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The company state officials blame for the botched rollout of Maryland's online health exchange will repay $45 million to settle the claims in an agreement announced Tuesday. The settlement — just over 60 percent of what the state paid Noridian Healthcare Solutions — was approved unanimously by the health exchange board during a meeting Tuesday afternoon. U.S regulators still must approve the deal, because much of the funding was federal. (Cohn and McDaniels, 7/21)

The prime contractor hired to build Maryland’s flawed online health exchange will pay $45 million to the state and federal governments to avoid a lawsuit over its performance, Attorney General Brian Frosh announced Tuesday. Maryland’s health exchange drew national attention last year when the Web site crashed moments after launching. It was plagued by glitches for months afterward. (Hicks, 7/21)

The main contractor in Maryland's initially flawed health care exchange website has agreed to repay $45 million to avoid legal action over its performance, officials announced Tuesday. Maryland's website crashed right after opening Oct. 1, 2013, as part of President Barack Obama's health care law, and it wasn't the only state to have problems. Oregon, Nevada and Hawaii abandoned their state-run exchanges and now use the federal one. (7/21)

Policymakers in Medicaid expansion states likely will try to wring some cash from hospitals starting in 2017 when the federal government no longer pays the full tab for the coverage expansion, experts say. Higher-than-expected enrollment means expansion states will be on the hook for hundreds of millions more than they anticipated when they took advantage of the Affordable Care Act's Medicaid expansion to adults earning up to 138% of the federal poverty level. For instance, in Oregon, 386,000 people enrolled Medicaid in 2014, up from a pre-expansion estimate of 222,700. (Dickson, 7/21)

The state health department has hired a consultant to help recommend next steps as Gov. Bill Walker's administration plans to implement Medicaid expansion and looks to make further changes to the existing Medicaid program. The contract with Agnew::Beck Consulting LLC calls for a finalized report in January recommending alternative Medicaid expansion models and options to help contain costs within the Medicaid program. A report due in May would address a timeline and costs for carrying out the recommendations. (Bohrer, 7/21)

At the paper mill in Longview, Wash., Kurt Gallow and his wife, Brenda, are worrying about his company’s proposed new health care plan, which would require workers to pay as much as $6,000 toward their families’ medical bills. ... The union is now in heated negotiations with the mill’s owner, KapStone Paper and Packaging, over benefits, among other issues. The couple and many other employees have been enrolled in a popular Kaiser Permanente health maintenance organization, which charged just $25 for a doctor’s visit. But that may change by January. Pointing to the looming new tax on high cost insurance plans imposed under the federal health care law, KapStone wants to replace its existing policies with plans that could prove far more expensive for workers and their families. By doing so, the company would save almost $3 million in additional taxes in just the first two and a half years. (Abelson, 7/21)

It’s getting more expensive to be an employer and small business owners say that’s making it harder for them to make money. The health care law, minimum wage increases and paid sick leave laws in some states and cities are increasing costs. ... They may be required to offer health insurance starting Jan. 1 if they go ahead with plans to offer dinner at the restaurant, which now serves breakfast and lunch. The expansion could give the Lamons 50 or more workers, the point at which employers must provide coverage. (Rosenberg, 7/22)

The two-term Republican governor’s bid will test whether a candidate who has bucked the right flank of his party on issues ranging from Medicaid expansion to immigration can gain traction in a primary. (McCain Nelson, 7/21)

One of his biggest challenges will be getting into the top tier of Republican candidates to qualify for some early debates. And he must convince primary voters who question his conservative credentials that his decision to expand ObamaCare in Ohio was a moral imperative to help the poor. (7/21)

The Unintimidated PAC, which was started in April by two of Walker’s closest political advisers, has collected just over $20 million, The Washington Post has learned. The super PAC was named for Walker’s 2013 book that chronicled his highly visible fight with public-sector unions and is able to accept unlimited donations, although it is required to disclose its donor list. (Johnson, 7/21)

Three groups supporting Scott Walker's run for president have raised $32 million, which is less than what two of his Republican rivals have collected but on target with the Wisconsin governor's goal for this point in the campaign. ... Walker was first elected governor in 2010 and within months proposed effectively ending collective bargaining for most public workers, coupled with requiring them to pay more for health insurance and pension benefits to help solve a budget shortfall. The fight led to a 2012 recall election against Walker, which he won, further raising his national political profile in advance of this year's announcement that he hopes to run for the White House. Walker won re-election last year. (7/21)

While most of his successes have produced incremental change, Mr. Sanders was responsible for the biggest legislative victory for Senate Democrats last year. At the time, he was chairman of the Senate Veterans Affairs Committee and, after extensive negotiations with Sen. John McCain (R., Ariz.), the committee’s top Republican, and House Veterans Affairs Committee Chairman Jeff Miller (R., Fla.), he passed a measure to shorten wait times at the Department of Veterans Affairs after agency leaders were accused of abandoning patients and cooking the books to get bonuses. The agreement marked the largest expansion of government services since Republicans took control of the House in the 2010 elections. (Hughes, 7/21)

It sounds odd to argue that by moving left, a Democratic candidate can capture disaffected voters in the center or even on the right. ... Sen. Claire McCaskill (D-Mo.) ... She told MSNBC's "Morning Joe" that Sanders wanted a single-payer system in insurance and more generous entitlements and that he opposed free trade. Polls suggest that support for a single-payer system is limited to liberals, and while polls on expanding Social Security suggest the idea could win the support of a large majority, most Americans think that free trade has been good for the country. (Ehrenfreund, 7/21)

Congress’ planned crackdown on Planned Parenthood is looking increasingly real. Republican leaders are weighing a series of votes to defund Planned Parenthood — possibly beginning before the August recess — after the release of a second undercover sting video allegedly showing one of the abortion rights group’s officials discussing the sale of fetal organs. (Bade and Sherman, 7/21)

Critics of Planned Parenthood on Tuesday released a second secretly recorded video related to fetal parts, putting the group on the defensive and spurring fears on the left of a new ACORN scandal. The new video shows Dr. Mary Gatter, a Planned Parenthood official, apparently negotiating the price of fetal tissue for medical research. The Center for Medical Progress, which is behind the video, says it shows Planned Parenthood illegally profiting off the sale of fetal organs. (Sullivan and Ferris, 7/22)

Senate Minority Leader Harry Reid suggested Tuesday that while two recent videos raise questions about Planned Parenthood, he doesn't believe the organization broke the law. "These politically motivated videos raises questions, but nothing I've seen indicates that Planned Parenthood violated federal law," the Nevada Democrat told reporters. (Carney, 7/21)

Clumped together in the single digits in recent national polls, GOP Sens. Rand Paul of Kentucky, Marco Rubio of Florida, Ted Cruz of Texas and Lindsey Graham of South Carolina sense an opportunity to get some much-needed traction in the must-pass legislation. And they’re seizing it, with plans to tack on controversial proposals — or potentially hold up the entire bill if they don’t get what they want. Paul is pushing an amendment to defund Planned Parenthood precisely at the moment the women’s health group is under siege for videos showing officials discussing harvesting organs from aborted fetuses. The Kentucky lawmaker, of course, is well practiced in the art of taking over the Senate floor to promote his causes, most recently forcing the PATRIOT Act to lapse temporarily. (Everett, 7/21)

An anti-abortion group says a second under cover video proves that Planned Parenthood is selling the body parts of aborted fetuses, a practice that is illegal and that the group denies doing. The Center for Medical Progress, an anti-abortion group, released both edited and unedited videos last week of a Planned Parenthood executive discussing money related to aborted fetus organs and tissues. (Scott, 7/21)

In another portion of the video, she appears to suggest that abortion procedures could be modified in some cases to get more intact fetuses. Under federal law, there should be no alteration in the timing or method of an abortion done solely for the purpose of obtaining fetal tissue. Planned Parenthood spokesman Eric Ferrero said the source of the videos "is a group of extremists who have intimidated women and doctors for years in their agenda to ban abortion completely." (7/21)

The group behind last week’s undercover Planned Parenthood video is out with a new release showing a different executive talking about the acceptable cost of handling a fetal tissue sample. The video features Mary Gatter, who is president of the group’s medical director council, engaging in a conversation with the Center for Medical Progress’ actors, who posed as representatives of a firm that handles fetal tissue donations. (Haberkorn, 7/21)

Missouri elected officials announced efforts Tuesday to investigate Planned Parenthood following the release of a controversial video that raised questions about whether the national abortion provider was selling fetal tissue for profit — and if Missouri affiliates were participating in such a scheme. The separate moves by Democratic Attorney General Chris Koster and the Republican-led state Senate propel Missouri into the forefront of a national uproar caused by the video after it was made public last week. The video specifically mentions St. Louis as a possible location to obtain fetal tissue. (Shapiro, 7/22)

A growing number of lawmakers want to increase the influence of medical industries and members of the public in the work of a federal health panel, which is best known for recommending against the general use of a prostate-cancer test and cautioning against widespread use of mammography for women in their 40s. The panel, the United States Preventive Services Task Force, is currently in the midst of finalizing a reaffirmation of the controversial mammography guidelines. Rosa DeLauro of Connecticut, the top Democratic House appropriator for federal health programs, added a rider to the fiscal 2016 Labor-HHS-Education spending bill that would block the task force from finalizing the recommendations for a year. (Young, 7/21)

The law supporting meals, home-based care and transportation services for low-income seniors scored a critical victory last week when the Senate voted unanimously for its renewal. But that long-sought momentum could stall in the House, despite advocates warning that vulnerable elderly are at risk. (Ehley, 7/21)

The Food and Drug Administration this week is expected to approve the first in a new class of cholesterol-lowering medications that could represent the most significant advance in cardiology since statin drugs hit the market decades ago. But, in part because the new treatments have yet to demonstrate that they reduce the incidence of strokes and heart attacks, their approval appears set to trigger the latest fight over the high price of many drugs in the United States. (Dennis, 7/21)

If you had any doubt that prescription drug prices are the proverbial hot potato for the pharmaceutical industry, consider some recent developments. The Laura and John Arnold Foundation plans to give a $5.2 million grant to the Institute for Clinical and Economic Review, a non-profit that examines the value of new medicines, so it can double its staff and produce more reports suggesting benchmark prices for up to 20 drugs over two years, according to The Wall Street Journal. (Silverman, 7/21)

An appeals court ruled that Novartis AG could begin the first U.S. sales of a knockoff biotech drug on Sept. 2, a key step in efforts to contain spending on high-cost therapies through lower-priced competition. The ruling Tuesday by the U.S. Court of Appeals for the Federal Circuit in Washington came on the same day Switzerland-based Novartis said its second-quarter profit fell 32% amid a strengthened U.S. dollar and a weak result from the company’s eye-care-treatment business. (Rockoff, 7/21)

Aetna's agreement to acquire rival Humana would further concentrate the business of selling private Medicare plans to seniors in Illinois, according to data provided by the Kaiser Family Foundation. In the state, Humana and Aetna are already the second- and third-largest players, respectively, in the Medicare Advantage market. Medicare Advantage plans offer lower out-of-pocket costs than traditional Medicare does, but customers usually have fewer options in choosing doctors and hospitals. (Sachdev, 7/21)

Novartis has taken one in the eye. Flat sales in its eye-care business, Alcon, which accounts for about a fifth of revenues, hit second-quarter results. That sent the stock skidding, despite strong results in its pharmaceuticals and generics units. The result also dashed hopes for an increase in its full-year guidance and emphasizes that the Swiss company’s challenge is to live up to high expectations. (Thomas, 7/21)

Women with early memory problems worsen significantly faster than men at the same stage of dementia, according to a new study that offers what is perhaps the best evidence yet suggesting sex differences in vulnerability to Alzheimer’s disease. The results come from an analysis of 398 people with mild cognitive impairment enrolled in a large, national, long-term study called the Alzheimer’s Disease Neuroimaging Initiative, or ADNI. (Wang, 7/21)

There's new evidence suggesting that women's brains are especially vulnerable to Alzheimer's disease and other problems with memory and thinking. Women with mild cognitive impairment, which can lead to Alzheimer's, tend to decline faster than men, researchers reported this week at the Alzheimer's Association International Conference in Washington, D.C. (Hamilton, 7/21)

Deep learning is a type of artificial intelligence in which computers learn to identify and categorize patterns in huge data sets. ... A deep learning system that’s able to digest a massive amount of genetic data has the potential to understand the impact of genetic mutations better than humans ever have. The impact of mutations depends on their context. As Frey gets access to more data sets, of say individuals with autism, the deep learning system can better draw conclusions about how genetics is driving real world outcomes. (McFarland, 7/22)

Google's Calico, a biotechnology firm created by the search-engine giant to study aging and related diseases, will delve into the genetic database amassed by a unit of Ancestry.com to look for hereditary influences on longevity. AncestryDNA, a division of the Provo, Utah-based genealogy company, has gathered more than 1 million DNA samples from the $99 testing kits it sells to consumers to help map their family history. Beside the genetic information, Calico will have access to tens of millions of public family trees created by consumers, which include birth and death dates, relationships, and geographical locations. (Chen, 7/21)

Tens of thousands of people have been removed from the state's Medicaid program during the first phase of an eligibility review, according to figures from Gov. Charlie Baker's administration obtained by The Associated Press. The eligibility checks, required annually under federal law but not performed in Massachusetts since 2013, began earlier this year as part of Baker's plan to squeeze $761 million in savings from MassHealth, the government-run health insurance program for about 1.7 million poor and disabled residents. (Salsberg, 7/21)

Humana Inc. has added SCL Health to its network for Medicare Advantage members, who will have in-network access to SCL's inpatient, outpatient and emergency services at its medical centers, officials announced Monday. Medicare Advantage plans are offered by private companies that contract with Medicare to provide all hospital and medical benefits (Part A and Part B). This move by Humana will give metro area seniors in-network access at Saint Joseph Hospital in Denver, Lutheran Medical Center in Wheat Ridge and Good Samaritan Medical Center in Lafayette. (Draper, 7/21)

One large health system in North Carolina is ready to launch a Medicare Advantage plan, and two others are mulling the pros and cons of becoming a payer. The reason? Nearly every healthcare executive agrees that a hospital or health system today is more than just a site to treat pneumonia or mend a broken leg. For Jim Roskelly, the evolving definition of his organization includes taking on risk to pay for that care. (Herman, 7/21)

The Massachusetts Nurses Association is pushing a state bill that would mandate plans to protect employees from workplace violence. Union President Donna Kelly-Williams and several other members are testifying Tuesday at a Massachusetts state hearing on the bill. Elizabeth Dalton, a nurse in the Cardiac Intensive Care Unit at Brigham and Women's Hospital in Boston, will testify about her experience dealing with the irate father of a dying patient who threatened her with a knife, a situation she argues could have been prevented if the hospital had a better handle on the father. (Rubenfire, 7/21)

Paula Kent Meehan made a fortune after launching the Redken hair-care products company in the 1960s. She spent the last years of her life giving that money to charity. One of the biggest beneficiaries was supposed to be St. John's Health Center, a storied Santa Monica hospital founded by Roman Catholic nuns that has cared for celebrity patients such as Michael Jackson, Elizabeth Taylor and President Reagan. But in 2013, Meehan revoked her pledge to the St. John's foundation after the ouster of the hospital's top executives and the proposed sale of the nonprofit Catholic hospital. And now the hospital's foundation is suing her estate for the $5 million that she originally promised. (Pfeifer, 7/21)

A panel chaired by Lt. Gov. Gavin Newsom hopes to guide the debate on the legalization of marijuana in California with an emphasis on limiting children’s access to cannabis, reducing illegal activity and tightly regulating the drug's growth and sales. In a report released Wednesday, the group lays out 58 recommendations and goals for implementing general legalization -- an issue expected to go before voters next year. The document offers broad principles --“protecting California’s youth” -- as well as nitty-gritty suggestions for collecting data and limiting advertising. (Mason, 7/22)

When the Minneapolis Veterans Medical Center decided to limit the dispensing of narcotic painkillers to stop veterans from becoming drug dependent, the new policy led to sometimes tragic results, according to a recent Star Tribune report. (Ibrahim, 7/21)

The health of kids in North Carolina has improved over time and they’re also doing better in school. But many children live in families struggling to recover from the economic downturn in 2009. That’s according to the annual Annie E. Casey Foundation KIDS COUNT Data Book, a report on state and national trends in child well-being released on Monday. North Carolina placed 35th in overall child well-being, said the report, which looked at trends between 2008 and 2013. The state ranked in the lower half of all states in the four categories measured: economic well-being, education, health and family and community. (Herzog, 6/22)

The overall wellbeing of South Carolina's children has improved slightly, even while poverty continues to worsen, according to a national report released Tuesday. The latest Kids Count Data Book, released by the Annie E. Casey Foundation, shows that South Carolina ranks 42nd overall in a child's chance of succeeding. That's up from 45th last year and the highest ranking South Carolina's achieved in the report's 25-year existence. (Adcox, 7/21)

Kansas improved its ranking in child health but dropped in child poverty in the latest data released by a national nonprofit that advocates for children. The state retained its No. 15 overall ranking from the Annie E. Casey Foundation in 2015 Kids Count data published Tuesday. The latest information comes from 2013 and shows Kansas improving from No. 21 to No. 13 in the nation based on four measures of child health: Low birth weight (7 percent), children without health insurance (6 percent), child and teen deaths per 100,000 (28 percent), and teens who abuse drug and alcohol (5 percent). (Marso, 7/21)

There are more problems in the operating room at the Denver VA Hospital. 7NEWS has learned that the hospital is quietly limiting certain surgeries because of problems with sterilization. "What is shut down is anything that takes a lot of complex instrumentation, such as open heart surgery," said Dan Warvi, a spokesman for the Denver VA. During the second week of July, the operating room was shut down for "maintenance," according to an official statement, indicating surgeries would begin against July 13. (Allen, 7/21)

GOP voters looking for harder ideological edges won’t find them in [Ohio Gov. John] Kasich. Though he stresses his belief in personal responsibility, he frequently talks about the importance of empathy and public policy that helps those on the margins. Whereas some GOP governors boast about clamping down on the working poor, he insists that “we’re not going to bang you over the head because you’re trying to get ahead.” ... As governor, Mr. Kasich accepted federal funds to expand his state’s Medicaid program, a policy that helps ... the truly disadvantaged. Many GOP governors, including some in the presidential race, did the opposite, sacrificing the well-being of their constituents to anti-Obamacare extremism. (7/21)

He arguably has achieved more than any other sitting governor in the race. As he said, he began with an $8 billion budget gap, balanced the budget and built up the rainy day fund from 89 cents (yes, cents) to more than $2 billion. During his tenure, he created more than 350,000 jobs. (Over a slightly different time span, New Jersey created about 170,000 jobs under Gov. Chris Christie and Wisconsin created about 155,000 under Gov. Scott Walker.) He boasts of $5 billion in tax cuts, “the largest in the country.” Fiscal conservatives, however, will never forget his expansion of Medicaid, which he insists brought money back to Ohio and was needed to help the poor in his state. Nevertheless, add to his list of accomplishments nursing care reform, drug rehabilitation efforts, education reform and steps to make the state more business-friendly, and you have an impressive record. (Jennifer Rubin, 7/21)

Less consistent with this resume is Mr. Kasich’s 2013 decision to participate in ObamaCare’s Medicaid expansion. When Republicans in the Ohio legislature tried to block this gambit, Mr. Kasich imposed new Medicaid unilaterally through an executive panel. He then became the leading Republican evangelist for ObamaCare’s Medicaid expansion and accused anyone who disagreed with him of bad faith—literally. ... If increasing the reach of federal health care is the ticket into heaven, then the Almighty is selling at a discount. Medicaid’s quality of care, access to physicians and outcomes continue to decline. Meanwhile, Medicaid spending will consume 49% of Ohio general revenue funds in 2016, 51% in 2017. Yet Mr. Kasich often says that national Republicans who care about such details are waging “a war on the poor.” (7/21)

Choosing a health plan in the newly created health insurance exchanges has become technically smoother. But in many ways, it seems that the reduction in glitches has been traded for an overwhelming array of network choices. The proliferation of insurance plans that offer “narrow, ultra-narrow, limited, high-value, high-performance or skinny networks” that include or exclude specific clinicians and hospitals highlights both troublesome problems in the quest to improve the US health care system, as well as promising solutions. Such networks predate the Affordable Care Act (ACA), with roots in many employer-sponsored plans in the 1990s attempting to constrain costs in a managed care–conscious era. (Kavita Patel, 7/21)

Planned Parenthood head Cecile Richards apologized last week for the uncompassionate tone her senior director of medical research, Deborah Nucatola, used to explain the process by which she harvests aborted body parts to be provided for medical research. Nucatola had been caught on an undercover video talking to anti-abortion activists posing as representatives of a biological tissue procurement company. The abortion doctor said, “I’d say a lot of people want liver,” and “a lot of people want intact hearts these days.” Explaining how she could perform later-term abortions to aid the harvesting of such intact organs, she said, “We’ve been very good at getting heart, lung, liver, because we know that, so I’m not gonna crush that part, I’m gonna basically crush below, I’m gonna crush above, and I’m gonna see if I can get it all intact.” (Kirsten Powers, 7/21)

A hidden-camera video released last week purported to show that Planned Parenthood illegally sells tissue from aborted fetuses. It shows nothing of the sort. But it is the latest in a series of unrelenting attacks on Planned Parenthood, which offers health care services to millions of people every year. The politicians howling to defund Planned Parenthood care nothing about the truth here, being perfectly willing to undermine women’s reproductive rights any way they can. (7/22)

Most older Americans close to death have to make a difficult choice: continue with traditional medical treatment or switch to hospice care, which focuses not on a cure but on easing their remaining days. Now, Medicare is testing a third alternative: both. (Margot Sanger-Katz, 7/22)

One summer day 14 years ago, when I was a new cardiology fellow, my colleagues and I were discussing the case of an elderly man with worsening chest pains who had been transferred to our hospital to have coronary bypass surgery. We studied the information in his file: On an angiogram, his coronary arteries looked like sausage links, sectioned off by tight blockages. He had diabetes, high blood pressure and poor kidney function, and in the past he had suffered a heart attack and a stroke. Could the surgeons safely operate? (Sandeep Jauhar, 7/22)

This year marks the 25th anniversary of the Americans with Disabilities Act (ADA), which was signed into law on July 26, 1990. This historic, groundbreaking legislation has improved the lives of people with disabilities in many ways big and small, while bringing the issues of access and inclusion to the forefront of our national consciousness. Prior to the disability rights movement, even the most basic aspects of daily life were unattainable for many Americans. The lack of fundamental access to city streets, buildings and restrooms, or public transportation — which most of us take for granted — prevented people with disabilities from fully engaging in their communities. (Sue Birch and Jed Ziegenhagen, 7/21)

Forbes published a pointed commentary recently on the topic of unnecessary health care, one of the most serious problems facing our current healthcare system. This issue is one that all of us need to be aware of each time we interact with our doctors and the healthcare system — if we want our medical care to help rather than harm. (Susan Perry, 7/21)

Drug safety challenges have bedeviled the US Food and Drug Administration (FDA) for many years, and for good reason. The phased approach to drug development is primarily geared to establishing evidence of efficacy. ... However, it may not be until after approval, when the medication is used by as many as hundreds of thousands of patients, that rare but serious adverse events appear or there is sufficient statistical power to determine whether the drug increases rates of more common potential adverse outcomes .... It may not be feasible for the FDA to reconcile all competing interests and opinions about complex questions of drug safety. A more realistic goal is a rigorous, fair, and transparent framework that will make drug safety less a recurrent crisis and more just another difficult task facing a very important agency. (Joshua M. Sharfstein and Aaron S. Kesselheim, 7/21)

An estimated 100 million people in the United States will experience a serious brain disorder at some point in their lives—ranging from autism in childhood, to mood disorders and addiction in adults, to neurodegenerative disease and stroke later in life. Medicine lacks cures or even effective treatments for many of these tragic diseases, in part because of limited understanding of their causes and effects in the brain. This Viewpoint will describe recent advances in neuroscience and genetics that are providing a new view of brain function in health and disease. As these areas progress, neurology and psychiatry should see targeted treatments based on an understanding of the biological processes underlying brain disorders. (Cornelia I. Bargmann, 7/21)