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With a Supreme Court decision looming that could lead to the loss of health insurance for millions of Americans, supporters and opponents of President Obama’s health-care law already are mobilizing for the next stage of the battle: influencing policy alternatives if the court upends a key component of the law. (Sun, 6/15)

Senior Republicans who are worried they’ll be blamed for killing health insurance for millions of Americans have been busy assembling a range of options if the Supreme Court strikes down the law’s subsidies in 34 states. But the GOP senators running for president — starting but not ending with firebrand Ted Cruz — threaten to stymie their leaders’ carefully hatched plans. Any whiff that the GOP’s Plan B is a continuation of Obamacare is bound to spark furious protests from the conservative base, putting pressure on the presidential hopefuls to respond. Cruz, for one, would press for a wholesale repeal of the law — or to allow states to opt out of Obamacare — if the high court provides the opening. (Raju and Everett, 6/16)

The Bush administration health policy band is getting back together — to tell states they will probably have to think about setting up their own insurance exchanges under the health law if the Supreme Court rules that is a condition of their residents continuing to get tax credits to help pay premiums. Former Health and Human Services Secretary Mike Leavitt, acting general counsel Thomas Barker, chief of staff Rich McKeown, assistant secretary for legislation Vince Ventimiglia, deputy secretary Tevi Troy and the former acting Centers for Medicare and Medicaid Services administrator Kerry Weems have signed an open letter to governors telling them there’s a good chance this will fall to the states to decide, and that they should get ready. (Radnofsky, 6/15)

If the Supreme Court rules against ObamaCare this month, states will have more power to demand major changes to the healthcare law. And a group of former Bush administration health officials have outlined what they think should be the terms of that grand bargain. (Ferris, 6/15)

The Obama administration gave conditional approval Monday to Arkansas, Delaware and Pennsylvania to expand their roles in the insurance marketplaces created under the 2010 health care law, ahead of a high court decision that could wipe out federal health insurance subsidies for millions. Letters from U.S. Health and Human Services Secretary Sylvia Burwell to Pennsylvania Gov. Tom Wolf and Delaware Gov. Jack Markell, both Democrats, and Arkansas Republican Gov. Asa Hutchinson say the approval reflects the expectation that the states' roles in the marketplaces will expand beginning in the 2016 policy year. (Levy and Alonso-Zaldivar, 6/15)

While receiving approval Monday, officials cautioned that a final decision on moving to a state-run exchange has not been made. Delaware currently is one of seven states that operate exchanges with the help of the federal government, including using the federal web portal to enroll people. (Chase, 6/15)

A hospital group in cash-strapped Illinois says the state might be able to set up a health insurance exchange at a lower cost by "leasing" the federal government's technology, an option that could appeal to as many as 34 states where subsides could be jeopardized by an unfavorable U.S. Supreme Court decision. In a memo written for Gov. Bruce Rauner and state lawmakers and released to The Associated Press, the Illinois Hospital Association says it anticipates the federal government "will be developing a leasing fee" for states to use HealthCare.gov as the backbone for their own insurance exchanges. It also lists an alternate possibility of renting an exchange system from another state that has its own, such as Connecticut or Kentucky. (Johnson, 5/15)

A majority of Americans say Congress should make sure Obamacare subsidies to buy health insurance are available nationwide if the Supreme Court rules that the payments in at least 34 states are illegal, according to a poll released on Tuesday. The Kaiser Family Foundation poll surveyed 1,200 people from June 2 to June 9 in both English and Spanish. (Gumpert, 6/16)

Asked whether lawmakers should pass a law "so that people in all states can be eligible for financial help," just one-quarter of those surveyed said no, according to the poll by the nonprofit Kaiser Family Foundation. The legal challenge, brought by conservative activists, argues that a strict reading of the health statute makes subsidies available only in states that established their own insurance marketplaces through the law, something that just 13 states and the District of Columbia did. (Levey, 6/16)

The Supreme Court is set to issue a ruling in a major Affordable Care Act case that could force millions off their health insurance this June. But if you're like most Americans, you're pretty much clueless about it. That's right: More than seven in 10 people have heard "nothing at all" or "only a little" about King v. Burwell, a lawsuit brought by conservative and libertarian activists that seeks to eliminate Obamacare's health insurance subsidies for 6.4 million people in 34 states, according to survey results published Tuesday by the Henry J. Kaiser Family Foundation. The share of Americans saying they'd heard nothing -- 44 percent -- about this latest challenge to Obamacare's survival outnumber those who have heard "a lot" or at least "something" by almost two to one. (Young, 6/16)

Nearly three in four Americans say the costs of prescription drugs are 'unreasonable,' with most putting the blame on drugmakers, according to a poll released Tuesday. The survey by the Kaiser Family Foundation found 74 percent of those taking prescription drugs find the costs unreasonable, as do 72 percent of those not taking such drugs. (KHN is an editorially independent program of the foundation.) (Galewitz, 6/16)

Drug companies take nearly all the blame from U.S. consumers when it comes to the high prices of pharmaceuticals, with insurers mostly left off the hook, a new poll from the Kaiser Family Foundation finds. Nearly three-quarters of the 1,200 people surveyed said drug costs are unreasonable. And when asked whether the problem was insurance companies requiring excessive co-pays or pharmaceutical companies setting prices too high, 76 percent put the onus on pharma. (Karlin, 6/16)

The Obama administration has been making billions of dollars in payments to insurance companies under the health law without being able to confirm just how much it owes each insurer, according to an inspector general’s report to be released Tuesday. The federal government has paid subsidies for many enrollees’ premiums and deductibles directly to insurers since January 2014 ... But the back-end system for the Centers for Medicare and Medicaid Services to determine the exact amounts the government owes for each enrollee still hasn’t been completed. (Radnofsky, 6/16)

Four of the nine health insurers selling Obamacare plans in Indiana are expecting to cut their average rates next year, according to filings with the Indiana Department of Insurance. The largest seller of Indiana plans on the federal marketplace — health insurance giant Anthem of Indianapolis — is seeking a small rate increase, 3.8 percent. (Groppe, 6/15)

State regulators on Monday unveiled data showing that Coloradans will have more choices of health insurance plans next year but also will, on average, pay more for premiums. Among the state's largest insurers, premium changes for individual plans ranged from an 8.2 percent increase for HMO Colorado Inc., a branch of Anthem Blue Cross Blue Shield, to a 5.1 percent decrease for Cigna Health and Life Insurance Co., according to the data. ... The state has not yet approved the 2016 insurance rate change requests, and actual premium amounts were not disclosed. (Finley, 6/15)

President Obama’s advisers will tell him to veto a law sponsored by Rep. Erik Paulsen, R-Minn., that repeals a sales tax on medical devices. The White House made the announcement late Monday afternoon. It reaffirms a stance Obama took earlier when the device industry lobbied extensively to kill the levy. (Spencer, 6/15)

House Republicans are poised to offset the cost of repealing a Medicare cost-cutting board created by the 2010 health care law by tapping into a fund authorized by the law to promote preventive care and public health programs, in a move that would sap the effort of much of its Democratic support. The House Rules Committee will set up floor consideration of a repeal bill and a separate effort to scrap a 2.3 percent excise tax on medical devices at a markup Monday evening. Both measures have bipartisan support and are part of GOP efforts to take aim at unpopular provisions in the 2010 overhaul. The cost of the device tax repeal is not expected to be offset. (Attias, 6/15)

The two biggest U.S. health insurers by revenue, UnitedHealth Group Inc. and Anthem Inc., are seeking to buy smaller rivals in a merger scramble aimed at cutting costs as the companies cope with the federal health-care overhaul. UnitedHealth made a preliminary takeover approach to Aetna Inc. in the last few days, people familiar with the matter said. Given Aetna’s market value of about $42 billion, any deal for the company would likely be valued at least that high. UnitedHealth has a market value of more than $110 billion. Aetna has been eyeing Humana Inc., which is exploring a sale. Meanwhile, Anthem and Cigna Corp. have been in discussions about a deal for months, though Cigna has rebuffed Anthem’s advances, according to people familiar with the matter. (Cimilluca, Mattioli and Wilde Mathews, 6/15)

Shares of health insurers from Cigna Corp. to Aetna Inc. surged on speculation that the industry is heading for a round of mergers to boost profits. Anthem Inc. has explored takeovers of smaller health-insurance rivals Cigna and Humana Inc., a person with knowledge of the matter said, asking not to be identified discussing private information. In a third possible combination, Humana has also drawn interest from Aetna Inc., another person said. (Tracer and Hammond, 6/15)

Another consolidation wave may be coming to the health insurance industry with Anthem Inc. playing a major role. Analysts have pegged Anthem as one of three potential bidders for Humana Inc., which is prized for its big presence in the Medicare Advantage program. (Terhune, 6/15)

Shares of Cigna surged Monday following a report the health insurance giant has been approached by rival Anthem in a potential takeover overture. Cigna shares closed up 11.74% at $153.43 following a report in The Wall Street Journal that Anthem had made two recent acquisition bids, the most recent in the range of $175 a share. (McCoy, 6/15)

Target will sell its pharmacy and clinic businesses to the drugstore chain CVS Health for about $1.9 billion in a deal that combines the resources of two retailers seeking to polish their health care reputations. (6/15)

The voracious CVS Health is already a dominant player in nearly every corner of the health care world — it is the nation’s largest dispenser of prescription drugs, the biggest operator of health care clinics and the second-largest pharmacy-benefits manager. And with the news Monday that it had agreed to buy Target’s pharmacy and clinic businesses in a deal worth about $1.9 billion, it demonstrated that its appetite shows no signs of abating. (Thomas, Bray and Tabuchi, 6/15)

The deal comes a little less than a month after CVS entered into an agreement to acquire Omnicare, for about $12.7 billion, in a move to expand its presence in the senior care market. More than 1,660 Target pharmacies in 47 states will be rebranded as CVS/pharmacy. Target's clinics, nearly 80 in total, will be renamed MinuteClinic. (Bomey, 6/15)

CVS executives said the deal would allow them to reach a broader base of customers. They will enter metropolitan areas where they don’t currently have a strong presence, such as Seattle, Portland and Denver, and perhaps capture a different kind of shopper: While CVS’s 7,800 drugstores are often a destination for a “fill-in trip,” in which you grab two or three items, Target’s massive merchandise assortment makes it a logical destination for a bigger shopping trip. (Halzack, 6/15)

For Target, the deal divests a business that was "modestly negative" in terms of profits. While Target will lose revenue, its sales, general and administrative costs will drop by $1 billion. Target Chief Executive Brian Cornell said the move fits with the company's focus on a handful of categories where it believes it can be most competitive including apparel, items for children and health and wellness-related goods. Target will continue to handle the sale of over-the-counter drugs. (Ramakrishan and Layne, 6/15)

The announcement Monday by CVS Health Corp. that it would purchase Target's pharmacies and clinics for $1.9 billion represents a major acceleration in the retail clinic revolution. Since the concept of having a small, walk-in doctor's office inside a store made its debut in the American market in 2000, millions of consumers have taken advantage of the convenience of being able to get a flu shot, refills for prescriptions, and treatment for things like ankle sprains or a cough at the same time they are shopping. (Cha, 6/15)

Smoking cigarettes may lead to a whole lot more than just lung cancer, according to a new study that linked the habit to cancers of the esophagus, colon, bladder and eight other regions of the body. The research, published in the JAMA Internal Medicine Monday, estimates that nearly half of U.S. deaths to cancer of people 35 and older in 2011 -- 167,805 out of 345,962 -- were associated with smoking. (Cha, 6/16)

Roughly half of deaths from 12 smoking-related cancers may be linked directly to cigarette use, a U.S. study estimates. While the largest proportion of deaths associated with smoking were for cancers of the lung, bronchus, trachea and larynx, about half of fatalities from tumors of the oral cavity, esophagus and bladder were also tied to cigarettes, the study found. (Rapaport, 6/15)

Smoking has long been associated with increased risks of cancer, but a research team has now estimated the number of deaths from a wide variety of cancers that are linked to cigarette use. According to a study published Monday in the journal JAMA Internal Medicine, almost half of the 346,000 deaths from 12 different types of cancers in individuals 35 years of age or older in 2011 were attributable to smoking cigarettes. (Pockros, 6/15)

The payments couldn’t help but catch the attention of the top procurement official at the Department of Veterans Affairs. Employees in the purchasing department of a VA hospital in the Bronx, N.Y., had used government purchase cards like credit cards at least 2,000 times to buy prosthetic legs and arms for veterans. (Rein, 6/16)

The parents of an Iowa National Guard veteran who committed suicide are helping organize an event Saturday at the Statehouse to encourage other troubled vets to seek help. Dillion Naslund of Galva took his own life in December 2012. His parents, Lisa and Jeff Naslund, said he apparently was overwhelmed by anxiety from what he'd seen in wars in Iraq and Afghanistan. (Leys, 6/15)

The Supreme Court on Monday rejected an appeal from North Carolina to revive a requirement that abortion providers show and describe an ultrasound to a pregnant woman before she has an abortion. The justices left in place an appeals court decision that said the 2011 North Carolina law was “ideological in intent” and violated doctors’ free-speech rights. The measure was championed by conservative Republicans in the state legislature, who overrode a veto from the then-Democratic governor to approve the law. (6/15)

The Supreme Court’s one-sentence order, as is the custom, gave no reasons. Justice Antonin Scalia noted a dissent, also without saying why. The order left in place an appeals court ruling that had held the law unconstitutional as a violation of the First Amendment. (Liptak, 6/15)

The Supreme Court has not decided a major abortion case since 2007. But a round of abortion restrictions passed by state legislatures across the country may be leaving the justices with little choice but to weigh in on the subject next term. The justices for weeks have been considering at their private conferences whether to accept a case from Mississippi that would effectively close that state’s only abortion clinic. (Barnes, 6/15)

A North Carolina law that would require women who want an abortion to have an ultrasound scan prior to the procedure suffered a final defeat Monday, when the Supreme Court refused to review the case. A federal judge declared the law illegal in early 2014. The controversial law had been placed under an injunction soon after it took effect back in 2011. It was struck down on the grounds that it reflected ideological, rather than medical, priorities and violated doctors' right of free speech. (Chappell, 6/15)

Mandatory ultrasound laws have been increasingly popular among conservative legislatures who have taken aim at abortion access in recent years. Abortion-rights activists have protested that the laws are attempts to “personify the fetus” and to make the procedure more costly. Ten states require ultrasounds before abortions, and three require the woman to see the images. (Ferris, 6/15)

Attorneys who represented Texas doctors in a lawsuit against the state’s 2011 abortion sonogram law are considering their legal options following the U.S. Supreme Court’s Monday decision not to revive a similar North Carolina law. The high court refused to reconsider a North Carolina appellate court's decision striking down a state law that would have required doctors to perform an ultrasound on a pregnant woman and describe the fetus before she could obtain an abortion. Texas has a similar sonogram law — which has been upheld by a federal appeals court. (Ura, 6/15)

Nursing homes won some small relief on payment cuts, but hospitals were less fortunate as Governor Raimondo's Reinventing Medicaid Act of 2015 emerged from the House Finance Committee last week. The committee, meanwhile, left intact the governor's proposal to place the savings from those Medicaid cuts into a pool that in future years can be used to reward health-care providers for improving the quality of care while lowering costs. On Tuesday, the full House is expected to act on the budget. (Salit, 6/15)

Many Los Angeles County doctors who treat the poor in California’s Medi-Cal managed care program have earned poor grades on safety, cleanliness and other measures the state uses to monitor health care delivery for some of the state’s most vulnerable patients. Those poor marks, moreover, are often an indicator of even more serious problems. State records show that doctors who fail the managed care plans’ internal reviews or pass conditionally are twice as likely as other physicians to have been disciplined by the Medical Board of California, which licenses doctors and oversees the medical profession. (Urevich, 6/15)

Tennessee is asking a federal appeals court to throw out a class-action lawsuit that claims the state left thousands of TennCare applicants in indefinite limbo, with their applications neither approved nor rejected. With the rollout of the Affordable Care Act in October 2013, the government changed the method used to determine financial eligibility for Medicaid. But in Tennessee, a new computer system designed to accommodate the change was behind schedule. So the federal government agreed temporarily to accept applications for TennCare — Tennessee's version of Medicaid — on behalf of the state. (Loller, 6/16)

The California State Auditor on Tuesday is slated to release a report 10 months in the making that will analyze the efficacy of the Medi-Cal managed care program. Medi-Cal is California's Medicaid program. (Gorn, 6/15)

For the second year running, Belhaven Mayor Adam O’Neal has walked to Washington, D.C. Last year, O’Neal made the journey to raise the red flag over the closure of the hospital in his small eastern North Carolina town. This year, he walked to raise awareness of rural hospitals facing closure across the country. He arrived at the Capitol on Monday morning. (Hoban, 6/15)

Facing a $55-million deficit during the Great Recession, Sacramento County officials made a choice: To save money, they would close their free health clinics to people who entered the country illegally. Six years later, they want to reverse that decision. (Karlamangla, 6/15)

Clinics in East Haven and Branford are scheduled to close as Yale-New Haven Health System contends with higher state taxes and lower Medicaid reimbursement rates from the state, hospital executives said Monday. Yale-New Haven wants to close the two clinics to save about $1 million annually in lease payments for office space, said Vin Petrini, senior vice president of public affairs at Yale New Haven Health System. (Sturdevant, 6/15)

The state is appealing part of a federal judge’s ruling that sought to ensure timely competency services for mentally ill defendants. Health officials said they are only appealing the portion that mandates competency evaluations within seven days of a judge’s order. They said one week was not enough time to allow some defendants who may be under the influence of alcohol or drugs to stabilize. Evaluators send people to hospitals before their mental state is fully understood, officials said. (Bellisle, 6/15)

The rise in health care costs is beginning to slow for some southeast Michigan businesses. But not because health care is getting less expensive. A new employer survey shows that businesses and government employers are dealing with the growing expense of employee health care by passing more of the costs on to workers and introducing high-deductible insurance plans. (Reindl, 6/16)

The office of the New York City comptroller plans to send letters on Tuesday to City Hall and various agencies demanding that they take steps to ensure that people in need of housing are not sent to illegal boarding homes, known as “three-quarter” houses, and to provide information that will help the office compile a list of such homes. The actions by the comptroller, Scott M. Stringer, who is responsible for auditing city agencies, follow an article published by The New York Times last month on three-quarter homes, flophouses paid for with government money that cater to addicts and those with nowhere else to go. The article examined the practices of the operator of some of the most troubled homes, Yury Baumblit, a felon accused of taking kickbacks on Medicaid fees for drug treatment while forcing people to live in squalor. (Barker, 6/15)

Proposed changes to Proposition 13, California's landmark property tax initiative, could generate as much as $9 billion a year for state and local governments. In addition to helping schools, public safety and infrastructure, the money would improve delivery of health care services, proponents say. Opponents say tinkering with the landmark initiative passed in 1978 would harm the state, including the health care delivery system. (Lauer, 6/15)

Children’s National Medical Center has agreed to pay $12.9 million to settle a suit claiming the hospital submitted false information to receive Medicaid and federal funding, the U.S. Justice Department announced Monday. (Zauzmer, 6/15)

With a midnight deadline hours away, lawmakers on Monday approved a $117.5 billion state budget that pumps more money into child care, health care and higher education. (Calefati, 6/15)

West Virginia program that protects seniors from health care fraud and abuse is getting a boost from the federal government. U.S. Sens. Joe Manchin and Shelley Moore Capito on Monday announced just over $242,000 in federal funding for the West Virginia Bureau of Senior Services for Senior Medicare Patrol Program projects. The program offers education and training to increase s awareness and understanding of health care programs. (6/16)

University of Cincinnati Medical Center opened an expanded state-of-the-art "hybrid" operating room last week. The suite is designed to make heart surgery less invasive, offer non-surgical valve replacement and repair, introduce catheter-based treatment of stroke and blood vessel aneurysms and reduce recovery time for patients. The 854-square-foot room is on the hospital's second floor and connects the existing catheterization laboratory with the operating room. The expansion is a $6 million investment for UC Health. (Saker, 6/15)

An Orange County doctor accused of gross negligence in the care of two patients who fatally overdosed on drugs he prescribed has been placed on probation by the Medical Board of California. Van H. Vu, who owns a busy pain clinic in Huntington Beach, agreed not to contest the board's accusation, to take classes in prescribing and record keeping and to submit to an outside practice monitor for five years. In exchange, the board allowed Vu to keep his license and continue prescribing potent painkillers. (Girion, 6/15)

In the next two weeks, the Supreme Court will rule in King v. Burwell, a challenge that threatens to dismantle Obamacare by ending financial subsidies for 6.4 million Americans. If the challengers win, it would throw the health-care law into chaos. But if the White House prevails, something equally momentous will have occurred: President Obama's signature legislative accomplishment will actually, really, definitely be here to stay. (Sarah Kliff, 6/15)

Two reports published this month provide fresh evidence of the hard-to-justify high prices that many hospitals charge for common procedures. The prices drive up premiums for many privately insured patients and can be ruinously expensive for those who are uninsured or inadequately insured or who go to a hospital or doctor outside their insurance network. A study published in the June issue of Health Affairs, a policy journal, found that the 50 hospitals with the highest prices in 2012, the latest data available, charged an average of 10 times what is allowed by Medicare, which was used as a baseline for cost. ... A second report, released on June 1 by the federal Centers for Medicare and Medicaid Services, showed a similar pattern. For a major joint replacement, the most common reason for hospitalization, the average hospital charged more than $54,000 in 2013 while Medicare on average paid less than $15,000. (6/15)

Health-care costs are starting to accelerate again in the U.S., a sign that more effort is needed to constrain cost growth. Yet the House of Representatives is set to vote this week to do the opposite -- by repealing the Independent Payment Advisory Board. Following a 31-8 vote for repeal in the Ways and Means Committee, the vote in the full House looks to be overwhelming. It's crucial that the Senate not follow suit. (Peter R. Orszag, 5/15)

Last September, days before her 16th birthday, my daughter was diagnosed with Type 1 diabetes. ... In the hours after her diagnosis, through my own tears, I went to pick up her lifesaving prescriptions. As I reached across the counter for two armloads of meds, I handed over $60. If we had been uninsured, the cost would have been more than $1,100. I want everyone to have good insurance just like my family has. The Tennessee legislature has already refused to cover hundreds of thousands of our citizens by refusing to expand TennCare. ... Now our state is apparently ready to exclude hundreds of thousands more because the legislature still refuses to authorize a state "exchange." (Lisa Quigley, 6/15)

I first experienced chest pain and shortness of breath when my wife and I were vacationing in London several years ago. An ambulance took me to University College Hospital, where, after routine tests, I was told I suffered from indigestion and should return to my hotel and take antacids. The next day, I was barely able to walk back to our hotel from a nearby museum, and was whisked again to the same hospital. This time, after additional tests, a cardiac condition just short of a heart attack was diagnosed. I was entrusted to the National Health Care program of the United Kingdom — a system that many Americans would have us emulate. I was treated well, if somewhat indifferently. And, as I lay in my bed, no longer able so much as to sit up, I was told that several people were ahead of me for treatment, and that I could be attended to in about three weeks. (Stuart Clark Rogers, 6/15)

Abortion clinics are closing in the U.S. at a record pace. In four states — Mississippi, North Dakota, South Dakota and Wyoming — just one remains. American women were having fewer abortions before clinic closings accelerated in the last couple of years. So no one can be sure how much the push to restrict clinics is connected to falling abortion rates. But the new strategy adopted by abortion opponents, and the court battles it has set off, may define how far abortion rights can be limited without being overturned. (Esmé E. Deprez, 6/15)

Parents everywhere received welcome news last week: underage alcohol use has decreased significantly in the past decade. Better still, binge drinking among minors has also declined. Cause and effect is always hard to determine in these matters, but the many prevention measures adopted in recent years by governments, schools and other public service organizations seem to be having an impact. (6/15)

In March 2015, the Alcohol and Tobacco Tax and Trade Bureau (TTB) approved several powdered alcohol products, sold under the brand name Palcohol, for sale in the United States. ... Although alcohol has been converted into crystalline form for more than 200 years, Palcohol constitutes the first entry into a new US alcohol market. ... Public health concerns about powdered alcohol focus primarily on its use in binge drinking (ie, drinking to the point of intoxication) or youth drinking and its potential for undermining retail businesses and alcohol regulations. In terms of binge drinking and alcohol poisoning, the use of powdered alcohol introduces the potential for overdose on the basis of the amount of powder used or the amount of liquid or food into which it is diluted or mixed. (Timothy S. Naimi and James F. Mosher, 6/15)