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Asked at a confirmation hearing two weeks ago if he was working with President Trump on a secret plan to replace the Affordable Care Act, Representative Tom Price, Mr. Trump’s nominee for secretary of health and human services, smiled broadly and answered: “It’s true that he said that, yes.” The committee room, filled with health care lobbyists, consumer advocates and others with a vital stake in the future of the health care law, erupted with knowing laughter at Mr. Price’s careful formulation. (Shear and Pear, 2/6)

There's a moment in the Broadway musical Hamilton where George Washington says to an exasperated Alexander Hamilton: "Winning is easy, young man. Governing's harder." When it comes to health care, it seems that President Trump is learning that same lesson. Trump and Republicans in Congress are struggling with how to keep their double-edged campaign promise — to repeal Obamacare without leaving millions of people without health insurance. (Kodjak, 2/6)

A House conservative leader called Monday for votes "as soon as possible" on legislation voiding and replacing the health care law, even as President Donald Trump's latest remarks conceded that the effort could well stretch into next year. (2/6)

Some observers welcomed Trump's statement as his belated recognition of the reality of the cumbersome legislative process. They argued it gives congressional Republicans political permission to slow down and craft a more workable replacement plan -- even though House conservatives are demanding swift and total repeal with or without a replacement ready. But others said the president's words signal that the GOP repeal-and-replace train could be headed for a train wreck. (Meyer, 2/6)

The Trump administration is considering major changes to Obamacare that may help convince insurers to remain in the law's marketplaces while Congress drafts a replacement plan — but the proposals may also limit enrollment and increase costs for older Americans, according to documents obtained by POLITICO. The administration is looking to alter rules around insurers charging older customers more, how much cost they can shift onto customers, and who's allowed to sign up outside the standard enrollment window. They represent changes that the industry had previously asked the Obama administration to make. (Diamond, Haberkorn and Demko, 2/6)

In the clearest sign yet that Republicans are tapping on the brakes on health care, President Donald Trump over the weekend said that an Obamacare replacement plan is coming by the end of this year, maybe early 2018. That's very different from last month, when the president was talking about a plan coming as soon as his Health and Human Services nominee Tom Price was confirmed. Many hospitals see the GOP going from a sprint to a slow jog as a lobbying win for them in Washington. (Gorenstein, 2/6)

Conservative Republicans, worried about growing voices within the party advising or accepting a slower pace for repealing the Affordable Care Act, are redoubling their push to speed the GOP’s long-desired goal. President Donald Trump on Sunday became the latest top Republican to sound cautious notes about the party’s ability to rapidly repeal large swaths of the 2010 health law and enact its own vision. He told Fox News’s Bill O’Reilly that “maybe it’ll take until sometime into next year,” saying repeal and replacement was “statutorily” difficult to accomplish quickly. (Peterson and Radnofsky, 2/6)

Two of the top Republicans in Congress on Monday said they are pushing ahead with the plan to begin repealing ObamaCare this spring, despite any confusion caused by President Trump saying the process could spill into next year. House Ways and Means Committee Chairman Kevin Brady (R-Texas) told reporters that he is working off of Speaker Paul Ryan’s (R-Wis.) timeline of moving repeal legislation by the end of March. (Sullivan, 2/6)

It may not crash the economy, but repealing key provisions of the Affordable Care Act would certainly create job losses in every state. That’s the consensus of a growing body of studies that suggest the economic fallout from the health law’s partial demise would ripple through the entire economy, not just the health care sector. Josh Bivens, Director of Research at the Economic Policy Institute, estimates the proposed repeal would eliminate nearly 1.2 million jobs in 2019. (Pugh, 2/7)

Some people mapping the options for Massachusetts under various "repeal and replace" scenarios are reluctant to talk about returning to Romneycare. They don’t want to create the impression within the state or in Washington, D.C., that Massachusetts might try to go it alone or might be just fine on its own. And in fact, Massachusetts would not be just fine. The state will bring in just over a billion dollars more in federal funding this year than it did before passage of the ACA, according to the Baker administration. (Bebinger, 2/7)

What’s going to happen to the federal health law? The quick answer is no one knows. But in the midst of the uncertainty about the Affordable Care Act, states still must govern their insurance markets. Most have been muddling through with the 2017 status quo, but Minnesota is a special case, taking three unusual actions that are worth a closer look. (Zdechlik, 2/7)

As the Trump administration looks to unravel the Affordable Care Act, Boulder County’s medical device industry is hopeful that a tax on its products, designed to help fund the law, will be repealed — and soon. A two-year moratorium designed to give them some relief from the measure is set to expire at the end of this year, but they say true balance won’t be restored until the tax is completely dead. (Castle, 2/6)

Michelle Andrews writes: "In some recent emails, readers asked about what to expect as Republicans move to overhaul the health law. Should people bother paying the penalty for not having health insurance when they file their taxes this year? Will they be able to sign up on the exchange for 2018 after their COBRA benefits end? Here are some answers." (Andrews, 2/7)

Minnesota would become one of the first states in the nation with a “public option” in the marketplace for individual health insurance under a plan pitched by Gov. Mark Dayton and endorsed Monday by two outstate DFL legislators. Private health insurance options are dwindling for rural Minnesotans, said Rep. Clark Johnson, DFL-North Mankato, so opening more space in the 25-year-old MinnesotaCare program makes sense. (Olson, 2/7)

The number of Californians newly signed up for health insurance through Covered California, the state’s insurance marketplace created under the Affordable Care Act, dropped 3 percent compared with last year, according to enrollment figures released by Covered California on Monday. About 412,000 people signed up for health plans through the exchange during the open enrollment period for 2017, compared with 425,000 who signed up during open enrollment last year. The falloff comes amid a national decline in enrollment in health plans through Healthcare.gov, the federal insurance marketplace used in several dozen states but not California, which fell for the first time, according to figures released by the Centers for Medicare and Medicaid Services on Friday. (Ho, 2/6)

Connect for Health Colorado, the state’s marketplace for insurance plans sold under the Affordable Care Act, on Monday reported a record number of sign-ups during the just-ended open-enrollment period. For the open-enrollment period that officially closed on Friday, Connect for Health Colorado announced that 175,964 people picked a health or dental plan on the exchange. That’s a 12 percent increase over the same time last year, when more than 150,000 people had selected a plan. (Ingold, 2/6)

Amid the January rumbling toward the start of the Trump administration, the Ohio Medicaid Department dropped its annual assessment with some startling information: The report found that since the health program was expanded under the Affordable Care Act, the rate of uninsured Ohioans has dropped to the lowest rate ever. Plus, Ohioans who became eligible for health care coverage through the Medicaid expansion reported that it was easier for them to keep or find work. Most people also reported better health and financial security as a result of obtaining coverage. (Saker, 2/7)

Time is running out for Minnesotans who want to buy 2017 health insurance on the individual market. Unlimited enrollment expires at midnight Wednesday, Feb. 8. After that, people can buy insurance only if they have a special situation, such as losing their old insurance or having a baby. Wednesday’s deadline is one week later than the original deadline, Jan. 31. It was extended to give Minnesotans more time to react to premium subsidies passed by the Legislature in late January. (Montgomery, 2/6)

Republican Rep. Gus Bilirakis held a town hall Saturday, to hear ideas about replacing the Affordable Care Act. But he was met with opposition as about every one of the 200 people gathered at The Centre of Palm Harbor were in support of Obamacare. Many came to voice their concerns with the law's potential repeal. One activist held a cardboard cutout of the Statue of Liberty. A few people held signs that read "Obamacare Saves Lives" and others had handmade signs that advocated for the retention of the ACA. (Walters, 2/6)

The Republican drive to deliver a death blow to President Barack Obama’s health care law has overshadowed a quieter assault using annual government funding bills that’s gone on for years. It’s not as glamorous or high-decibel as the news conferences and floor debates surrounding the repeal of the law, but it certainly has proved controversial. What’s more, the law’s supporters see this GOP tactic as partly responsible for many of the failures in the law that Republicans now say they must fix. Lawmakers have, with little fanfare, rolled back provisions and chopped funding levels in the health care law each year since its enactment in 2010. And while top Republicans contend that the law’s “death spiral” is due to the legislation’s inherent flaws, they do admit their own actions have had an impact. (Mejdrich, 2/7)

The Trump administration's proposed rule to stabilize the individual marketplace could be an effort to beat the clock as insurers decide whether to offer coverage on the marketplaces in 2018. During a Senate Health, Education, Labor and Pensions Committee hearing Wednesday, witnesses that included representatives from America's Health Insurance Plans, the National Association of Health Underwriters and the National Association of Insurance Commissioners suggested that plans could make decisions about next year by March. That same day, the Trump administration submitted a proposed rule to the Office of Management and Budget. The exact contents of the rule have yet to be revealed publicly. (Dickson, 2/3)

House Republicans are seeking consensus with rank-and-file Democrats on ways to stabilize the health insurance marketplaces created by the 2010 health care law. The effort could provide a narrow opportunity for bipartisanship, despite entrenched partisan disagreements and acrimonious rhetoric over GOP plans to repeal the law. Congressional aides on both sides of the aisle say Energy and Commerce Committee Republicans are actively trying to garner bipartisan support for health care legislation, including the modest marketplace-focused bills discussed at a panel hearing last week. (Williams and Mershon, 2/7)

Many foreign-born doctors work in rural communities because that lets them stay in the US after their medical residency instead of returning home for two years. [Dr. Chalak] Berzingi, though, had already earned his US citizenship when he chose to work here. He gave up the chance at a more lucrative private practice, accepted a grueling commute that takes him from his family — and has stuck with it for the past five years, logging more than 100,000 miles to get to the Elkins clinic three days a week. (Blau, 2/7)

The Trump administration has mounted a vigorous defense of its ban on travel from seven majority-Muslim nations, saying it is necessary to prevent terrorists from entering the United States. But the ban, now blocked by a federal judge, also ensnared travelers important to the well-being of many Americans: doctors. (McNeil, 2/6)

From tiny startups to global giants, the companies that sustain the $324 billion U.S. biotech industry are increasingly alarmed as President Donald Trump considers following his controversial travel ban with restrictions on skilled foreign immigrants. To crank out discoveries, U.S. biotech firms such as Amgen Inc. and Gilead Sciences Inc., as well as overseas companies with stateside operations, rely on the world’s best scientists and lower-level researchers with scarce expertise. A crackdown on visas for these workers could set back research, including the treatment of cancer, executives said. It also comes as companies, hospitals and universities struggle with the aftermath of Trump’s immigration ban from seven Muslim-majority counties, which has for now been blocked in court. (Bloomfield, Lauerman and Campbell, 2/7)

Joyous homecomings and family reunions broke out at airports across the country after a federal judge in Washington state blocked the implementation of President Donald Trump’s order barring visitors from seven predominantly Muslim countries. But Dr. Suha Abushamma, a Cleveland Clinic medical resident, is still abroad and it’s not clear she’s going to be allowed home anytime soon. A first-year resident at the Cleveland Clinic, she was forced to leave the U.S. hours after landing at New York’s John F. Kennedy International Airport on Saturday, Jan. 28. Abushamma, a Sudanese citizen, was given the choice of withdrawing her visa application “voluntarily” or being forcibly deported and not allowed back to the U.S. for at least five years. (Ornstein, 2/6)

In the three years since the Affordable Care Act took effect, its federally funded expansion of Medicaid to low-income adults has become the states’ most powerful weapon in the battle against the nation’s worsening opioid epidemic. Now, as Congress and President Donald Trump debate potential replacements for the law, governors, health care professionals and advocates for the poor are cautioning that any cut in federal funding for addiction treatment could reverse much of the progress states have made. (Vestal, 2/6)

California’s millennials continue to flood hospital emergency departments because of heroin, a trend that has increased steadily statewide over the past five years, according to the latest figures. The state data released last week show that in the first three months of 2016, 412 adults age 20 to 29 went to emergency departments due to heroin. That’s double the number for the same time period in 2012. Overall, emergency department visits among heroin users of all ages increased, but the sharpest was among the state’s young adults. About 1,500 emergency department visits by California’s millennials poisoned by heroin were logged in 2015 compared with fewer than 1,000 in 2012. (Abram, 2/6)

It sounds like a godsend for America's opioid epidemic: genetic tests that can predict how a patient will respond to narcotic painkillers, as well as an individual's risk of misuse, addiction, and potentially deadly side effects. Proove Biosciences of Irvine, Calif., claims its "opioid response" and "opioid risk" tests are the only precision medicine tools on the market to do all that, giving doctors information "to guide opioid selection and dosage decisions as well as treat side effects." (McCullough, 2/6)

Nearly 4,000 grams of drugs seized. More than 570 needles collected, and 350 Narcan kits distributed. More than 19,000 visits to Hope For NH Recovery by individuals seeking help with addiction. These are just a few of the statistics included in a 24-page report detailing the city of Manchester’s response to the opioid crisis in 2016. (Feely, 2/7)

Picking the pain reliever that’s best for you can be a confusing task. Pharmacy and supermarket shelves are lined with a dizzying array of boxes, names and labels describing the symptoms the medications are intended to address. While they all share the same goal, making you feel better, their active ingredients vary, and all have potential drawbacks. (Mele, 2/6)

A new device may hold the promise of eliminating an anguishing part of many breast-cancer surgeries: a follow-up operation to remove lingering cancer cells. Several surgeons are using a tool that shows promise in reducing the number of repeat procedures. (Lagnado, 2/6)

In an effort to more accurately reflect the U.S. car-driving population, at least one manufacturer is making crash-test dummies – the pretend people used to test automobile safety features – bigger and older. “The typical patient today is overweight or obese – they’re the rule rather than the exception,” said Dr. Stewart Wang, director of the University of Michigan International Center for Automotive Medicine, in a statement. “You can’t talk about injuries without talking about the person.” The new crash-test models include a 273-pound dummy, more than 100 pounds heavier than normal, as well as a prototype based on an overweight 70-year-old woman. (Buck, 2/6)

It was the most ordinary of family dinners, with pizza and cauliflower. Two exhausted parents sipped red wine. Two children giggled over silly jokes and squabbled over a stuffed animal named Baby Jaguar. A few moments later, 8-year-old Elijah Simpson-Sundell, his face slightly swollen and his speech slurred, walked unsteadily away from the table. His father gently reproached 6-year-old Genevieve: “When your brother wants something, and he doesn’t feel well, we should try to accommodate him.” (McGinley, 2/6)

Why is he so tired, Jackie Mann wondered, not for the first time, as Evan, the middle of her three children, wandered off to his bedroom to take an after-school nap. Small for his age, the 12-year-old seemed to fall asleep easily and anywhere: in the car on the way to soccer or gymnastics, on the afternoons he came straight home from school, while doing his homework and, once, while waiting to see the pediatrician. (Boodman, 2/6)

Promoting fixes for fading memories has become big business.Yet consumer advocates and scientists like Dr. Bob Speth, of Nova Southeastern University in Davie, say some dietary supplement marketers are making millions by tapping into the deepest fears of seniors and aging baby boomers. They say there is little proof such products can stave off cognitive decline by beefing up brain function, as some of the companies selling them advertise. The latest example Speth and others are pointing to is the supplement Prevagen. (Lade, 2/6)

Yuma is the nation's largest supplier of winter greens — lettuce, cabbage, spinach, kale, spring mix and more. The speed of the process often astonishes those outside the industry. In some cases, leafy greens picked one day could end up on your plate the next. They are harvested, packaged and shipped from the field directly to the store.Before the fork gets to your mouth, lots of effort is put forth to assure the produce is safe. After E. coli outbreaks jolted the nation and industry a decade ago, the nation's food-safety net tightened up. (Anglen, 2/6)

A key Kansas lawmaker says the state doesn’t have the money to fix problems in its mental health system, which a new report says are getting steadily worse. The report, the second from a task force created in 2015 to advise the Kansas Department for Aging and Disability Services, says the system has continued to deteriorate. The task force’s first report, issued about 18 months ago, concluded the system was “stretched beyond its ability to provide the right care at the right time in the right place.” (Wingerter, 2/6)

As news spread that the suspected gunman told FBI agents in Alaska that he was hearing voices, Florida officials called for improvements to mental health care and tougher measures to keep guns away from people with severe psychological disorders. The Jan. 6 mass shooting was just the latest to be followed by hand-wringing from politicians, particularly gun-rights supporters, who blamed shortcomings in the mental health system for the tragedy. Despite years connecting mental illness and mass shootings, lawmakers in both parties have been reluctant to pass major legislation taking firearms out of the hands of people diagnosed with severe disorders. (Auslen and Clark, 2/6)

Jason Farned set down a clear container in the middle of a table. The people gathered around leaned forward to peer at the tiny, zooming blurs trapped inside. “The deadliest creature in the world is the mosquito,” said Farned, who works for the San Gabriel Valley Mosquito and Vector Control District, a government agency that manages insect populations. By some estimates, mosquitoes transmit diseases that kill more people each year than any other creature. (Karlamangla, 2/6)

Orange County Mayor Teresa Jacobs calls them Batman and Robin. When county leaders summon Dr. George Ralls and Dr. Chris Hunter, trouble’s usually afoot. Name a public health threat in Orange County, from a heroin epidemic to Zika, and Ralls, Hunter or both swing into action. (Hudak, 2/6)

Reported cases of sexually transmitted diseases in Kansas City, Missouri, rose last year, in some cases dramatically, in part due to increased testing and outreach by health authorities. Preliminary data from the Kansas City Health Department shows a nearly 27 percent increase in reported cases of gonorrhea, 8 percent in chlamydia and 7.6 percent in syphilis. The figures reflect national trends, with reported STDs reaching an unprecedented high in the United States in 2015. (Margolies, 2/6)

To prosecutors, Bernard Greenspan saw dollar signs when a blood-testing lab company came to his office seeking referrals several years ago, and he reaped a $200,000 windfall in illegal bribes. Greenspan's attorney tells a different story, of an "old-school, solo family practitioner" still practicing while pushing 80 whose transactions were legitimate but who wound up in the wrong place at the wrong time — in the middle of an investigation into a $200 million health care fraud scheme. (2/7)

The University of Miami Health System and VitalMD — among South Florida’s largest physician providers — are teaming up to create a network of doctors focused on women’s health and cancer care, the two institutions announced this week. Under the alliance, patients who use VitalMD doctors will have access to UHealth’s broad range of specialty medical services and research, including cancer treatment at Sylvester Comprehensive Cancer Center. In return, UHealth will reach a broader segment of South Florida patients and their families, according to a press release announcing the partnership. (Chang, 2/6)

The Wright County Attorney's office has brought felony charges against two former employees of Otsego-based Minnesota Medical Solutions, saying they smuggled concentrated marijuana oils out of state to aid their parent company. According to the complaint filed Monday, Ronald Owens, who worked as security director of Minnesota Medical Solutions, and Laura Bultman, the company's former chief medical officer, conspired in December 2015 to transport 5.6 kilograms of concentrated marijuana oils from its Otsego, Minn. facility to New York because parent company Vireo Health was struggling to meet a production deadline for facilities licensed in New York state. (Scheck, 2/6)

anta Monica middle school reopened Monday after being ordered closed late last week after a potential norovirus outbreak, officials said. John Adams Middle School officials on Friday canceled classes and closed the campus for cleaning after dozens of students came down with symptoms akin to norovirus, which typically include nausea, vomiting, diarrhea, aches and fever, after a recent science trip to Yosemite National Park. (Fry, 2/6)

All of a sudden the press is filled with stories about Republicans supposedly retreating from their promise to repeal and replace ObamaCare. Liberals are claiming vindication and conservatives are getting nervous, but the stampede to declare failure is premature. The orderly transition to a more stable and affordable health-care system is merely beginning. (2/6)

Over the last few days, the Republicans’ campaign against the Affordable Care Act has undergone a subtle shift in branding. They’re no longer talking about a strategy of “repeal and replace’: The new buzzword is “repair.” Close followers of GOP efforts to gut the law, which has brought health insurance to some 20 million Americans and protected millions of others from being denied coverage because of medical conditions, are skeptical that this signals a real change in the Republican caucus’s approach. (Michael Hiltzik, 2/6)

About one-third of American workers covered by health insurance are now in high-deductible health plans, in which the policy holder pays a substantial portion of the cost of health care services out of pocket before insurance coverage kicks in. Many economists and health policy experts believe that these plans are a promising way to reduce health care spending. So when a high-deductible plan became available through my employer, Harvard University, a couple years ago, I decided to enroll my family in it. If this is going to be a big national experiment, I thought that I, as a physician and a health policy scholar, ought to know what it’s like to live with this kind of health insurance. (Ashish Jha, 2/6)

News leaks from last month's Republican congressional retreat revealed there's a growing concern that precipitous change to the individual health insurance markets created by Obamacare will trigger their collapse. (Merrill Goozner, 2/4)

Each year, a publication called Medscape creates a portrait of the medical profession. It surveys thousands of doctors about their job satisfaction, salaries and the like and breaks down the results by specialty, allowing for comparisons between, say, dermatologists and oncologists. As I read the most recent survey, I was struck by the answers from orthopedic surgeons. They are the highest-paid doctors, with an average salary of $443,000 in 2015 — which, coincidentally, was almost the exact cutoff for the famed top 1 percent of the income distribution. (David Leonhardt, 2/7)

Republican lawmakers and the National Rifle Association often attribute gun massacres to the country’s inadequate mental health system, rather than the easy availability of firearms. Now, those same people want to make it easier for those with schizophrenia, psychotic disorders and other mental health problems to buy guns. (2/7)

The House last week voted to overrule an Obama administration regulation prohibiting gun ownership by a small group of people with severe psychiatric disorders. The Senate shouldn’t follow suit. The Obama rule is sensible, and to expend energy repealing it implies there should be no reasonable limits on firearms ownership. (Dinah Miller, 2/6)

As Republicans struggle to find a way to repeal and replace Obamacare, and liberals and conservatives gear up for a battle over Supreme Court nominee Neil Gorsuch, it strikes me that the same lesson can be drawn from both phenomena: how much easier it is to hold radical opinions when you have no hope of passing legislation. (Megan McArdle, 2/6)

Instead of tackling legitimate problems, some Republican state lawmakers are fixated on meddling in the reproductive lives of their constituents. It seems they will do anything to send a message they oppose abortion. That includes targeting health providers who offer the legal procedure. (2/6)

In the current national political climate—which has understandably been preoccupied with questions around immigrants and refugees, around the electoral shenanigans committed by Russia, around charges of voter fraud and lying about crowd size—Kentuckians should not overlook a potentially sweeping bill submitted by the Republican controlled house. House Bill 149, which is being touted as yet another attempt to defund Planned Parenthood of Indiana and Kentucky (PPINK), will have much more broad-reaching effects than just taking aim at a favorite GOP target. (Derek L. Penwell, 2/6)

Not only do people wait in line to see doctors and counselors, there is a shortage of psychiatric beds for those needing in-patient care. And then, even those who receive care often are released with nowhere to go and no support system to help them remain stable. Even when families are willing to take in a troubled relative, they often lack the knowledge and the resources to help them sufficiently. Often, it is the patient's family that is desperately appealing for help and finding little. (2/7)

What do toxins have to do with detox? Nothing. In medicine, detoxification means managing withdrawal from alcohol or opioids, treating a medication overdose, or the medical management of poisoning. Exposure to actual toxins, like the ones described above, is treated with antidotes, antibiotics and often specialized supportive and intensive medical care. Because doctors have terrible handwriting along the way, detoxification was shortened to detox. (Jen Gunter, 2/6)

“I think the president, it’s no secret, has made it very clear that he’s a pro-life president,” White House Press Secretary Sean Spicer told reporters at his first briefing as he defended President Donald Trump’s decision to wildly expand what is known as the Global Gag Rule. But if Trump’s move was pro-life, it was pro-life only by name. The new and expanded Global Gag Rule is a radical policy, far beyond what any other Republican president has ever done before. And it will lead to an enormous loss of life. (John Norris and Jamila K. Taylor, 2/7)