrician liable for the birth injuries was a federal employee — even though that doctor was also working in labor and delivery at Temple. (McCullough, 4/17)

A suit filed last week alleges that an employee of a Kansas City, Kan., psychiatric hospital for children broke the arm of a 9-year-old patient. Jeffrey Wallace of Salina brought the suit on behalf of his son, who is not named because he’s a minor. (Marso, 4/17)

Los Angeles County pressed forward with an effort to strengthen the safety net for its most vulnerable residents Monday with a budget plan that carves out significant allotments for social services, healthcare and other support for the poor. The proposed budget is a slight increase from last year, and officials said they are trying to channel some of that money toward helping those who rely on county government for critical services. (Agrawal, 4/17)

No one knows how a young Berkeley couple and their two cats were fatally poisoned with carbon monoxide during a storm one night in January... But three months, one lawsuit and a procession of experts later, the source of the carbon monoxide remains a mystery. Toxicology professionals say that’s not just bizarre, but a possible danger to public health. (Veklerov, 4/17)

San Francisco’s attempt to require health warnings on billboard ads for sugary drinks is unfair and misleading because the messages imply that sodas are uniquely dangerous when they aren’t really dangerous at all, a beverage industry lawyer told a federal appeals court Monday. (Egelko, 4/17)

A man has filed a wide-ranging lawsuit in Travis County for severe skin burns he says he suffered from a defective battery used to power an electronic cigarette. Matthew Bonestele was carrying an LG Chem battery in his right pants pocket when it suddenly exploded on April 21, 2016, the lawsuit says. (Autullo, 4/17)

Despite the rise of the tea party and unified Republican control of government, one decidedly anti-free-market idea appears ascendant: single-payer health care. And it’s no wonder, given that a record-high share of the population receives government-provided health insurance. As a country, we’ve long since acquiesced to the idea that Uncle Sam should give insurance to the elderly, veterans, people with disabilities, poor adults, poor kids, pregnant women and the lower middle class. (Catherine Rampell, 4/17)

I’ve been reading Medicare-for-All explanations by legislators, doctors, public interest groups and journalists. I’m no expert, but the fundamental concepts are coming clear to me. Here is some central information for those who wonder how Medicare-for-All would work in America. (Mariann Regan, 4/17)

No one would blindly take a pill from an unlabeled bottle. Yet when it comes to prescription medications, Californians are routinely required to rely on a murky, mysterious industry to determine what drugs they can receive, at what cost, from what pharmacist. It’s time to put a label on that bottle. (Jim Wood, 4/17)

On April 13 CMS published the agency’s final “market stabilization” rule. ... The final rule, ostensibly a carbon copy of the proposed, finalizes the six proposed changes without, again, providing any evidence these changes will stabilize the markets by increasing enrollment and issuer participation. ( David Introcaso, 4/17)

The most interesting policy argument in America right now is the debate between conservatives’ real position on health care and their fake position. The fake, but popular, position goes something like this: Conservatives think everyone deserves affordable health insurance, but they disagree with Democrats about how to get everyone covered at the best price. This was the language that surrounded Paul Ryan and Donald Trump’s Obamacare alternative .... Their real position is that universal coverage is a philosophically unsound goal, and that blocking Democrats from creating a universal health care system is of overriding importance. To many conservatives, it is not the government’s role to make sure everyone who wants health insurance can get it, and it would be a massive step toward socialism if that changed. (Ezra Klein, 4/17)

Earlier this month, The New York Times reported that Obamacare is not in the death spiral that Republicans are claiming, and health insurers might soon see profitable years ahead. ... However, when you read further you learn why insurers may start profiting from the Obamacare exchanges. ... Simply stated, insurers are charging individuals more while offering fewer choices and services. This isn’t a positive development for our health system or the American people. (Rep. Jim Sensenbrenner, (R-Wis.) 4/17)

Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services, recently praised Medicare's prescription drug benefit for giving seniors access to affordable medicines, saying she was "thankful" for the program. There's a lot to be thankful for. Medicare Part D, as the drug benefit is known, provides seniors with huge discounts on medicines, enabling them to live healthier, longer lives. A recent University of Illinois study found that Part D has reduced elderly mortality by 2.2 percent annually since 2006. That's good news for the more than 41 million Americans who currently rely on the program for prescription drug coverage. (Joel White, 4/18)

Jack had access to care. Despite this, the correct diagnosis was not made early on in his disease course; early diagnosis and appropriate intervention may have made a difference. We need a better understanding into the science behind mental health illnesses, including substance abuse disorder, to develop better methods of detection, prevention and treatment. (Kathryn Beattie, 4/17)

As a publicly traded company, Mallinckrodt routinely discloses information affecting the company, such as the agreement in principle reached with the U.S. Drug Enforcement Agency and U.S. Attorneys’ Offices to settle the previously disclosed investigations of the company’s monitoring programs for controlled substances. The disclosure of the $35 million settlement was in no way meant to downplay the seriousness of the opioid epidemic. Mallinckrodt recognizes that prescription drug abuse is one of the St. Louis region’s — and the nation’s — greatest health and safety concerns, with devastating societal and emotional effects as well as an economic burden on the healthcare system. (Mark Trudeau, 4/18)

One of the biggest fears people have about retirement is getting sick and running out of money to cover their health issues. So in comes long-term care insurance, which can cover the cost of nursing homes, assisted-living facilities and in-home care. Medicare — except in very limited situations — does not cover long-term care. Medicaid covers long-term care, but to qualify for the benefit, you have to be pretty poor. (Michelle Singletary, 4/17)

As pediatricians in training, here are some patients we have encountered recently: a previously healthy toddler who did not receive his yearly influenza vaccine and was placed on full life support due to multi-organ failure from the flu. An infant too young to receive vaccines who caught whooping cough at her older sister’s school and required admission to intensive care. A preschooler who was receiving chemotherapy for leukemia, now in remission, who cannot safely attend school because of the number of unvaccinated children. A child who has undergone multiple complex heart surgeries requiring intensive and risky anesthesia, medications and interventions, but whose parents will not vaccinate him against illnesses that routinely killed even healthy children before the age of vaccines. (Dr. Phoebe Danziger and Dr. Rebekah Diamond, 4/15)

Translating fundamental scientific knowledge into actual treatments for diseases is exceedingly challenging. Research often reveals the molecular and systemic changes that cause or contribute to a disease. Although that can lead to new ideas about how to prevent or treat that condition, only a tiny fraction of these ideas ever make it to being tested in humans. Of the few that do, the necessary clinical trials can take hundreds of millions of dollars and many years to complete, and in that process most will fail to show sufficient safety and effectiveness. It’s also next to impossible to predict which avenues of research will ultimately lead to medical breakthroughs. (Paula J. Bates, Diane Fabel, Clinton T. Rubin, Vadim J. Gurvich and Charles C. Muscoplat, 4/17)

Cupertino Union School District is in the midst of a furious debate about sexual education that is reverberating through the Peninsula and making national news. As the school board considers adopting new curricula, I would like to remind them of their responsibility to the health and futures of our students. (Stacy Tong, 4/17)