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Democratic and Republican states are moving in opposite directions on health policy, leaving Americans with starkly divergent options for care depending on where they live. The Trump administration and congressional Republicans, by easing many of the Affordable Care Act’s nationwide requirements after failing last year to repeal the entire law, are effectively turning major components of health policy over to the states. The roughly half of states controlled by Republicans are therefore moving aggressively to roll back the law widely known as Obamacare, while the smaller number of Democratic states are working to bolster it. As a result, the health-care options in any given state are likely to depend on which party controls the statehouse. (Armour, 2/28)

Little by little, the Trump administration is dismantling elements of the Affordable Care Act and creating a health care system that looks more like the one that preceded it. But some states don’t want to go back and are working to build it back up. Congress and the Trump administration have reduced Obamacare outreach, weakened benefit requirements, repealed the unpopular individual insurance mandate and broadened opportunities for insurers to offer inexpensive but skimpy plans to more customers. (Margot Sanger-Katz, 2/28)

The latest lawsuit against Obamacare poses little immediate danger to the health care law — but it could look a lot more potent if the balance of the Supreme Court changes in the next two years. The case may look like a long shot, given that the courts have upheld the health law more than once. But proponents of Obamacare have notoriously underestimated the stream of legal challenges against the Affordable Care Act, and the staying power of the conservatives intent on scrapping the 2010 law. (Haberkorn, 2/27)

One day after 20 states including Wisconsin sued to eliminate the Affordable Care Act, GOP Gov. Scott Walker visited two hospitals to hold ceremonial signings of a measure to spur a 1332 waiver application to stabilize the state's individual market.It's a tale of of two tactical plans. While Wisconsin and other Republican-majority states have to work the political arena and appeal to conservatives to shore up their exchanges, they're also using the courts to dismantle the law. (Luthi, 2/27)

Idaho’s rebellion began in early January with executive order No. 2018-02. The directive from Gov. C.L. “Butch” Otter told his state insurance department to allow “creative options” in health coverage, unfettered from “the overreaching, intrusive nature of Obamacare and its infringement on Idahoans’ freedoms.” Within a matter of weeks, the department decreed that insurance companies have substantial wiggle room as long as they offer at least one health plan that meets the Affordable Care Act’s rules. They can sell policies that lack maternity care and charge older residents more than permitted under the 2010 law. They can impose yearly coverage limits and block coverage of customers’ prior medical conditions. (Goldstein, 2/27)

An Idaho official says Trump administration officials did not give him an indication on whether they are going to block his state’s controversial move to get around ObamaCare rules after a meeting Saturday. Idaho insurance commissioner Dean Cameron and Gov. Butch Otter (R) met with Health and Human Services (HHS) Secretary Alex Azar to discuss the state’s plan. Democrats are pressing Azar to step in and enforce ObamaCare's rules, saying that Idaho’s move is plainly illegal. (Sullivan, 2/27)

In other news —

Kaiser Health News: Ding Dong! The Obamacare Tax Penalty Is(n’t) Dead
Rick, Patrick and Michael recently commented on Covered California’s Facebook page, urging others to ditch health insurance because: “No more fines or penalties!!! Trump took care of that!! Saved me 700 bucks this year!!!” “Trump removed the penalty for not having insurance.” “I’m pretty sure Trump abolished the illegal penalty.” They’re right — and wrong. (Bazar, 2/28)

Gov. Scott Walker signed a $200 million bill Tuesday to stabilize Obamacare markets in Wisconsin even as state Attorney General Brad Schimel sued seeking to block the entire law. The GOP governor — a longtime critic of the Affordable Care Act — has emphasized in recent weeks that he wants to hold down prices for insurance purchased through the law and make sure it's affordable for state residents. (Stein, 2/27)

Missouri and Kansas have joined 18 other states in seeking to have the Affordable Care Act declared unconstitutional following Congress’ repeal last year of the tax penalty associated with the individual mandate. In a lawsuit filed late Monday in federal court in Texas, the coalition of 20 mostly red states claimed that the elimination of the tax penalty for those who don’t buy health insurance renders the entire healthcare law unconstitutional. (Margolies, 2/27)

The Justice Department is throwing its weight behind plaintiffs in a sprawling, high-stakes prescription opioids lawsuit in Ohio, Attorney General Jeff Sessions said on Tuesday. Mr. Sessions said that the Justice Department plans to file a so-called statement of interest in the lawsuit, a technique that past administrations have typically reserved for cases that directly affect the federal government’s interests, like diplomacy and national security. (Benner and Hoffman, 2/27)

Sessions said the Justice Department will file a "statement of interest" in the case, currently being heard by a federal judge in Cleveland, filed by local governments, including Cincinnati and Cuyahoga County. The statement will argue that the federal government "has borne substantial costs from the opioid epidemic" in the form of law enforcement and social service expenditures, and seek to be reimbursed. It could have the effect of putting greater pressure on the drug companies to settle, an outcome for which the federal judge overseeing the case has indicated he prefers. (Tobias, 2/27)

The move is part of a broader effort to more aggressively target prescription drugmakers for their role in the epidemic, Attorney General Jeff Sessions said. The Justice Department will file a statement of interest in the multidistrict lawsuit, arguing the federal government has borne substantial costs as a result of the crisis that claimed more than 64,000 lives in 2016. The Trump administration has said it is focusing intensely on fighting drug addiction, but critics say its efforts fall short of what is needed. (Gurman and Mulvihill, 2/27)

“We will use criminal penalties. We will use civil penalties. We will use whatever laws and tools we have to hold people accountable if they break our laws,” Sessions said at a news conference attended by several state attorneys general. (Horwitz, Zezima and Bernstein, 2/27)

A long list of manufacturers, including Purdue, Endo Pharmaceuticals, Insys, Janssen, and Teva, have faced scrutiny and often aggressive legal action from state and local governments seeking compensation for what many plaintiffs allege are the costs resulting from the companies’ disingenuous marketing tactics. (Facher, 2/27)

The move by the Justice Department is bound to add to the costs companies incur in resolving claims that they understated opioids’ risks, said Richard Ausness, a University of Kentucky law professor. “If the plaintiffs were thinking about asking for a certain number from each company in a settlement, now they’ve got to ask for a higher number because they know the feds are going to want part of the total pot,’’ Ausness said. (Feeley and Harris, 2/27)

Manufacturers and distributors have been blamed by some for fueling the prescription painkiller and heroin epidemic. The rate of overdose deaths is increasing, jumping nearly 28 percent from 2015 to 2016, according to Centers for Disease Control and Prevention data. (Roubein, 2/27)

The federal government’s decision Tuesday to join lawsuits against opioid manufacturers and distributors is a “game changer,” said Ohio Attorney General Mike DeWine. DeWine, along with attorneys general from several other states, attended a press event where U.S. Attorney General Jeff Sessions said a new federal task force not only will seek civil and criminal charges against manufacturers, but also would “examine existing state and local government lawsuits against opioid manufacturers to determine where we can be of assistance.” (Torry, 2/27)

A bipartisan group of senators is introducing legislation Tuesday to address the opioid epidemic, framing it as a follow-up bill to the Comprehensive Addiction and Recovery Act (CARA) signed into law in 2016. Dubbed CARA 2.0, the legislation includes a host of policy changes, such as establishing a three-day initial prescribing limit on opioids for acute pain, beefing up services to promote recovery and aiming to increase the availability of treatment. (Roubein, 2/27)

The CARA 2.0 Act, billed as the sequel to the Comprehensive Addiction and Recovery Act of late 2016, would be the most substantive action Congress has taken to address the opioid crisis since President Trump took office. The legislation’s unveiling comes as Republicans in both chambers of Congress are ramping up their legislative efforts to address the opioids crisis. The two-year budget deal Congress passed earlier this year included $6 billion in extra funding to address the crisis in 2018 and 2019, but offered only broad outlines of how the funds would be used. Now, legislators, lobbyists, and policy advocates are hurrying to identify policies that could fit into that funding framework. (Facher, 2/27)

The measure would impose a three-day limit on initial opioid prescriptions for acute pain, in line with what the Centers for Disease Control and Prevention recommended. There would be exceptions for chronic pain or pain for other ongoing illnesses. The bill would allow states to waive the number of patients that a physician can treat with buprenorphine, a drug to treat addiction to narcotics, since physicians are currently capped at 100 patients. The bill would require physicians and pharmacists to utilize state prescription drug monitoring programs when they provide or dispense opioids. It would increase the civil and criminal penalties for drugmakers that fail to report suspicious orders for opioids or who don't keep effective controls against opioids being diverted. (McIntire, 2/27)

Top Republicans and Democrats on the House Ways and Means Committee are requesting information from critical stakeholders on how to prevent and treat opioid addiction in Medicare, as the panel seeks to craft bipartisan legislation to curb the opioid epidemic. Specifically, they’re asking insurers, benefit managers, providers and prescribers to submit information on how the Medicare program can help stem the opioid epidemic — noting that one in three beneficiaries in Medicare’s prescription drug program received a prescription opioid in 2016. (Roubein, 2/27)

House GOP leaders downplayed the need for Congress to pass expansive new gun control measures on Tuesday, instead turning their ire on the FBI and local law enforcement for failing to prevent the Parkland, Fla. school shooting. Speaker Paul Ryan told reporters at a press conference that “we shouldn’t be banning guns for law-abiding citizens” but “focusing on making sure that citizens who shouldn’t get guns in the first place, don’t get those guns.” Ryan — who said arming teachers was a “good idea” but a local issue that Congress should not infringe upon — touted a House-passed bill to reinforce background checks under current law. (Bade, 2/27)

A key GOP lawmaker says it’s “unlikely” that a provision restricting research on gun violence gets removed in next month’s spending bill. “It's unlikely that we would remove it in this particular legislation simply because this is a $1.2 trillion bill,” Rep. Tom Cole (R-Okla.), the chairman of the House Appropriations Health Subcommittee, told reporters on Tuesday. “It shouldn't be derailed for a single thing.” (Sullivan, 2/27)

Connecticut has had a “red flag” law for years, but after the Parkland, Fla., school shooting, some in Congress think other states should be prodded to allow authorities to remove guns, at least temporarily, from those who may be a danger to themselves or others. Connecticut’s red flag law, enacted in 1999 and the first in the nation, allows two law enforcement officers, or one state’s attorney, to petition a court for a firearms restraining order. (Radelat, 2/27)

Some gun safety proposals passed their first Florida Senate committee without an assault weapons ban. While top GOP lawmakers are calling the effort bipartisan, some Democrats pushing for more gun reforms disagree. Hundreds of people crowded inside and outside a Senate committee room Monday for the first hearing of the gun safety bills in the Senate Rules committee. (Cordner, 2/27)

After spending most of 2017 defending the Affordable Care Act from GOP attacks, a growing number of Democrats believe the law's reliance on private insurance markets won't be enough and the party should focus instead on expanding popular government programs like Medicare and Medicaid. The emerging strategy — which is gaining traction among liberal policy experts, activists and Democratic politicians — is less sweeping than the "single-payer" government-run system that Sen. Bernie Sanders (I-Vt.) made a cornerstone of his 2016 presidential campaign. (Levey, 2/27)

Seeking to put a blistering travel controversy behind him, embattled Veterans Affairs Secretary David Shulkin said Tuesday he is focused on expanding medical care for veterans, even as he hints that rebellious VA staff remaining opposed to him may soon leave the department. Speaking to reporters at an American Legion event, Shulkin said he had delivered a clear message to department employees that he was in charge and that bad behavior wouldn't be tolerated. (Yen, 2/27)

In other veterans health care news —

A leading activist for Camp Lejeune veterans exposed to toxic tap water said Tuesday he will ask Congress to allow families poisoned at the base to sue the federal government for damages. Retired Master Sergeant Jerry Ensminger, whose daughter died of leukemia after her family lived at the North Carolina base, said in Atlanta that he wants Congress to pass a new law that will mitigate the impact of a 2014 U.S. Supreme Court decision that effectively blocked Lejeune families from seeking relief through the courts. (Schrade, 2/27)

More women appear to be traveling to Illinois from out of state to have an abortion, according to Illinois Department of Public Health figures, and activists say it could be because surrounding states have tighter restrictions. A December state report says more than 4,500 women crossed into Illinois to terminate a pregnancy in 2016. That compares with just over 3,200 abortions provided to out-of-state women in the previous year. (2/27)

Ohio's health department is asking the state Supreme Court not to revisit a decision that upheld the shuttering of an abortion clinic. Justices ruled the department was within its rights when it revoked the license of Capital Care of Toledo. At the time, the clinic didn't have a required patient-transfer agreement with a local hospital. (2/28)

Mississippi moved a step closer on Tuesday to passing the United States' most restrictive abortion law when a state Senate committee approved a bill banning most procedures after 15 weeks of gestation. The measure, House Bill 1510, now heads to the full Senate after passage by the Public Health and Welfare Committee, Lieutenant Governor Tate Reeves said in a statement. Current state law bans abortion at 20 weeks after conception. (Simpson, 2/27)

Vice President Pence predicted Tuesday that legal abortion would end in the U.S. "in our time." "I know in my heart of hearts this will be the generation that restores life in America," Pence said at a luncheon in Nashville, Tenn., hosted by the Susan B. Anthony List & Life Institute, an anti-abortion organization. (Hellmann, 2/27)

Who takes care of the unclaimed dead, the people who were homeless or estranged from family members, or who outlived all their kin, and left no assets behind? The answer is usually funeral homes that get reimbursed by state or local governments for the cost of cremation or burial. But payments are not keeping up with ever-rising expenses in some places, like Massachusetts, meaning the number of funeral homes willing to shoulder the burden is dwindling. In at least one state, West Virginia, drug overdose victims have used up nearly all the money set aside for the unclaimed dead. (Richer, 2/28)

Meanwhile, in other news on the opioid epidemic —

When she started collecting brains, neuroscientist Yasmin Hurd’s peers wondered what she could possibly be thinking. Studying animals made way more sense as a way to trace how chronic drug use changes the brain, they thought — after all, how was Hurd going to parse the long-term effects from the trauma of the overdoses that killed the brain donors? (Thielking, 2/28)

A class action lawsuit was filed Monday against several pharmaceutical manufacturers and distributers on behalf of babies born in Louisiana with opioid addictions.The suit, filed in the 22nd Judicial District Court in St. Tammany Parish on behalf of a child identified by the initials K.E.R, seeks money to cover long-term treatment for K.E.R. and other infants who are born suffering opioid withdrawals. (Clark, 2/27)

Collaborations and partnerships with public and private organizations were cited as key factors in the fight against the opioid epidemic by law and health officials at a news conference on Tuesday at the Lake County Health Department in Waukegan. Acknowledging one of those partners in attendance was Mark Pfister, the Health Department's executive director, who said the Virginia-based pharmaceutical company Kaleo has been instrumental in assisting with the mission, by donating more than 10,000 doses of the fast-acting opioid antidote naloxone. (Olson, 2/27)

Federal agents on Tuesday raided two locations of a Baltimore County pain management clinic. Agents executed search warrants at the Owings Mills and Towson offices of Rosen-Hoffberg Rehabilitation and Pain Management Associates, federal law enforcement officials said. (Knezevich, 2/27)

Two more needle exchanges soon will open up in Greater Cincinnati and Northern Kentucky, in a move to stem the rise of HIV and hepatitis C in the region. (DeMio, 2/27)

New research calls into question what's in those IV bags that nearly every hospitalized patient gets. Using a different intravenous fluid instead of the usual saline greatly reduced the risk of death or kidney damage, two large studies found. The difference could mean 50,000 to 70,000 fewer deaths and 100,000 fewer cases of kidney failure each year in the U.S., researchers estimate. Some doctors are hoping the results will persuade more hospitals to switch. (Marchione, 2/27)

About one in 14 pregnant women who gave birth in the United States in 2016 smoked cigarettes during her pregnancy, according to a report released Wednesday. The findings, gathered by the Centers for Disease Control and Prevention's National Center for Health Statistics, revealed that 7.2% of all expectant mothers smoked -- but that the percentage of pregnant smokers varied widely from state to state. (Howard, 2/28)

MIT neuroscientists may have taken a step toward treating brain disorders associated with memory loss — including epilepsy and Alzheimer’s disease, the researchers said in a recent paper. Here’s what the study, published Feb. 8 in the journal Neuron, said:First, a gene called Npas4 is necessary to create long-term memories. This gene exists in the brain’s CA3 subsection, one of three regions in the brain’s hippocampus, said Feng-Ju (Eddie) Weng, lead author of the study. (Takahama, 2/27)

Despite the growing openness of medical information in electronic health records and wearable gadgets, personal medical devices are still black boxes, off-limits to patients and caregivers. The industry, slow to adapt, has grappled with concerns over security, privacy, and patient safety. A web of balkanized regulations across several health agencies has further slowed potential changes. Typically, health care laws have considered data generated inside clinical settings part of the patient’s records. But the laws are less clear on how to treat data generated from implanted devices, which are often collected by device manufacturers or contractors they hire to manage that information. (Blau, 2/28)

Frequent exposure to diesel exhaust on the job is associated with a higher risk of amyotrophic lateral sclerosis, according to a study by a Harvard researcher. “The overall risk of developing ALS is low, but our findings suggest that the greater the exposure to diesel exhaust, the greater the risk of developing ALS,” Aisha Dickerson of the Harvard T.H. Chan School of Public Health said in a statement. (Finucane, 2/27)

Weight Watchers International Inc., coming off a turnaround plan that more than doubled profit for two-consecutive years, says it wants to be the global destination for wellness, a “partner in health and wellness.” “The world doesn’t need another diet,” Chief Executive Mindy Grossman said Tuesday during a conference call with analysts. “Today, healthy is the new skinny.” (Armental, 2/27)

When the economy takes a turn for the worse, birth rates go down. It's both common sense and an empirically observed phenomenon. But it's not the whole story. A team of economists, taking a closer look at the connection between fertility and recessions, found that conception rates begin to drop before the economy starts its downturn — and could even be used to predict recessions. (Domonoske, 2/27)

A new data study shows that the number of teenagers sending and receiving sexts is on the rise. The analysis, which was published this week in The Journal of the American Medical Association, showed that more than one in four teenagers reported that they’d received a sext, defined by the study as a sexually explicit image, video or message that is sent electronically. About 15 percent of people, slightly more than one in seven, reported sending a sext. (Rosenberg, 2/27)

When you feel a sneeze or a cough coming on, covering your mouth prevents the spread of infectious germs. You probably knew that. But the way you cover up also matters, and there are plenty of people who haven’t yet heard the consensus guidance of health officials: If no tissue is available, you should aim into your elbow, not your hand. Even if that means breaking a long-held habit. (Victor, 2/27)

Cities and states are trying new ways to entice food stamp recipients to eat their fruits and vegetables. One approach that’s gaining popularity: offering rebates to low-income families when they buy fresh produce. A program in Massachusetts was so popular that it ran out of rebate money and had to be suspended. By rewarding food stamp recipients for making healthy choices, advocates hope to encourage low-income people to eat more fruits and vegetables. (Wiltz, 2/28)

California counties are sitting on money from a special tax on millionaires that should be spent on mental health programs, but the state isn’t moving fast enough to reclaim the funds, according to a state audit released on Tuesday. California State Auditor Elaine Howle found that county mental health programs had stashed $231 million from the tax that should have been returned to the state by the end of the 2015-16 budget year. (Ashton, 2/28)

Molina Healthcare's former CFO John Molina, the last Molina family member still linked to the health insurer, has resigned from the board. John Molina stepped down from the board more than two months after his brother, former CEO Mario Molina, cut ties with the company. The Long Beach, Calif.-based insurer said John Molina, who has served on the board since 1994, will pursue other endeavors. He is a founding partner of Pacific6, a California-based investment and development partnership. (Livingston, 2/26)

Hospitalizations and outpatient visits for influenza continue to decrease statewide, indicating that the powerful flu season could be nearing its end. While health officials hope the worst period is over, they still advise those who are not vaccinated to do so quickly. The most recent statewide data show intensive care unit admissions and outpatient visits for influenza have decreased, according to an Illinois Department of Public Health report. That marks two consecutive weeks of a decrease in both categories, which are among several markers officials use to track influenza, according to the report. (Thayer, 2/27)

In the week ending Feb. 17, Georgia reported 19 new flu-related deaths, for a seasonal total nearing 100. And this week, Grady Memorial Hospital decided it will be keeping its “mobile emergency unit,” a specialized tractor-trailer in its parking lot housing 14 hospital beds, for one more month, a hospital spokeswoman said. (Hart, 2/27)

Three might not be a crowd for Partners HealthCare. The Boston-based health care giant, which has been in talks to acquire Care New England Health System of Providence, has opened up the discussions to include Lifespan, the operator of Rhode Island Hospital and several other medical facilities in that state. (McCluskey, 2/27)

Community Health Systems' financial position took a nosedive at the end of 2017, a result of a number of factors including significantly decreased revenue and volume. Franklin, Tenn.-based CHS reported a $2 billion net loss in the fourth quarter of last year—about $18 per share—significantly wider than the $220 million net loss the company reported in the fourth quarter of 2016. The company in a news release pinned the poor results on a revaluation of goodwill and assets held for sale, and in part to increased contractual allowances and in bad debt provision. (Bannow, 2/27)

A U.S. judge blocked California from requiring that the popular weed-killer Roundup carry a label stating that it is known to cause cancer, saying the warning is misleading because almost all regulators have concluded there is no evidence that the product's main ingredient is a carcinogen. U.S. District Judge William Shubb in Sacramento issued a preliminary injunction on Monday in a lawsuit challenging the state's decision last year to list glyphosate as a chemical known to cause cancer. (2/27)

Local denizens of the Spaceship and other Apple offices will be getting boutique medical care starting this spring, according to Apple. The Cupertino tech giant plans to launch a network of “AC Wellness” medical clinics for its employees and their families, according to the AC Wellness website, which describes the network as “an independent medical practice dedicated to delivering compassionate, effective healthcare” to Apple workers and their dependents. (Baron, 2/27)

Christopher Bathum built an empire in California’s lucrative addiction treatment industry despite the fact that he held no license in drug counseling and no college degree. The self-described “Rehab Mogul” founded what was once known as Community Recovery Los Angeles, a chain of about 20 facilities in Southern California and Colorado for patients battling alcoholism and drug addiction. At some of Bathum’s luxurious sober-living houses, patients had access to private chefs, a pool, yoga, excursions and a wide array of therapy options. (Schmidt, 2/27)

A Tennessee court has ruled that a former CEO of CHS subsidiary Lutheran Health Network disclosed the Fort Wayne, Ind., hospital system's confidential information, but he can still work with competitor IU Health to create a new primary-care practice in the area. Judge Joseph Woodruff of the Circuit Court of Williamson County, Tenn., said Lutheran Health Network will likely prevail in their suit accusing former CEO Brian Bauer of sharing information with third parties, and he cannot create a competing healthcare network with anyone who received that information. But that doesn't include IU Health. Bauer admitted he shared confidential and proprietary information with a venture capital firm and others. (Livingston, 2/27)

Grady Memorial Hospital has extended the lease on its mobile ER through March. The Atlanta hospital opened the mobile unit in late January to handle its increasing emergency department patient volume. Flu-related hospitalizations in Georgia have soared through the first weeks of 2018. But the latest state Public Health and CDC figures show a downward trend, indicating that the flu season may have passed its peak. (Miller, 2/27)

The mother of one of the residents evacuated last week from what police described as a bedbug-ridden mental health facility in Dixmoor said Tuesday she tried to raise the alarm with village officials months ago about issues at the center. Dixmoor police on the evening of Feb. 22 removed 35 men and women from the facility, known as The Mothers House, who were living in what the village’s police chief called “deplorable” conditions. (Nolan, 2/27)

Los Alamos National Laboratory has failed to keep track of a toxic metal used in nuclear weapons production, potentially exposing workers to serious health consequences, a federal watchdog has found. The New Mexico lab’s failure to adequately track beryllium — small amounts of which can cause lung disease and cancer — violates federal regulations put in place to prevent worker overexposure, according to a report last week from the Department of Energy’s inspector general. (Moss, 2/26)

The amount of lead from the water fountain in the girls’ locker room was nearly three times what the state considers acceptable. That water fountain at Salem Middle School in Chesterfield County has since been replaced, and was rarely used to begin with, Salem Principal LaShante Knight wrote in a letter to parents. It was also the highest of Chesterfield’s 137 “water outputs” that tested above the state threshold and were used for drinking. Of the 137 outputs flagged for the amount of lead in the water, nine were drinking sources. (Remmers and O'Connor, 2/26)

Eleven people, including some Marines, “started to feel ill” after an envelope containing an unknown substance was opened Tuesday at Joint Base Myer-Henderson Hall in Arlington, authorities said. At around 5:55 p.m., the Arlington Fire Department tweeted that 11 people were sickened after a letter was opened in an administrative building at Fort Myer. (Moyer, 2/27)

The cause of a major fire at a metal recycling facility in Richmond that sent high levels of toxic smoke into the air last month may never be known. Investigators have spent weeks interviewing employees of the Sims Metal Management site and sifting through large amounts of burned debris, but in the end they could not find conclusive evidence of what exactly sparked the Jan. 30 blaze, according to Inspector Eric Govan of the Richmond Fire Department. (Goldberg, 2/27)

Trial began Monday for a man accused of shooting three people and suffocating a newborn girl he’d ripped from her mother’s arms during a bizarre plot to kidnap infants in Long Beach and El Segundo. Prosecutors allege Anthony McCall, 32, was the muscle in an elaborate but ultimately failed scheme to steal two babies and pass them off as another woman’s children. (Dobruck, 2/27)

A Newport Beach entrepreneur has created a mobile app that expands the idea of concierge doctors to include specialists. Concierge Key Health, which launched this month in Orange County, Phoenix and New York City, connects patients who pay $3,000 for an individual annual membership or $5,000 for an annual family plan to expedited appointments with doctors in fields such as cardiology, dermatology, pediatrics, reproductive health, ophthalmology and dentistry. (Davis, 2/27)

When Teva Pharmaceuticals announced recently that it would begin selling a copycat version of Syprine — an expensive drug invented in the 1960s — the news seemed like a welcome development for people taking old drugs that have skyrocketed in price. Syprine, which treats a rare condition known as Wilson disease, gained notoriety after Valeant Pharmaceuticals International raised the price of the drug to $21,267 in 2015 from $652 just five years earlier. Along with similar practices by pharmaceutical executives like Martin Shkreli of Turing Pharmaceuticals and Heather Bresch of Mylan (the maker of the EpiPen), the story helped spark a national conversation about the high cost of prescription drugs, not to mention Congressional inquiries and federal investigations. (Thomas, 2/23)

As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance. ... The clauses force the pharmacists to remain silent as, for example, a consumer pays $125 under her insurance plan for an influenza drug that would have cost $100 if purchased with cash. Much of the difference often goes to the drug benefit managers. (Pear, 2/24)

Depending on how you look at them, pharmacy-benefit managers are either low-margin middlemen that fight to reduce drug costs, or highly profitable intermediaries that take a cut of every prescription and earn more when drug prices rise. Pharmacy-benefit managers are hired by businesses such as insurers that pay for drugs to negotiate lower prices with pharmaceutical companies. When the largest pharmacy-benefits manager, Express Scripts Holding, reports fourth quarter earnings on Tuesday, analysts expect a profit margin of just 4.7%, according to FactSet. Rival companies owned by CVS Health and UnitedHealth Group report similarly low margins. (Grant, 2/24)

In a closely watched case, a U.S. patent appeals board ruled that a Native American tribe cannot claim sovereign immunity in order to avoid a certain type of patent challenge. The decision is a blow to Allergan (AGN), which last fall transferred patent rights to one of its biggest-selling medicines to the St. Regis Mohawk Tribe in hopes of thwarting generic competition. (Silverman, 2/23)

A bill taking aim at a hidden scam that has been driving up prescription drug prices is just one step away from becoming law. HB 1177 has now passed the House and the Senate. The measure, sponsored by Delegate Todd Pillion from Virginia’s 4th District, would give pharmacists the freedom to tell patients about the cheapest way to pay for their prescriptions, and ideally put money back in the consumer’s pocket. (O'Brien, 2/26)

Heidi Barrett has a complicated relationship with prescription drugs. On one hand, they help the Everett resident and four of her five children cope with the intense joint pain caused by a genetic form of arthritis. On the other, Remicade, the prescription drug Barrett and her children take, has drained the family’s finances, destroyed retirement funds and forced them at times to choose between putting food on the table or living a pain-free life. (Wasserman, 2/25)

Seeking to provide more transparency into medical industry practices, the Ontario government last week unveiled draft regulations that would require drug makers to disclose payments and gifts to prescribers, an effort that industry critics suggest could become a model for all of Canada. (Silverman, 2/27)

Take a look at the last two decades’ worth of drug launches and one thing is clear: Hepatitis C has fueled some NASA-worthy blastoffs—and some declines that ended with a parachute back to earth. That’s not necessarily news to pharma watchers. But hep C isn’t the only type of drug that’s quickly conquered. Multiple sclerosis, cancer and eye disease have, too—several with launches in the last few years. And then there are the Cox-2 inhibitors—Pfizer’s Celebrex, still chugging away today, and Merck & Co.’s late lamented Vioxx, pulled off the market after it was overwhelmed by safety concerns. They’re still among the top 10, according to EP Vantage, citing EvaluatePharma data. (Staton, 2/26)

Martin Shkreli, the smirking "pharma bro" who gained worldwide infamy by raising the price of a lifesaving drug 5,000 percent, is awaiting sentencing next month on three counts of securities fraud. But as told on the season premiere of CNBC's "American Greed," Shkreli's crimes have nothing to do with the price hike. (Cohn, 2/23)

The generics sector has been looking to M&A as a way to combat the pricing pressure crushing top lines around the industry. But that strategy just got a whole lot less attractive. The Federal Trade Commission (FTC) has suggested it will take steps that could force buyers to hold onto drugs they don't want, a shift that may even be holding up one big deal already. (Helfand, 2/26)

Last September, Aegerion Pharmaceuticals (AEGR) agreed to pay $40 million to settle civil and criminal charges of illegally marketing a pricey cholesterol medicine, failing to adhere to a regulatory safety program, and misleading investors. The settlement stemmed from a whistleblower lawsuit filed by three former employees, including Tricia Mullins, who last June had already taken a position with Horizon Pharma (HZNP). But a few weeks after the Aegerion deal was announced, Mullins lost her new job. (Silverman, 2/26)

President Donald Trump has complained that U.S. drug companies are "getting away with murder." For once the hyperbole is forgivable: It suggests he takes the problem of drug costs seriously and might be willing to do something about it. Unfortunately, his administration's efforts up to now suggest the opposite. The White House has proposed tweaks to government health-care programs. Some of these measures are worth trying -- they could help at the margin -- but tweaks aren't enough. The underlying problem is drug prices that are indeed murderous: Americans and their insurers often pay many times what people in other developed countries pay for the same medicines. That's what policy needs to confront. (2/27)

President Trump continues to vent about high drug prices, most recently in his State of the Union speech. Democrats like Senators Bernie Sanders and Claire McCaskill keep proposing legislation to curb rising medicine costs. But these pronouncements may not be worrying drug companies too much. They can see that for all of his bluster, the president has not embraced any significant reforms, and that Democrats don’t get much support on anything from the Republicans who control Congress. (Fran Quigley, 2/27)

A new survey of U.S. companies from analysts at Morgan Stanley estimates that 43 percent of the savings from the Republican tax cut bill will be paid to investors in the form of higher dividends and stock buybacks. Leading the way are large pharmaceutical companies, which Axios.com reported last week are spending a combined $50 billion on stock-buyback programs. Only 13 percent of corporate America’s tax-cut savings will be passed on to employees, the Morgan Stanley analysts reported. Much of that will go to executives, whose compensation is often tied to stock prices, and they’ll benefit as well when share buybacks cause stock prices to jump. (2/26)

Compared with the rest of the world, the U.S. market for prescription drugs is rigged against consumers and in favor of the pharmaceutical industry. Unlike other advanced nations, the United States refuses to use its purchasing power to negotiate better prices. When Congress, in 2003, passed the Medicare Part D bill to help senior citizens buy prescriptions, it prohibited the government from negotiating cheaper prices for those drugs. (2/27)

The health-care industry may hope a joint venture on its turf by Amazon.com Inc., Berkshire Hathaway Inc., and JPMorgan Chase & Co. (ABC from now on) might be happy just rolling out an app and driving better deals with third-party vendors. But that's wishful thinking, according to Warren Buffett. The Berkshire CEO said in an interview Monday that ABC is looking for "something much bigger than that. "Far more savings can be had by cutting out the health industry's middlemen and their warped incentives altogether. ABC appears to be headed down that path -- but it is a difficult one. (Max Nisen, 2/26)

Thanks to a surprising and devastating diagnosis, I know more than most physicians about what it’s like to live with the brain cancer known as glioblastoma, everything from self-titrating my anti-epileptic medications to making sure the right ICD-10 code appears on my MRI referrals. As much as I’d rather not have this expertise, I’ve learned that it is extremely valuable for medical students, physicians, people with brain cancer, pharmaceutical companies, and others. I’ve also learned that it is undervalued. (Adam Hayden, 2/27)

Up to now, single-payer and universal health coverage proposals in the U.S. have foundered on one shoal or another: They're ungodly expensive; they replace plans that people like; they're too sudden; they're not sudden enough; they're politically impossible, etc., etc., etc. But now take a look at "Medicare Extra for All." It's a universal coverage proposal released last week by the Center for American Progress, a progressive think tank associated with the Democratic Party. (Michael Hiltzik, 2/27)

It is not quite right to say that Nikolas Cruz, the alleged mass murderer at Marjory Stoneman Douglas High School, fell through the cracks. The truth is even more unsettling. Long before he is alleged to have walked into the South Florida high school and started shooting, many people were alerted to Mr. Cruz’s troubling behavior. School officials, police, state social services workers and friends sought to intervene and help. Their failure underscores just how difficult it is to deal with mental illness. There are no magical formulas or easy cure-alls, and it is often hard to determine when disturbing behavior morphs into a real threat. Most people with mental illnesses pose no danger. And the law limits what authorities can do; people are not jailed in anticipation of what they might do. (2/27)

The organ looked like an overripe melon smashed by a sledgehammer, with extensive bleeding. How could a gunshot wound have caused this much damage? The reaction in the emergency room was the same. One of the trauma surgeons opened a young victim in the operating room, and found only shreds of the organ that had been hit by a bullet from an AR-15, a semi-automatic rifle which delivers a devastatingly lethal, high-velocity bullet to the victim. There was nothing left to repair, and utterly, devastatingly, nothing that could be done to fix the problem. The injury was fatal. (Healther Sher, 2/26)

Knowledge is power. Yet Congress has limited its own access to facts vital to understanding the nation's gun violence pandemic. That's because, since 1996,  Congress has effectively prevented the Centers for Disease Control and Prevention from continuing public health research into the consequences of gun violence. At the same time, while Congress forever proclaims its support of the men and women in blue, lawmakers have fettered law enforcement around the country in understanding gun-crime trends by restricting how the Bureau of Alcohol, Tobacco, Firearms and Explosives can share its gun-trace data. (2/28)

One in five Americans is on Medicaid, and Medicare and Social Security will require huge future tax increases. Yet some in the ostensible party of limited government think this is the perfect time to add a new entitlement for paid family leave. Who wrote that book about Republican Party suicide again? Florida Senator Marco Rubio and his sidekick Mike Lee of Utah are teaming up with Ivanka Trump to design a plan for federal paid leave. President Trump has endorsed the concept, and his budget includes an outline involving unemployment insurance. (2/27)

When Typhoid fever broke out in Pakistan in late 2016, doctors noticed that many patients were not responding to an antibiotic, ceftriaxone, that had worked before. Now we know why. Scientists reported Feb. 20 that the organism that caused the illness, Salmonella enterica serovar Typhi, had become extensively resistant to antibiotics. This development should be another warning that the global threat of antimicrobial resistance remains real and urgent. (2/26)

“Homes end homelessness.” That was the simple and ultimately persuasive slogan of the Proposition HHH campaign in 2016. In November of that year, an overwhelming 77% of Los Angeles city voters opted to raise their own property taxes to pay for $1.2 billion in homeless housing — 10,000 units to be built over a decade. Politicians exulted in the win and vowed that after years of short-lived strategies and half-hearted measures, they would finally address the crisis with the resolve and the resources needed to bring it under control. (2/27)

I must be a terrible doctor. That was one possibility I thought of to account for the six teenage patients of mine who over a recent three-month period presented to emergency rooms for depression and suicidal thinking. They were all between 14 and 16. Four of the six were girls. All of the girls had been actively self-mutilating, colloquially known as “cutting.” Four of the six were admitted to an in-patient psychiatric ward as significant and immediate “dangers to themselves." In other words, they were deemed by the psychiatrist in the emergency room as a potentially dangerous suicide risk. (Lawrence Diller, 2/28)

According to a new report from the Heritage Foundation, 71 percent of Americans between 17 and 24 are ineligible for military service. According to 2017 Department of Defense data, these young Americans can’t join the military because they didn’t graduate from high school, they have criminal records, or they are physically unfit. The largest reason by far is obesity. (2/28)

What McDonald's has done is teach kids to associate its less-than-ideal meals with fun, which is what matters to them more than the quality of the chicken or beef. That's why McDonald's tinkers with its food offerings, but not with the toys. When San Francisco banned toy giveaways with meals that didn't meet certain nutritional requirements, McDonald's simply sold the toys for 10 cents to anyone who bought a Happy Meal. That toy is a canny way to secure lifetime customers. (Karin Klein, 2/23)