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The UnitedHealth Group, one of the nation’s largest health insurers, told investors on Tuesday that it continued to lose hundreds of millions of dollars selling individual policies under the federal health care law. The company said it planned to pull out of a majority of states where it offered coverage and would offer policies on the public exchanges in “only a handful of states” for 2017. (Abelson, 4/19)

After losses on the exchanges, UnitedHealth Group Inc. will pare its presence from 34 states this year to “only a handful” in 2017, said Chief Executive Stephen J. Hemsley during the company’s first-quarter earnings conference call Tuesday. Mr. Hemsley said that the “smaller overall market size and shorter-term, higher-risk profile within this market segment continue to suggest we cannot broadly serve it on an effective and sustained basis.” UnitedHealth also steepened its projected loss on the 2016 exchange business to $650 million from around $525 million, amid signs that new enrollees’ health status appeared worse. (Wilde Mathews, 4/19)

The company saw particularly strong results with its health service business Optum, which consults with industry players on how to cut costs and better the quality of care. It saw $19.7 billion in revenue during the first quarter as compared to $12.8 billion during that quarter last year. (Jones, 4/19)

UnitedHealth said in the fall it expects to lose more than $500 million this year on plans sold on public exchanges. But those are a small part of UnitedHealth’s business. And, since the insurer booked most of those expected losses last year, these exits mean that shareholders can cross a worry off their list. No wonder the stock is handily outperforming major indices this year. These days, peace of mind doesn’t come cheap. The shares trade at 16 times forward earnings; well above historical norms for a health insurer. The dividend yield on the shares lies well below 2%. (Grant, 4/19)

UnitedHealth’s plan to dramatically curtail involvement in the exchanges would severely limit competition in parts or all of about 10 states — mostly in the South and Midwest, according to an analysis from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) That could mean higher premiums for consumers in states and counties left with only one or two insurers, unless another company enters those markets. Oklahoma and Kansas would be left with only one insurer if UnitedHealthcare pulls out. (Galewitz, 4/19)

UnitedHealth Group Inc's decision to exit most of its Obamacare health insurance exchanges next year means rivals will need to raise prices further to prop up an unprofitable business, healthcare analysts and policy experts said on Tuesday. The largest U.S. health insurer's move would likely reduce consumer choices, particularly in states where UnitedHealth has been one of only a handful of players to offer insurance under President Barack Obama's healthcare law, they said. (Humer, 4/19)

The Obama Administration attempted to downplay any departures from UnitedHealth. "We have full confidence, based on data, that the Marketplaces will continue to thrive for years ahead. The number of issuers per state has grown year-over-year," Health and Human Services spokesman Ben Wakana said in a statement released Monday morning. "The Marketplace should be judged by the choices it offers consumers, not the decisions of any one issuer." (Johnson, 4/19)

The company’s startling losses cast a spotlight on problems that insurers have been warning about for months: Fewer Americans have signed up for the exchanges than predicted, enrollees have proved to be sicker and more costly than anticipated, and losses are mounting. UnitedHealth’s exit may be more of a symbolic blow to the law than anything — the company is still profitable, and its exchange business was relatively small. But it poses a fresh headache for the White House ahead of the fall sign-up period for 2017 health plans, the final enrollment season under the Obama administration. The White House is scrambling to set the insurance marketplaces on firm footing before it leaves office. (Demko, 4/19)

UnitedHealth hiked its 2016 forecast after the nation's largest health insurer topped Wall Street's first-quarter earnings expectations. The Minnetonka, Minnesota, company now expects annual adjusted earnings ranging from $7.75 to $7.95 per share. That's up 15 cents from when it last reaffirmed its outlook in January. (Murphy, 4/19)

UnitedHealthcare, a major health insurer, will no longer sell insurance on the Affordable Care Act marketplace in Texas next year, according to a letter filed with state regulators. (Walters, 4/19)

UnitedHealthcare will stop offering plans through Connecticut’s health insurance exchange after this year, continuing the company’s departure from the state-level marketplaces created by the federal health law. (Levin Becker, 4/19)

Thirty of Georgia’s 159 counties will be left with just one insurer in the state insurance exchange when UnitedHealthcare exits the exchange next year, a new study says. Another 47 Georgia counties will go from having three exchange insurers to two, according to the study, released Monday by the Kaiser Family Foundation. (Miller, 4/19)

Minnetonka-based UnitedHealth Group reported a first-quarter net income of $1.6 billion, up 14 percent over last year. Revenue grew 25 percent to $44.5 billion. CEO Stephen Hemsley told investors UnitedHealth is serving more customers than ever before and that customer retention also is at record levels. (Zdechlik, 4/19)

Arkansas lawmakers broke a stalemate over the state's hybrid Medicaid expansion Tuesday after Democrats acceded to an unusual plan that'll require them to initially vote to end the subsidized health insurance for thousands of poor people. The Joint Budget Committee endorsed a Medicaid budget bill that includes a provision ending the program, which uses federal funds to purchase private insurance for the poor, on Dec. 31. Republican Gov. Asa Hutchinson has said he'll veto that provision, which would allow lawmakers to effectively fund the expansion by upholding his decision with a simple majority vote. (DeMillo, 4/19)

The Senate is expected to vote on the bill Wednesday. Sen. Jim Hendren, R-Gravette, the governor’s nephew, presented the amendment as a way to maneuver around the opposition of 10 Republican senators who have blocked funding for the governor’s Medicaid expansion plan, titled Arkansas Works. Nine votes are enough to block an appropriation bill requiring a three-fourths vote in the 35-member Senate. (Lyon, 4/20)

The Medicaid expansion, enacted by the Legislature in 2013, extended coverage to adults with incomes of up to 138 percent of the poverty level: $16,394 for an individual, for instance, or $33,534 for a family of four. Most of the 267,000 people covered receive the coverage through what is known as the private option, which uses Medicaid funds to buy private insurance coverage. The Arkansas Works legislation approved in the special session makes changes that Hutchinson has said would encourage enrollees to stay employed and take responsibility for their health care. (Wickline, 4/20)

The Obama administration on Tuesday warned officials in all 50 states that actions to end Medicaid funding of Planned Parenthood may be out of compliance with federal law. Ten states have taken action or recently passed legislation to cut off Medicaid funding to Planned Parenthood after antiabortion activists released covertly filmed video in the summer purporting to show that the women’s health organization and abortion provider illegally sold fetal tissue for a profit. Planned Parenthood supporters have criticized the videos as deceptively edited, and multiple state investigations have turned up no wrongdoing on the part of the organization. (Sun, 4/19)

The guidance outlined in a letter from Centers for Medicare and Medicaid Services explains to state Medicaid directors that the law requires that Medicaid beneficiaries may obtain services, including family planning, from any qualified provider. States that terminate their Medicaid-provider agreements with Planned Parenthood affiliates because they offer abortions may be in violation of that law because they are restricting access by not permitting recipients to get services from providers of their choice. (Armour, 4/19)

Planned Parenthood Arizona says Arizona is among at least 24 states that have tried to cut off funding for legal services in the past year. A 2012 Arizona law barring any non-abortion Medicaid funding for abortion providers was blocked by federal courts because it violated the "free choice of provider" provision. The letter comes as the Arizona Senate is poised to vote to require the state's Medicaid plan to exclude abortion providers if they don't fully segregate money they get for covered services. House Bill 2599 also requires funding cutoffs and license revocations for providers that violate medical waste rules or submit a claim for abortion-related procedures. (Christie, 4/20)

Last month, Florida Gov. Rick Scott signed a controversial law that blocks all state money, including Medicaid, from abortion clinics, including preventive services like cancer screenings and HIV testing. State law already prevented taxpayer dollars from funding abortions. The state can't do that unless the federal government agrees. And Wachino's letter sounds like an early "no." (Auslen, 4/19)

A controversial measure to defund Planned Parenthood because the organization performs abortions is again under consideration at the statehouse, with the blessing of Governor Branstad. (Russell, 4/19)

The National Institutes of Health shut down production of clinical-study drugs at two laboratories after an internal inquiry found them “not in compliance with quality and safety standards.” One lab of the National Cancer Institute, and another of the National Institute of Mental Health, weren’t suitable to produce the sterile or infused drugs that have been used in clinical studies, the inquiry found. However, NIH officials said they are working rapidly and hope to have the laboratories up and running again soon. (Burton, 4/19)

"There is no evidence that any patients have been harmed, but a rigorous clinical review will be undertaken," the NIH said in a statement provided to NPR Tuesday. "NIH will not enroll new patients in affected trials until the issues are resolved." (Greenfieldboyce, 4/19)

The National Institutes of Health has suspended operations at two of its facilities involved in clinical research trials after a probe last year identified serious contamination problems. (Scott, 4/19)

Congressional Republicans say they have evidence that suggests an unnamed abortion provider and an unnamed fetal tissue company may have run afoul of federal laws that ban them from profiting from handling fetal tissue. (Haberkorn, 4/19)

The Senate on Tuesday approved an aviation bill that requires major airports to provide lactation rooms for breastfeeding mothers, a provision pushed by Sen. Claire McCaskill of Missouri. Under the bill, large and medium hub airports would have two years to install the lactation rooms and could use federal funds from the Airport Improvement Program, which is supported by airline passenger fees. (Tate, 4/20)

When does hype cross the line into illegal activity? That’s the big question animating criminal and civil probes into Theranos, the once high-flying Silicon Valley startup that aimed to revolutionize medical testing by developing technology that could perform an array of lab tests with just a few drops of blood. (Robbins, 4/19)

Theranos Inc. board member David Boies defended Chief Executive Officer Elizabeth Holmes on Tuesday, saying she has the management and scientific skills to lead the blood-testing startup despite criminal and civil investigations of the company by U.S. authorities. (Kohlatkar and Chen, 4/19)

Direct primary care is an offshoot of so-called concierge medicine, which has been growing steadily since the 1990s. But concierge doctors usually bill insurers, in addition to charging monthly fees. Typically, their patients pay at least $100 a month, and sometimes several hundred or even thousands of dollars monthly. (Dayal McCluskey, 4/20)

In another sign of the changes taking place in the health care market, Aurora Health Care is partnering with Anthem Blue Cross and Blue Shield in Wisconsin to start an insurance company. (Boulton, 4/19)

White women are dying at a slightly younger age than they used to. That's according to a report released Wednesday by the Centers for Disease Control and Prevention's National Center for Health Statistics. The life expectancy for non-Hispanic white women in the United States declined by one month — from 81.2 years to 81.1 years — from 2013 to 2014. Though just one month may not seem like much, demographers worry — it's the first time since the government began keeping records that white women saw their life expectancy decline, according to the report. (Kodjak, 4/20)

The last time there was a one-year drop for white women was in 2008. That was considered a statistical blip, said Robert Anderson of the CDC's National Center for Health Statistics. That could also be the case for the 2014 decline "or it could be a harbinger of things to come," Anderson said. That won't be known until data from more years comes in, he added. Some recent reports have shown rising suicide and drug overdose death rates for white women — particularly middle-aged ones. (4/20)

Amid the bleak news for whites have been the improving numbers for African Americans and Hispanics, the new study indicates. Hispanic life expectancy rose from 81.6 to 81.8 years between 2013 and 2014; gains were seen for both males and females. Life expectancy for blacks rose from 75.1 to 75.2 years, driven by a particularly large jump among black males, from 71.8 to 72.2 years. "The gap between the white and black populations is quickly closing, and it's mainly because the black population is experiencing a great drop in mortality," said [Elizabeth Arias, a demographer with the CDC's National Center for Health Statistics]. (Achenbach, 4/20)

First came Colorado and Washington. Then Alaska, Oregon and Washington, D.C. Now advocates for legal marijuana are looking to New England, hoping this part of the country will open a new front in their efforts to expand legalization nationwide. But this largely liberal region is struggling with the devastating effect of opiate abuse, which is disrupting families, taxing law enforcement agencies and taking lives. And many lawmakers and public officials are balking at the idea of legalizing a banned substance, citing potential social costs. (Bidgood, 4/19)

Maine could become the first state to add addiction to opioid prescriptions and illegal narcotics like heroin to its list of conditions that qualify for medical marijuana. Nearly 30 medical marijuana caregivers and patients told state regulators at a public hearing on Tuesday that marijuana eases the symptoms of opioid withdrawal and offers a healthier alternative to the prescription painkillers that can lead to addiction. (Bell, 4/19)

A Minnesota lawmaker who lost a daughter to a heroin overdose is proposing funding to hand out the anti-overdose medication naloxone at treatment centers and needle exchanges across the state. (Collins and Wurzer, 4/19)

Government health officials will team up with minor league baseball as part of a new $36 million campaign to discourage rural teenagers from using chewing tobacco. Baseball stadiums will feature the campaign's central message this summer — "smokeless doesn't mean harmless" — via advertising and promotions with players. Ads will also run on local television, radio and online in 35 markets across the U.S., including cities in Michigan, Montana, South Carolina and Tennessee. (4/19)

The Food and Drug Administration (FDA) is mounting a campaign to discourage teenagers from using smokeless tobacco. The anti-smokeless tobacco campaign will target white, male teenagers in rural areas, who are twice as likely as other teenagers to use products such as dip, chew and snus. The television ads will run in 35 rural markets around the country. (Devaney, 4/19)

There are just eight places that sell tobacco and/or e-cigarettes in Leawood, but they might soon find their clientele more restricted if this week’s positive reaction by City Council members to the Tobacco 21 initiative is any indication. For six months, a consortium of groups known as Healthy KC and led by the Greater Kansas City Chamber of Commerce and Blue Cross and Blue Shield of Kansas City has been pushing area municipalities to raise the minimum age for buying smoking products from 18 to 21. They say it would protect young people from nicotine addiction and improve health across the community. (Hellman, 4/19)

With the Obama administration swinging behind Biden’s “moonshot” effort, and with the National Institutes of Health looking to build on its biggest funding increase in 12 years, cancer advocacy organizations see a window of opportunity to gain additional funding and attention for their respective causes. But if the history of cancer politics in Washington is any guide, the competition will be intense. There are more than 75 cancer advocacy groups that try to make their case in Washington, and while they may share broad goals, scarce resources have long engendered competition among them, fueling tension that is only likely to intensify with more money at stake. (Nather and Kaplan, 4/19)

Flora Yang is small, spry and not afraid to tell you her age: "90-something." She walks twice a week at Mazza Gallerie in Northwest Washington, D.C., and says mall walking keeps her young and fit. Health officials are starting to notice that effect too and say more malls should open their doors to walkers. The Centers for Disease Control and Prevention has put out a guide saying the mall is a perfect place for seniors to get in their steps. (Gorman, 4/20)

It happens every day to the most vulnerable infants in hospital intensive care units: fragile babies born way too soon are poked, prodded and jabbed as part of medical care meant to help them survive — and it can be heart-wrenching to watch. ... experts say, pain relief for newborns and especially preemies is often inadequate, despite evidence that low-tech comforting methods and medication can both be effective. (Tanner, 4/20)

Michigan Attorney General Bill Schuette will announce criminal charges Wednesday in connection with his ongoing investigation of the Flint drinking water crisis, three sources familiar with the investigation told the Detroit Free Press Tuesday. Among those to be charged is a city of Flint official who signed a document saying the homes Flint used to test tap water under the federal Lead and Copper Rule all had lead service lines — a statement investigators allege was false. (Egan and Dolan, 4/19)

It's not just Flint, Michigan. Over the past few decades, school districts in Los Angeles, New York City, Seattle, Washington and elsewhere have found higher than acceptable lead levels in their students’ drinking water due to old plumbing systems. The NewsHour's April Brown reports on how schools in cities like Ithaca, New York, are confronting the crisis of lead contamination. (4/19)

A second bottled water pickup has been scheduled for Southern New Hampshire residents whose wells were contaminated with the compound known as PFOA. The state Department of Environmental Services will provide the bottled water, paid for by Saint-Gobain, at the Litchfield Transfer station on Sunday, from 9 to 3. (Corwin, 4/19)

State health officials confirmed Tuesday they have asked the Obama administration to keep a 15-month lifeline of federal Medicaid money flowing into Texas to help hospitals treat uninsured patients. That money would offer temporary relief to health care providers who face losing the funds — some $3.1 billion annually — over state leaders' refusal to provide government-subsidized health coverage to low-income adults under the Affordable Care Act, President Obama's signature health law. (Walters, 4/19)

Health care providers that predominantly rely on Medicaid funding are balking at the Labor Department’s proposed overtime rule. The health care groups provide services to people with disabilities. They say that doubling the salary threshold for overtime pay to $50,440 — under which virtually all workers qualify — is unworkable for an industry that can’t boost prices to cover added costs. (Levine and Pradhan, 4/20)

“You really see democracy in action,” state Department of Health and Human Services Sec. Rick Brajer said Monday evening. He was referring to the series of public hearings convened by his department to receive feedback on the state’s impending proposal to move Medicaid from a fee-for-service model to one administered by private managed care companies and local provider-led entities. (Sisk, 4/19)

More than 22,000 retired city workers want the Illinois Supreme Court — which decided a similar case in favor of state employees — to overturn Mayor Rahm Emanuel’s plan to save $130 million a year by completing a three-year phase-out of the city’s 55-percent subsidy for retiree health care. (Spielman, 4/19)

More Des Moines-area families are claiming religious exemptions to vaccinations this school year, even though no major organized religion forbids the shots. (Leys, 4/19)

In a downtown library in Council Bluffs, Iowa Right to Life director Jenifer Bowen says efforts underway in Iowa are one step toward widespread euthanasia of society's weak. (Clayworth and Munson, 4/19)

The Missouri Supreme Court has upheld a lower court ruling that allows caps on some damages in wrongful death lawsuits. Shannon Dodson died five years ago at Mercy Medical Center in St. Louis County after an artery was punctured during a heart catheter test. Her family received nearly $11 million in damages, including $9 million in non-economic damages. (Griffin, 4/19)

The House Select Committee on Medical Marijuana kicked off its initial hearing Tuesday with plenty of questions about a bill that seeks to create a strictly regulated system in Ohio. (Siegel, 4/20)

The Department of Veterans Affairs has closed its medical clinic at Fort Howard in eastern Baltimore County, a property that is proposed for redevelopment. (Wood, 4/19)

Noble Health Alliance, organized 2013 by Abington Health, Aria Health, Crozer-Keystone Health System and Einstein Healthcare Network, will disband in June, after three of the founding members entered into mergers or sales, the Fort Washington group said Tuesday. (Brubaker, 4/19)

On high alert due to the Zika virus, South Florida mosquito control officials are ramping up their insecticide spraying programs as the wet summer months — prime time for insect breeding — roll in. While that may be a good way to control bad bugs, what happens if you have medical conditions or allergies aggravated by these chemicals? (Lade, 4/19)

President Obama claimed credit at a Los Angeles fundraiser last week for “the steady progress that happens when people who love this country decide to change it,” and reality is unlikely to darken his farewell tour. But for everyone else, note that the largest U.S. health insurer is quitting ObamaCare. ... Liberals claim this doesn’t matter because UnitedHealth was insufficiently committed to ObamaCare, as if it preferred to leave money on the table. The insurer didn’t plunge head-first into the exchanges in year one of the law like the larger industry, but the latecomer expanded to 34 states in 2016 from 23 in 2015 and four in 2014. Mr. Hemsley has been more vocal than most insurance CEOs about the long-term importance of retail, customer-facing coverage outside of the employer business. (4/19)

UnitedHealth Group, the nation's largest commercial health insurer, made good on a six-month-old threat and announced Tuesday that it will pull out of Affordable Care Act exchanges in all but "a handful of states" after this year. The questions that raises, as we observed a couple of weeks ago, are will that hurt, and if so, who does it hurt? United had previously announced its withdrawal from Arkansas, Michigan, and Georgia (although a subsidiary, Harken, will continue to serve some Georgia counties). Other early reports said the company would leave Oklahoma and Louisiana. United has filed a rate request for 2017 in Virginia, albeit for HMOs only, so it appears to be staying in that state at least for one more year. (Michael Hiltzik, 4/19)

UnitedHealth Group, America’s largest health insurer, announced today that it would be abandoning Obamacare’s insurance exchanges, after absorbing hundreds of millions in losses. While the exchanges can continue to function without United, United’s departure could represent the “canary in the coal mine”: a signal that other insurers will not be able to remain in these highly unstable markets. (Avik Roy, 4/19)

The Post reports, “UnitedHealth Group, the nation’s largest health insurer, said Tuesday that in 2017 it will exit most of the 34 states where it offers plans on the Affordable Care Act insurance exchanges.” The concept of an exchange — a marketplace with some consumer choice (albeit one highly regulated by the government in required benefits) — was at the heart of Obamacare. No longer. ... Sen. Ben Sasse (R-Neb.), who represents a great number of rural Obamacare participants — the group likely to be impacted the most — was livid. In a statement, he bashed the president. “This isn’t about spreadsheets and quarterly reports — it’s about the President’s broken promise that families would have more choices under ObamaCare. (Jennifer Rubin, 4/19)

How should the government police the health-care industry? That question is before the Supreme Court on Tuesday as the justices hear arguments in an important case about the False Claims Act. Under the law as interpreted in most of the country, any time a health-care provider submits a bill to the government -- which is to say, millions of times a day -- the provider can be sued for a false claim if it’s failed to follow any of the myriad state and federal regulations governing the field. The law is meant to encourage citizens to blow the whistle on fraud, so it lets anyone bring a claim with the promise of receiving statutory damages up to three times the cost of the violation. (Noah Feldman, 4/19)

Every time you turn around, a member of Congress is criticizing the Veterans Administration health care system. What you don’t hear lawmakers say: We are responsible for a good share of the problems. But they are. In response to a national scandal over waiting lists for care at VA clinics, in 2014 Congress created the Veterans Choice program. The goal was to make it easier for veterans to get care at private facilities if no care was quickly available at a nearby government one. Except the “fix” is creating more problems for veterans, according to a recent story by Register reporter Tony Leys. (4/20)

With her solid victory over Vermont Sen. Bernie Sanders in the New York presidential primary Tuesday, Hillary Clinton took a big step toward clinching the Democratic Party nomination and taking her ambitious healthcare agenda into the November general election. (Harris Meyer, 4/19)

There’s a definite art to combining two companies into one. Done right it can spark innovation; done not-so-right it can slow or stifle progress. (Ulf M. Schneider, 4/20)

Vice President Joe Biden’s new “moonshot” effort against cancer is an unexpected and exciting boon for those of us searching for a cure for this deadly disease. But it is also an opportunity to target these new funds at the most deadly forms of cancer — something the current funding streams fail to do. (Bruce Zetter and Lara Maggs, 4/20)

In the first sentence of her story in Sunday’s Post-Dispatch about lawsuits filed against patients who’ve used SSM Health emergency rooms, reporter Samantha Liss used the phrase “Las Vegas-based collection firm.” That looked ominous, especially for low-income patients now being squeezed by debt collectors. SSM, the area’s second-largest health care system, outsourced emergency room care at most of its area hospitals to Schumacher Clinical Partners of Lafayette, La., in 2008. SSM retained responsibility for emergency care at Cardinal Glennon Children’s Hospital. Last September, it acquired St. Louis University Hospital from Tenet Healthcare Corp. and runs the ER there as well. (4/19)

Why was a dentist convicted of child sex offenses even being considered for work at a family dentistry practice where children would likely be present? Something seems badly broken in medical permitting if such a scenario had been allowed to proceed. (4/19)

KidsCare is the federal- and state-funded program to help children whose parents' income is between 138 percent and 200 percent of the federal poverty level. It will be 100 percent funded by the federal government for the next year and a half and probably two years longer, and at the very least 75 percent funded after that. Parents are required to pay premiums, unlike other Medicaid programs. (Tim Jordan, 4/19)

California and New York have taken very different paths to a $15 minimum wage. Now, they are differing on how to provide paid family leave, in ways that are instructive for other states and for the federal government. Since 2004, workers in California have been entitled to receive 55 percent of their wages for up to six weeks of leave to care for a new child or a seriously ill relative. Starting in 2018, a new law will lift that rate to 70 percent for the lowest-paid earners, defined as those making up to one-third of the state’s average weekly wage of $1,121 currently. For almost all other workers, the rate will rise to 60 percent, up to a maximum weekly benefit of about $1,200. (4/20)