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Add Tennessee and Kansas to the list of states that have been warned by the Obama administration that failing to expand Medicaid under the Affordable Care Act could jeopardize special funding to pay hospitals and doctors for treating the poor. The Centers for Medicare & Medicaid Services confirmed Tuesday that it gave officials in those states the same message delivered to Texas and Florida about the risk to funding for so-called “uncompensated care pools” — Medicaid money that helps pay the cost of care for the uninsured. (Galewitz, 4/21)

CMS has told nine states — some that remain fiercely opposed to Medicaid expansion as well as others that have implemented the Obamacare provision — that its willingness to provide billions of dollars for hospital uncompensated care pools is quickly waning. (Pradhan, 4/21)

While the 40-member Senate convened a rare emergency meeting to discuss Florida’s budget dilemma Tuesday — with more than 100 lobbyists, citizen activists and reporters attending — House Republicans took up the same issue behind closed doors. To keep reporters and members of the public out, a legislative aide was posted at the door. After the meeting, House Speaker Steve Crisafulli, R-Merritt Island, told reporters that the caucus discussed the major sticking points of this year’s legislative session: Medicaid expansion and the future of federal hospital funding known as the Low Income Pool. (McGrory, 4/21)

Blaming the federal government for Florida's financial woes, Gov. Rick Scott on Tuesday said he was prepared to call Florida lawmakers back for a special session to complete the budget — and even encourage them to pass a bare-bones budget if necessary. ... During a closed-door meeting, House Speaker Steve Crisafulli, R-Merritt Island, could be heard encouraging the Republican caucus to hold firm in its opposition to Medicaid expansion, one of the key sticking points of the session. "We're asking you to trust us," an Associated Press reporter heard Crisafulli saying. Senate President Andy Gardiner, meanwhile, received a standing ovation from the entire Senate — and applause from lobbyists and activists in the audience — when he said the Senate would continue its fight for expanded coverage. (McGrory and Van Sickler, 4/21)

With time running out, Florida Gov. Rick Scott on Tuesday injected himself into the state's ongoing budget showdown, telling Republican legislators that he would call them back into a special session if they fail to reach a deal soon. Scott made his suggestion at the end of a topsy-turvy day that witnessed GOP leaders in the Florida House and Senate remaining firm in their positions regarding health care funding and whether to expand Medicaid. The impasse means legislators will not pass a new budget by the May 1 end of the regular session. (Kennedy and Fineout, 4/22)

The federal government is balking at Michigan's approval request to continue health care coverage for nearly 600,000 low-income residents, state officials say. The development, they say, threatens the program's future. Under state law, Michigan must, by Dec. 31, receive a waiver from the Centers for Medicare and Medicaid Services on the health care cost-sharing requirements in its Medicaid expansion law — or the state's program will end. ... The program could continue if federal officials find a way to approve the waiver or if the Legislature changes the state's Medicaid expansion law to meet federal concerns. The final legislative approval of the expansion squeaked through the state Senate, 20-18, in August 2013, and political experts and lawmakers indicated Tuesday that changing the law would be an uphill battle. (Bouffard and Livengood, 4/21)

Work in the Alabama Senate Tuesday came a halt over a resolution opposing efforts to expand Medicaid in Alabama. The resolution, sponsored by Sen. Trip Pittman, R-Montrose, ultimately passed the body on a 22-8 vote, but not before sharp criticisms from the Democratic minority, who have made the expansion offered under the Affordable Care Act a priority for years. Senate Minority Leader Quinton Ross, D-Montgomery, threatened to slow down future business of the Senate over the vote. (Lyman, 4/21)

Democrats in the Alabama Senate today said they would try to lock down the rest of the session with filibusters because the Republican majority passed a resolution opposing Medicaid expansion. "We tried to reach out to them, letting them know this is our No. 1 priority," said Sen. Quinton Ross, D-Montgomery, the Senate minority leader. "So why burn down the house? Why cause such a train wreck over a resolution that means nothing?" Sen. Trip Pittman, R-Mobile, said the resolution does carry meaning -- a statement that the Legislature will not allocate funds to support Medicaid expansion. "The reality is we can't sustain the health care we have and we sure don't need to expand," Pittman said. (Cason, 4/21)

The Alabama Senate locked down Tuesday in a partisan quarrel as GOP senators pushed through a resolution opposing Medicaid expansion under the Affordable Care Act. Senators voted 22-8 for the resolution saying that the position of the Alabama Legislature is against Medicaid expansion and lawmakers have no intention of allocating funds to an expansion. The resolution caused the first large partisan fight so far this year, and one that Democrats vowed will spill over into the rest of the session. (Chandler, 4/22)

A conservative leader says he's dropped a potential plan that sought to undermine Gov. John Kasich's expansion of Medicaid through a vote Wednesday in the Ohio House. State Rep. Jim Butler, R-Oakwood, had toyed with the idea of forcing a vote on a budget amendment to prohibit Ohio from spending state taxpayers' money on Medicaid expansion. ... But late Tuesday, Butler told The Enquirer he had abandoned the idea. (Thompson, 4/21)

The issue is highly partisan: accepting Medicaid expansion could be seen as giving in on the Affordable Healthcare Act, since Medicaid expansion is a major part of the heath care system forged by President Barack Obama. But could Louisiana's current "acute budget crisis," as put by state Rep. John Bel Edwards, D-Amite, be the factor that takes politics out of taking the money since Louisiana desperately needs money to close its $1.6 billion revenue shortfall? According to top Republicans, including one of just two Republican senators who last year intentionally voted in favor of a bill related to the expansion of Medicaid: it's not going to happen. (Lane, 4/21)

New Jersey lawmakers on Monday scrutinized the state's handling of thousands of low-income residents' Medicaid applications, as the Christie administration asserted it had made progress in reducing the backlog. Gov. Christie expanded Medicaid under the Affordable Care Act, and 400,000 residents have gained health insurance through the government program since 2014. However, thousands of applications have languished at understaffed county welfare agencies, in part because of the state's antiquated computer systems. (Seidman, 4/21)

Four clients of the state's Medicaid program want a say in the lawsuit challenging the legality of the program's 2013 expansion, arguing they don't trust the state to defend the controversial move. (Pitzl, 4/21)

The poll also showcased the public’s overwhelming ignorance of the law’s actual effects. Only 8 percent of respondents were able to correctly answer that the Affordable Care Act has thus far cost less than the Congressional Budget Office originally projected, while 50 percent said they think the law has been more expensive. A majority of respondents — 56 percent — answered that the law has not directly affected them. Nineteen percent said the law has helped them or their families personally, while 22 percent answered that it had hurt them. Again, answers to this question showed a significant partisan split. (Lerner, 4/21)

There's more evidence that President Obama's health care law is gaining in popularity. According to the monthly Kaiser Health Tracking Poll released Tuesday, 43% have a favorable view of the Affordable Care Act and 42% have an unfavorable view -- the first time the law has been in positive territory since November of 2012, the month President Obama won re-election. Of course, the poll points out that the margin is "one percentage point, and the difference is within the survey's margin of sampling error and is not statistically significant." (Jackson, 4/21)

Reforming the Affordable Care Act may be on the public’s health care wish list, but it only comes after making medications for chronic diseases affordable, ensuring adequate provider networks and increasing the transparency of health care quality and costs, according to a poll released Tuesday by the Kaiser Family Foundation. (Villacorta, 4/21)

Two Senate Republicans with heartburn over the cost of a recent Medicare overhaul are hoping a final GOP budget will find offsets — throwing another curveball into budget negotiations that have already blown a week past the original deadline. (Bade, 4/21)

House Speaker John Boehner pecked Democratic Leader Nancy Pelosi on the cheek. House Republican leader Kevin McCarthy conferred amiably with Treasury Secretary Jack Lew. Republicans and White House officials slapped each other on the back. (4/21)

Sen. Ron Johnson (R-Wis.) unveiled legislation on Tuesday that would allow people to temporarily keep their ObamaCare plans if the Supreme Court guts the law's subsidies. Johnson’s bill is the latest Republican effort to put forward contingency plans for the possibility that the high court could strike down subsidies that help 7.5 million people afford health insurance. (Sullivan, 4/21)

Veterans Affairs Secretary Robert McDonald criticized the House military construction and veterans’ affairs fiscal 2016 spending bill, which would provide $1.4 billion less to the agency than President Barack Obama's request. (Adams, 4/21)

Senior and provider groups are angry that Medicare cuts will help pay for one of the trade bills that Congress will soon consider and are waging a last-ditch effort to nix the cuts. The Trade Adjustment Assistance reauthorization bill hasn't received as much attention as the fast-track trade authority bill, but Democrats see it as a priority: The program helps workers who have been put out of a job because of foreign trade with job-training and placement as well as health-insurance costs. ... But on Tuesday, senior and provider groups started criticizing the proposal. They're unhappy because about $700 million of the $2.9 billion cost would be offset by increasing the cuts to Medicare authorized by the automatic budget cuts known as sequestration in fiscal year 2024 by 0.25 percent, according to a Congressional Budget Office score of the House bill. (Scott, 4/21)

Leading healthcare provider groups are objecting to Medicare cuts being used to help pay for a new House Republican trade bill. The Trade Adjustment Assistance (TAA) bill helps workers displaced by trade and provides a tax credit to help pay for health insurance. It was rolled out in addition to a proposal to give President Obama “fast-track” authority on trade. The healthcare providers object to the TAA bill including a 0.25 percent cut in Medicare payments in fiscal year 2024, which amounts to a $700 million cut, according to the Congressional Budget Office. (Sullivan, 4/21)

Providers are raising alarms about potential cuts to Medicare that would bankroll benefits for workers hurt by future free-trade agreements. The Trade Adjustment Assistance Act, sponsored by Rep. David Reichert (R-Wash.), would rely on $700 million in reduced Medicare spending in 2024 to pay for healthcare coverage and other benefits for workers who lose coverage because of any agreements negotiated under fast-track trade authority sought by President Barack Obama. (Demko, 4/21)

Former U.S. Rep. Allyson Schwartz (D., Pa.) will become the president and CEO of a group working to support Medicare Advantage, a Medicare program that has often been targeted for reform. She will be leading the Better Medicare Alliance, made up of health insurers (like Aetna), hospitals, medical providers, and advocates for Medicare Advantage recipients. The U.S. Chamber of Commerce is another member of the alliance, which launched in December. (Tamari, 4/21)

Loretta Lynch, a U.S. attorney in New York, is expected to win confirmation as soon as Thursday under the deal, which ended a partisan dispute over abortion restrictions in an unrelated bill. Senate GOP leaders insisted on clearing that impasse before moving forward with Lynch. (DeBonis, 4/21)

Democrats said they had become aware of an anti-abortion provision, blocking the legislation from moving forward as they demanded that Republicans remove language barring victims from using criminal fines in a victims’ fund to pay for abortions. As a compromise, the fund will now essentially be split in two. One pool of money, collected from criminal offenders, will be deposited into the general fund of the Treasury and used for non-health care services, which will not be subject to abortion restrictions. Other money would come from that already appropriated by Congress for Community Health Centers. It would be available for health care and medical services and would be subject to longstanding laws restricting the use of federal funds for abortions. Many victims would be able to obtain abortions under the laws’ exception in cases of rape. (Huetteman and Steinhauer, 4/221)

The same day that the Senate reached a deal on abortion language in a bill to combat human trafficking, the House of Representatives began considering legislation that is igniting a new controversy over the divisive social issue. The House Oversight Committee is expected to approve a resolution on Tuesday that would attempt to overturn a law passed by the District of Columbia Council in December that bans employers from taking punitive action against any employees for using abortion services or birth control. (Walsh, 4/21)

A potential $40.1 billion generic-drug merger already has Brad Arthur bracing for a blow to his family-run pharmacy in Buffalo, New York. Arthur has been contending with rising generic drug prices for the better part of two years -- a trend that has drawn Washington’s attention and caused an outcry from consumer advocates. Now the pharmacist says he fears the proposed takeover of Mylan NV by Israel’s Teva Pharmaceutical Industries Ltd. could threaten businesses like his by reducing competition even further. (Koons, 4/21)

Teva Pharmaceutical Industries Ltd on Tuesday made an unsolicited $40 billion offer for smaller rival Mylan NV, a bold bid for growth as its lucrative Copaxone drug faces generic competition. The offer followed weeks of speculation that Israel-based Teva, the world's largest generic drugmaker, would soon target Mylan. Shares of Mylan traded below the offer price of $82 in cash and stock, evidence of investor skepticism that Teva can win over the company, which has set up a defense that includes a poison pill. (Cohen and Humer, 4/21)

Generic drug giant Teva formally offered to buy fellow drugmaker Mylan for about $40.1 billion in cash and stock on Tuesday, despite Mylan's cold shoulder and the certainty the proposed acquisition will bring intense scrutiny by antitrust regulators. If Israel-based Teva Pharmaceutical Industries Ltd. succeeded, the combination would dominate the global generic drug market, be a major contender in some other specialty drug categories — and have the leverage to try to raise generic drugs prices. (Johnson, 4/21)

Amgen Inc., the maker of cancer treatments and blood boosters to combat anemia, reported first-quarter profit that topped analysts’ estimates and raised its forecast for the year on stronger-than-expected drug sales. The shares rose in late trading. (Chen, 4/21)

Health insurer Humana has acquired Your Home Advantage, a Deerfield Beach, Fla.-based company that sends nurse practitioners and other providers to assess and care for patients in their homes. The company will become part of Humana At Home, Humana's home-based services division that was previously known as SeniorBridge Family Cos. Humana bought SeniorBridge in 2012. (Herman, 4/21)

Four years ago, Warner-Chilcott caused a stir by adding a line, or “score,” to its Doryx tablets that are prescribed for treating acne. The move gained notice because it was seen by some as another effort by a brand-name drug maker to thwart generic competition, since any generic rival would have had to take the same time-consuming production steps to win regulatory approval to sell a copycat version. (Silverman, 4/21)

Health-care real-estate investment trust HCP Inc. said Tuesday that the U.S. Department of Justice has filed a complaint against its HCR ManorCare Inc. venture for alleged false claims related to Medicare reimbursement. The Justice Department complaint, which was released from seal on Monday, follows a civil investigation of lawsuits filed by former HCR employees, according to a regulatory filing. In the previously sealed lawsuits, the employees claimed, under a provision of the federal False Claims Act, that HCR submitted claims to Medicare for therapy services that were unskilled, unnecessary, not covered by the skilled-nursing facility benefit and therefore not covered by Medicare reimbursement. (Chen, 4/21)

The Justice Department said Tuesday that it is stepping into a long-running lawsuit against one of the nation's largest nursing-home chains, accusing it of systematic Medicare overbilling and sometimes putting frail, dying patients through arduous rehab schedules just to increase revenue. The lawsuit alleges that ManorCare routinely pressured administrators of its nursing homes, assisted living and rehab facilities to meet financial targets by billing for unnecessary care. (Barakat, 4/21)

Healthcare real estate investment trust HCP Inc said the U.S. Department of Justice had filed a lawsuit against one of its clients over the company's billing practices. The lawsuit against HCR ManorCare Inc, which operates and manages healthcare facilities owned by HCP, alleges that the operator billed Medicare for services that were not "medically reasonable and necessary." (4/21)

A top federal drug regulator says that increased safety problems with homeopathic remedies contributed to the government's decision to revisit its oversight of the products at a public hearing this week. The Food and Drug Administration on Tuesday wrapped up a two-day meeting to hear from supporters and critics of products like Zicam Allergy Relief and Cold-Eeze, alternative remedies that are protected by federal law, but not accepted by mainstream medicine. (Perrone, 4/21)

The Food and Drug Administration issued two draft guidance documents Tuesday outlining how medical device companies should handle data from overseas clinical trials and how drug makers should submit promotional materials for prescription drugs and biologics. The guidance on medical devices follows on a provision in the Food and Drug Administration Safety and Innovation Act codifying the agency’s long-standing policy of accepting data from clinical trials conducted outside the US, as long as the manufacturer proves the data meet the agency’s standards. (Gustin, 4/21)

A proposal to require more children to be vaccinated before entering school in California was revamped Tuesday to address concerns that it might bar many young people from a public education. But key members of the Senate Education Committee, which is scheduled to vote on the measure Wednesday, remained noncommittal about it. (McGreevy, 4/21)

A bill that would eliminate the option California parents use to skip their child’s school immunizations faces a do-or-die test Wednesday in a state Senate committee that came close to rejecting it last week. (Gutierrez, 4/21)

On the heels of a measles outbreak in California fueled by vaccination fears that scientists call unfounded, another large study has shown no link between the measles-mumps-rubella vaccine and autism. The study examined insurance claims for 96,000 U.S. children born between 2001 and 2007, and found that those who received MMR vaccine didn’t develop autism at a higher rate than unvaccinated children, according to results published Tuesday by the Journal of the American Medical Association, or JAMA. Even children who had older siblings with autism—a group considered at high risk for the disorder—didn’t have increased odds of developing autism after receiving the vaccine, compared with unvaccinated children with autistic older siblings. (Whalen, 4/21)

A federal appeals court on Tuesday denied St. Luke's Health System's request for a rehearing before a full panel of judges, raising the possibility that the system might take its widely watched antitrust fight to the U.S. Supreme Court. (Schencker, 4/21)

St. Elizabeth’s Hospital received the green light from state health regulators Tuesday to move from downtown Belleville to O’Fallon, Ill. All eight of the board members present at Tuesday’s hearing in Bolingbrook, Ill., voted in favor of the controversial project. The Illinois Health Facilities Services Review Board has nine members; one was absent from Tuesday’s hearing. (Liss, 4/21)

Two psychiatrists at a Texas state hospital have resigned after being told they would face disciplinary actions for accepting hundreds of thousands of dollars in speaking and consulting fees from AstraZeneca while also promoting one of its drugs to state officials, according to a spokeswoman for the Texas Department of State Health Services. (Silverman, 4/21)

Texas hospital Citizens Medical Center will pay the government $21.8 million to settle allegations that it illegally paid doctors for referrals, the U.S. Justice Department announced Tuesday. The government alleged that the hospital paid several cardiologists more than the fair market value of their services. It had also alleged that the hospital paid bonuses to emergency room doctors based partly on the value of their cardiology referrals. The compensation arrangements, the Justice Department said, triggered the False Claims Act because they violated the Stark law, which governs physician referrals and financial relationships. (Schencker, 4/21)

A measure to reinstate limits on lawsuit awards for pain and suffering in medical malpractice cases is heading to Missouri Gov. Jay Nixon's desk three years after the state Supreme Court overturned lower caps. The Missouri House on Tuesday voted 125-27 to approve a measure that limits noneconomic damages in malpractice cases. It's a change supporters have been calling for since the state's high court eliminated caps in a 2012 decision that hospital and doctor's groups warned would increase insurance costs, stall expansions of hospitals and deter doctors from practicing in the state. (French, 4/22)

During the past five years, Colorado’s teen pregnancy rate plummeted 40%, a dramatic reduction that public health officials attribute to an unusual contraception program financed by investor Warren Buffett. Now the future of the program, which made birth control devices available to thousands of Colorado women at reduced costs, is in jeopardy. It is set to expire this summer and some state lawmakers are balking at using state money to continue the project. (Frosch, 4/21)

Doctors in Kansas City rake in more money from pharmaceutical companies than physicians in any other U.S. city, according to a survey by BetterDoctor.com. The San Francisco-based company, a web and mobile-based physician search service, found that Kansas City doctors were paid an average of $2,945 by drugmakers, the most in the nation. (Margolies, 4/21)

It took an average of 54 minutes for callers to reach a Department of Social Services worker by phone last month. That’s an improvement over February’s 70-minute average, and one of the lower average monthly wait times in the past year. But client advocates say it’s far too long for people to wait for help with health care coverage, food stamps or other programs that provide for basic needs. (Levin Becker, 4/21)

Republican Rep. Matt Dean, who chairs the House Health Care Finance Committee, joined MPR News' Tom Weber to talk about his bill to end MinnesotaCare. (4/21)

Louisiana Gov. Bobby Jindal's administration has rewritten the state's abortion clinic regulations, a move that abortion-rights supporters say was unnecessary and intended to hinder the operation of clinics. (4/21)

Here is the good news: Maine lawmakers want health insurers to start paying for fertility treatments. Many more hopeful Mainers might soon be able to have children. Here is the icky news: Only married people would qualify, and only if they hadn’t become infertile because of a sexually transmitted disease. So far, 13 states have laws requiring insurers to cover assistive reproductive therapies according to the National Conference of State Legislatures. (Guo, 4/21)

There are growing worries about the future of an ambitious federal demonstration aimed at improving coordination of care for millions of low-income and disabled Americans who are dually eligible for Medicaid and Medicare. Health plan leaders and state officials expressed concern during a webinar event on April 16 that current federal-state demonstrations in 11 states may not yield the cost savings the Obama administration and the states hoped for – at least in the projected time frame. (Dickson, 4/21)

A lawmaker's push to increase Texans' access to raw milk stirred controversy on Tuesday, as dairy farmers, doctors and consumer advocates gathered at the Capitol to debate the merits of unpasteurized milk. House Bill 91 by state Rep. Dan Flynn, R-Canton, would allow licensed farmers to sell raw milk at farmers' markers and through direct delivery to consumers. The proposed legislation would not allow the sale of raw milk in supermarkets. While raw milk is currently legal in Texas, it can only be sold at farms. (Hershaw, 4/21)

No one who lived through the 1990s would have suspected that one day people would look back on the period as a golden age of bipartisan cooperation. But in some important ways, it was. Amid the policy fights that followed the Republican victories of 1994, President Bill Clinton and the new majorities in Congress reached one particularly good deal: doubling the budget for the National Institutes of Health. (Newt Gingrich, 4/22)

Lawmakers passed a health-care payment reform this month, ending one of the major, recurring legislative crises that has led to a lot of embarrassing last-minute activity over the years. They did so in large part with their usual bipartisan commitment to widening the deficit, but they did include some useful changes, too. They also relented on ill-considered defense spending caps. Assuming the trafficking compromise holds over the coming days, the Senate finally will vote on, and presumably for, Ms. Lynch, with at least some Republican support. ... Legislators have a long way to go. But in an age in which unbridgeable disagreement has been the norm, green shoots of compromise should be welcomed and nurtured. (4/21)

Although Washington and the physician community were expressing euphoria over the end of the SGR, ... unresolved issues are concerning. But moving away from a billing system that reimburses for microunits of service and that indiscriminately increases or decreases unit reimbursement across all physicians irrespective of their own behavior is worth some downside risk. Physician groups and others are rightly raising concerns about the process that will be used to determine which alternative delivery systems warrant bonus payments, as well as the metrics that will determine bonuses and penalties for those remaining in a fee-for-service payment system. What is useful to remember is that the payment under the SGR and until MIPS debuts in 2019 implicitly assumes that there are no variations in quality, efficiency, or value in the clinical care provided by physicians—or at least none worth paying for. These assumptions are surely wrong. (Gail Wilensky, 4/21)

Congress did its job, passing legislation last week -- specifically, a bipartisan Medicare reform bill. And it is pleased with itself. Jon Stewart is not. "The people we picked to be legislators legislated something," the "Daily Show" host said Monday. "So are we supposed to throw them a party for that?" (Hunter Schwarz, 4/21)

Dozens of states, including California, already have similar laws on the books that are stronger and more comprehensive than the proposed federal law. But the federal law would preempt all state laws. ... Take the case of the recent data breach experienced by health insurer Anthem. The personal information of nearly 80 million policyholders was endangered after hackers accessed a company database. Under California's notification law, Anthem had no choice but to disclose the breach. The state law requires that notification be made whenever the personal information of any resident is "acquired, or reasonably believed to have been acquired, by an unauthorized person." (David Lazarus, 4/21)

In the “history lesson” that House Republican leaders gave to their members on Tuesday, they handed out a resource guide that they could refer to in the coming weeks to bolster their position to oppose Medicaid expansion. Included in the packet was an article written by Jason Fodeman, an assistant professor of medicine at the University of Arizona. Why Fodeman? Well, if Nexis-Lexis is any guide, and it is, then Fodeman is one of the earliest opponents of Obamacare. A former health policy fellow at the right-wing Heritage Foundation, Fodeman has made a career out of slamming Obamacare. (Michael Van Sickler, 4/21)

The expansion of Medicaid to cover the thousands of Alaskans in the “doughnut hole” of low income between existing Medicaid coverage and subsidies under the federal Affordable Care Act has long been popular in Alaska despite its association with a president with low approval in the Last Frontier. It was one of Gov. Bill Walker’s most successful issues in his campaign against former Gov. Sean Parnell. A recent poll found support of both the governor and Medicaid expansion surpass 60 percent among Alaska residents. Yet the Legislature is so opposed to passing Medicaid expansion — and accepting the great sum of federal help with medical costs that come along with it — that Gov. Walker is already openly talking about calling legislators back into a special session to deal with the issue. It’s unusual for elected representatives to be so far out of step with the will of the people. (4/19)

Gov. Paul LePage and his administration have claimed repeatedly over the past few years that Maine can’t afford to expand Medicaid to about 70,000 low-income parents and adults without children. But policymakers in Maine can now inform their decisions with the experience so far of states where Medicaid coverage expanded on Jan. 1, 2014. Drawing on that experience, a new analysis of Medicaid expansion’s potential impact on Maine’s state budget complicates the narrative that extending health coverage would be prohibitively expensive. The analysis, released Wednesday by the Maine Health Access Foundation, projects a $26.7 million budget benefit in 2016 if Maine expands Medicaid. (4/21)

The passage of Medicaid expansion in Montana this weekend was an unlikely defeat for the Koch brothers, who came in as heavy favorites and spent a fortune trying to kill the measure. Sadly for the Kochs, poor people in Montana will now get medical care. Montana is the only state where the Kochs got beaten down like this. What is to be learned from this episode? ... The right-wingers the Koch brothers rub elbows with are the kind that go to Lincoln Center. The ones in Montana are a different breed, something the Kochs may not have fully understood. (Eric Stern, 4/21)

Likely Republican presidential candidate Jeb Bush wants to require everyone to fill out an advance directive governing their end-of-life care before they can receive Medicare benefits. His proposal is both ironic and politically audacious. It's notable coming from the former Florida governor who in the mid-2000s battled to keep Terri Schiavo, a brain-damaged young woman, alive on a feeding tube despite multiple courts' determination that it wasn't her wish to be kept alive in that state through artificial support. ... Bush's comments also represent a remarkable reversal from previous GOP rhetoric calling a proposed policy to encourage physicians to help patients fill out advance directives “death panels” and rationing. (Harris Meyer, 4/21)

[Washington's] mental health funding has been in the news. Writing that “jails are not hospitals,” U.S. District Court Judge Marsha Pechman recently ordered the state to stop warehousing those criminal defendants awaiting competency determinations. Both parties in the Legislature have budget proposals that would address the issue. This is both compassionate and legally necessary under Judge Pechman’s orders. Regrettably there is not such bipartisan unanimity when it comes to serving law-abiding seniors with dementia, many of whom are served in assisted living facilities. Medicaid care in assisted living facilities has gone years without funding increases, and has actually seen funding cuts. Rates can be as low as $46.51 a day for 24/7 care, meals and housing, a decrease of 55 cents from 2011. (Robin Dale, 4/22)

Behavioral disorders of childhood are increasingly recognized as making a substantial contribution to poor physical and behavioral health, not only of children but across the lifespan. Advances in prevention and implementation science offer opportunities to avoid costly and devastating outcomes. Behavioral health for young children represents an opportunity for real advances in population health and health care cost containment. (Thomas F. Boat, 4/21)