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Congressional Republicans see a repeal of a tax on medical devices as their best opportunity to chip away at the Affordable Care Act after the Supreme Court’s recent decision turning away a challenge to a key component of the law. The House has already voted to repeal the tax, and Senate Republicans are weighing the best timing for a vote to undo the levy, which helps underwrite the health law. President Barack Obama would almost certainly veto a stand-alone repeal, but with a number of Democrats also opposed to the tax, lawmakers think they may be close to having the votes needed to override the president, or insist the tax be rolled back as part of a grand bargain on spending bills later this year. (Stanley-Becker, 7/6)

Last month's Supreme Court decision upholding the statute's federal subsidies, which help millions of Americans afford health care, shattered the GOP's best chance of forcing Obama to accept a weakening of his prized law. Without that leverage, Obama would likely veto any major changes they'd send him. They could, however, try sending him veto-bait legislation designed to show voters how they'd reshape the nation's health care system — if only Republicans could agree on what to do. With the GOP-run Congress back from a July 4 break, here's a look at their problematic path. (Fram, 7/6)

The Senate’s arcane rules are creating new fissures in the 2016 presidential primary: Candidates from outside Washington are vowing to gut the filibuster in order to repeal the Affordable Care Act, while GOP senators pursuing the White House want to keep the time-honored 60-vote threshold. (Strauss and Everett, 7/6)

Nearly 10 years ago, this county by the bay known for its progressive political leaps became one of the first in the nation to offer residents universal access to healthcare. Now the federal Affordable Care Act has been rolled out nationwide with the same goal in mind. But in an ironic twist, officials in this city are worried the new law could adversely affect some of the most vulnerable San Franciscans. The local health program known as Healthy San Francisco, which has served as many as 60,000 patients annually since its creation in 2007, is almost free. Obamacare plans, however, are not. ... County officials here are weighing ways to help residents pay for insurance plans offered through Covered California, the state's health insurance exchange. (Karlamangla, 7/6)

When economist Dan Polsky set out to study how many doctors were in the health-insurance networks available to Obamacare customers, he found out it was hard - even for him. How hard? "Nine out of 10," said Polsky, executive director of the University of Pennsylvania's Leonard Davis Institute of Health Economics. ... Polsky said insurers need to do more to help shoppers determine who is in the network they are considering. Otherwise, he predicted, lawmakers may set specific limits on how narrow networks can be. (Burling, 7/7)

After weeks of banking on a takeover, Humana Inc.’s shareholders reacted coolly to news of the insurer’s $34.1 billion announced sale to Aetna Inc., amid concerns over the deal’s antitrust prospects, the possibility of an interloper and weakness in Humana’s own business. Shares of Humana closed Monday 15.4% below the value of Aetna’s cash-and-stock offer, a yawning gap that suggests investors worry the deal may face challenges. Some of the same concerns socked Aetna’s stock, which fell 6.4%. ... The largest unknown is antitrust approval, investors and analysts said. Aetna and Humana are the third- and fourth-biggest U.S. health insurers by revenue, and together would have about a million more Medicare subscribers than their next-closest competitor. (Hoffman and Wilde Mathews, 7/6)

You may have heard the news over the weekend of a mega-merger between two of the country's biggest health insurance companies, Aetna and Humana. The $37 billion deal is just one of a series that are expected to reshape the health insurance landscape, after the Supreme Court decision last month made it clear that health care reform was here to stay. The question most people care about outside Wall Street -- what effect these mergers will have on what we pay for health care is a source of some disagareement among specialists. One of the most surprising -- and weird -- things about the insurer merger mania is that ultimately, some analysts think it might have benefits for consumers. But others say there is some evidence that a marketplace with fewer insurers will be bad for consumers. (Johnson, 7/6)

Aetna Inc.'s chief executive said Monday he was confident any antitrust review of the health insurer's proposed purchase of smaller rival Humana Inc. would allow the deal to close in the second half of 2016. Mark Bertolini said Aetna had already prepared for possible divestitures to address overlaps with Humana's business in the largest-ever U.S. health insurance deal. The two sides announced the $37 billion transaction on Friday. Hospital and state officials said they would take a hard look at whether the deal would diminish competition for consumers. (Humer, 7/6)

Humana Inc., fresh from announcing an agreement to be purchased by larger rival Aetna Inc., prompted new investor concerns about the $33 billion deal on Monday by lowering its 2015 financial forecasts. The transaction announced on Friday is already expected to face a tough review by U.S. antitrust regulators, particularly if another major deal among health insurers emerges. (Humer, 7/6)

Emdeon Inc. is in the process of buying Altegra Health, a data aggregation and analytics company, for about $910 million. Nashville-based Emdeon will combine Altegra with its existing Intelligent Healthcare Network, enabling the company to offer products to clients that help improve care quality and customer experience. (Pickert & Fletcher, 7/6)

The Obama administration announced on Monday that it will give doctors a 12-month transition period related to new medical codes that have drawn criticism from some Republican lawmakers as a needless expansion of bureaucracy. The deadline for doctors to adopt a new set of codes that identify medical conditions and procedures is Oct. 1. They are known as ICD-10, for the tenth version of the International Classification of Diseases. (Sullivan, 7/6)

A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 in kickbacks from a drug company in exchange for prescribing its high-priced drug to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative. But when the federal government released data Tuesday on payments by drug and device companies to doctors and teaching hospitals, the payments to nurse practitioner Heather Alfonso, 42, were nowhere to be found. That's because the federal Physician Payment Sunshine Act doesn't require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions in most states. (Ornstein, 7/6)

Doctors and nurses understand that working while they're sick can put their patients at risk. But most do so anyway, a new survey of workers at the Children's Hospital of Philadelphia suggests -- influenced by factors as varied as concerns over who will fill in for them, worries that their patients can't get by without them and a widespread notion that healthcare workers who stay home to nurse a cold or stomach bug are somehow weak or unprofessional. (Brown, 7/6)

In today's digitally focused world, there are some cases where a trip to the doctor can be easily replaced with the download of an app or the power of a text message. The health care industry is in the midst of a technological boom, a transition which physician Bob Wachter, author of The Digital Doctor, says is necessary – but no one has gotten it completely right yet. (Thadani, 7/6)

After a dozen years of flat funding, the National Institutes of Health has become a top target on Capitol Hill — not for less money but more, potentially billions more by 2020. It’s a remarkable turnaround for the huge medical research agency, one triggered by a confluence of circumstances. Fears that the United States is losing ground to international competitors in science and technology synched with lawmakers’ need to show frustrated voters that they can work in a bipartisan manner, and NIH offered “an easy win” on both, advocates say. (Karlin, 7/7)

Packaged caramel-coated apples. Frozen ice cream sandwiches. Fresh peaches and nectarines. Organic chia seed powder. Products such as these, rarely considered a risk for foodborne illness before, all have been recalled from store shelves in the past year or so. The foods were linked to disease outbreaks in multiple states. Public health officials say the outbreaks are largely because of safety gaps in the way food is processed, manufactured and packaged, as microbes, such as listeria and salmonella, contaminate more foods. (Landro, 7/6)

Within the next two months, the Food and Drug Administration is expected to complete rules that would require federal approval for nearly all flavored liquid nicotine juices and e-cig devices sold in vape shops like Mr. Mercer’s. The approval process could cost anywhere from $2 million to $10 million to collect data and put forward an application for each item, according to the regulatory consulting company SciLucent LLC. (Mickle, 7/6)

A new study indicates that antipsychotic drug use has been on the rise among adolescents, even though most had not been diagnosed with a mental disorder. The study, published this week in JAMA Psychiatry, used data from thousands of prescriptions to analyze trends between 2006 and 2010. The percentage of teens using the medication ticked up during the time period, with the highest rates of usage recorded among teens ages 13-18, according to the data. About 1.19 percent of that age group were using the drugs in 2010, compared with about 1.1 percent in 2006. (Gebelhoff, 7/6)

For most people, Lyme disease, when caught early enough, is resolved after two to four weeks of treatment with antibiotics. But for as much as an estimated 10% of patients treated for the disease, symptoms, such as severe muscle and joint pain, fatigue and cognitive difficulties, can last for months or even years. The condition is called post-treatment Lyme disease syndrome, or PTLDS, and experts are divided on what it is, what causes it and how best to treat it. (Reddy, 7/6)

It could trade for 400 times more than the price of crude oil and 2,000 times more than iron ore. If sold off the shelf, it could cost more than 150 times the price of a gallon of cow’s milk and 15 times more than coffee. Going for as much as $4 per ounce, human breast milk is a hot commodity that is emerging as a surprisingly cutthroat industry, one that states are now seeking to regulate amid a battle for control between nonprofit and for-profit banks that supply hospital neonatal units. ... Each side claims the moral high ground, with nonprofits generally saying milk distribution should be altruistic and for-profit companies arguing mothers deserve to be compensated. (Catalini, 7/7)

Charles Conn stopped in to see his pharmacist to fill a prescription for a cough that had persisted for a month. Once he saw how much the medication cost, he could have used a side order of blood pressure pills. The price, under his insurance plan, was $91 for 30 nonnarcotic Benzonatate gel caps. ... Luckily, the pharmacist ... had flagged the prescription and was able to sell the medication for $26.10 in cash. Mr. Conn, 66, happily paid the lower price but the episode left him wondering: Why would a prescription cost nearly four times more through his insurance plan than paying cash? The answer may lie in the vagaries of pharmaceutical pricing, which include the wholesale prices that hardly anyone pays and the largely unseen influence of third-party pharmacy benefit managers. (Twedt, 7/6)

The importance of regular mammograms to ending breast cancer has been widely endorsed by everyone from a government-backed panel to patient advocacy groups and Angelina Jolie. Is it possible they've all been wrong? A new study in JAMA Internal Medicine published Monday looked at data from 16 million women in 547 U.S. counties in 2000. More than 53,000 were diagnosed with breast cancer that year. As expected, the researchers found that the number of breast cancer diagnoses rose with more aggressive screenings. The surprise: the number of deaths remained the same. (Cha, 7/6)

Science and politics are making uneasy bedfellows as officials at the Food and Drug Administration weigh a proposed drug to enhance female sexual desire, a trio of experts on drug safety warned Monday. The FDA is expected to decide next month whether it will allow Sprout Pharmaceuticals to market the drug flibanserin as a treatment for low sexual desire in premenopausal women. The agency has rejected flibanserin twice before. But its latest round of deliberations follow last month's 18-6 vote in favor of approval by an FDA advisory panel .... In an editorial published online Monday in JAMA, three members of the advisory panel warned that the agency's decision is being made in a "politically charged atmosphere." (Healy, 7/6)

Patients of a Detroit-area doctor received "stunning" doses of a powerful, expensive drug that exposed them to life-threatening infections, an expert testified Monday as a judge heard details about a cancer specialist who fleeced insurance companies and harmed hundreds of people. Dr. Farid Fata is headed to prison for fraud and other crimes. But U.S. District Judge Paul Borman first is hearing from experts and former patients about the extent of his scheme to reap millions of dollars from Medicare and other health programs. (White, 7/6)

Marietta Crabtree dabbed her teary eyes with tissue while she clutched a printout of the words her husband never had a chance to speak against Dr. Farid Fata. The cancer doctor—who pleaded guilty to Medicare fraud in September after being accused of giving hundreds of patients unnecessary or inappropriate treatments, including chemotherapy—potentially faces life in prison in a federal sentencing hearing that began Monday. (Dolan, 7/6)

A metro Detroit doctor who raked in millions of dollars committing fraud against insurance companies grossly over treated hundreds of patients, sometimes giving nearly four times the recommended dosage amount of aggressive cancer drugs, a government witness testified Monday in federal court. Dozens of victims and their families packed into a courtroom and overflow rooms to face Dr. Farid Fata, 50, who has admitted to reaping millions through the treatments. (Stafford, 7/6)

A bill that would allow California physicians to help terminally ill patients end their lives is struggling to muster enough support ahead of a legislative vote Tuesday. Aid-in-dying advocates had hoped the nationally publicized case of Brittany Maynard, the 29-year-old California woman with brain cancer who moved to Oregon to legally end her life last fall, would prompt a wave of new state laws allowing doctors to prescribe life-ending medications. No state has passed right-to-die legislation this year, however, and efforts have been defeated or stalled in Colorado, Maine, New Jersey and elsewhere. (Nirappil, 7/7)

When Jennifer Glass goes to Sacramento Tuesday to deliver testimony in favor of the California End-of-Life-Options Act, the trip will require some complex logistics. ... Glass's testimony in support of the right to die is an intensely personal one. She was diagnosed with lung cancer in 2013, and last month she learned it had become resistant to the oral Tarceva she was taking; the cancer is now in both lungs and in her liver, abdomen, pelvis, cervix and brain. ... The bill, the most recent in a long line of such bills that have been introduced in California since 1995, passed the state Senate in early June by a vote of 23 to 14. The Assembly's health committee is scheduled to vote on it Tuesday. (Marantz Henig, 7/7)

As “death with dignity” legislation heads toward a crucial vote in an Assembly committee on Tuesday, it seems increasingly unlikely that California will become the fourth state to legalize physician-assisted suicide — at least not this year. The reason: A split between the Democratic Party’s white legislators from affluent, liberal coastal districts and its Latino members, who tend to represent working class areas and cities in the state’s agricultural heartland. Called the “End of Life Option Act,” SB 128 would let terminally ill patients request a drug that would hasten their death. Introduced by Democratic Sens. Bill Monning of Carmel and Lois Wolk of Davis, the legislation got a boost last month when the California Medical Association — long opposed to turning doctors into suicide-providers — moved to a neutral stance. (Greenhut, 7/6)

Dr. Kendra Fleagle Gorlitsky recalls the anguish she used to feel performing CPR on elderly, terminally ill patients. 'I felt like I was beating up people up at the end of their life,' she says. ... Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forego resuscitation and aggressive treatment if facing a terminal illness. It was about 10 years ago, after a colleague had died swiftly and peacefully, that Dr. Ken Murray first noticed doctors die differently than the rest of us. (O'Neill, 7/6)

In the United States, which ranks 53rd globally, a person on average can expect to survive 78 years and several months, mostly thanks to vaccines, improved sanitation, antibiotics and other health advances. People over 90 now are the fastest-growing part of the U.S. population, and there is a new category — “supercentenarians” — open to anyone who makes it past 110. “Longevity is good in general. In the specifics, it becomes a very different picture,” said John Carney, head of the Center for Practical Bioethics in Kansas City, Mo., a nonprofit group that among other things is attempting to catalyze productive discussions — at the individual and societal levels — about how to deal with the ethical, emotional and medical issues that complicate the final months, weeks and days of our lives. (Shields, 7/6)

For several decades, King/Drew hospital in South Los Angeles served one of the neediest parts of Los Angeles .... Its opening in 1972 was viewed as a victory of the civil rights era and a source of pride for black Los Angeles. But plagued in later years by poor medical care, staff errors and a series of controversial patient deaths, it came to be viewed by many as a place of peril, nicknamed Killer King. On Tuesday, delivering on a long-delayed promise to replace the facility, officials will open the doors on the new, state-of-the-art Martin Luther King, Jr. Community Hospital. It shares the site of the original medical center, but it has a new management structure and operating philosophy as it enters a dramatically different healthcare landscape than the one exited by its predecessor. (Karlamangla and Jennings, 7/6)

In the latest move in a legal and political battle, a circuit judge has issued an order blocking a new law that requires women to wait 24 hours before having an abortion in Florida. After a hearing by conference call on Thursday, Leon Circuit Judge Charles Dodson granted a motion by the American Civil Liberties Union and the Center for Reproductive Rights to vacate a stay that had allowed the 24-hour waiting period to remain in effect. (Menzel, 7/6)

San Francisco wants to take Nevada to court. That's after the U.S. Supreme Court declined to hear Nevada's appeal of a lawsuit over what's known as patient dumping. San Francisco had sued, wanting the state to reimburse it for busing indigent psychiatric patients from Rawson-Neal Psychiatric Hospital to the Bay Area. Nevada filed the appeal of that suit. (Morell, 7/6)

Oregon women will no longer have to visit a health clinic for a birth control prescription starting next year. Instead, they can head straight to their pharmacist for contraception under a measure signed into law Monday by Gov. Kate Brown. Advocates said the measure gives Oregon women the easiest access to birth control in the nation. Rep. Knute Buehler, a Bend Republican who sponsored the measure, said it gives women more control over their health care while helping prevent unwanted pregnancies. (7/6)

Gov. Terry Branstad, who pushed through a controversial plan to close two of Iowa's four state mental hospitals, is leaving open the possibility of closing one or both of the remaining two. Reporters asked Branstad on Monday if he would propose closing the mental hospitals at Independence and Cherokee, as he did with the ones at Clarinda and Mount Pleasant. He declined to make a commitment, but suggested such closures were possible. (Leys and Pfannenstiel, 7/6)

In six years, the number of beds at the state-run psychiatric hospital at Fort Logan has dropped from 222 to 94, forcing the mental institution to admit only patients with the most severe illnesses. Yet while the overall level of severity of patients with psychosis, schizophrenia and bipolar disorder has increased, the staff-to-patient ratio has not budged. Five staff members per shift run each 24-patient unit at Colorado Mental Health Institute at Fort Logan in south Denver. (Brown, 7/7)

Maine is undergoing its worst acute hepatitis C outbreak since it began recording cases in the 1990s. Reported cases of the disease have soared since 2013, corresponding with skyrocketing heroin use, and are more than triple the national average. The heroin epidemic is causing many undesirable ripple effects in Maine, public health advocates say, including the spread of infectious diseases such as hepatitis C. (Lawlor, 7/6)

In an unusual bit of collaboration between a private and a public school, Texas Christian University and the University of North Texas Health Science Center announced plans Monday to open a medical school together. The school will operate on the Fort Worth campuses of the UNT Health Science Center and TCU. Administrators hope to enroll the first class of students in the fall of 2018. At full enrollment, the school will have about 240 students working toward medical degrees. (Watkins, 7/6)

On January 5, 2014, [Keith] Vidal's mother said, her son was having a particularly bad day. He wasn't acting violently, but "it didn't seem like Keith was in reality," Mary Wilsey said. He refused to go to the hospital for an evaluation, so his family called 911 for help. ... Police responded to the family's home in Brunswick County, North Carolina. Law enforcement from three different agencies arrived, and Vidal was shot. ... Wilsey, Keith Vidal's mother, said she believes that specialized training in mental health issues would have led to a different outcome for her son. She's advocating for "Keith's Law," which would make mental health training mandatory for North Carolina police departments. (Lucas, 7/6)

At 52, Dajaun Alexander says he's looking for a fresh start. He graduated from a cooking course here last month and has been chosen for a paid apprenticeship. His prospects for a full-time job after that are very good, his chef instructor said. For Alexander, completing Community Servings' 12-week course represents a rare achievement in a life punctuated by what he calls "bad decisions." He is a recovering alcoholic with a history of incarcerations, broken relationships and spotty employment. Cooking, he said, "is my passion." It may also be his path to sobriety. (Vestal, 7/1)

Few people seem comfortable with the idea of paying patients to do what we want them to do. That’s unfortunate, because there’s a significant amount of research that says this works. I’m not talking about things like wellness programs, which offer reductions in insurance premiums if you do what your employer wants. Those are really a means of cost-sharing in which expenses are shifted onto people who are less healthy. I’m talking about paying incentives directly to people in exchange for changes to their behavior or health. (Aaron E. Carroll, 7/6)

Sometimes, it's good to be unfriendly. California's hostility toward smoking — it was the first to ban smoking in public indoor spaces, and many municipalities have made it illegal in certain outdoor venues as well — has helped give the state the second-lowest smoking rate in the nation (behind Utah). The question is how to push that number still lower than the current rate of less than 12% without trampling on the individual's right to make the unwise, unhealthful decision to smoke. Two bills before an Assembly committee on Wednesday share the worthwhile aim of fighting the nicotine habit, but both have flaws. (7/6)

When President Obama signed the Affordable Care Act (ACA) in 2010, millions of Americans received prescription drug coverage as part of their new health insurance. While this expanded coverage provided new access to prescription drugs for many Americans, it brought with it additional pharmacy requirements for both states and the federal government. Fast-forward to five years later and those ACA requirements are putting a heavy strain on state Medicaid programs as they work to manage pharmacy benefits for an increasingly diverse beneficiary population and an increasingly expensive array of drugs. (Bruce Caswell, 7/6)

A disproportionate share of U.S. health care spending is focused on a relatively small number of people, many with multiple chronic diseases. This is especially true for Medicaid, the health insurance program for people with low income. Just 5 percent of Medicaid beneficiaries account for more than half of all Medicaid spending, and 1 percent account for 25 percent of total spending, according to an analysis of national Medicaid spending. So, if you want to improve health outcomes for Medicaid recipients and hold the line on state Medicaid spending, it makes sense to improve care for high-cost, high-needs patients, many of whom live in New Jersey’s poor, urban communities. (Joan Randell, 7/6)

Patients today are demanding that their physicians communicate quickly and effectively with each other. They expect referrals to be sent electronically and their medical history and personal data to be at their physicians’ fingertips. Ideally, these communications would flow through one easy-to-access, universally available, completely private channel. Making this a reality is a tall order, but one that health care professionals are taking seriously. The wide adoption of electronic medical records over the past 10 to 15 years is an important step forward in making information more readily accessible. However, if a medical practice or a hospital begins to use electronic medical records, their system may not be capable of sharing this information with other physicians or hospitals – and that’s a serious problem. (Elizabeth A. W. Williams, 7/6)