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Florida's Legislature collapsed into chaos Tuesday as the House unilaterally ended the annual session with more than three days left, leaving dozens of major bills dead and escalating tensions between the House and Senate over their health care stalemate. The state Senate responded by remaining in session for two more hours and announcing plans to return Wednesday, an attempt to send the message that they are willing to work through the impasse that has bitterly divided Republicans, and frayed emotions. (Klas and Bousquet, 4/28)

A fight over Medicaid expansion among Republicans in the Florida Legislature turned rancorous Tuesday after the House of Representatives adjourned three days early, leaving in limbo the state’s $77 billion budget, a trail of unfinished bills and an unresolved feud with the Senate over the federal program. The surprise announcement means that the House speaker and Senate president, both Republicans, must agree to a special session. They must also overcome their differences on Medicaid expansion — the House opposes it, the Senate supports it — to finish the state’s budget by the June 30 deadline. (Alvarez, 4/28)

The Florida House – at odds with the state Senate over the expansion of Medicaid – abruptly ended its session three days early on Tuesday, leaving hundreds of bills unrelated to health care unfinished. Shortly after the adjournment, Gov. Rick Scott, a Republican, filed a lawsuit against the federal government over the same issue. (Hatter, 4/29)

Deep divisions over healthcare funding in Florida's Republican-dominated statehouse brought a dramatic end to the legislative session on Tuesday, with the state senate vowing to keep working even as the other chamber's members were leaving town with no budget passed. With the 60-day legislative session scheduled to conclude on Friday, the state House of Representatives called it quits three days early. (Cotterell, 4/28)

Florida Gov. Rick Scott sued the Obama administration Tuesday, charging that federal officials are coercing the state to expand Medicaid in order to get $1 billion in federal hospital funds. The Republican governor points to a 2012 U.S. Supreme Court decision saying the federal government can't coerce states to expand Medicaid, which is exactly what he says the Obama administration is doing by withholding hospital funds. (Kennedy, 4/28)

As a standoff over Medicaid expansion brought the legislative session to an unexpected halt on Tuesday, Gov. Rick Scott filed a lawsuit claiming that the federal government tried to force the healthcare policy upon Florida. Scott first floated the idea two weeks ago, after federal health officials said they would be more likely to continue a $2.2 billion hospital funding program known as the Low Income Pool if state lawmakers voted to expand healthcare coverage to low-income Floridians. (McGrory, 4/28)

Florida Governor Rick Scott sued the Obama administration on Tuesday, challenging the federal government’s decision not to extend a $1 billion healthcare funding program for low-income patients. The state argued that federal healthcare officials cut the funding as a way to coerce Florida into dropping its refusal to expand Obamacare for the working poor in Florida. (Cotterell and Adams, 4/28)

Hours after Gov. Rick Scott announced he's filed a lawsuit suing the federal government for linking the Low Income Pool to Medicaid expansion, CMS released a statement saying that LIP funding is "not dependent on whether it expands Medicaid." ... Here's the statement from Aaron Albright, spokesman for CMS: “The decision to expand Medicaid, or not, is a state decision. We will work with Florida and each state that has an uncompensated care pool regardless of its Medicaid expansion status, to support access to health care for low-income residents that works for individuals, hospitals and taxpayers, taking into account the state’s specific circumstances. CMS will review proposals regarding uncompensated care pools based on the same principles whether or not a state has expanded Medicaid.” (Klas, 4/28)

Medicaid expansion has given a budget boost to participating states, mostly by allowing them to use federal money instead of state dollars to care for pregnant women, inmates, and people with mental illness, disabilities, HIV/AIDS, and breast and cervical cancer, according to two new reports. States that levy assessments and fees on health care providers, which have collected higher revenues as a result of expansion, have reaped extra benefits. (Ollove, 4/29)

Senate Democrats Tuesday evening pushed through a resolution stating their support for an expansion of Medicaid. The resolution – passed with most Republicans abstaining – comes a week after a GOP-backed resolution urging no expansion of the program brought the Senate to a halt. Democrats said the resolution did not speak for them and threatened to slow down work in the chamber after it passed. (Lyman, 4/28)

If you've only half paid attention to what's happening in Baton Rouge, you probably already know lawmakers are trying to agree on the best way to patch a $1.6 billion hole in Louisiana's budget. And you may have heard this week that the state's private hospitals are working with House leaders to try to come up with one solution the Louisiana Hospital Association thinks would be mutually beneficial — and that puts Medicaid expansion squarely on the table as key to helping fill that funding gap. ... Here are a few questions and answers that have surfaced in our recent coverage. (Catalanello, 4/28)

Lawmakers are again considering proposals to expand Louisiana's Medicaid program, to give government-funded health insurance to the working poor. The House and Senate health committees have scheduled Wednesday hearings on the coverage expansion legislation. (DeSlatte, 4/29)

Supporters of Medicaid expansion said Tuesday morning outside Columbia City Hall that if the federal government offered Missouri an additional $400 million to build roads and bridges, the state would take that money without question. The group of 20 people, including city and county elected officials and health care providers, called on the Missouri General Assembly to act quickly to expand Medicaid before the legislative session ends May 15. The Republican-controlled legislature’s unwillingness to debate and positively act on Medicaid expansion illustrates “the conflict between ideology and logic,” Columbia Mayor Bob McDavid said. (Jackson, 4/28)

Colorado officials are considering hiking user fees for the health exchange as high as 4.5 percent, a significant jump over the current 1.4 percent rate and well over the fees for the federal exchange. “Obviously, the level at which we are currently at is not adequate,” said exchange board member Arnold Salazar. “In any configuration, we’re probably going to have to look at a rate increase. The question is whether we look at 3.5 percent or 4.5 percent.” If Colorado’s exchange fees jump higher than the 3.5 user fees for those who buy on Healthcare.gov, calls to scrap Colorado’s troubled exchange and fold it into the federal exchange could grow significantly louder. (Kerwin McCrimmon, 4/28)

Rep. Joe Courtney has plunged into the latest fight over the Affordable Care Act, attacking the so called “Cadillac tax” that will eventually be implemented on high-cost health care policies. The ACA will impose a 40 percent excise tax on premiums over $10,200 per person and $27,500 per family. Although implementation of the tax has been delayed until 2018, companies are wrestling with it now as they plan employee benefits. ... Courtney, D-2nd District, on Tuesday introduced a bill to repeal the tax and is among a growing number of Democrats seeking to eliminate it, even as they support most other aspects of the ACA. (Radelat, 4/28)

The Obama administration’s top health official defended the federal overhaul that has boosted health insurance rolls nationally and said the government will move aggressively to support precision medicine. Sylvia Mathews Burwell, secretary of Health and Human Services, told more than 800 people gathered in Boston Tuesday for the World Medical Innovation Forum, sponsored by Partners HealthCare, that government leaders must team up with businesses and consumers to assure further progress in integrating health care delivery and holding down costs. (Weisman, 4/28)

A single senator on Tuesday stopped the advance of a House-Senate agreement that would ostensibly deliver the first balanced budget of this century, but the deal’s fate faced far greater obstacles than just his objections. Even before its official unveiling, the agreement is already threatened with irrelevance amid a bipartisan clamor for more spending in a new era of loosening belts. ... A bipartisan group of lawmakers is pushing measures to speed the Food and Drug Administration’s approval process for drugs and medical devices, which would probably require additional spending. ... From the outside, Newt Gingrich, the former House speaker and a co-author of the balanced budget agreement of 1997, called for doubling the National Institutes of Health’s budget. All of those efforts would conflict with the strict domestic spending caps established by the Budget Control Act of 2011 — which the Republican budget accord did nothing to change. (Weisman, 4/28)

Sen. Bob Corker has slammed the brakes on a much-awaited budget deal that was supposed to sail to passage this week — taking on Republican leadership, budget negotiators and appropriators alike over what he calls a spending “gimmick” that produces billions in fantasy savings. The Tennessee Republican on Tuesday said he would not sign the final budget deal because the agreement would let appropriators take unspent money from mandatory programs — like a crime victims fund or children’s insurance account — and use it to pay for other congressional priorities. Because the money was never going to be spent anyway, lawmakers like Corker think it’s dubious to count it as “savings.” (Bade, 4/29)

Political pragmatism appears to have once again trumped ideological fervor as the Republicans put the finishing touches on their budget plan for fiscal 2016. The new budget blueprint originally was conceived as a first major step towards wiping out the deficit within the coming decade through a series of draconian spending cuts and changes in Medicare, Medicaid and other costly entitlement programs. But for now, at least, Congress is on track to approving substantially more spending in the coming year. (Pianin, 4/28)

Senators are asking administration health officials on Tuesday for ideas on how to speed the discovery and approval of new medicines, as the House works toward a bill this week. Streamlining the Food and Drug Administration (FDA) approval process has been a focus in both chambers and both parties. Reps. Fred Upton (R-Mich.) and Diana DeGette (D-Colo.) have been working for months on their 21st Century Cures initiative, with a bill due to be released ahead of a hearing Thursday. (Sullivan, 4/28)

A funding increase for the National Institutes of Health is one of the sticking points for a bipartisan group of House leaders trying to reach consensus on a landmark medical innovation bill. Leaders of the House Energy and Commerce Committee are working to narrow down a 400-page draft document into a final version of what has been dubbed the 21st Century Cures initiative. The legislative text was slated to be released as early as last week, though lawmakers Tuesday are still ironing out details. (Ferris, 4/28)

The head of the Food and Drug Administration's drug review office told a Senate panel Tuesday that the agency isn't responsible for holding up approvals of new medical products, deflecting charges that it delays treatments from reaching consumers. (Gustin, 4/28)

The Senate Finance Committee is demanding more attention on the growing backlog of Medicare appeals claims, which federal officials are continuing to blame on a lack of funding. The Office of Medicare Hearings and Appeals is receiving a record number of appeals, with the processing time for each claim more than quadrupling over the last five years to an average of 550 days. (Ferris, 4/28)

The Senate Finance Committee is scouting for ideas that might break a massive logjam of denied Medicare claims appealed by providers and suppliers. The backlog now exceeds 500,000 cases across the first three of five levels of appeal for denied claims, Finance Committee Chairman Orrin Hatch (R-Utah) said during a hearing Tuesday that included testimony from claims administrators and the CMS' Office of Medicare Hearings and Appeals. (Dickson, 4/28)

Creating a filing fee for contesting Medicare payment decisions would have benefits beyond driving new revenue to a backlogged government appeals office, said the official who leads the division. “The filing fee would encourage appellants to take a closer look at what they are appealing and to be a little more discriminating with what they bring before us,” Nancy J. Griswold, chief administrative law judge at the Office of Medicare Hearings and Appeals, said at a Tuesday Senate Finance Committee hearing. (Young, 4/28)

David Tharp, a Department of Veterans Affairs psychologist, says he was so distraught by retaliation he suffered as an agency whistleblower that he went to war for relief. After his complaints about research deception and other corruption at a VA facility in Waco, Tex., “the pressure of hostilities was so intense, my wife and I decided my only options were to quit the VA or deploy to a war zone,” said Tharp, who also is a lieutenant colonel in the Air Force Reserve. “At least in Kandahar, Afghanistan, I knew who my enemy was. At the VA, I come back and it’s been a minefield ever since — and continues.” ... The Veterans Affairs Retaliation Prevention Act provides specific penalties for supervisors who take revenge against whistleblowers. Retaliators would be suspended for at least 14 days for the first offense and fired for a second. (Davidson, 4/28)

The poor and punishing treatment of whistleblowers inside the Department of Veterans Affairs has been described as part of a “corrosive culture” that Veterans Affairs Secretary Bob McDonald has vowed to change. But whistleblowers say that change, one year later, has still not happened. (Wax-Thibodeaux, 4/28)

Aetna Inc, the third-largest U.S. health insurer, is submitting 2016 individual insurance rates to state regulators but said it might need to reexamine them after the U.S. Supreme Court rules on the legality of most Obamacare exchange subsidies. The nation's top court is expected to announce a decision in June on whether federal subsidies can stand in three dozen states where the U.S. government runs an enrollment website. Opponents of the law say the Affordable Care Act, or Obamacare, allows for subsidies only in states that run their own exchanges. (Humer, 4/28)

Aetna has hiked its 2015 forecast beyond analyst expectations after booking a 17-percent jump in first-quarter earnings, as enrollment gains and moderate medical cost growth helped the nation's third-largest health insurer. (4/28)

Aetna beat earnings estimates and recorded $777.5 million of profit in the first quarter of this year, prompting the Hartford, Conn.-based health insurer to raise profit predictions for the rest of the year. Aetna's overall medical-loss ratio declined year over year, from 80.4% to 79.1%. That shows Aetna paid about 79 cents in medical claims for every premium dollar it collected. Utilization of healthcare services did not increase as much as economists or insurance executives have predicted, and Aetna said it was able to build higher profits into its commercial and Medicare and Medicaid health plans. (Herman, 4/28)

Anthem Inc. said a major effort to overhaul how it pays primary-care doctors appears to be lowering overall health-care costs, as patients spend less time in the hospital. The second-biggest U.S. health insurer unveiled a high-profile program in 2012 that provided doctors with additional payments and an opportunity to earn more if they lowered the cost of patients’ care and met quality requirements. (Wilde Mathews, 4/28)

Anthem Inc., the second-biggest U.S. health insurer by market value, posted earnings that topped estimates as membership climbed. First-quarter operating earnings were $3.14 a share, beating the $2.68 average of 19 estimates surveyed by Bloomberg. ... Anthem, which changed its name from WellPoint last year, is among health insurers that are adjusting to new taxes and regulations under the Affordable Care Act. The health-care law also creates new customers for the firms, since it requires almost all Americans to carry health insurance. (Tracer, 4/29)

Insurance giant Humana Inc., whose earnings are under pressure from rising medical costs, has a prescription it hopes will bring it relief: helping its 13.8 million members improve their own health. That isn’t easy, given that people aren’t likely to stop smoking, eat better or get more exercise simply because a big company says they should. Humana is tackling these tough behavioral issues by reaching out to its customers where many of them more or less live—on their mobile phones. ... Across the street from its headquarters here, the insurer has set up a mobile-apps lab that designs tools like HumanaVitality, which lets people set personal health targets and challenge themselves or one another to fitness goals. (Loftus, 4/28)

Cost-cutting and sales of new drugs helped Pfizer overcome a strong dollar and patent expirations to beat Wall Street projections for the first quarter, though it cut its outlook for the year, citing the unfavorable currency exchange rates. The world's second-biggest drugmaker on Tuesday said its 2015 profit forecast includes a negative impact of $3.3 billion from currency exchange, and another $3.5 billion from generic competition. Most major drugmakers have overcome multibillion-dollar revenue hits from the unprecedented wave of patent expirations that began in 2011, but Pfizer isn't out of the woods yet. One of its top sellers, pain and arthritis treatment Celebrex, just got much cheaper generic competition in the U.S. (Johnson, 4/28)

Genworth Financial Inc., which has been hurt recently by charges related to its long-term care business, reported lower first-quarter operating income but said it made progress in its review of strategic options. The goals of Genworth’s review include strengthening its mortgage-insurance businesses and its long-term care insurance capital, earnings and sales. (Beckerman, 4/28)

Boston Scientific Corp. swung to a loss in its first quarter, hurt by litigation costs and currency rate fluctuations. The medical-device maker on Tuesday also said it would pay $119 million to settle nearly 3,000 product liability lawsuits and claims related to its transvaginal surgical mesh products. More than 25,000 claims or suits over the devices have been made against Boston Scientific, the company has said in regulatory filings. (Walker and Beilfuss, 4/28)

As a measles outbreak that started in California grew from seven cases on Jan. 7 to more than 100 a month later, sales of Merck & Co.’s measles vaccine surged as well. From the first week the measles outbreak was in the news to a month later when cases neared their peak, the use of Merck’s M-M-R II vaccine more than quadruped to more than 4,000 a week, according to data compiled by Bloomberg. (Armstrong and Koons, 4/28)

A consumer advocacy group has filed a class-action lawsuit against Cigna saying a new policy discriminates against people with HIV and AIDS and violates the federal health law by requiring them to get their medications from its mail-order pharmacy. Consumer Watchdog filed the lawsuit Monday in South Florida federal court. It says sending the drugs through the mail puts privacy at risk because packages could end up at the wrong address or be seen by others. It also says the mail is not a reliable way to ensure people get their medications on time and prevents them from interacting in person with a pharmacist. Patients who do not obtain their medications by mail must pay full price. (Kennedy, 4/28)

Your employer may one day help determine if your genes are why your jeans have become too snug. Big companies are considering blending genetic testing with coaching on nutrition and exercise to help workers lose weight and improve their health before serious conditions like diabetes or heart disease develop. It's a step beyond the typical corporate wellness programs that many companies are using to make workers more aware of their risk factors and improve their health. (Murphy, 4/28)

The parent company of Assurant Health said Tuesday that it will sell or shut down the Milwaukee health insurer — which employs 1,200 people in the area — by the end of next year. Assurant Health has struggled to adjust to changes in the health insurance market imposed by the Affordable Care Act and is expected to report an operating loss of $80 million to $90 million in its first quarter. That comes after it lost $64 million last year. The company, whose headquarters is in downtown Milwaukee, specializes in health insurance for small employers and individuals, the two market segments that have faced the most changes from the Affordable Care Act. (Boulton, 4/28)

More than 1,000 people died from overdoses of heroin and other opioids last year in Massachusetts, according to figures released Tuesday that provide the sharpest portrait yet of an epidemic that has devastated families across the state. The data, released at an event that included Governor Charlie Baker and the nation’s top health official, show that opioid-related deaths increased 3.3 percent in 2014 compared with 2013. More striking, the number of such deaths last year was 33 percent higher than in 2012. (Lazar, 4/28)

More than 1,000 people in Massachusetts died of opioid-related overdoses last year, according to an estimate made public by state health officials on Tuesday. That’s a 33 percent jump over 2012 figures. The Massachusetts Department of Public Health says there were 600 confirmed opioid-related deaths in 2014, with an additional 408 overdose deaths estimated. (Swasey, 4/28)

As the last of the snow melts in New England, an assortment of debris is emerging — including heroin syringes. It's gotten so bad in this small town that the police chief asked civilians like Pezzati for help. Now that heroin has gotten cheaper and easier to find in rural towns like this, discarded syringes are turning up everywhere. Chip Dodge, the local police chief, says his small force can't keep up. (Brown, 4/28)

National health officials hope to use the lessons learned from efforts to contain an HIV outbreak in southern Indiana as "a model response" for the nation in combatting future outbreaks tied to intravenous drug use, a Centers for Disease Control and Prevention leader said Tuesday. (4/28)

House Republicans moved ahead early Wednesday in their efforts to cut about $1 billion in state spending on health and human services, setting up a clash with the DFL-led Senate and Gov. Mark Dayton, who have decried the cuts as draconian. ... The legislation’s most controversial provision is a proposal to eliminate MinnesotaCare, the state’s basic health care insurance plan for lower-income Minnesotans who don’t qualify for medical assistance or have access to coverage through their job, among other requirements. (Lopez, 4/29)

A lawsuit accuses Legacy Health of firing a manager who complained of unsafe cadaver handling in Portland and claims a manager ordered the shredding of records that were subpoenaed by the FBI. The lawsuit sheds light on why the FBI last year began investigating Legacy's body donation program. Two former employees of the program filed the lawsuit in Multnomah County Circuit Court, saying they were retaliated against for raising concerns. (Budnick, 4/28)

A bill (SB 149) that would give terminally ill Californians greater access to experimental medications advanced through a Senate committee on Monday. The "Right-to-Try Act," by Sen. Jeff Stone (R-Riverside County), would allow patients with terminal illnesses to use early-stage drugs that have not yet been approved by FDA. (Vesely, 4/28)

Opponents of a bill requiring more schoolchildren in California to get vaccinated will bring in a legal scholar Tuesday to argue it is unconstitutional, but the controversial measure is likely to get out of the Senate Judiciary Committee this afternoon. The California Coalition of Health Choice plans an 11 a.m. rally on the Capitol steps Tuesday before the committee hearing. (McGreevy, 4/28)

A health care company CEO says he was “speechless and stunned” when the feds asked Georgia to return more than $100 million in payments made to his firm’s nursing homes. Ronnie Rollins, CEO of Macon-based Community Health Services of Georgia, said in an interview Monday that company nursing homes had received the extra Medicaid funding in question for more than a decade without a problem. Then, this past December, a federal ruling declared the funding to be inappropriate. (Miller, 4/28)

An official with the Kansas Department of Health and Environment said Tuesday that the department still expects the Legislature to pass a bill that will allow agency officials to regulate mental health drugs. State law currently bans prior authorization or other regulatory tools for antipsychotic drugs covered by Medicaid. An attempt to roll back that ban this year failed due to opposition by mental health advocates, but a compromise measure that would establish an independent advisory panel to develop guidelines for antipsychotic regulations has passed committee and is awaiting House and Senate votes once the full Legislature returns Wednesday for what’s known as the veto session. (Marso, 4/28)

The 38-year-old schizophrenic homeless woman — clad only in paper pajamas — showed up in front of the Union Rescue Mission one day in September, allegedly dropped off by a hospital van. She wandered without identification, money or medication through Los Angeles' skid row before someone at another shelter contacted the owner of the van, Gardens Regional Hospital & Medical Center in Hawaiian Gardens, according to a lawsuit filed Tuesday by L.A. City Atty. Mike Feuer. (Holland, 4/28)

House Republicans are moving to license Minnesota abortion providers and ban taxpayer dollars for paying for the procedure. The Republican-controlled House added both provisions to a health care budget bill on the floor Tuesday night. A handful of Democrats joined Republicans to approve the changes. (4/29)

When the expansion of Medicaid eligibility allowed 420,000 more New Jerseyans to receive health coverage, it became the latest in a long line of additions to the primary program for insuring low-income residents and providing long-term care for seniors and people with disabilities. In fact, there’s such a broad range of services offered through Medicaid that it’s one of the primary drivers of New Jersey’s state budget, making up most of the $6.74 billion that the state Department of Human Services plans to spend in the next fiscal year, as well as most of the $10.86 billion that the federal government gives the department. (Kitchenman, 4/28)

The UnitedHealthcare Children’s Foundation in Maryland says families are eligible to receive up to $10,000 in medical care and services not covered by health insurance. (4/29)

Nine Minnesota counties where pollution from vehicle exhaust, power plant emissions and wood burning is tracked scored well on an annual air pollution report released Wednesday by the American Lung Association. Anoka, Dakota, Hennepin, Lyon, Olmsted, Ramsey, Scott, St. Louis and Stearns counties all received A or B grades for particle pollution in the three-year period that ended in 2013, meaning they had few or no days where state public health officials had to warn those sensitive to air pollution to cut back on outdoor activities. (Dunbar, 4/28)

Even as Iowa struggles under the weight of a bird flu outbreak that has affected nearly 10 million birds in about a week, officials in Minnesota are hopeful they are finally making progress in dealing with the deadly virus in their state. Minnesota has reported only one new case since Friday, after averaging as many as four cases a day the previous week. The state expects to be caught up with its efforts to kill birds at infected facilities as soon as Thursday. (Eller and Doering, 4/28)

Venessa Fitzsimmons attacked her manager five years ago, losing control. Her boss called the police, who in turn called the Fire Department, who took her to Chicago-Read Mental Health Center after she threatened suicide. Fitzsimmons, who is bipolar and deals with depression, came to Leyden Family Services in January 2009. She credits the Franklin Park social service agency with saving her life. The services Fitzsimmons received could be reduced if Gov. Bruce Rauner has his way. In an effort to reduce a $7.4 billion shortfall in the state budget, Rauner has proposed cuts in the state's human services budget that could impact clients' ability to function or, said Fitzsimmons, just to survive. Among Rauner's proposed cuts is a $129,014 supplemental grant used by Leyden Family Services to employ a psychiatrist. (Lawton, 4/28)

The Tempe City Council continued to consider a proposed ordinance that would fine drivers $50 for a first offense and $100 for subsequent violations if they smoke while a child is in the car. Smokers of all types, including e-cigarette smokers, could be punished under the proposed ordinance. (DaRonco, 4/28)

The Boston Fire Department is vowing to tackle cancer and other health issues in the force with the purchase of protective gear, the creation of a wellness division, and the help of former Navy SEALs to get firefighters back to better form. ... [Fire Commissioner Joseph E. Finn] said that the city’s firefighters are 2½ times more likely to be afflicted with the disease than other city employees. Since 1990, Finn said, more than 150 Boston firefighters have died of cancer. At least four are now battling the disease, he said. Finn said many reasons are to blame, including carcinogens that become embedded in gear and exposure to toxins. The department has budgeted $3 million to buy high-tech air tanks and masks that firefighters can wear for longer periods. (Irons, 4/29)

Dallas County’s head disease expert said Tuesday that the county health department was unequipped to handle last year’s Ebola scare on its own. Wendy Chung, chief epidemiologist for Dallas County Health and Human Services, said the department lacked the resources it needed to track and manage the Ebola outbreak. Without enough staff or proper infrastructure, her team needed significant help from the Centers for Disease Control and Prevention. “We can’t continue like this,” Chung said after appearing on a panel about battling potential epidemics. “This is not ideal.” (Lane, 4/28)

A high school student visiting Massachusetts from Western Europe has been diagnosed with measles, the first reported case of 2015, according to the state Department of Public Health. The Hinton State Laboratory confirmed the illness Tuesday. Because of high vaccination rates in Massachusetts, health officials consider the disease unlikely to spread. But because the measles virus is airborne and highly infectious — it can linger in the air for up to two hours — health authorities are investigating the immunization status of all those known to have had contact with the student while he was infectious. (Freyer, 4/29)

Section 1332 of the ACA, known as “State Innovation Waivers,” allows states, starting in 2017, to apply to the federal government for 5-year renewable waivers from key provisions of the legislation. For instance, states could request changes to or exemptions from the individual and employers mandate, the market exchanges, the exchange subsidies, the Essential Health Benefits requirements, and other provisions. Moreover, states can combine waivers from ACA provisions with waivers from Medicaid provisions (so-called 1115 waivers), Medicare, the state Children’s Health Insurance Program, and waivers available through “any other Federal law relating to the provision of health care items or services.” The opportunity for states to transform the ACA within their borders is breathtaking. It’s little wonder that a former top aide to the late Senator Edward Kennedy describes Section 1332 as “state innovation on steroids.” (Stuart Butler, 4/28)

Remember, Republicans have very good reasons for trying to offer a fix: With some of them openly worrying that the political fallout from millions losing insurance will land squarely on them, they are eying a temporary patch to the subsidies to punt that fallout until after 2016. And putting forth such a contingency plan could also be a way to maximize leverage over Democrats to get them to accept changes to the law Republicans want in exchange for keeping the subsidies going — and keeping insurance markets from imploding — such as junking the tyrannical individual mandate. (Greg Sargent, 4/28)

The Florida Senate will be in session this morning, debating public policy and passing legislation. The Florida House will be dark because its Republican leaders abruptly adjourned three days early in an arrogant power play over Medicaid expansion that they should not win. It is irresponsible, and it is an insult to Floridians who deserve better. (4/29)

Medicaid accounts for more than 30 cents of every state dollar spent. Especially in light of our soaring structural deficit ... we must act now to reinvent Medicaid in Rhode Island. We need to preserve the health benefits of a more widely-covered population. We need to rethink our state system to provide the highest quality of care for patients when, where and how they need it, while also protecting taxpayer dollars. ... But before we can address many of the underlying structural challenges and make meaningful, sustainable reforms, we need to lay a fiscally-sound foundation for reform. Governor Raimondo’s budget lays that foundation and includes $90 million of specific cost savings in Medicaid that maximize efficiency of the state’s managed-care contracts, improve program oversight to combat fraud and waste, transition long-term and hospital services to models that provide incentives for high quality and coordination, and focus programs on those who use them most. (Elizabeth Roberts, 4/29)

A serious ethics complaint was filed last week against U.S. Senator Tammy Baldwin that calls into question not only her ethics, but also her basic competence as the manager of an office that serves the people of Wisconsin. If these allegations are true, Baldwin should resign. In her complaint, Marquette Baylor — a Senate staffer with over a decade of experience working for Senators Herb Kohl and Baldwin — paints the picture of an office with no standard operating procedures, a reluctance to address serious problems with the health care provided to Wisconsin's veterans, and a plan to cover up mistakes with hush money . ... Baylor's complaint makes a strong case that the actions of Baldwin and her staff have endangered the health and welfare of Wisconsin's veterans. (Kevin Nicholson, 4/27)

For decades, Californians have resisted making assisted suicide legal for the terminally ill. Now another try, the End of Life Option Act, is making its way through the Legislature. It has passed one committee, been endorsed by U.S. Sen. Dianne Feinstein, and was buoyed by the attention paid to Brittany Maynard, who last year left her California home for Oregon to carry out her own legal assisted suicide. Dr. Ken Murray is a retired clinical assistant professor of family medicine at USC, whose touchstone essay on death, "How Doctors Die," has ricocheted around the Internet since it was published in 2011 on the Zocalo Public Square website. I asked him to assess the law's ethics and options. (Patt Morrison, 4/28)

In late July 2013, 16-year-old Pablo Garcia, who was in the hospital for a routine colonoscopy to check on his congenital gastrointestinal condition, began complaining of numbness and tingling all over his body. Soon he was having seizures. What caused this strange condition? His medication, it turned out: He'd been given 39 times too much antibiotic. ... There were a lot of human errors that led to that horrific outcome, but here are the two that stand out: alert blindness, and excessive trust in the automated system. (Megan McArdle, 4/28)

In response to what they see as outdated sex education, recent graduates of the University of Tennessee are building a sex ed app that teenagers and young adults can use to ask questions anonymously — and get answers from volunteer experts and Planned Parenthood educators. But can an app provide the necessary guidance? Should technology play a role in teaching kids about health and sexuality. (4/28)

Providing free sunscreen dispensers to Boston’s parks and playgrounds — as City Councilor Matt O’Malley proposed at a council hearing on Wednesday — might seem like a lot of effort for the city to expend on solving a pretty mundane problem. But with the rates of skin cancer on the rise in the United States, providing free lotion could actually be a boon to the Hub’s residents, especially if it’s done at no cost to the taxpayer. O’Malley’s plan would call for free sunscreen dispensers to be set up in all of Boston’s parks as a way to nudge people to take better care of their skin during the summer. (4/29)