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Under the Affordable Care Act’s Medicaid expansion, enrollment in the program is soaring past expectations in a handful of states, raising some concerns about whether states will have trouble covering the costs down the road. (Ehley, 5/19)

Despite the efforts of healthcare advocates, hospitals and notable former legislators, the Missouri legislature did not pass Medicaid expansion this year, or even bring it to the debate floor. That means an estimated 147,000 Missourians will have another year without health coverage, and the community health clinics that care for the uninsured will continue trying to bridge the gap. “I don’t know what it will take, I don’t know what more information [lawmakers] need to motivate them to change,” said Dr. Johnetta Craig, Chief Medical Officer at Family Care Health Centers in St. Louis. Craig said that if the past two years are any indication, patients will defer care when they can’t afford it, leading to emergencies and more expensive health care down the road. (Bouscaren, 5/18)

Florida hospitals have a response to Gov. Rick Scott’s proposal that lost federal health care funding be offset by profit sharing: No way. On May 8, the governor wrote in a letter that surpluses from profitable hospitals could be used to help keep afloat those that don’t break even as a possible replacement for the federally funded Low-Income Pool, which ends June 30. But the FHA says its hospitals already fund poor Floridians’ health care by way of Medicaid. Pointing to a report commissioned by the state, FHA points out that hospitals contribute roughly $1.3 billion to Medicaid. (Auslen, 5/18)

State agencies on Monday met Gov. Rick Scott's deadline to list critical services that could be affected by a possible government shutdown if lawmakers cannot agree on a budget for the state by June 30. (Auslen and Bousquet, 5/18)

A new task force will take up some of the biggest potential changes to the state’s MNsure exchange after lawmakers this weekend couldn’t reach agreement on several competing proposals. A massive spending bill for health and human services does not include House Republican plans to shift MinnesotaCare enrollees to the health exchange next year, nor does it include a Republican proposal to shut down MNsure in 2017. DFLers in the Senate, meanwhile, didn’t get their wish for MNsure to become more of a traditional state government agency. The MNsure board of directors will retain its authority, including choice of MNsure’s top executive. (Snowbeck, 5/18)

MNsure seemed headed for big changes and possibly closure when the Legislature opened in January. Now, as the session near its end, it appears MNsure won't be changing much at all. State lawmakers over the weekend agreed on a health and human services bill that falls far short of the changes some Democrats and Republicans had hoped to make to the health plan exchange. (Zdechlik, 5/18)

Some state legislatures are moving to shield residents’ federal health insurance subsidies in advance of a U.S. Supreme Court decision regarding the Affordable Care Act. The Kansas Legislature is not among them. (Marso, 5/18)

The organization that regulates health care in Vermont says the two providers offering health insurance through the state health exchange are seeking rate increases. The Green Mountain Care Board said Monday that Blue Cross Blue Shield of Vermont has requested an average annual rate increase of 8.4 percent over 2015 rates while MVP Health Care has requested an average annual rate increase of 3 percent. (5/18)

Another Republican lawmaker is warning House GOP leaders that they need to come up with a fully fledged plan in case the Supreme Court rules against ObamaCare next month. Without a plan, Rep. Bruce Poliquin (R-Maine) argued consumers would face chaos in the market if the high court rules against subsidies to buy ObamaCare on the federal marketplace. (Ferris, 5/18)

House lawmakers continued Monday afternoon to negotiate how to pay for the 21st Century Cures legislation which was scheduled to be marked up starting Tuesday. But they have yet to reach agreement on the estimated $10 billion to $15 billion offset for the bill. (Norman, 5/18)

Sen. Bernie Sanders (I-Vt.) and Rep. Elijah Cummings (D-Md.) on Monday introduced a bill aimed at lowering the taxpayer burden for rising generic drug prices. Brand-name drug manufacturers are required by law to pay a rebate to Medicaid when their drug prices rise faster than inflation. Sanders and Cummings’s bill would extend this requirement to generic drug manufacturers. (Sullivan, 5/18)

Mammograms at 40 or 50? Every year or every other year? What’s the best colon check? Screening for cancer has gotten more complicated in recent years with evolving guidelines that sometimes conflict. Now a doctors’ group aims to ease some confusion — and encourage more discussion of testing’s pros and cons — with what it calls advice on “high-value screening” for five types of tumors. (Neergaard, 5/18)

Americans get too many tests to screen for common types of cancer, and the American College of Physicians wants them to stop. New clinical guidelines from the medical group include a litany of statistics that illustrate our obsession with cancer screening. Among them: About 6 in 10 adults submitted to a colonoscopy more often than they needed to. One-third of men who got a PSA test to screen for prostate cancer couldn’t remember being asked by their doctor to do so. And 69% of women who had their cervix removed during a hysterectomy still got tested for cervical cancer. (Kaplan, 5/18)

Many patients could be screened less often for certain cancers to minimize their risk of receiving unnecessary follow-up tests or treatment for tumors that are unlikely to become harmful, U.S. doctors recommend. Less frequent screening for some malignancies, as well as starting tests later in life and ending them earlier in old age, may make sense for some adults without a family history or other risk factors for cancer, according to American College of Physicians (ACP) guidelines published May 18 in the Annals of Internal Medicine. (Rapaport, 5/18)

Millions of women could lose access to free mammograms under changes to breast cancer screening guidelines that influence insurers, the consulting firm Avalere estimates. The Avalere analysis is based on an update to breast cancer screening recommendations proposed by the U.S. Preventive Services Task Force, a group of medical experts whose work guides health care standards and policy. The public comment period on the proposal expires Monday. (Kelto, 5/18)

While it's often suggested that women with dense breasts get ultrasound or other extra screenings after a mammogram, a new study suggests those added tests may only help certain women. Breast density increases breast cancer risk and can mask tumors during mammograms, the researchers explain in the Annals of Internal Medicine. (Doyle, 5/18)

South Carolina Sen. Lindsey Graham will announce his campaign for president next month, after saying Monday he is running for the Republican nomination. Here’s a snapshot of where Graham stands on issues likely to be debated in the Republican presidential primaries. ... He voted against the Affordable Care Act and supports the GOP’s “Ryan Budget” that would curtail Social Security and Medicare spending and benefits over time. ... On abortion, Graham receives high marks from state and national organizations that oppose a woman’s right to terminate a pregnancy. But he’s also tried to bridge the gap between conservatives who support absolute bans on abortion and those who support exceptions for rape, incest and health of the mother. Graham argues absolute bans aren’t politically feasible. (Barrow, 5/19)

In an email sent to reporters, Mr. Jindal was harshly critical of President Obama and said the country was ready “to try a dramatically different path.” “While other Republican leaders are talking about change, I’ve published detailed plans to repeal and replace Obamacare, rebuild America’s defenses, make America energy independent, and reform education for our nation’s children,” Mr. Jindal wrote in the statement. (Corasaniti, 5/18)

[Bobby] Jindal, 43, now in his second term as governor, has been far down in most Republican presidential polls. He’s positioned himself as friendly to the party’s religious right. He’s also regarded as an expert on health care issues. (Lightman, 5/18)

Sen. Ted Cruz, R-Texas, one of the federal health law’s fiercest critics, will not participate in Obamacare after all. Cruz and his family have bought coverage in the private market instead of going through Cruz’s employer, Congress, which offers plans for federal workers under the Affordable Care Act. The Texas senator said in March after he announced his presidential candidacy that he was considering plans offered through the federal health care law, triggering stories and commentary about the irony of Cruz signing up for Obamacare. (Recio, 5/18)

A coalition of labor and minority groups is launching an effort to support progressive Democrats running in Virginia’s June 9 primary election and has promised five candidates a last-minute infusion of cash and a small army of door-knocking volunteers. Coalition leaders said they will try to mobilize young and minority residents who have not voted in large numbers in the past and urge them to back local candidates who want to boost the minimum wage, expand health-care coverage for the poor, and create new protections and opportunities for immigrants. (Sullivan, 5/18)

Endo International PLC agreed to buy rival drug maker Par Pharmaceutical Holdings Inc. for $8 billion, the latest in a string of cross-border mergers steering tax revenue away from the U.S., despite Washington’s efforts. Endo, which relocated from Pennsylvania to Ireland last year, is one of several drug companies lately using their lower-tax foreign addresses as springboards for acquisitions in the U.S., which has one of the world’s highest corporate tax rates. (Hoffman, 5/18)

Drugmaker Endo International PLC is climbing toward the top of the steadily consolidating generic medicine business with a deal to buy Par Pharmaceutical Holdings Inc. for about $8.05 billion. The deal would enable Dublin-based Endo to leapfrog from No. 10 to No. 5 in U.S. generic drug sales barely five years after its first foray into generics. (Johnson, 5/18)

Endo Pharmaceutical P.L.C. said Monday that it will pay $8.05 billion for privately held Par Pharmaceutical Holdings L.L.C., to strengthen its position on the shifting landscape of generic drugmakers. The stock-and-cash sale comes amid consolidation in the market for generic drugs, as companies strive for greater leverage and profit, while patients and payers complain of rising prices. Some of the large generic drugmakers also sell so-called branded drugs, which usually carry higher prices because they are protected from market competition by patents. (Sell, 5/19)

A West Hollywood woman sued insurer Anthem Blue Cross for refusing to cover the cost of an expensive drug that she says would cure her hepatitis C infection. Shima Andre said in the lawsuit that Anthem has refused to pay the estimated $99,000 it would cost to be treated with the controversial drug Harvoni, which has been shown to destroy the deadly virus in most patients. In a denial letter, Anthem explained that the drug was “not medically necessary” because Andre does not have advanced liver damage, the lawsuit said. (Pfeifer, 5/18)

A consumer advocacy organization has launched a campaign to get state officials to explain why they revoked Blue Shield of California's tax-exempt not-for-profit status last year. (Lauer, 5/18)

After the Florida Department of Health denied Jackson Health System its bid for a trauma unit in South Miami-Dade April 30, Jackson is fighting back, saying that the department changed the requirements of the application beyond what is outlined in state law, leaving the hospital in a “guessing game.” In a petition to the department on Monday, Jackson fought back against the department’s claims that its application for a license to operate a trauma unit at Jackson South Community Hospital was denied because it was missing documentation and some of the information was not up to state standards. (Herrera and Chang, 5/18)

The Black Caucus in the Alabama House of Representatives today proposed a budget plan that shifts money to cover what it says are critical services without raising taxes. The plan proposes changes to a budget bill approved by the House Ways and Means General Fund Committee last week. ... Compared to the committee plan, the Black Caucus plan would add $34 million for Medicaid, $19.7 million for Corrections, $4.8 million for Public Health and $1 million each for Law Enforcement and Finance. It would offset those increases by skipping a $15 million repayment to the Alabama Trust Fund due next year and making other reductions from the committee approved plan. (Cason, 5/18)

Proposed restrictions on minors seeking abortions without parental consent could put the state at risk of a lawsuit, a Senate Democrat said Monday. (Ura, 5/18)

Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine. Iowa and Minnesota are the only states that offer so-called "telemed" abortions. Women who choose this option confer with a doctor through an Internet video connection and can then be prescribed two drugs, mifepristone and misoprostol, which when taken in sequence induce an abortion. Women who opt for a medication abortion can be no more than nine weeks into their pregnancy. (Andrews, 5/19)

More than half of all new HIV infections in Oregon occurred in Multnomah County in 2012. That same year, the Food and Drug Administration approved the use of a pill that effectively prevents a person from contracting the virus. No one really knows about the medication today, public health officials say. (Hernandez, 5/18)

Employers struggling to pay for workers' health coverage can slow annual spending by about 5 percent by switching to high-deductible health plans, but the burden likely will fall on patients and health care professionals who'll be expected to pick up the slack. The costs might drive patients to delay care or struggle to come up with a $5,000 deductible, while hospitals ultimately might have to write off any balance due. One Western Pennsylvania hospital has even begun requiring patients having elective surgery to meet first with a finance counselor. (Twedt, 5/18)

You probably never would have guessed it, but one of the front lines of public health in New Hampshire is on the second floor of an elementary school in Claremont - in a storage closet. Here a dental hygienist meets with a second grade girl to talk teeth. ... Looking into a child’s mouth can tell you a lot about her health. In fact, oral hygiene is a sort of canary in a coal mine for not just a child’s health, but also the environment she grows up in. In New Hampshire, some are tackling oral hygiene through both caring for children’s teeth and the environment the child grows up in. (Rodolico, 5/19)

What happens during the first months and years of a child’s life matters - a lot. Researchers know, for example, that middle- and upper-income children are more likely to have positive, nurturing relationships with the adults who care for them and, as a result, they do better in school, form healthier relationships and are less likely to suffer from mental illness. Meanwhile, children who grow up poor are often subjected to abuse and neglect that creates unrelenting “toxic” stress that damages their developing brain, increasing the likelihood they will be diagnosed with developmental delays and emotional disorders. ... Over the past several years, as attention was focused on the collapse of New Hampshire’s adult mental-health system, advocates and community-health workers have launched programs aimed at young children and families in two of the state’s poorest areas. (Wallstin, 5/19)

California will have to invest millions of dollars to better protect its 63,000 foster children from the excessive use of powerful psychiatric medications in a state where prescribing physicians, caregivers and the courts have long supported the drugging of as many as one in four foster teens. (de Sa, 5/18)

About once a week, healthcare providers call the 24-hour palliative-care hotline at the University of Vermont Medical Center with the same basic question: How should they respond to patients who want to take advantage of the state's new law allowing physicians to prescribe lethal drugs to terminally ill patients who want to die? (Schencker, 5/16)

Facing a $1 billion budget deficit, Arizona's Republican-led Legislature has reduced the lifetime limit for welfare recipients to the shortest window in the nation. ... The cuts of at least $4 million reflect a prevailing mood among the lawmakers in control in Arizona that welfare, Medicaid and other public assistance programs are crutches that keep the poor from getting back on their feet and achieving their potential. (5/18)

Medical providers and first responders on Monday urged Sen. Kelly Ayotte to consider further incorporating mental health treatment into her efforts to address New Hampshire's heroin and prescription drug crisis. Ayotte, a Republican, is co-sponsoring several pieces of legislation related to drug addiction treatment, including one that would direct the federal government to develop a strategy to help infants diagnosed with newborn withdrawal. At a discussion she led at Catholic Medical Center, hospital officials told her that the number of infants born at the hospital after being exposed to drugs in the womb has more than doubled to 7 percent in the last year. (Ramer, 5/18)

A Cape Cod doctor has been charged with illegally prescribing opiates and overbilling the state's low-income health program. Attorney General Maura Healy said Dr. Mohammed Nassery was indicted Friday on 11 counts of illegal prescribing, nine counts of Medicaid false claims and one count of larceny. Healy said Nassery has agreed not to practice medicine in Massachusetts. (5/18)

Despite concerns from some lawmakers that they were taking the first step toward legalizing marijuana, the Texas House tentatively approved a bill Monday that would allow epilepsy patients in Texas to use medicinal oils containing a therapeutic component found in the plant. (Batheja, 5/18)

One of the more bizarre spectacles of U.S. government in the modern age is the sight of political leaders complaining that a public program is actually working. On Monday, Politico delivered a striking case in point. The subject was Obamacare, or more specifically the expansion of Medicaid through which millions of low-income families receive health coverage. According to author Rachana Pradhan, in many states that expanded Medicaid and even some that rejected expansion under the Affordable Care Act, enrollment has significantly exceeded projections. To some political leaders, for some reason, this is supposed to be a bad thing. (Michael Hiltzik, 5/18)

Medicare means many things to many people. To seniors, it's a program providing good, low-cost healthcare at a stage in life when it's most needed. To Congress, it's beginning to look more like a piggy bank to be raided. (Michael Hiltzik, 5/18)

Despite serious safety and effectiveness concerns, the nonpsychotic use of these [atypical antipsychotics] drugs — which include aripiprazole (Abilify), quetiapine (Seroquel) and olanzapine (Zyprexa) — has soared over the past decade. (Susan Perry, 5/18)