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Over the past few weeks, Medicare Advantage insurers demanded that the Biden administration give them higher payment rates for next year. The government’s data on how much people were using health care didn’t match their own data, insurers and lobbyists griped — and therefore they wouldn’t be paid enough to cover those costs. But the federal government was not persuaded by the industry’s data or lobbying push. The Biden administration and its Medicare agency decided to stick with their proposals from January on Monday, dealing a blow to an insurance industry that has come to rely on Medicare Advantage for a steady stream of profits. (Herman, 4/1)

The Biden administration on Monday followed through on its proposal to cut next year's base payments to Medicare Advantage plans an average of 0.16%, despite pressure from insurers and their allies in Congress. Why it matters: While the plans will wind up seeing a net increase once payments are risk-adjusted to account for the health of their customers, the news sent shares of UnitedHealth, CVS Health, Humana and Centene falling amid predictions of continued financial pressure. (Goldman, 4/2)

Medicare’s recent move to cover the weight-loss drug Wegovy for some recipients with heart disease risk could drive up the cost of monthly premiums for many of the 65 million adults enrolled in the federal health insurance program, experts warn. How much of a price jump isn’t yet known. The premium increase would depend on how many millions qualify for the popular medication, which is priced at around $1,300 a month. (Lovelace Jr., 4/2)

Seniors relying on Medicare to pay for their health care are being targeted by a widespread "phantom billing" scam that has the potential to rob them of thousands of dollars. Phantom billing occurs when fraudulent charges are filed to Medicare by health care providers/doctors and medical equipment companies without the recipient's knowledge. Some seniors targeted reported being billed for urinary catheters they never asked for. (Blake, 4/1)

Health care costs are getting so high that prices are literally running off of the page. Medicare on a couple of occasions recently has had to deal with billing forms that don’t provide adequate space for prices. (Wilkerson, 4/2)

�鶹Ů�� Health News: ACA Plans Are Being Switched Without Enrollees’ OK 

Some consumers covered by Affordable Care Act insurance plans are being switched from one plan to another without their express permission, potentially leaving them unable to see their doctors or fill prescriptions. Some face large IRS bills for back taxes. Unauthorized enrollment or plan-switching is emerging as a serious challenge for the ACA, also known as Obamacare. (Appleby, 4/2)

More kids than ever are covered through the Affordable Care Act as the law's insurance markets help catch those affected by the nationwide Medicaid enrollment purge that began a year ago this week. Why it matters: The transition to the ACA marketplaces from Medicaid or a sister program just for kids comes with tradeoffs that hundreds of thousands of families may be discovering about their child's new coverage. (Goldman, 4/2)

Blue Cross Blue Shield Association and its Michigan affiliate must face a lawsuit from Ford Motor accusing them of artificially inflating the automaker’s costs for health insurance, a U.S. judge has ruled. U.S. District Judge Linda Parker in a ruling on Saturday in Detroit federal court said Ford had adequately alleged for now that it was overcharged for commercial health insurance products purchased from Blue Cross. (Scarcella, 4/1)

The Health and Human Services Department issued a guidance document and an open letter to teaching hospitals, medical schools and state regulators Monday reiterating that federal law requires informed consent to conduct tests on unconscious patients. The guidance ... cite reports of patients undergoing "sensitive examinations" unrelated to their treatments while under anesthesia without consent. (Hartnett, 4/1)

Amid the response to the Change Healthcare ransomware attack, the Department of Health and Human Services is aiming to better organize its healthcare cybersecurity resources and programs. HHS is creating a  “one-stop shop” for cyber at the department’s Administration for Strategic Preparedness and Response, according to Brian Mazanec, the deputy director for ASPR’s Office of Preparedness. ASPR leads U.S. health and medical preparedness for disasters and other public health emergencies. (Doubleday, 4/1)

The White House’s timeline for banning menthol cigarettes and flavored cigars appears to have slipped again after the administration missed its self-imposed target to finalize the rules by March. This is the third time the FDA has attempted to restrict menthol cigarettes, first in 2013 and again in 2018. Another delay could push the date beyond the 2024 November election. (Clason, 4/1)

The Food and Drug Administration is considering plans to update its 2013 premarket guidance for pulse oximeter manufacturers as research suggests the devices may provide inaccurate readings for patients with dark skin. The problem, according to several studies, is that pulse oximeters may overestimate blood oxygen levels for patients with darker skin and these false readings can lead to inaccurate diagnoses and the wrong treatments. (Gauchat, 4/1)

senior Defense Department official who attended last year’s NATO summit in Vilnius, Lithuania, had symptoms similar to those reported by U.S. officials who have experienced “Havana syndrome,” the Pentagon confirmed Monday. Havana syndrome is still under investigation but includes a string of health problems dating back to 2016, when officials working at the U.S. Embassy in Havana reported sudden unexplained head pressure, head or ear pain, or dizziness. (Copp, 4/1)

The Florida Supreme Court on Monday ruled that the state’s Constitution does not protect access to abortion, letting the current 15-week ban stand and triggering a stricter six-week ban. That six-week ban is now set to take effect in 30 days. But the court separately on Monday gave the OK for an amendment to go on November’s ballot that would protect abortion. (Ellenbogen, 4/1)

A six-week ban on abortion, passed last year but paused due to the state Supreme Court’s case, will go into effect May 1. That change is set to bring Florida in line with other restrictive states in the Deep South, severely limiting access to abortion for the whole region. ... Adding abortion protections to the Florida ballot could drive voter turnout, as Democrats hope to turn the Sunshine State purple once again after years of strong performance by Republicans. The Biden campaign described the state as “winnable” on Monday, citing the abortion ballot measure. (Robertson, 4/1)

A 2019 law banning most abortions in Ohio is unconstitutional following an abortion referendum last year, the state’s Republican attorney general said in a court filing Monday. The filing comes after abortion clinics asked a Hamilton County judge to throw out the law since Ohio voters decided to enshrine abortion rights in the state constitution last November. (Hendrickson, 4/1)

Backed by a Republican majority, Kansas lawmakers approved legislation Monday making it illegal to coerce a woman into getting an abortion. GOP legislators sidestepped efforts from Democrats to criminalize all forms of reproductive coercion arguing the language would reinforce Kansas’ existing protections for abortion rights. The bill, which the Kansas House approved with a near-veto-proof majority Monday roughly along party lines, now heads to Democratic Gov. Laura Kelly’s desk. The Kansas Senate passed the measure last week. (Barackman and Bernard, 4/1)

The Montana Supreme Court released its revised ballot language on Monday to describe a constitutional abortion rights amendment that voters may consider this fall, rejecting a version drafted last week by Attorney General Austin Knudsen. The unanimous ruling by six justices moves the initiative’s supporters, Montanans Securing Reproductive Rights, closer to launching a massive signature-gathering campaign that must be completed before a June deadline. (Silvers, 4/1)

�鶹Ů�� Health News: California Universities Are Required To Offer Abortion Pills. Many Just Don't Mention It 

When Deanna Gomez found out she was pregnant in September 2023, she felt the timing couldn’t have been worse. The college senior at California State University-San Bernardino worked 60 hours a week at two jobs. She used birth control. Motherhood was not in the plan. Not yet. “I grew up poor. And I don’t want that for my children, like, ever,” she said. She wanted a medication abortion. (Fortiér and Guzman-Lopez, 4/2)

Alex Kamer considers herself lucky — she didn’t have to fight a legal battle for the parental rights to her biological children. Kamer and her husband, Alan Kamer, grew their family via surrogates; their younger son was born in June. But the couple lives in Michigan, where a 1988 law had banned the use of surrogacy contracts and compensated surrogacy. That had left uncertainty about what could happen once the baby was born last year. Michigan was the last state in the country with such a law on its books, and for more than 30 years, those who violated it could, in extreme cases, face jail time. (Vitali, 4/1)

A person in Texas became ill with bird flu after contact with infected dairy cattle, state officials reported Monday. It’s the first human case of the highly pathogenic strain of avian influenza in Texas, and it’s the second recorded in the U.S., according to the health alert state officials issued. “The risk to the general public is believed to be low; however, people with close contact with affected animals suspected of having avian influenza A(H5N1) have a higher risk of infection,” the alert said. (Bohra, 4/1)

Sid Miller, commissioner of the Texas Department of Agriculture, said it’s not yet clear whether the person was infected by a dairy cow or through the same source that infected the dairy cows, which appears to be dead waterfowl that were found on the property. Regardless of the source, Miller said the public should not be worried. The Centers for Disease Control and Prevention issued a similar statement Monday, saying, “This infection does not change the H5N1 bird flu human health risk assessment for the U.S. general public, which CDC considers to be low.” (Sullivan, 4/2)

These developments are concerning. But how worried should we be? Here’s what to know about the risk to humans and to the millions of farmed and wild animals. (Jones and Torrella, 4/2)

The Supreme Court on Monday rejected the appeal of a Minnesota woman who said she was wrongly denied unemployment benefits after being fired for refusing to be vaccinated for COVID-19 because of her religious beliefs. The Minnesota Department of Employment and Economic Development determined she wasn’t eligible for benefits because her reasons for refusing the vaccine were based less on religion and more on a lack of trust that the vaccine was effective. (Groppe, 4/1)

A new study found that states with a higher percentage of Republican voters are seeing more reports of adverse side effects from COVID-19 vaccines. The study published in the JAMA medical journal looked at 620,456 vaccine adverse events reported to the federal Vaccine Adverse Event Reporting System (VAERS) from adults 18 and older. (Choi, 4/1)

The Food and Drug Administration has cleared Otsuka Pharmaceutical’s digital treatment for major depressive disorder, offering a new option for millions of people who struggle with the stubborn mental health condition. Called Rejoyn, the smartphone-based treatment for major depressive disorder symptoms was developed with digital therapeutics company Click Therapeutics, and it is intended for use by prescription alongside antidepressants. (Aguilar, 4/1)

Behind the blockbuster success of drugs like Ozempic and Wegovy is a less-noticed phenomenon: Some people don’t lose much weight on them. There is wide variation in weight loss on these types of drugs, called GLP-1s. Doctors say roughly 10% to 15% of people who try them are “non-responders,” typically defined as those who lose less than 5% of their body weight. These patients, doctors say, don’t experience enough appetite reduction to result in significant weight loss. (Reddy, 4/1)

Costco and its low-cost healthcare partner are expanding into weight-loss management. Costco will begin offering its members in the U.S. access to a weight-loss program through Sesame, a healthcare marketplace, Sesame exclusively told USA TODAY. The service, which will cost $179 every three months, is scheduled to become available April 2. (Lin-Fisher, 4/2)

Only 16% of US adults aged 27 to 45 have received the human papillomavirus (HPV) vaccine, with men, Hispanic respondents, and people with less education at even lower levels, according to a large survey study published last week in Human Vaccines & Immunotherapeutics. Although routine HPV vaccination was initially recommended for children aged 11 to 12 years, with catch-up vaccination through age 26, the Food and Drug Administration (FDA) expanded the age range in 2018 to adults 27 to 45 years, as well. (Wappes, 4/1)

"People need to know the situation," said Dr. Jinping Xu, a professor at Wayne State University. Xu is referring to several reports released recently outlining the state of the health care profession, particularly relating to primary care physicians. ... Xu said the primary care workforce is not growing fast enough for the population, and one of the main reasons is that primary care doctors are overworked and underpaid. (Vicci, 4/1)

�鶹Ů�� Health News: More Patients Are Losing Their Doctors — And Trust In The Primary Care System

First, her favorite doctor in Providence, Rhode Island, retired. Then her other doctor at a health center a few miles away left the practice. Now, Piedad Fred has developed a new chronic condition: distrust in the American medical system. “I don’t know,” she said, her eyes filling with tears. “To go to a doctor that doesn’t know who you are? That doesn’t know what allergies you have, the medicines that make you feel bad? It’s difficult.” (Arditi, 4/2)

A group of more than 1,000 residents and fellows at UChicago Medicine is taking steps to unionize, following a recent, similar effort by peers at Northwestern Medicine. The doctors filed a petition Monday morning with the National Labor Relations Board to hold a formal election to decide whether to unionize under the Committee of Interns and Residents, a union representing resident physicians and fellows. Residents often work at hospitals after earning medical degrees, as they train to become specific types of doctors. (Schencker, 4/1)

In what’s expected to be a three-day strike impacting three South Bay hospitals and possibly patient care, thousands of Santa Clara County nurses plan to walk off the job early Tuesday in protest over workplace conditions, wages and staffing ratios. The strike — the first in the union’s history — is scheduled to start at 4:59 a.m. Tuesday and end at 6:59 a.m. on Friday. It could affect county-owned clinics as well as its three hospitals. (Hase, 4/1)

Two decades ago, a group of senior-housing executives came up with a way to raise revenue and reduce costs at assisted-living homes. Using stopwatches, they timed caregivers performing various tasks, from making beds to changing soiled briefs, and fed the information into a program they began using to determine staffing. Brookdale Senior Living, the leading operator of senior homes with 652 facilities, acquired the algorithm-based system and used it to set staffing at its properties across the nation. But as Brookdale’s empire grew, employees complained the system, known as “Service Alignment,” failed to capture the nuances of caring for vulnerable seniors, documents and interviews show. (MacMillan and Rowland, 4/1)

Thousands of North Carolinians with intellectual and developmental disabilities rely on caregivers, known as direct support professionals, for help with everyday tasks like bathing and eating. But those workers are in short supply. A recent study by The Arc of North Carolina, a nonprofit that advocates for people with cerebral palsy, Down syndrome and other conditions, found that the state needs at least 20,000 more direct support professionals to meet the current demand. (Baxley, 4/2)

A Senate committee has asked three major private-equity firms for information on how they run or staff hospital emergency departments to see if private equity’s management of a large share of the nation’s ERs has harmed patients. Led by its chairman, Sen. Gary Peters’ ... staff conducted interviews with over 40 emergency department physicians who expressed “significant concerns” about patient safety and care resulting from the aggressive practices of private-equity firms in the arena. (Morgenson, 4/1)

Intermountain Health has closed Saltzer Health after failing to find a buyer for the network of multispecialty clinics. Nampa, Idaho-based Saltzer is still in talks with organizations about purchasing some of its health services, the provider said in a Friday statement. (DeSilva, 4/1)

The Federal Trade Commission is seeking a preliminary injunction to block Novant Health from acquiring two of Community Health Systems' North Carolina hospitals for $320 million. The agency, which sued in January to block the deal announced in February 2023, alleges the purchase would be anticompetitive, and alleges the deal would  "irreversibly consolidate the market for hospital services in the Eastern Lake Norman Area in the northern suburbs of Charlotte." (DeSilva, 4/1)

State regulators have cleared the way for Valley Regional Hospital in Claremont to become part of the Dartmouth Health system. Dartmouth Health — already New Hampshire’s largest health system — and Valley Regional announced plans to affiliate in 2022. The New Hampshire Attorney General’s Office said Monday it will allow the deal to go forward, but with a number of conditions meant to ensure patients don’t face higher costs or lose access to services. (Cuno-Booth, 4/1)

A Universal Health Services subsidiary was ordered to pay $535 million related to negligence charges filed after a 13-year-old patient was sexually assaulted by another patient at a psychiatric facility in Illinois, the for-profit health system said Monday in a Securities and Exchange Commission filing. (Kacik, 4/1)

Many digital health startups that received hefty funding rounds in 2021 and 2022 find themselves in need of a lifeline in early 2024, either from investors with deep pockets or a buyer. In 2021, venture capital investors wrote a record number of checks for digital health companies based on the promise of greater demand for virtual care, a part of the market that showed promise during the COVID-19 pandemic. But venture capital funding for digital health companies plummeted last year. (Perna, 4/1)

Add mergers and acquisitions to the list of things the Change Healthcare cyberattack has disarrayed. Healthcare deals are on the rise. But the ransomware attack against the UnitedHealth Group division has already caused dealmakers to more intensely scrutinize cybersecurity vulnerabilities and to consider the financial damage potential targets have endured, according to attorneys who specialize in M&A. (Hartnett, 4/1)

Fitch does not anticipate any credit impact on not-for-profit hospitals in the United States from the cyberattack at UnitedHealth's tech unit Change Healthcare that caused disruption to pharmacies across the U.S., the ratings agency said on Monday. The agency said it does not see any negative rating implications tied to the hack if the care providers can return to normal operations in the near term and maintain a large-enough cash cushion. (4/1)

Adults who are admitted to the hospital are often inappropriately diagnosed with — and treated for — pneumonia, new research suggests. These misdiagnosed adults almost always receive a full course of antibiotics that may not be necessary, according to a new study published in JAMA Internal Medicine. Among older adults who were treated for community-acquired pneumonia in the hospital, 12% were misdiagnosed, researchers found. (Sudhakar, 4/1)

Table saws are widely considered the most dangerous power tool, and approximately 30,000 blade-contact injuries require medical treatment each year in the United States. About 4,000 result in amputations that can be career-ending for some professional carpenters and contractors. The Consumer Product Safety Commission says that when a person is hospitalized, the societal cost per table saw injury exceeds $500,000 when you also factor in loss of income and pain and suffering. (Neuman and Arnold, 4/2)

Exercise-related injuries to the head and face have increased in recent years, rising almost 33 percent overall from 2013 to 2022, according to a study in the Journal of Craniofacial Surgery. Men accounted for nearly 56 percent of those injured, but the increase in incidence in the 10-year span was nearly twice as high in women as in men (44.5 vs. 24.2 percent). By age, those 15 to 19 had the highest rate of head and face injuries at about 10 percent. (Searing, 4/1)

Eating a ketogenic diet appears to help people with bipolar disorder and schizophrenia, according to a new study led by Stanford researchers — underscoring the importance of diet in the management of serious mental illness. The study, published in Psychiatry Research on March 27, found that trial participants who were instructed to follow a ketogenic diet — high in protein and fat, and low in carbohydrates — for four months showed improvements in both psychiatric outcomes and metabolic syndromes like obesity and insulin resistance. (Ho, 4/1)

Galveston County officially broke ground last week on a $13 million development to expand access to mental health services. The Mental Health Wellness Center will be centrally located in La Marque to serve the communities in Galveston County, including League City, Texas City and Dickinson. It's part of ongoing expansion of access to healthcare services in the Bay Area. (Orozco, 4/1)

The number of American lives lost to suicide in 2022 exceeds the capacity of Fenway Park, Samaritans CEO Kathy Marchi said Monday as she lamented the country’s all-time high suicide rate. But Marchi, joined by mental health advocates, survivors, and lawmakers, recounted Samaritans’ evolving work over the last half-century to provide preventive and crisis services, as well as community outreach to raise awareness about signs of suicide. (Kuznitz, 4/1)

A man comes to Northwell Health’s hospital on Staten Island with a sprained ankle. Any allergies? the doctor asks. How many alcoholic drinks do you have each week? Do you have access to firearms inside or outside the home? When the patient answers yes to that last question, someone from his care team explains that locking up the firearm can make his home safer. ... Northwell Health is part of a growing movement of health-care providers that want to talk with patients about guns like they would diet, exercise, or sex—treating firearm injury as a public-health issue. (Walecki, 4/1)

Oregon’s Democratic Gov. Tina Kotek on Monday signed into law a bill that recriminalizes the possession of small amounts of drugs, ending a first-in-the-nation experiment with decriminalization that was hobbled by implementation issues. The new law rolls back a 2020 voter-approved measure by making so-called personal use possession a misdemeanor punishable by up to six months in jail. It also establishes ways for treatment to be offered as an alternative to criminal penalties by encouraging law enforcement agencies to create deflection programs that would divert people to addiction and mental health services instead of the criminal justice system. (4/1)

Oregon’s governor has signed a measure to reimpose criminal penalties for hard drugs. Mayor Ted Wheeler of Portland talks about why the experiment “failed.” (Baker, 4/1)

�鶹Ů�� Health News: Track Opioid Settlement Payouts — To The Cent — In Your Community 

State and local governments are receiving billions of dollars in settlements from companies that made, sold, or distributed prescription painkillers and were accused of fueling the opioid crisis. More than a dozen companies will pay the money over nearly two decades. As of late February 2024, more than $4.3 billion had landed in government coffers. �鶹Ů�� Health News has been tracking how that money is used — or misused — nationwide. (Pattani, Zuraw and Hacker, 4/2)

Floridians will vote on recreational marijuana in November after the Florida Supreme Court signed off Monday on ballot language for a proposed constitutional amendment. The amendment would permit nonmedical marijuana use and would remove criminal or civil penalties for adults over 21 who possess and use up to 3 ounces of pot for personal use. (Wilson and Ellenbogen, 4/1)

Mayor Brandon Johnson debuted his pick for Chicago’s first chief homelessness officer during a Monday news conference that also saw him stand firm against the real estate lobby and other political adversaries over his progressive agenda. Sendy Soto, a former senior director at the Chicago Community Trust and ex-managing deputy commissioner at the city’s Department of Housing, will helm the post starting next week, the mayor’s office announced. Soto’s chief task will be to develop a five-year plan on addressing the city’s homelessness crisis. (Yin, 4/1)

A long discredited, arcane 150-year-old law is back in the news in 2024, and that should terrify anyone who supports reproductive freedom. Last week at the Supreme Court, the Comstock Act of 1873 was referenced on three separate occasions during oral arguments in a case dealing with access to mifepristone, one of two drugs typically used in medication abortions. (Tina Smith, 4/2)

There are 100,000 people in the United States waiting for a kidney. More than half a million are on dialysis, which from my own experience I know to be more of a means of survival than a form of living. About 4,000 people die each year while waiting for a kidney. Another 4,000 become too sick to undergo surgery — a gentler way of saying that they, too, die. (Dylan Walsh, 4/2)

A just-published investigation by Russian, American and German journalists has unearthed startling new information about the so-called Havana syndrome, or “Anomalous Health Incidents,” as the government calls the unexplained bouts of painful disorientation that U.S. diplomats and intelligence officers have suffered in recent years. (4/1)

Screening for colorectal cancer isn’t exactly something most people look forward to. It can be uncomfortable, invasive and time-consuming. No wonder 1 in 3 people who should get tested have never received any screening, according to the American Cancer Society. (Leana S. Wen, 4/2)

This month, the Biden administration announced an executive order proposing a $12 billion fund to improve our long-overdue understanding of women’s health and to strengthen women’s health research standards across federal agencies. (Dr. Irving Kent Loh, 3/30)