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A federal appeals court Tuesday handed the Obama administration another victory in its effort to guarantee coverage of contraceptives under the Affordable Care Act, rejecting a challenge by the Little Sisters of the Poor, an order of Roman Catholic nuns. The United States Court of Appeals for the 10th Circuit, in Denver, found that the nuns could opt out of a requirement to provide contraceptive coverage under an “accommodation” devised by the administration. The rule does not impose a “substantial burden” on the nuns’ free exercise of religion, the court said. (Pear, 7/14)

Under alternative arrangements finalized by the Obama administration last week, employers who have such objections must tell their insurance company or the federal government. The insurance company then takes over responsibility for providing the coverage to employees who want it. The Little Sisters of the Poor and other religiously affiliated employers such as Christian universities say those steps are inadequate because they still require the insurance plan the employers set up to provide contraception, which they believe to be wrong. Some plaintiffs are opposed to most forms of birth control; others object specifically to forms such as the so-called morning-after pill, which they consider tantamount to abortion. (Radnofsky, 7/14)

The case involves a group of Colorado nuns and four Christian colleges in Oklahoma. Religious groups are already exempt from covering contraceptives. But the plaintiffs argued that the exemption doesn't go far enough because they must sign away the coverage to another party, making them feel complicit in providing the contraceptives. The 10th Circuit Court of Appeals disagreed. The judges wrote that the law with the exemption does not burden the exercise of religion. (7/14)

The federal healthcare law requires employers to provide health insurance policies that cover preventive services for women including access to contraception and sterilization. (7/15)

The Denver-based Little Sisters of the Poor, who sued to avoid complying with the Obamacare contraception mandate, lost Tuesday in the 10th Circuit Court of Appeals, which ruled it must allow employees to have contraception coverage. Little Sisters challenged the process it must follow to get out from under the contraception mandate but failed, the court decided, to show a substantial burden on the exercise of its religion. (Draper, 7/14)

A judge has ruled against a Wyoming Indian tribe's claim that the federal government shouldn't classify it as a large employer under the Affordable Care Act — a designation requiring the tribe to provide insurance coverage for its hundreds of employees. An official with the Northern Arapaho tribe said the decision could have ramifications for other tribes as well, leaving them a choice between purchasing expensive group health insurance for their employees or facing federal penalties. (Neary, 7/14)

Senate Majority Leader Mitch McConnell said Tuesday that the Senate will consider using a fast-track budget procedure to repeal some of Obamacare but declined to say when that may take place. GOP leaders have not made a final decision on how exactly to use the powerful procedural tool, called reconciliation, which allows the Senate to avoid a filibuster and pass legislation with just a simple majority. Many Republicans, particularly the conservative wings in both chambers, would like to use the maneuver to attack Obamacare. On Tuesday, McConnell signaled that Obamacare was a likely reconciliation option, but did not make a firm commitment. (Kim and Haberkorn, 7/14)

Senate Majority Leader Mitch McConnell (R-Ky.) on Tuesday said he does not have a timeline for using reconciliation to repeal ObamaCare, but indicated that Republicans would look to roll back as much of the law as they can. “I don't have a time to give you, but we're certainly going to consider using budget reconciliation for repealing as much of ObamaCare as is reconcilable,” McConnell told reporters. “There're certain rules that have to be applied to what is reconcilable and that's an active consideration, as you can imagine.” (Sullivan, 7/14)

A group of Republican-appointed health officials is urging the Senate to confirm President Obama’s nominee [to] take over one of the government’s biggest health agencies. Two former health secretaries and four former Medicare chiefs — all appointed by former President George W. Bush — are urging the Senate to confirm Andy Slavitt as administrator of the Centers for Medicare and Medicaid Services (CMS). (Ferris, 7/14)

Lawmakers on Tuesday accused the Obama administration of being slow to implement inspector general recommendations on fraud in the Medicare prescription drug program. At a hearing of the House Energy and Commerce oversight subcommittee, lawmakers pointed out that the administration has not fully implemented nine recommendations from the inspector general to crack down on fraud in the program, known as Medicare Part D, even though some of those recommendations were made as far back as 2006. (Sullivan, 7/14)

Tax season is a pain in the neck for millions of people, but many Americans this year may be getting a pass from unpleasant questions—or even an audit—from the Internal Revenue Service about their compliance with Obamacare. A leading tax audit defense company said its clients so far are seeing a surprisingly low rate of queries tied to the Affordable Care Act this year—the first in which Americans were asked to disclose their health insurance status. (Mangan, 7/14)

House Republican leaders canceled a vote on Tuesday on legislation that would have created a commemorative coin to raise money for breast cancer awareness, after some House conservatives raised concerns the coin sale funds would be used to support an abortion rights group at the center of a controversial new video. The bipartisan bill directed the Treasury Department to mint a new coin and send some of the proceeds from it to the Susan G. Komen for the Cure and the Breast Cancer Research Foundation. But shortly before the vote on what many considered a non-controversial coin, several anti-abortion rights advocacy groups launched an effort to defeat the measure. They argued the Komen Foundation supports programs run by the Planned Parenthood Federation of America, a group that provides women's health care, including abortion services. (Walsh, 7/14)

Republican leaders pulled yet another bill from the House floor Tuesday after conservatives expressed concern that a seemingly harmless piece of legislation supporting breast cancer research might actually fund Planned Parenthood. The Breast Cancer Awareness Commemorative Coin Act would have directed the Treasury to sell commemorative coins and give the proceeds to the Susan G. Komen for the Cure organization. (Fuller, 7/14)

A Senate Appropriations subcommittee reported out by voice vote Tuesday a $20.5 billion draft spending bill for the Agriculture Department, Rural Development and FDA in fiscal 2016. The funding is $1.1 billion below the president’s request. The spending bill is $65 million below the enacted level for fiscal 2015 discretionary funding. The subcommittee bill now moves to the full Senate Appropriations Committee without amendments. The full panel will mark up the draft bill on Thursday. (Ferguson, 7/14)

The GOP-led panel included a controversial policy rider that would require pending 2015 Dietary Guidelines to be based “solely on nutritional and scientific evidence and not extraneous information." Republicans included this provision in another spending bill as well. The bill also includes a provision that would delay by one year a calorie-count regulation that was scheduled to take effect in December. The FDA, however, announced last week that it would delay the rule anyway until late 2016. (Shabad, 7/14)

Senate Democrats are urging the Obama administration to complete the rollback on the lifetime ban on gay and bisexual men donating blood. In a letter Tuesday, Sens. Elizabeth Warren (D-Mass.) and Tammy Baldwin (D-Wisc.) and 81 of their congressional colleagues asked the Food and Drug Administration (FDA) to lift the ban in the blood donation policy and replace it with a one-year deferral. (Wheeler, 7/14)

When Amanda Dykeman was certain she was done with having children, she had two options for permanent birth control: surgical sterilization, which typically involves general anesthesia and a laparoscopy, or Essure, the only nonsurgical permanent birth control option approved by the Food and Drug Administration. She chose Essure. And she says her life has never been the same. (Haelle, 7/14)

Anti-abortion activists on Tuesday released an undercover video showing a senior Planned Parenthood official discussing the disposition of parts from aborted fetuses. The activists contended the video reveals illegalities, but Planned Parenthood said the activity in question was the legal, not-for-profit donation of fetal tissue to research firms. (7/14)

The Center for Medical Progress, which recorded and edited the video, says the footage proves that Planned Parenthood is breaking the law by selling fetal organs. But the video does not show Nucatola explicitly talking about selling organs. The Planned Parenthood official says the organization is “very, very sensitive” about being perceived as illegally profiting from organ sales and charges only for the cost, for instance, of shipping the tissue. (Somashekhar and Paquette, 7/14)

Republican presidential candidates are furious about an undercover video they say shows a Planned Parenthood executive discussing the sale of fetal organs. The nearly 9-minute video, released by the Center for Medical Progress and posted on the pro-life group’s YouTube page, features Planned Parenthood’s Senior Director of Medical Services Dr. Deborah Nucatola eating a salad with a glass of wine and calmly discussing various body parts. (Collins, 7/14)

Several Republican presidential candidates are criticizing Planned Parenthood after viewing a controversial new video circulated on Tuesday by an undercover group anti-abortion activists. (Scott, 7/14)

In Louisiana, Gov. Bobby Jindal, who is among the large field of Republican presidential candidates, directed the state health department to launch an investigation even though Planned Parenthood does not perform abortions there. The founder of the Center for Medical Progress, David Daleiden, previously worked with the anti-abortion group Live Action, which has released several undercover videos aimed at discrediting Planned Parenthood. Ferrero said the new video "falsely portrays Planned Parenthood's participation in tissue donation programs that support lifesaving scientific research." (7/14)

Sen. Ted Cruz, R-Texas, is calling for an immediate investigation into Planned Parenthood after a video surfaced Tuesday showing a high-level official from the organization allegedly discussing harvesting and selling fetal tissue. “Congress should immediately begin an investigation of Planned Parenthood’s activities regarding the sale and transfer of aborted body parts, including who is obtaining them and what they are being used for,” Cruz wrote in a statement late Tuesday. Other Republican candidates also seized on the video. (Sutton, 7/14)

After an anti-abortion group on Tuesday released an undercover video showing an executive at Planned Parenthood discussing how to preserve an aborted fetus’s organs for medical research, Gov. Greg Abbott announced an investigation into the alleged practice. “The video of a high-level Planned Parenthood executive discussing the details of internal abortion procedures — including harvesting of baby body parts — is unnerving and appalling,” Abbott said in a statement. “In light of the video, I have directed the Texas Health and Human Services Commission to conduct an immediate investigation of this alleged practice in addition to a separate investigation ordered by the Texas Office of the Attorney General.” (Walters, 7/14)

U.S. stocks posted their first four-day winning streak since January, as semiconductor and biotechnology shares rallied while weaker-than-expected retail sales spurred speculation on timing for higher interest rates. Micron Technology jumped 11 percent, leading chipmakers higher, amid talk of a buyout. The Nasdaq biotechnology index increased 2.3 percent to a record. Apache and Chesapeake Energy rose more than 2.1 percent as oil gained. JPMorgan Chase advanced 1.4 percent after its quarterly profit beat analysts' estimates as expenses fell. (Renick and Alexander, 7/14)

Blue Cross and Blue Shield will be providing identity protection services to all eligible members across the U.S. by the start of the new year. The services — which include credit monitoring, fraud detection and fraud resolution — will be available to eligible members for as long as they have a Blue Cross and Blue Shield insurance policy. Blue Cross and Blue Shield companies provide health coverage to more than 106 million members. (7/14)

The Fort Washington, Pa., plant was closed in 2010 after J&J recalled more than 135 million medicine bottles when customers found, for instance, tiny metal particles floating in children’s Tylenol. Since then, J&J has been spending tens of millions of dollars upgrading the plant, which J&J said recently underwent the Food and Drug Administration inspections needed to get an OK to reopen. The recalls tarnished J&J’s image and prompted the company to upgrade its supply chain, rework its portfolio of over-the-counter medicines and agree in 2011 to tough FDA oversight. The company lost billions of dollars in sales after pulling products from retail shelves. (Rockoff and Dulaney, 7/14)

But as the economy has recovered, revenues have gone up. The rates of inflation for expensive health care programs like Medicare have fallen and annual agency budgets have remained tight, contributing to the improved deficit. ... While the new numbers reflect improvement, budget hawks continue to warn that the nation’s long-term fiscal trajectory is unsustainable and will require lawmakers to eventually tackle the rising costs of expensive benefit programs such as Medicare. (Taylor, 7/14)

A Wal-Mart Stores Inc employee sued the retailer on Tuesday, saying its prior policy of denying health insurance to the spouses of gay employees violated gender discrimination laws. The lawsuit, filed in U.S. District Court in Boston, seeks nationwide class-action status. Wal-Mart, the largest private U.S. employer, began offering health insurance benefits to same-sex spouses last year, after the U.S. Supreme Court in 2013 struck down part of the Defense of Marriage Act that denied federal benefits to married gay couples. Even after that change, the lawsuit says, Wal-Mart workers still live with the uncertainty of losing spousal coverage. (Wiessner, 7/14)

Two civil rights groups are trying to build a class action against Wal-Mart Stores Inc. over the retailer’s former policy of denying health-insurance benefits to the same-sex spouses of gay employees. In January 2014 Wal-Mart started offering benefits to domestic partners of U.S. employees regardless of their sexual orientation. But a lawsuit filed in federal court on Tuesday says the company should be held liable for refusing to extend employee benefits to same-sex partners in the past. (Gershman, 7/14)

In February 2012, LaVerne Stiles went to Citrus Memorial Hospital near her home in central Florida for what should have been a routine surgery. The bubbly retired secretary had been in a minor car accident weeks earlier. She didn’t worry much about her sore neck until a scan detected a broken bone. The operation she needed, a spinal fusion, is done tens of thousands of times a year without incident. Stiles, 71, had a choice of three specially trained surgeons at Citrus Memorial, which was rated among the top 100 nationally for spinal procedures. She had no way of knowing how much was riding on her decision. The doctor she chose, Constantine Toumbis, had one of the highest rates of complications in the country for spinal fusions. (Allen and Pierce, 7/14)

Two new, unrelated search tools opened to the public Tuesday promise to make elective surgery planning easier and more transparent. They're delivering on that promise by arming patients with information about thousands of surgeons' previous patient outcomes. (Smart, 7/14)

If you're thinking about having an operation, you may want to do some research about the surgeon before signing up. It could mean the difference between a smooth procedure and complications, according to data compiled by ProPublica. (Terry, 7/14)

It's bad enough spending three or more days in a hospital undergoing a barrage of medical tests and procedures. Brace yourself for even more pain at discharge if the hospital reveals that you were actually never admitted but were on Medicare "observation status." That designation could cost you big time. Hospitalized Medicare beneficiaries who are under observation are considered outpatients, even if they spend many days in the hospital. If you find yourself in this boat, there's a chance you'll pay more for services than if you'd been formally admitted. Observation patients are also ineligible for certain extended-care benefits. (Garland, 7/15)

When searching for a skilled nursing care facility, one place to start is medicare.gov/nursinghomecompare, a 5-star quality rating system by the federal Centers for Medicare and Medicaid Services. It’s supposed to help consumers look beyond slick marketing brochures and alluring websites to see what kind of care they can expect at certified nursing homes. (Berrios, 7/15)

Health Savings Accounts make a lot of sense–at least, on paper. For account holders, they provide a triple tax advantage. Money set aside, earned or withdrawn from the accounts to pay for medical expenses is all held out of Uncle Sam’s reach. Also, any untapped money can be used to supplement retirement savings and pay Medicare costs after age 65. Plus, there is the added benefit that the accounts encourage consumers to sift through their health care options for the most cost-effective options, since any savings go directly to their bottom lines. That, in turn, puts downward pressure on spiraling health care costs. The problem, according to a new study, is that few account holders are doing what it takes to even coming close to maximizing the potential of HSAs. (Fletcher, 7/14)

Ana Maria Campos had been in the United States for less than a year when she was diagnosed with leukemia. Campos, then 18, had just moved from Guanajuato, Mexico, to Dade City with her mother and nine siblings to join their father. With six months of chemotherapy ahead, her mother fought to find health insurance options. The Florida KidCare program, which provides subsidized health coverage for lower-income children under 19 for little to no cost, seemed like the best option. Even though Campos was a legal U.S. resident, she couldn't qualify. (Schmidt, 7/14)

When you visit a doctor you expect to get quality medical advice, regardless of the physician's religious beliefs. But an Illinois law allows doctors and hospitals to withhold information from patients based on a "right of conscience," potentially endangering lives and, at the very least, limiting patients' medical options. Senate Bill 1564 amends the Illinois Health Care Right of Conscience Act — the broadest such law in the nation according to the American Civil Liberties Union — making it clear that doctors, nurses and hospitals have an obligation to make patients aware of all their medical options so they can make an informed decision about what's best for them whatever the religious beliefs that others may hold. (Kadner, 7/14)

Despite cutting millions of dollars to aid the state's disabled community, Gov. Rick Scott signed a new law Monday that allows individuals with disabilities to boost their savings from $2,000 to $100,000 without jeopardizing their state and federal benefits. The law will go into effect by July 1, 2016. The more celebrated news, however, was that 2,000 people previously on a wait list for a Medicaid waiver from the Agency for Persons with Disabilities will be able to receive care at home instead of being institutionalized. Under the state budget that went effect July 1, $40 million will go toward providing services for these 2,000; 20,000 people are on the wait list. (Luna, 7/14)

California and Oregon will be the first states in the nation to allow women to get birth control pills and other hormonal contraceptives directly from their pharmacists – without a doctor’s prescription. As California officials were busy finalizing regulations on a state law passed in 2013, Oregon’s governor Kate Brown signed a similar bill into law last week. (Feder Ostrov, 7/15)

After a Church of Scientology-backed group helped organize a campaign against it, Gov. Greg Abbott vetoed legislation that would have given Texas doctors more power to detain mentally ill and potentially dangerous patients, according to records obtained by The Texas Tribune. The governor's early June veto of Senate Bill 359 caught many of the measure’s proponents off-guard. The legislation had sailed through the House and Senate with little debate and only a handful of negative votes — and during committee hearings in both chambers, a range of mental health advocates, medical groups and law enforcement officials showed up to testify in its favor. (Smith, 7/14)

The U.S. health-care system does not spend enough money on preventing diseases. That’s what Lee Hood and Clayton Lewis think, and why they launched a Seattle startup, Arivale, to promote health. Arivale is announcing Tuesday that it has raised $36 million in a series B financing round from Arch Venture Partners, Polaris Partners and Maveron. Lewis and Hood, a renowned biologist, launched Arivale out of research from Seattle’s Institute for Systems Biology, which Hood co-founded in 2000. Arivale looks at participants’ genetics and baseline health, then pairs them with a coach to make diet, exercise and general wellness plans to avoid disease and conditions. (Lerman, 7/14)

The state’s largest public employees union and 20 Democratic legislators are suing Gov. Terry Branstad over his closure of two state mental hospitals. The American Federation of State County and Municipal Employees said Monday that it filed suit in Polk County District Court against Branstad and Department of Human Services Director Charles Palmer. The suit seeks to force Branstad to reopen the state mental hospitals at Mount Pleasant and Clarinda, which the administration closed last month. The suit cites a section of Iowa Code spelling out that the state shall have mental hospitals at those two locations and at Cherokee and Independence. (Leys, 7/14)

At the Birth and Wellness Center in O'Fallon, Mo., women deliver babies in a low-tech, homelike setting with midwives. Yet it and other birth centers nationwide are being studied as an "innovative" approach to reducing preterm births among the poor. Only 0.4 percent of all births take place in birth centers, yet those centers boast impressive health outcomes at a cost far less than hospital births, according to data compiled from over 15,000 birth center deliveries released three years ago. (Munz, 7/14)

But he speaks with near-equal passion about a domestic issue that has all but disappeared from the campaign conversation: entitlement reform, and the importance of a balanced approach to achieving it. Here Graham is the only candidate willing to say two words that have become ideological poison for both sides: Simpson-Bowles. That debt-reduction proposal has become anathema for Republicans because it calls for trillions in new tax revenue and, equally, anathema for Democrats because it calls for entitlement changes such as raising the Medicare eligibility age and changing the method for calculating Social Security cost-of-living increases. (Ruth Marcus, 7/14)

Hillary Clinton was criticized by a number of mainstream outlets for a speech yesterday light on substance and, in its anti-Wall Street rhetoric, disingenuous coming from someone who has gotten rich off the same Wall Street moneymen she now decries. All that won’t matter to the electorate, however, if the GOP nominee does not seize the opening. Here’s how to do that. ... no candidate can get away with promising to repeal Obamacare without explaining what he or she will put in its place. The rationale for the alternative must be directed to people who are hurt by or not helped by Obamacare. That means the alternative must deliver on the “affordable” part of the Affordable Care Act and restore greater choice to consumers. Ideally, the case should be made that consigning the poor to unreformed Medicaid is tantamount to saying the poor will get inferior care. (Jennifer Rubin, 7/14)

A week after the White House’s celebration of the King v. Burwell decision, insurance companies across the nation asked for rate increases of 20 to 60 percent. When asked, Obama suggested consumers pressure state regulators to deny the increases. As it turns out, at least in Oregon, the insurance commissioner actually made several companies raise premiums more than they asked and approved average rate increases of over 24 percent for all companies. ... Unfortunately, as premiums increase, those who are not heavily subsidized are less likely to buy insurance. This means the younger and healthier people only buy insurance when they get older and sicker. This is what is happening. Can anyone say “insurance death spiral”? (Sen. Bill Cassidy, R-La., 7/13)

The Affordable Care Act (ACA) is working. And the numbers and stories back it up. In my home state of California, more than 3 million people now have health security because of the ACA. In my district, the number of uninsured residents has drastically declined, by 50 percent. ... But we know that, just like with any other large piece of legislation, there are fixes to be made and follow-up efforts that are required to bring the promise of high-quality, affordable, accessible healthcare to all Americans. We must continue to work to address affordability, ensuring that all Americans have access to care at a rate that fits their budgets. ... We must also continue to work to improve provider network adequacy and ensure that Americans have access to the healthcare providers they need and trust. (Rep. Lois Capps, D-Calif., 7/13)

After the Supreme Court recently upheld yet another provision of the ACA, it is time for opponents of healthcare reform to accept that the ACA is here to stay and stop partisan attempts to block, repeal or undermine key elements of the successful law. States should take steps to more fully implement the Affordable Care Act. The states that have adopted Medicaid expansion have seen larger gains in coverage than non-expansion states and generally are saving money in their budgets. Recent reports confirm that hospitals in these states are treating fewer uninsured patients and experiencing steep declines in the amount of uncompensated care they are providing. (Rep. Gene Green, D-Texas, 7/13)

The Supreme Court’s ruling on the high-profile and historic King v. Burwell case upholding federal subsidies distributed under ObamaCare has caused Republicans in Congress to ask the next logical question: Where do we go from here? Many legal experts had expected the Supreme Court to rule in a favor of a plain reading of the law, which clearly states that the federal subsidies are illegal. Conservatives who had believed this decision might finally be the death knell for ObamaCare are frustrated — and in one sense, rightfully so. But despite this frustration, I’m optimistic that this decision might be the first step to finally achieving full repeal of this disastrous law. (Rep. Charles Boustany Jr., R-La., 7/13)

No matter how many times the U.S. House of Representatives votes to repeal the Affordable Care Act, the outcome will be the same. Failure. First, despite many votes for repeal by the Republican-controlled House, the legislation has never cleared. (Bob Sigman, 7/14)

CVS Health did something the other day that we don't see enough in the business world. It stood up for its principles. The pharmacy giant announced it was quitting the U.S. Chamber of Commerce after reports that the influential business organization was lobbying against anti-smoking laws around the world. (David Lazarus, 7/14)

The birthrate among teenagers across Colorado plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health. The declines were similar for married women under 25 who have not finished high school. A private grant allowed the Colorado experiment, which advocates are scrambling to find a way to continue as their original funding is running out. What can Texas, which has some of the highest teen birth rates in the U.S., learn from the Colorado story? (Sharon Grigsby, 7/14)

Last week, Congress passed the bipartisan 21st Century Cures Act, which has been heralded as a “once-in-a-decade” bill designed to improve the process of discovering, developing and delivering treatments to patients, and to boost biomedical research. Included in this package is a provision which will improve patient access to potentially life-saving investigational drugs when all other options have been exhausted. The British Parliament has also been debating its own legislation, called the Medical Innovation Bill, a slightly different, albeit no less important effort to reduce barriers that prevent doctors from using novel medicines when their patients have no other options. (U.S. Rep. Michael McCaul, R-Texas, and Lord Maurice Saatchi, member of Parliament, 7/15)

A new report by a health care advocacy group confirmed what many of us in Florida already know: it's too difficult to compare prices for medical services and procedures. Medical pricing remains an enigma, it seems, because the industry likes it that way. Consumers without information are consumers who can't vote with their wallets. Florida and all but five other states received an "F" for price transparency from the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute. The report evaluates states based on whether they have laws or regulations that require health prices be made public. New Hampshire was the only state to receive an "A," the result of its NH HealthCost site. The site allows consumers to compare prices based on geography, type of insurance and other factors for everything from a basic visit to the doctor to complicated medical tests. (Kassab, 7/14)