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A federal appeals court panel will hear arguments Tuesday on whether a federal judge in Texas was correct in striking down the Affordable Care Act, a case with enormous stakes not only for millions of people who gained health insurance through the law but for the political futures of President Trump and other candidates in the 2020 elections. The case, which could make its way to the Supreme Court ahead of those elections, threatens insurance protections for people with pre-existing medical conditions and many other sweeping changes the 2010 law has made throughout the health care system. (Goodnough, 7/9)

It's unclear when the panel will rule in a case that appears destined for the Supreme Court, which has reviewed the law before. The ultimate outcome will affect protections for people with pre-existing conditions; Medicaid expansions covering roughly 12 million people; and subsidies that help about 10 million others afford health insurance. Tuesday's arguments are the latest in a lawsuit filed by Republican officials in 18 states, led by the Texas Attorney General's Office. It was filed after Congress — which didn't repeal the law, despite pressure from President Donald Trump — reduced to zero the unpopular tax imposed on those without insurance. (McGill and Santana, 7/9)

Kaiser Health News: Federal Appeals Court Takes Up Case That Could Upend U.S. Health System
Here are five important things to know about the case. (Rovner, 7/9)

The broader legal fight will likely stretch beyond the 2020 election. Whoever is elected will decide whether to drop or defend lawsuits over such issues as contraception coverage, family planning funding, and health plans that don’t comply with the ACA. “Medicaid work requirements? Another administration will not defend that,” said Loren Adler, associate director of the Center for Health Policy at the Brookings Institution. He said the Trump administration has seemed to stretch legal boundaries more than previous administrations. (Armour, 7/8)

Legal experts across the political spectrum, who had earlier dismissed the lawsuit as a long shot, contend Reed’s decision was an overreach. Even if the individual mandate was unconstitutional, they say unrelated provisions of the law — like the expansion of Medicaid to millions of low-income adults in nearly two-thirds of states — should be allowed to stand. Even a pair of Republican attorneys general in Ohio and Montana, which both expanded Medicaid, have argued that O’Connor’s ruling went too far and would have detrimental consequences. “There’s a pretty strong bias … to try to preserve things under law, rather than knock them down,” said Tom Miller, a health care expert at the conservative American Enterprise Institute. “The preponderant stance has been to go minimal in terms of knocking out broad federal laws.” (Demko, 7/8)

Left-leaning and conservative legal experts alike say there's little chance the three-judge panel in New Orleans agrees with the lower court and declare the ACA unconstitutional. The arguments used by the Republican states that sued to wipe out the ACA are "frivolous," the experts say. "This case is different from all of the previous Obamacare cases because there is a consensus among the Republican intellectual establishment that the legal arguments are frivolous," said Yale University health law professor Abbe Gluck. "You've got a lot of prominent Republican legal experts siding against the Trump administration in this case, so I think that most people are hoping that this circuit will apply very settled law and reverse the lower-court decision." (Livingston, 7/8)

As they push a federal court to repeal the Affordable Care Act, Trump administration lawyers are arguing the law is no longer workable because Congress eliminated a penalty on people who don’t have health insurance. But for months, senior administration officials and lawyers have been making the exact opposite case in other settings, a review of government reports, court filings and public statements made by Trump appointees shows. In fact administration officials, including White House economists, this year repeatedly have hailed the strength of insurance marketplaces created by the 2010 law. (Levey, 7/8)

Some potential political ramifications of the lawsuit are already seen across the country —

"It is Trump's nightmare, that at the height of the 2020 campaign he could be in the Supreme Court trying to overturn protections for people with preexisting conditions," says Democratic consultant Jesse Ferguson, in a verdict privately echoed by many GOP strategists. "I think people underestimate what this could all mean." (Brownstein, 7/9)

The Democratic Attorneys General Association is rolling out an ad blitz that takes aim at Utah Attorney General Sean Reyes for supporting a lawsuit against the Affordable Care Act. The six-figure ad campaign will also target Republican attorneys general in Louisiana, Missouri, Indiana and West Virginia, all of whom have backed the anti-Obamacare case that is scheduled for a Tuesday court hearing. (Rodgers, 7/8)

Members of New Hampshire’s congressional delegation lobbied for public support of the Affordable Care Act on Monday, the day before opening arguments in a federal lawsuit that could dissolve the national health care plan. The delegation, all Democrats, warned of dire consequences should the latest legal challenge to the ACA succeed in the 5th Circuit Court of Appeals. (Alden, 7/8)

The Democratic Attorneys General Association is taking aim at Louisiana General Jeff Landry and several other Republican AGs for their role in a lawsuit that seeks to overturn the Affordable Care Act. The group bought Sunday newspaper ads in The Advocate and four other papers in other states as part of a campaign attacking the Republican AGs who are part of the lawsuit and who are running for reelection this year. The ads come as oral arguments are scheduled for this week in New Orleans in the case, which is expected to determine whether the landmark health law is unconstitutional.  (Karlin, 7/8)

The campaign group for Democratic attorneys general launched a six-figure ad campaign targeting their Republican counterparts for trying to undo the Affordable Care Act (ACA) in court. The Democratic Attorneys General Association's (DAGA) digital and print ad campaign will target Republican attorneys general in five states who are currently involved in a lawsuit seeking to overturn the health care law also known as ObamaCare. (Hellmann, 7/8)

The Senate Democratic campaign arm is launching a round of ads on Tuesday morning attacking GOP senators over a Republican lawsuit seeking to overturn ObamaCare. The five-figure Facebook ad campaign launches ahead of arguments in court on Tuesday in the lawsuit, which was brought by 20 GOP-led states seeking to invalidate the Affordable Care Act. (Sullivan, 7/8)

A federal judge ruled on Monday that the Trump administration cannot force pharmaceutical companies to disclose the list price of their drugs in television ads, dealing a blow to one of the president’s most visible efforts to pressure drug companies to lower their prices. Judge Amit P. Mehta, of the United States District Court in the District of Columbia, ruled that the Department of Health and Human Services exceeded its regulatory authority by seeking to require all drugmakers to include in their television commercials the list price of any drug that costs more than $35 a month. The rule was to take effect this week. (Thomas and Rogers, 7/8)

The narrow ruling by U.S. District Judge Amit Mehta in Washington, D.C., struck down a requirement that was set to go into effect within hours, on Tuesday. Drugmakers had argued that requiring them to disclose list prices amounted to coercion that would violate their free speech rights under the Constitution. But in his 27-page ruling Mehta avoided debating the First Amendment, saying simply that the Trump administration had failed to show it had legal authority under the statutes that govern federal programs such as Medicare to require price disclosure. (Alonso-Zaldivar, 7/8)

Mehta in his ruling set aside the entire rule as invalid, saying the HHS lacked authority from the U.S. Congress to compel drug manufacturers to disclose list prices. "It is outrageous that an Obama appointed judge sided with big PhRMA to keep high drug prices secret from the American people, leaving patients and families as the real victims," White House spokesman Judd Deere said in a statement, referring to President Donald Trump's Democratic predecessor, Barack Obama. (Bellon and Raymond, 7/8)

Three drug manufacturers — Merck, Eli Lilly and Amgen — sued the administration after the Department of Health and Human Services finalized the rule in May, arguing that HHS overstepped its authority because it did not have permission from Congress to impose the requirement. HHS Secretary Alex Azar, formerly the president for the U.S. division of Eli Lilly, has sought to deliver drug pricing wins that President Trump can tout on the campaign trail. In May, Azar called the rule “the single most significant step any administration has taken toward a simple commitment: American patients deserve to know the prices of the health care they receive.” (Abutaleb, 7/8)

It’s a big loss for the Trump administration. The proposal was the first major drug pricing policy finalized by the administration since releasing its sweeping drug pricing plan in May 2018. Other Trump proposals, like its plan to peg what Medicare pays for drugs to what other countries pay, are likely years away from being enacted. (Florko, 7/8)

The administration said the goal of the rule was to increase transparency, which would put pressure on drugmakers to keep prices low. It argued that list prices matter to patients, especially consumers with high deductibles who must often pay the full amount. The U.S., one of the few countries to allow TV ads for drugs, currently requires them to disclose side effects and other information. “If drug companies are ashamed of those prices—lower them!” Mr. Trump tweeted in May. (Armour, 7/8)

While the new rule does not have an enforcement mechanism, Azar said failing to include the price would be considered a deceptive trade practice and could prompt lawsuits by industry rivals. (Luhby, 7/8)

Many drugmakers, including Lilly and Amgen, have created websites to disclose prices, but argued that including them in ads could result in patients being scared away from seeking treatment. The Trump administration had said that forcing drugmakers to disclose prices for drugs, which have risen sharply in recent years, could push down list prices. (Armstrong, 7/8)

AARP vice president Nancy LeaMond called the ruling a disappointment. “Today’s ruling is a step backward in the battle against skyrocketing drug prices,” she said in a statement. “Americans should be trusted to evaluate drug price information and discuss any concerns with their health care providers.” (Lam, 7/9)

The House will consider new legislation to address the treatment of migrants at the southern border, Speaker Nancy Pelosi said Monday — less than two weeks after passage of a $4.6 billion emergency spending package left scores of Democrats angered about a lack of accountability for the Trump administration. “Legislation is necessary,” Pelosi (D-Calif.) said in a letter to Democrats, pointing to House provisions that were left out of the Senate-negotiated spending bill that ultimately passed last month — including medical care standards for migrants in U.S. custody, a 90-day limit on children’s stays in federal “influx shelters” and guaranteed access to border facilities without notice for members of Congress. (DeBonis and Kim, 7/8)

Pelosi has urged President Trump to adopt the additional protections unilaterally. But her latest message suggests she's not holding her breath for the administration to act on its own to ensure that those placed in federal custody after arriving at the U.S.-Mexico border have ready access to medical treatment, hygiene products and other simple necessities. "Whether or not the President responds to our request to improve medical care standards for the health and safety of children, and while Senator McConnell still refuses to help the children suffering in these deplorable conditions, we must lead a Battle Cry across America to protect the children," Pelosi wrote in the "Dear Colleague" letter.  (Lillis, 7/8)

Juul is gearing up for an all-or-nothing fight over the surge of local bans on vaping around the country. And the battle is starting in its headquarters city of San Francisco, which just enacted the nation's first blanket prohibition on e-cigarette sales. More than 200 jurisdictions have placed limits on selling flavored tobacco products, including nearly two dozen cities and counties in California. San Francisco's ordinance, signed last week, goes further by cutting off all sales, including online purchases delivered to city addresses, until the products go through FDA reviews. (Colliver, 7/9)

Meanwhile —

Two months after key lawmakers sidetracked a proposed ban on the sale of flavored tobacco products in California, an influential state legislator has quietly introduced a less restrictive measure that some health groups say is designed to protect electronic-cigarette makers. The new proposal, which also targets marketing to youth, was announced by lawmakers led by Assemblyman Adam Gray (D-Merced), whose chairmanship of the powerful Assembly Governmental Organization Committee makes him a gatekeeper for all tobacco-related bills. (McGreevy, 7/8)

The Trump administration this week will announce a series of initiatives to encourage more kidney transplants and treatment at home, the start of a process intended to overhaul a market in which the federal government spends more than $100 billion per year. President Donald Trump is slated to unveil the strategy in a speech Wednesday morning and is eyeing additional actions like a possible executive order, according to four individuals with knowledge of the upcoming announcement. (Diamond and Roubein, 7/8)

And in other kidney health news —

Researchers are studying the brains of altruistic kidney donors, i.e., people who donate one of their kidneys to a complete stranger. CBS News got a look at the science and were introduced to two women connected by the ultimate gift. As a mother, firefighter and paramedic… putting others first is a way of life for Jo Kummerle. So, it wasn’t a difficult choice when she decided to donate one of her kidneys to a total stranger. (7/8)

Facing mounting fears about likely coverage losses, New Hampshire's Republican Gov. Chris Sununu announced Monday that he is delaying implementation of the state's Medicaid work requirement program for 120 days. In addition, Sununu signed a Democratic-sponsored bill that would halt the work requirement if 500 or more people are disenrolled due to noncompliance, or if providers report an increase in uncompensated care resulting from beneficiaries being disenrolled due to noncompliance. (Meyer, 7/8)

In New Hampshire, eligibility to qualify for Medicaid was expanded from 63 percent to 138 percent of the federal poverty level in 2015. Sununu said outreach efforts have included four direct mailings, radio ads, information booths and grocery and retail stores, 50,000 telephone calls, and text messages. They’ve also asked health care providers to inform patients of the requirements. “No other state has taken the efforts, and I think the pains if you will, of making sure we are engaging with this population as aggressively as we can,” Sununu said. “Making sure we get this right is absolutely paramount.” (Hayward, 7/8)

Department of Health and Human Services Commissioner Jeff Meyers said that out of the 24,895 Medicaid recipients enrolled in June without a qualifying exemption, 16,874 people failed to provide proof to the state that they met the new Medicaid work rules, which require people to work for 100 hours each month, or prove some other type of qualifying community engagement. The low compliance rate comes despite months of outreach by the state, including radio ads, public information sessions, direct mailings and text messages. (Bookman, 7/8)

State action to implement work requirements into their Medicaid programs is heating up, as some states roll out their programs while others are fighting in court to keep them alive. New Hampshire announced Monday it would delay suspending any Medicaid coverage until September because of consumers' noncompliance with the work requirements. Meanwhile, Indiana on July 1 began the first steps of implementing its work requirements. Court action in three states is also expected in the coming months. (Raman, 7/9)

In other Medicaid news —

As California prepares to expand Medicaid coverage to young adults here illegally, the number of undocumented immigrant children in the program is slowly declining, new state data show. Unauthorized immigrant children have been eligible for Medi-Cal, the state’s Medicaid program for low-income residents, since May 2016, and their enrollment peaked nearly a year later at 134,374, according to the data from the state Department of Health Care Services. (Ibarra, 7/8)

We all hope for some peace and comfort at the end of life. Hospices are designed to make that possible, relieving pain and providing emotional and spiritual support. But two new government studies released Tuesday morning find that the vast majority of hospices have sometimes failed to do that. And there's no easy way for consumers to distinguish the good hospices from the bad. (Jaffe, 7/9)

Over 80 percent of hospice facilities had at least one deficiency, and most of those had multiple deficiencies. One in five had a serious deficiency. “When we looked into some of the more extreme examples of how those deficiencies can impact patients, we found cases where patients were actually harmed by their hospice care,” Bliss said. (Kosnar, 7/9)

A state inspector in Missouri documented the grim details: a deep, poorly treated pressure wound on the patient’s tailbone, apparent pain that caused grimacing and — in a crisis requiring a trip to the emergency room — a “maggot infestation’’ where the feeding tube entered his abdomen. The official cited Vitas Healthcare, the nation’s largest hospice chain, for putting the patient in “immediate jeopardy,” the most severe category of violation. The inspector found that Vitas staffers had skipped home visits and failed to assess the amount of pain the patient endured. (Rowland, 7/9)

An appellate court panel ruled Monday that the American Civil Liberties Union can soon begin collecting signatures that would put a new Missouri law banning abortions at eight weeks of pregnancy to a public vote. A three-judge panel of the state's Court of Appeals found that GOP Secretary of State Jay Ashcroft was "without authority" to reject petitions to put the law on the 2020 ballot on constitutional grounds. The 31-page ruling was issued just hours after the panel heard oral arguments in the case. (Hollingsworth, 7/8)

While the ruling revives an effort from the American Civil Liberties Union of Missouri to scrap the abortion ban, supporters won’t have a lot of time to gather roughly 100,000 signatures. And there could be more legal fights to come about whether a provision that goes into effect right away will derail the referendum in the future. Ashcroft rejected the referendum from the ACLU, as well as two other similar ones, because part of the abortion law went into effect right away under what’s known as an emergency clause. But the Western District Court of Appeals ruled that Ashcroft didn’t have the authority to make that decision. (Rosenbaum, 7/8)

The ACLU argued that the emergency clause that Republicans used to make that one aspect of the bill effective immediately was invoked “not because of an immediate need to preserve the public peace, health, or safety,” as the law requires, “but rather in order to defeat any attempt to refer the bill for voter approval or rejection under the fundamental right of referendum.” The court almost immediately ruled in their favor. (7/8)

A federal program to help injured veterans and their spouses conceive children through in vitro fertilization is being hobbled by anti-abortion forces that oppose how the process can lead to embryos being destroyed. Since 2012, Democrats in Congress have repeatedly championed legislation permanently extending IVF benefits to veterans whose injuries in the line of duty have left them unable to conceive children otherwise. But those bills have fizzled in the face of opposition from Catholic bishops and others in favor of a temporary program that must be reauthorized every year, complicating efforts by eligible veterans to begin or extend their families. (Carr Smyth, 7/8)

A state-court judge declined Monday to give a Kansas clinic permission to provide telemedicine abortions. Shawnee County District Judge Teresa Watson rejected a request from the Trust Women Foundation for an injunction to block the state from subjecting the clinic and its doctors to enforcement of state laws against telemedicine abortions. She did so despite another judge's ruling that no ban can be enforced and a Kansas Supreme Court ruling in April that access to abortion is a "fundamental" right under the state constitution. (Hanna, 7/8)

Monika Neall was standing outside an abortion clinic in Manchester when she saw a woman in her mid-20s dart out the doors. The woman moved towards a parked car, then suddenly froze. On the ground nearby lay plastic fetus models, candles and images of mothers gazing adoringly at babies. Panicking, she caught Neall's eye. "That's my car," she said, her voice starting to crack. Most Saturday mornings, Neall puts on a pink vest and joins a small group of women from the volunteer organization Sister Supporter. They stand outside the Marie Stopes clinic in the northern English city to oppose the anti-abortion protests that are held there weekly. (Woodyatt, 7/9)

The first sign something was wrong at the California in vitro fertilization clinic was that the couple had thawed and implanted two female embryos only to learn they were carrying boys. How could that be? A doctor at CHA Fertility Center in Los Angeles told the couple that sometimes sonograms get it wrong. He assured the couple "they were having girls and that nothing was wrong," according to a federal lawsuit filed by the couple and obtained by USA TODAY. Something was very wrong, according to the couple's legal claim. (Haller, 7/8)

The couple say in a federal lawsuit filed last week in the Eastern District of New York that after years of failed efforts to have children and spending over $100,000 to get pregnant at CHA Fertility, doctors used embryos that belonged to two other couples who had also received treatment there. After giving birth March 30 to a set of twins that were not of Asian descent, the lawsuit says, the couple “was shocked to see that the babies they were told were formed using both of their genetic material did not appear to be.” (Stelloh, 7/7)

The lawsuit claims genetic testing confirmed the babies belonged to two other couples, forcing them to give the babies up to their biological parents. They still don't know what happened to their two embryos that should have been implanted. The lawsuit names co-owners of CHA Fertility Center, Dr. Joshua Berger and Simon Hong, as responsible for the "unimaginable mishap." (7/8)

The lawsuit accuses the clinic and doctors of medical malpractice, negligence, negligent infliction of emotional distress, breach of contract and more. A lawyer listed for the clinic did not immediately respond to McClatchy’s request for comment on Monday. In the lawsuit, the couple also accuse the clinic of not telling them what became of the embryos that were supposed to be implanted in the would-be mother, and of “continuing to wrongfully conceal the whereabouts of … two embryos that we know were not transferred to” the woman. (Gilmour, 7/8)

Ever since their marriage in 2012, the couple has yearned for children. Specifically, their wish has been “to conceive, deliver and raise children of their own,” as their lawsuit claims. Their attempts to conceive a child were unsuccessful, so they turned to different strategies, including artificial insemination. But natural as well as alternative measures left them disappointed. (Stanley-Becker, 7/8)

In 2015, Travis Rieder, a medical bioethicist with Johns Hopkins University's Berman Institute of Bioethics, was involved in a motorcycle accident that crushed his left foot. In the months that followed, he underwent six different surgeries as doctors struggled first to save his foot and then to reconstruct it. Rieder says that each surgery brought a new wave of pain, sometimes "searing and electrical," other times "fiery and shocking." (Gross, 7/8)

At least 92 lives have been saved with naloxone handed out at two Northern Kentucky syringe exchanges. ...The rescues with the opioid-overdose antidote were among records The Enquirer requested from the Northern Kentucky Health Department to learn outcomes of the first year of Covington and Newport syringe-exchanges. (DeMio, 7/8)

Last year, opioid-related deaths in Iowa decreased by 33 percent, marking a five year low for the state, according to statistics released this month from the state's Department of Health Statistics. Iowa had 137 opioid-related deaths in 2018, 206 deaths in 2017, 180 deaths in 2016, 163 deaths in 2015 and 168 deaths in 2014. (Krebs, 7/8)

La Paz County filed a lawsuit in Arizona court Wednesday against opioid manufacturers and distributors, alleging they created an opioid crisis and brought suffering to the rural community. Filed in La Paz County Superior Court, the lawsuit names multiple defendants, including Chandler-based Insys Therapeutics founder John Kapoor and former CEO and President Michael Babich, and Johnson and Johnson. (Curtis, 7/5)

Recent actions by antitrust enforcers and courts to block or regulate purchases of physician practices by hospitals and insurers may signal increasing scrutiny for such deals as policymakers intensify their focus on boosting competition to reduce healthcare prices. Last month, the Federal Trade Commission announced a settlement with UnitedHealth Group and DaVita unwinding United’s acquisition of DaVita Medical Group’s Las Vegas operations. (Meyer, 7/6)

Healthcare hiring ticked back up in June after taking a dive in April and May. The sector added 34,900 jobs last month, up significantly from 15,700 in May, the weakest month since September 2017, according to the U.S. Bureau of Labor Statistics' latest jobs report, released Friday. The U.S. unemployment rate grew slightly to 3.7% in June, compared with 3.6% in both May and April. Total nonfarm employment increased by 224,000 in June, according to the report. (Bannow, 7/8)

The CMS announced Tuesday it has extended coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings. The agency previously only covered the use of the device, which monitors blood pressure periodically over a 24-hour period, for patients with suspected elevated blood pressure levels due to anxiety from being in a clinical setting. The device can now also be used for patients suspected of having lower than usual blood pressure measurements when inside a doctor's office. Medicare will cover the use of the device once a year per patient. (Castellucci, 7/3)

Microsoft Corp. signed Providence St. Joseph Health as a customer of its Azure and artificial intelligence tools to help the hospital chain track electronic health data such as surgery outcomes and cancer therapies.  Providence, which operates hospitals in seven U.S. states, will shift data and applications from its own data centers to Microsoft’s cloud as part of the five-year agreement. The company’s 119,000 doctors and caregivers will also get access to Microsoft’s Office productivity software and its Teams chat service. (Bass and Tozzi, 7/8)

Millions of Americans use dietary supplements and a variety of diets to protect their heart health. But a large new analysis found that there was strikingly little proof from rigorous studies that supplements and some widely recommended diets have the power to prevent heart disease. The new research, published in the Annals of Internal Medicine, reviewed data from hundreds of clinical trials involving almost a million people and found that only a few of 16 popular supplements and just one of the eight diets evaluated had any noticeable effect on cardiovascular outcomes. (O'Connor, 7/8)

The findings were unsurprising, said Susan Jebb, a professor of diet and population health at the University of Oxford. "Except to prevent or correct specific deficiencies" such as low vitamin D levels, or in specific circumstances such as pregnancy, "there is generally good agreement that dietary supplements should not be recommended to the general population." (Azad, 7/8)

Still, the findings may do little to shake Americans' strong faith in supplements and vitamins. An estimated 3 out of 4 people in the United States take at least one dietary supplement, and Americans are projected to spend $32 billion on them this year alone. But, according to Khan's review of the available science, it's largely a waste of money — at least when it comes to heart health. (Edwards, 7/8)

In other heart health news —

Maintaining a low level of LDL, or “bad” cholesterol, is important for cardiovascular health, but extremely low LDL may also have risks, researchers report. The scientists studied 96,043 people for an average of nine years, recording their LDL level biennially and tracking cases of hemorrhagic stroke, caused by the rupture of a blood vessel in the brain. About 13 percent of strokes are of the hemorrhagic type. (Bakalar, 7/8)

On Aug. 1, New Jersey will become the eighth state to allow doctors to prescribe lethal medication to terminally ill patients who want to end their lives. On Sept. 15, Maine will become the ninth. So by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.) But while the campaign for aid in dying continues to make gains, supporters are increasingly concerned about what happens after these laws are passed. (Span, 7/8)

Finding a good primary care doctor can feel a little bit like dating. It's awkward. Your expectations are high. You know it's rough out there, but you're still secretly hoping to find the one. So where do you begin? Just like dating, finding a doctor you click with is all about trusting your intuition. "What you get in a snapshot isn't that far from the truth," says Dr. Kimberly Manning, a primary care doctor and associate professor at Emory University. "In terms of interactions, in how someone talks to you — I think those things can be really powerful markers to help you decide if this is a good fit." (Gordon, 7/8)

A new study of toddlers exposed to the Zika virus during their mothers’ pregnancies found that nearly a third suffered developmental delays and other problems — even if they were born without the abnormally small heads and underdeveloped brains often associated with the virus. The study of more than 200 babies, published Monday in the journal Nature Medicine, also shows that a very small number of children born with the congenital condition known as microcephaly had their symptoms improve. Conversely, a very small number of the children born without symptoms of microcephaly went on to develop it. (Bever, 7/8)

Hospitals today can be sonic hellscapes, which studies have shown regularly exceed levels set by the World Health Organization: droning IV pumps, ding-donging nurse call buttons, voices crackling on loudspeakers, ringing telephones, beeping elevators, buzzing ID scanners, clattering carts, coughing, screaming, vomiting. Then there are the alarms. A single patient might trigger hundreds each day, challenging caregivers to figure out which machine is beeping, and what is wrong with the patient, if anything. (Rueb, 7/9)

It’s been more than three years since the man who helped build Napster, Facebook, and the internet as we know it stormed into the world of science.When [Sean] Parker announced that he would spend $250 million of his fortune on efforts to harness the immune system to fight cancer, he seemed to be following a familiar playbook: Yet another billionaire was pouring money into yet another problem that had resisted previous attempts to tame it. Under the auspices of the Parker Institute for Cancer Immunotherapy, or PICI for short, he vowed to fund the research of leading scientists like [Jim] Allison and [Padmanee] Sharma — and encourage them to work together in new ways, always with an eye toward accelerating the development of new treatments. (Robbins, 7/9)

Navigating airports can be tricky. They’re loud, crowded and not always laid out intuitively. They’re even more challenging for visually impaired people. Chieko Asakawa knows those challenges firsthand, and she has also devised a remedy. Asakawa has been blind since she was 14 and is now an IBM Fellow and a professor in Carnegie Mellon University’s Robotics Institute. This spring, she and other researchers at Carnegie Mellon launched a navigation app for Pittsburgh International Airport that provides turn-by-turn audio instructions to users on how to get to their destination, be it a departure gate, restaurant or restroom. (De Groot, 7/8)

Democratic countries with free and fair elections generally had higher overall life expectancies among residents who were HIV-free than did autocracies. Democratic experience also eased the burden of chronic, noncommunicable diseases like heart disease or stroke, according to the study. (Lambert, 7/4)

In May, the World Health Organization announced that it is developing guidelines on mental well-being in the workplace and unveiled an expanded definition of “burnout,” based on new research in its International Classification of Diseases. Burnout is a syndrome resulting from “chronic workplace stress that has not been successfully managed,” according to WHO’s description, characterized by feelings of exhaustion, reduced effectiveness, and negative or disconnected feelings toward one’s job. (Johnston, 7/8)

Scientists are using gene-editing technologies to make mosquitoes that can't spread malaria, combat diseases caused by a single errant letter in a string of DNA and create designer babies that are protected against HIV. They may be thinking too small. A father-daughter team is plotting the best way to create a dragon. They've even written a new book to explore how they'd do it. (Miller, 7/8)

New research suggests legalizing recreational marijuana for U.S. adults in some states may have slightly reduced teens' odds of using pot. One reason may be that it's harder and costlier for teens to buy marijuana from licensed dispensaries than from dealers, said lead author Mark Anderson, a health economist at Montana State University. (7/8)

Florida travelers are catching serious mosquito-born diseases abroad, including dengue fever, chikungunya, malaria and Zika virus. Still, officials say the numbers are low and there’s no reason to panic. To be clear, there are no outbreak zones for any of these diseases in Florida where people are catching the disease from locals. But an increase in mosquitoes does increase the possibility that people could catch it from someone who travels. (Aboraya, 7/8)

There's the old saying that you should never discuss politics or religion in polite company. Nowadays, it seems climate change has joined that list. Barely more than a third of Americans broach the subject often or even occasionally, according to a recent survey by researchers at the Yale Program on Climate Change Communication. All this not talking about climate change has given Americans a rather skewed perception of what the rest of the country thinks about the issue. (Rosen, 7/8)

It was just weeks after 26 people were gunned down at Sandy Hook Elementary School when Lenny Pozner first saw people speculating online that the rampage had been staged, with crisis actors responding to a fake attack. His 6-year-old son, Noah Pozner, who had gone to school that morning in a Batman sweatshirt, was one of the 20 children killed in Newtown, Conn., in December 2012. (Svrluga, 7/8)

A top Virginia Republican is calling for a broad ban on guns in government buildings, surprise legislation he filed the day before state lawmakers are set to debate gun laws. Senate Majority Leader Tommy Norment filed a bill Monday that would extend a state prohibition on guns in courthouses to any "building owned or used by a locality for governmental purposes." It would also increase the penalty for breaking the law from a misdemeanor to a felony. (7/8)

Norment’s bill, which caught GOP colleagues off guard, goes further than a similar measure proposed by a Republican delegate. Both are the strongest signs that some GOP lawmakers might support at least one priority set by Gov. Ralph Northam (D) when he called the General Assembly back to work. Northam ordered the special session in the wake of the May 31 mass shooting in Virginia Beach in which 12 people were killed. Republicans who control the legislature have stymied gun control bills year after year and have accused Northam of trying to capi­tal­ize on tragedy for political gain. (Schneider and Vozzella, 7/8)

And in other gun safety news —

In all the debate about whether doctors should screen patients to prevent gun injuries or death, [Kamau] Karanja has stumbled on a key missing piece: What questions might deliver answers that matter?Slowly, cautiously, Karanja has begun testing some gun-related routine check-up questions with his patients. (Bebinger, 7/9)

Civil rights groups, including the American Civil Liberties Union, Southern Poverty Law Center and several that advocate for people with disabilities or mental health issues, said Tuesday that the state should re-evaluate its plan for creating an expansive database of student discipline and behavior. In a letter scheduled to be sent to Gov. Ron DeSantis at 6 a.m. Tuesday, the 32 groups wrote that the still-developing database amounted to an “overly broad” attempt at “mass surveillance” of students that could end up discouraging kids from reporting bullying incidents or mental health needs out of fear that they could be labeled as a “potential school shooter.” (Mahoney, 7/9)

Texas will have to submit to a federal court’s supervision of plans for relieving the “crushing” workloads of Child Protective Services caseworkers who track foster children, a federal appeals court has ruled. U.S. District Judge Janis Graham Jack of Corpus Christi and her court-appointed monitors also must sign off on the state protective-services agency’s studies that are designed to reduce workloads of residential child-care licensing investigators and inspectors, the appellate judges agreed. (Garrett, 7/8)

Beginning in 2021, Connecticut insurance providers will have to submit annual reports detailing their coverage of mental health and substance abuse services. The push toward greater transparency is aimed at ensuring the companies comply with state and federal mandates that bar them from placing greater restrictions on access to mental health services than on surgical or medical care. (Carlesso, 7/8)

A patient who alleged she was sexually assaulted by a UCLA Health gynecologist was awarded $2.25 million in a settlement finalized last month with the University of California regents, according to university records released Monday. The patient’s accusation stemmed from a February 2018 appointment with Dr. James M. Heaps. Heaps was charged in early June with sexual battery and exploitation in connection with his treatment of two patients — including the woman whose claim was settled last month. (Cosgrove, Watanabe and Winton, 7/8)

Veterans who have had brain injuries or are struggling with the effects of trauma may soon have a new treatment option if a new bill making its way through the legislature eventually becomes law. On Tuesday, a Senate Health Care ommittee greenlighted House Bill 50, the North Carolina Veterans Traumatic Brain Injury and Post-Traumatic Stress Disorder Treatment and Recovery Act which would allow medical professionals to prescribe hyperbaric oxygen therapy, or HBOT, to North Carolina veterans who have had traumatic brain injuries and/or have post-traumatic stress disorder. (Davis, 7/9)

New Hampshire passed a law last week forming a commission to advocate for the needs of its aging population. The Granite State has the second oldest population in the country, according to the U.S. Census Bureau. (Ernst, 7/8)

Even as Rennova Health's CEO vows to reopen the rural Tennessee hospital he was forced to close last month, local government officials are working up an extreme contingency plan: opening their own facility. "People's health is in danger because of stubbornness," Fentress County Executive Jimmy Johnson said. "That's all it is." Leadership closed Jamestown (Tenn.) Regional Medical Center the day after the CMS revoked its Medicare billing privileges in June for accumulating more than $4 million in unpaid bills, lacking key supplies and keeping money from employees' paychecks. (Bannow, 7/8)

Gov. Tony Evers used vetoes to funnel more funding toward facilities that will replace the state's juvenile prison, but he says he may need more time and money to get them built. The state under a recently approved law is required to close Lincoln Hills School for Boys by July 2021. But Evers said he may need more time, even with the additional money he secured for the new facilities with his vetoes. (Marley, 7/8)

State regulators have a backlog of about 200 complaints against nursing homes that need investigation, officials say. A high number of job vacancies for nurse surveyors is a major cause of the complaint backlog, according to the state Department of Community Health. (Miller, 7/8)

Sanford Health is exploring a merger with Des Moines-based UnityPoint Health to create a large health system that includes dozens of hospitals and nursing homes plus hundreds of medical clinics across six states including Minnesota. Leaders of the two groups signed a letter of intent last month to explore the merger, which they said would create a nonprofit company with more than $11 billion in annual revenue that would rank among the top 15 largest nonprofit health systems in the country. (Snowbeck, 7/9)

The eight-member task force publicly aired impressions of their visit to the embattled facility on Monday afternoon, meeting for the fourth time since lawmakers approved the committee’s formation following allegations that staff abused kicked, hit and tormented a patient in 2017. Describing the state’s only maximum security psychiatric hospital, Lawlor said the diamond-shaped, two-floor building has narrow corridors and lacks natural sunlight. Others said the infrastructure is not well maintained, and the furniture looked decades old. (Lyons, 7/8)

Connecticut is joining the growing list of states no longer willing to wait for the federal Environmental Protection Agency to study and make recommendations for how to respond to an emerging environmental threat from a class of 4,700 ubiquitous chemicals collectively known as PFAS substances. Gov. Ned Lamont announced the creation of an inter-agency task force Monday to develop an action plan on how to measure and address pollution from the chemical class known as per- and polyfluoroalkyl substances — a threat largely unknown to the public here until a spill of firefighting foam last month at Bradley International Airport. (Pazniokas, 7/8)

A 5-year $3.7 million federal grant from the Health Resources and Services Administration to LSU's School of Social Work is funding research and training to teach social workers, nurses and doctors how to work with geriatric patients in Louisiana. The grant is going to a partnership among LSU, Ochsner Health System, Chamberlain University College of Nursing and  nonprofit Alzheimer's Services of the Capital Area. (Mosbrucker, 7/8)

There’s been no shortage of criticism for Gov. Gavin Newsom’s plan to help California’s largest utilities stave off bankruptcy from costs associated with wildfires: No focus on prevention efforts. More difficulty proving utility negligence. Too much of the financial burden falling on millions of utility customers. The governor, six months into his first year in office, managed to overcome some of those complaints with a Senate vote of approval Monday. But he still faces a crucial test this week as he attempts to convince the rest of the California Legislature to ratify a multibillion-dollar utility wildfire fund before lawmakers leave Sacramento for a one-month recess. (Luna, 7/8)

Bayfront Health St. Petersburg has hired a new CEO five months after its previous chief executive resigned suddenly. Sharon Hayes will take the helm at St. Petersburg's oldest and largest hospital beginning July 15. She was previously the CEO of Regional Medical Center Bayonet Point in Hudson, where she's worked since Feb. 2018. (Griffin, 7/8)

The U.S. Court of Appeals for the 5th Circuit will consider on Tuesday one of the most outrageous rulings of the past year: the one in which a U.S. district court judge in Texas struck down the entire Affordable Care Act based on widely condemned legal reasoning. The question before the court is whether its appellate judges will taint themselves by associating with preposterous arguments. The Trump administration and the other Affordable Care Act challengers claim a key piece of the law is suddenly unconstitutional and, as such, the law can no longer work as intended. Obamacare, the argument goes, is an intricately designed system. (7/8)

Although Americans love anniversaries, we have overlooked the political importance of July 10, 1969. Speaking on that date from the Roosevelt Room of the White House, President Richard Nixon became the first president to declare that America faced a “massive crisis” in health care in the absence of “revolutionary change.” Similar predictions of impending catastrophe have, incredibly, persisted through each presidency for a half-century. The Trump administration, for example, has warned that “the system we have is unsustainable and it cannot continue.” Given the latest Wall Street Journal/NBC News poll, in which respondents picked health care as the top priority for the federal government, as well as the evidence from the first two Democratic presidential candidate debates, this election season will surely bring more of the same. (Michael L. Millenson, 7/8)

In recent years, the idea has spread that forcing consumers to pay more for healthcare — giving them “skin in the game” is the usual mantra — will prompt them to become more discerning medical shoppers. The goal is to improve the efficiency of the healthcare system by saddling consumers with higher costs if they opt for less useful or more overpriced services. Experts have identified numerous flaws with this concept, as we’ll get to in a bit. (Michael Hiltzik, 7/8)

In late June, President Trump signed an executive order that aims to make healthcare prices more transparent. The order calls on the Secretary of Health and Human Services to propose rules that would require hospitals to publicly post standard prices for medical care in an "easy-to-understand, consumer-friendly" format that will "allow patients to compare prices across hospitals." It also aims to ensure that doctors, hospitals, and insurance companies "provide or facilitate access to information about expected out-of-pocket costs for items or services to patients before they receive care." This is a worthwhile effort. When patients can easily access the price of healthcare, costs tend to go down. (Sally Pipes, 7/8)

If you try to use Medicare Advantage, figuring out which doctors are available (and where) can be exceedingly difficult, if not impossible. Medicare Advantage is the government-subsidized, private plan alternative to the traditional public Medicare program. It has had strong enrollment growth for years. (Austin Frakt, 7/8)

When the media covers antibiotic-resistant bugs, they typically describe them with a sense of alarm, fear and helplessness. Much of this is warranted: Antibiotic resistance is undermining the foundations of our modern medical system. No longer can we count on these drugs for a broad array of critical situations: for patients needing joint replacements or open-heart surgery or Caesarean sections; for immune-compromised individuals receiving cancer treatment or organ transplants; for people undergoing other increasingly commonplace, high-tech invasive procedures. (Michelle A. Williams, 7/8)

Health care is back in the limelight with primary season heating up. However, if you have been listening to the debate about the future of the American health-care system, you haven’t heard much, if any, discussion about the urgent problems developing for children’s coverage. As a primary care pediatrician for two decades, I am highly attuned to the challenges my patient families face. I recall in particular seeing a child with multiple medical conditions who hadn’t continued care with their many specialists, despite my reminders about the importance of follow-up. (David Rubin, 7/6)

If religious faith is an intimate and fundamental determination, which no one should be able to coerce or punish, then gender surely should be, too. What about the right of trans and gender variant people to discern this incredibly personal matter for ourselves? What of the sacredness of our convictions? (S.I. Rosenbaum, 7/5)

When Congress passed the Protecting Access to Medicare Act (PAMA) in 2014, it included an important provision related to clinical laboratory services. Section 216 of the law ended use of a static fee schedule, replacing it with a plan to utilize private sector prices to set Medicare reimbursement rates. The American Clinical Laboratory Association (ACLA) supported this shift, recognizing that reimbursement for some laboratory tests would be reduced, but believed the use of laboratory market data to set Medicare rates would provide the sustainable, predictable reimbursement system that Medicare beneficiaries need. (Julie Khani, 7/8)

This week, family members of residents of the Hacienda HealthCare Intermediate Care Facility (ICF) spoke out in defense of the unit our loved ones call home. We could no longer stay quiet while this outstanding facility suffers attacks by disgruntled former employees leaking half-truths and rumors, political opportunists and sensationalizing reporters. (Alan Strobel and Heidi Reid-Champigny, 7/5)

Requiring a smog check for trucks is long overdue. Currently, with the number of unhealthy smog days in Southern California on the rise after years of improvement, it’s especially important to finally crack down on truck pollution. Smoggy, unhealthy air is particularly bad in inland communities in Southern California and the San Joaquin Valley, where trucks play a crucial role in the agriculture and goods-movement industries. About a million heavy-duty diesel trucks operate in California each year, which is a small fraction of the total number of vehicles on the road. Yet diesel trucks account for nearly 60% of the smog-forming nitrogen oxides and 80% of the soot from motor vehicles. (7/9)

House Bill 1651, which Gov. Greg Abbott signed last month, won’t make headlines, but it will have a large impact on the health of more than 4,000 pregnant women incarcerated in Texas county jails each year — not to mention the health of their unborn offspring. Texas Jail Project, an Austin nonprofit that works to improve conditions in Texas’ 241 county jails, presented information to legislators about the need for mental health care for veterans, jailer training and personal recognizance bonds, as well as demographic data on inmates. However, much of our work focused on the unique vulnerability of pregnant inmates. (Diana Claitor, 7/5)