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President Donald Trump gave Republican congressional leaders a rallying cry and even a roadmap as they try to push through a sweeping and divisive agenda on health care, taxes and more. In his first address to a joint session of Congress, Trump said largely what GOP leaders were hoping to hear Tuesday night, staying on-message and talking in optimistic tones, even weighing in at one point to settle a brewing dispute over how to repeal and replace the Affordable Care Act. (Werner, 3/1)

President Trump didn’t repeat his promise to deliver a “terrific” replacement for Obamacare within days Tuesday evening. But the president did outline a series of “principles” that he said Congress should follow as it repeals the Affordable Care Act and develops an alternative. (Levey, 2/28)

In his first address to a joint session of Congress — a high-wattage moment to articulate his central goals — President Trump defied expectations he had repeatedly set that he was about to unveil a concrete plan to abolish the Affordable Care Act and steer federal health policy onto a more conservative path. The five minutes Trump devoted to health care Tuesday night was largely a recitation of longtime Republican ideas that he has adopted, with an emphasis on removing the rules the Affordable Care Act placed on insurers to try to promote comprehensive health benefits. (Goldstein, 2/28)

Mr. Trump repeated his promise to overturn the 2010 health law, at a time when the party’s factions are threatening to withhold support for the effort if their demands aren’t met. He said a new health-care plan should ensure coverage for pre-existing conditions and minimize disruptions for people with coverage under Obamacare. (Bender and Radnofsky, 3/1)

Trump backed the use of tax credits to help people purchase health insurance in a speech to Congress on Tuesday, the first time he signaled support for a key component of House Republican proposals to replace Obamacare. Republicans, who control the White House and Congress, are united in their opposition to former Democratic President Barack Obama's signature 2010 healthcare law, but have so far failed to agree on the details of how to replace it. (Abutaleb, 3/1)

His vow to rewrite health policy epitomized the challenges ahead in turning rhetoric into reality. Trump promised to replace Obamacare “with reforms that expand choice, increase access, lower costs, and at the same time, provide better healthcare.” The issue has vexed lawmakers from both parties who have struggled to provide both quality and access without driving up costs. (Bierman, Memoli and Bennett, 2/28)

A claim by President Donald Trump from his speech to Congress and how it stacks up with the facts. (2/28)

In what appeared to be a nod to governors who also met with the president this week, Trump called on Congress to give states resources and flexibility to tweak Medicaid as governors see fit. Finally, he returned to his campaign idea of allowing insurance be sold across state lines. "Mandating every American to buy government-approved health insurance was never the right solution for America. The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we will do," he said. (Dickson, 2/28)

Trump's support for tax credits to help Americans buy health insurance takes aim at conservatives like Republican Study Committee Chairman Mark Walker, R-N.C., and House Freedom Caucus Chairman Mark Meadows, R-N.C., who this week came out in opposition to a leaked draft plan that would provide tax credits to help Americans purchase coverage. The conservatives, who would rather rely on tax deductions, say the credits are akin to those in the health care law and amount to a "new health insurance entitlement." (Williams, 2/28)

Trump embraced a key element of the emerging House GOP health plan, in comments that cheered Republican House leaders and could help bring conservatives back in line. ... "We should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts - but it must be the plan they want, not the plan forced on them by the government," Trump said as he called on Republicans to make good on long-held promises to repeal President Barack Obama's health care law and replace it with something better. (Werner and Fram, 2/28)

Speaker Paul Ryan's (R-Wis.) office seized on the comments. "In his address, President Trump embraced a health care replacement plan that, among other important reforms, includes a tax credit to help individuals buy a health plan that fits their needs," Ryan spokeswoman AshLee Strong wrote in an email. "These comments demonstrate that the White House and Congress are coalescing around a particular approach that will help us keep our promise to the American people to repeal this broken law and replace it with a better system." (Sullivan, 2/28)

Senator Joe Manchin, a Democrat from West Virginia, has indicated a willingness to work with Republicans on Obamacare. He said he liked Trump’s tone, though he wished Trump had called to “repair” the law, as some more moderate Republicans have. (Edney, 2/28)

President Trump, as he has repeatedly in the past, said Tuesday that the Affordable Care Act is a disaster. "Obamacare is collapsing, and we must act decisively to protect all Americans," he said during his address to a joint session of Congress. This is a major exaggeration. (Levey, 2/28)

This year was definitely a rough year for Obamacare, with declining choice in plans and sharp price hikes seen around the country. But while the law may be on especially shaky ground in some places — the private markets in Tennessee and Oklahoma come to mind -- that’s not the case everywhere. Other independent analysts have said there are signs that the health of the individual market is improving and the law is not in a so-called “death spiral.” (Pradhan, 2/28)

Addicts and mentally ill people who gained access to treatment programs for the first time as a result of the Obama-era health care law are worried about the consequences if it’s repealed as Trump calls for. Repeal could end coverage for 1.8 million people who have undergone addiction or mental health treatment, and cut $5.5 billion in spending on such services, according to estimates by economist Richard Frank, a former Obama administration official now at Harvard Medical School. (2/28)

In responding to President Trump’s address to Congress on Tuesday, Democrats had to navigate between the expectations of their angry base in America’s cities and the need to appeal to a broader array of voters in parts of the country where the president is far more popular. The party handed that task to former Gov. Steven L. Beshear of Kentucky. ... Mr. Beshear noted that the Americans who had gained health insurance under the Affordable Care Act, a law he championed in his state, were the sort of “friends and neighbors” he surrounded himself with in the diner. (Martin, 3/1)

"You and your Republican allies in Congress seem determined to rip affordable health insurance away from millions of Americans who most need it," Beshear said. Republicans believe lower-income people "just don't deserve health care, that it's somehow their fault" they lacked it, Beshear said. Twenty million Americans have gained coverage under Obama's law. (Fram and Freking, 3/1)

It was a direct shot at Trump's support among working-class Americans, many of whom have benefited from the Affordable Care Act's coverage expansion. And it came from a 72-year-old ex-governor sitting in a Kentucky diner, a departure from the typical practice of choosing a rising star to give the party's response. (Diamond, 2/28)

Mr. Trump in his remarks to Congress anticipated Mr. Beshear’s defense of the health-care law. He cited Mr. Beshear’s successor as evidence the Affordable Care Act failed in Kentucky. “Governor Matt Bevin of Kentucky just said Obamacare is failing in his state, the state of Kentucky, it is unsustainable and collapsing,” Mr. Trump said. (Epstein, 2/28)

Sen. Bernie Sanders, I-Vt., burst into laughter during an interview when asked about President Donald Trump's recent claim that "nobody knew that health care could be so complicated." Trump made the comment in a White House meeting with dozens of governors Monday. While discussing his promise to completely overhaul the Affordable Care Act, the president told the governors, "It's an unbelievably complex subject. Nobody knew that health care could be so complicated." (Martichoux, 2/28)

Six weeks into unified government, Republican leaders are back to where they were in the Obama years — under fire from conservatives for giving too much ground on major policy issues. In particular, the party push to undo the health care law while avoiding major disruptions in coverage — a priority reinforced on Tuesday by President Trump in his prime-time address — is encountering major resistance from the right. (Hulse, 3/1)

Congressional Republicans, racked by divisions over health care, taxes and spending, are increasingly desperate for leadership from the White House to unite the party and point the way toward consensus. But presidential leadership does not appear to be forthcoming, leaving the party largely paralyzed at a moment it had thought would be full of legislative activity. (Steinhauer and Huetteman, 2/28)

Republicans are having a break-the-glass moment on Obamacare. After promising for years to upend the Democratic health care law the first chance they got — and with plans to hold a vote to repeal by early April — the party remains far from consensus. So far, in fact, that Senate Majority Leader Mitch McConnell has called a special all-members caucus meeting Wednesday to try and get his rowdy caucus in line. (Everett and Haberkorn, 2/28)

House Republican leaders were ebullient after President Donald Trump’s first address to Congress Tuesday night, convinced that their proposal to repeal and replace Obamacare had just gotten the presidential seal of approval. Conservatives who abhor the GOP leadership plan saw just the opposite. (Kim and Bade, 3/1)

Republicans are looking for a path forward on ObamaCare amid conservative opposition to key elements of their plan.  The leaders of the two top conservative groups in the House, Reps. Mark Walker (R-N.C.) and Mark Meadows (R-N.C.), on Monday said they could not support a leaked draft GOP plan because it featured tax credits to help people buy coverage, which they warn is creating a new entitlement. The two groups have enough votes to sink a bill, meaning their opposition would doom legislation. (Sullivan and Wong, 2/28)

Senate Republicans will meet Wednesday to discuss the caucus's strategy for nixing ObamaCare.  A spokesman for Majority Leader Mitch McConnell confirmed that the Kentucky Republican has convened a caucus meeting, noting it is "another in a series of meetings on Obamacare repeal and replace." But the closed-door session comes amid fresh concerns about whether Senate GOP leadership will ultimately have the votes to repeal the law. (Carney, 2/28)

Speaker Paul D. Ryan on Tuesday pushed back against GOP lawmakers who vowed to vote against a leaked draft of the House Republican plan to repeal and replace the 2010 health care law. A number of conservative lawmakers, including North Carolina Reps. Mark Meadows, chairman of the House Freedom Caucus, and Mark Walker, chairman of the House Republican Study Committee, came out on Monday in opposition to a discussion draft obtained last week by CQ Roll Call and other news outlets. The two groups hold considerable sway over conservatives. (Williams, 2/28)

More than a dozen lawmakers on the two House committees in charge of drafting the chamber's overhaul of the 2010 health care law hadn't seen draft legislative text before it leaked to CQ Roll Call and other news outlets Friday. Even the two subcommittee chairmen with jurisdiction over health care, Reps. Pat Tiberi, R-Ohio and Michael C. Burgess, R-Texas, said they hadn't received the draft ahead of time. Nor had House Budget Committee Chairman Diane Black, R-Tenn., whose panel often works closely with the Congressional Budget Office that will evaluate the bill's financial impact. (Williams and Mershon, 2/28)

House Freedom Caucus Chairman Mark Meadows’ wife is rallying North Carolina Republicans to sink Speaker Paul Ryan’s Obamacare replacement bill, telling activists in an email that “Ryancare” “will be wrapped around Republican’s necks.” In a Monday afternoon email, a copy of which was obtained by Politico, Debbie Meadows encouraged Republicans to call Ryan’s office and the White House to protest the House plan. (Bade, 2/28)

Republican leaders such as House Speaker Paul Ryan of Wisconsin and Ways and Means Chairman Kevin Brady of Texas have promoted the idea that consumers should have a “health care backpack,” which would make it possible to take insurance from job to job or when moving, starting a business or retiring. The concept — often referred to as “portability” — is appealing. Why should a health plan be tied to where you work or live? Why can’t it go where you go? (Appleby, 3/1)

Mike Caudill runs Mountain Comprehensive Care Corporation in five eastern Kentucky counties. Many of his 30,000 patients gained insurance through Medicaid expansion under the Affordable Care Act. No one knows if or when those folks might lose coverage. But, Caudill said, the impact could be considerable. “I don’t want to be a Chicken Little that the sky is falling. On the other hand, neither do I want to stick my head in the sand,” he said. “A lot of it is the unknown. We don’t know what is going to happen.” (Meehan, 2/27)

Insurance companies that sell coverage through the state’s health insurance exchange next year will be allowed to cover fewer hospitals, doctors and prescription drugs under changes the exchange’s board approved Tuesday. Officials hope those changes could help offset rate increases that would otherwise be required because of the increased price and use of medical care and prescription drugs. (Levin Becker, 2/28)

Georgia’s insurance commissioner has urged Tom Price, the new federal health secretary, to remove agents’ commissions from rules governing how insure companies spend the premium dollars they collect. The issue cited by Commissioner Ralph Hudgens in his letter to Price, a fellow Georgian, involves the “Medical Loss Ratio,” or MLR. (Miller, 2/28)

Oscar Insurance Corp., the startup trying to reinvent medical insurance with its Obamacare-focused plans, lost more than $200 million on the products in 2016 as it heads into a year that may see the undoing of the health law. The company offered plans in four states in 2016 and lost about $204.9 million on premium revenue of $425.9 million, according to filings. The loss widened from $121.7 million in 2015. The company says it exited some markets, invested in operations and is aiming for a turnaround in 2017, yet its fate may be closely linked to one of its key backer’s relatives. Oscar co-founder Joshua Kushner is brother to Jared Kushner, who is the husband of Ivanka Trump and a senior adviser to President Donald Trump. Trump has promised to repeal Obamacare -- the very law Oscar was founded to profit from. (Tracer, 2/28)

Los Angeles County arguably has more to lose than any other California county if the Affordable Care Act is repealed or dramatically scaled back. With more than 10 million residents, it is the state’s most populous county by far ― a distinction reflected in the number of Angelenos who obtained health coverage under Obamacare. (Bazar, 2/28)

[A] new study in the Journal of the American Medical Association reveals they are paying more than twice what hospitals do for devices inserted into hundreds of thousands of patients every year. This overpayment trickles down to patients in the form of higher premiums, say the study’s authors, but with regards to patient safety, the lack of information about manufacturers means it’s nearly impossible to track the performance of the implants ... commercial insurers paid an average of $10,605 for knee implants, while hospitals paid an average of $5,023 to get the devices from manufacturers. The difference was even greater for hip implants — $11,751, compared to $5,620. (Ross, 2/28)

Cancers of the colon and rectum have been declining in older adults in recent decades and have always been considered rare in young people. But scientists are reporting a sharp rise in colorectal cancers in adults as young as their 20s and 30s, an ominous trend. The vast majority of colorectal cancers are still found in older people, with nearly 90 percent of all cases diagnosed in people over 50. But a new study from the American Cancer Society that analyzed cancer incidence by birth year found that colorectal cancer rates, which had dropped steadily for people born between 1890 and 1950, have been increasing for every generation born since 1950. Experts aren’t sure why. (Rabin, 2/28)

While scientists have not pinpointed an exact cause, prime suspects include obesity, inactivity and poor diets, said researchers from the American Cancer Society, reporting in the Journal of the National Cancer Institute. “Colorectal cancer had been thought a success story,” because overall rates have fallen as screening has increased among older adults, said lead researcher Rebecca Siegel. “But it appears that under the surface, the underlying risk for colorectal cancer is rising, and it is rising pretty quickly among young adults.” (Painter, 2/28)

The study, which included scientists at the NCI, didn't determine the reason for the shift. But Siegel suggested one explanation might be a complex interaction involving the same factors that have contributed to the obesity epidemic — changes in diet, a sedentary lifestyle, excess weight and low fiber consumption. Experts said the cancers are not related to the human papilloma virus. HPV is associated with squamous cell cancers, which are common in HPV-related anal cancer, but not in colorectal cancers. (McGinley, 2/28)

“It’s still a disease of older folks,” said Dr. George J. Chang, chief of colon and rectal surgery at the University of Texas M.D. Anderson Cancer Center. ... But with a growing number of younger patients affected, physicians and patients need to be more open to the possibility that symptoms such as blood in the stool and changed bowel habits could be signs of cancer, he said. (Healy, 2/28)

Pap tests are one of the most familiar — and successful — cancer screening tests ever invented. Since their introduction in the 1950s, cervical cancer deaths in the US have fallen by more than 60 percent. But now, a growing number of scientists say, the Pap may be past its prime. In its place, they are calling for a simple test, one that’s already routinely used as a second-line test around the world: screening for human papillomavirus (HPV). (Sheridan, 3/1)

The rate of second malignancies in survivors of childhood cancer is declining — an improvement linked to reduced radiation treatment of the first disease, according to a new study. The research, published Tuesday in the Journal of the American Medical Association, focused on new cancers — not recurrences — that occurred within 15 years of the original ones. The rate for such cancers fell from 2.1 percent for survivors diagnosed in the 1970s to 1.3 percent for those diagnosed in the 1990s. (McGinley, 2/28)

A bill to create a commission to investigate a string of pediatric cancer cases on the Seacoast received unanimous support from the House Committee on Health, Human Services and Elderly Affairs today. The bill also has the support of Governor Chris Sununu. The commission would take up the work of a now-defunct taskforce that was investigating the unusually high number of rare pediatric cancer cases on the Seacoast. (Moon, 2/28)

As the country plunged into recession between 2008 and 2012, something unexpected happened: An earlier small decline in the number of new cancer cases became a much bigger one. The authors of a study published last month by the Cancer Prevention Institute of California believe they have a plausible explanation for the trend: People who lost their incomes or health insurance during that time were less likely to get routine screenings or visit the doctor. (Wiener, 3/1)

Scientists and public health authorities are expressing alarm about an extraordinary surge in bird flu infections among humans. The H7N9 bird flu virus, which has sickened and killed several hundred people in China for the past four winters, had seemed over the past couple of years to be diminishing as a threat. But a resurgent wave of activity this winter has produced more than a third of all infections recorded since the first human case was hospitalized in February 2013. And with this large burst of cases, H7N9 has overtaken another bird flu, H5N1, which has been causing sporadic human infections at least a decade longer than H7N9. (Branswell, 2/28)

The percentage of hospital visits for influenza symptoms reported by the U.S. Outpatient Influenza-like Illness Surveillance Network is on the rise, and the Centers for Disease Control and Prevention is encouraging everyone 6 months and older to get vaccinations if they have not done so in the past six months. It takes two weeks after vaccination for your body to build up antibodies to protect you from the viruses. (Snibbe, 2/28)

As the region rolls through the flu season, hospitals in Greater Cincinnati are limiting visitors to cut down on the spread of respiratory diseases to patients... The hospitals that are limiting visitors are asking that anyone ill with any respiratory symptoms including coughing, sneezing, runny nose or fever refrain from coming to the hospital. Anyone younger than 14 also is asked to stay away until after the flu season passes. (Saker, 2/28)

Researchers at the Johns Hopkins Bloomberg School of Public Health recommend that Baltimore turn to an unorthodox way of dealing with its heroin epidemic by opening two facilities that provide people a safe place to take drugs. In a report published and commissioned by the nonprofit Abell Foundation, the researchers suggest opening one facility on the city’s east side and another on the west. They say such facilities would prevent overdose deaths and other harms that addicts face. (McDaniels, 2/28)

Speaking this morning before the National Association of Attorneys General, U.S. Attorney General Jeff Sessions expressed doubt that marijuana could help mitigate the opioid abuse epidemic. “I see a line in The Washington Post today that I remember from the '80s,” Sessions said. "'Marijuana is a cure for opiate abuse.' Give me a break. This is the kind of argument that's been made out there to just — almost a desperate attempt to defend the harmlessness of marijuana or even its benefits. I doubt that's true. Maybe science will prove I'm wrong.” (Ingraham, 2/28)

This is the first time the mayor has walked around the neighborhood with three of the outreach workers he put here six months ago amid complaints about things such as used needles littering the streets and the number of people congregating in this area, many clearly inebriated, openly buying and/or selling drugs — most in desperate need of services. While many were clearly happy to talk with mayor, several had complaints about things such as the homeless shelters, police officers or the difficulty getting treatment. Jenna, 29, who doesn't want her last name used, says she has been using methadone for more than a year, but programs specifically for women are scarce. (Becker, 3/1)

For the past year, state and county prosecutors in New Hampshire have started enforcing a decades-old law that allows them to seek tougher penalties for drug dealers who sell lethal doses. So far, the policy has led to a handful of convictions, with sentences ranging from a few years to 20 years in prison. But critics warn this strategy will have little effect on the state’s epidemic of drug abuse. (Sutherland, 2/28)

When the Kansas Senate comes back after this week’s midsession break, it may consider legislation to form a comprehensive state plan to fight diabetes. House Bill 2219 would instruct the Kansas Department of Health and Environment to conduct an analysis of state costs from diabetes, identify best practices to prevent and control the condition, and develop a budget to implement those practices. (Marso, 2/28)

The Ohio Department of Health is cracking down on local health authorities that investigate childhood lead poisoning cases, demanding "action plans" to close open cases and alerting programs to a high number of cases being closed due to an inability to contact the affected child's family or a homeowner. In a strongly worded letter mailed in mid-February, ODH Director Rick Hodges reminded health officials at city and county programs that investigate lead cases, referred to as "delegated authorities," of the state's plans for enhanced monitoring. (Dissell and Zeltner, 3/1)

The Ohio Department of Health (ODH) is warning it will no longer accept the "high number" of lead poisoning cases statewide that are never investigated because local health officials fail to contact a child's family. ODH, which delegates its authority to investigate lead poisoning cases to local health departments, sent letters last month warning lead programs across the state that it expects them to do more to reach parents or guardians. (Dissell, 3/1)

Rise in Texas maternal deaths absent from legislative agendaThe maternal death rate has been overshadowed by issues like child welfare, the so-called “bathroom bill” and sanctuary cities. Around D.C., Sheila Jackson Lee's image belies her persistenceAccording to dozens of interviews with members of Congress, House staffers and political players back home in Houston, there is a method to Jackson Lee's madness. (Mansoor and Blanchard, 2/28)

Residents in Flint, Mich., are about to start paying the full cost of their water again, even though what’s flowing from their taps has yet to be declared safe to drink without an approved filter. On Wednesday, state officials will end a program that has helped pay residents’ bills since a series of ill-fated decisions by state-appointed emergency managers left the city’s water system contaminated with lead. Since that 2014 disaster, the state has spent roughly $41 million in credits to help offset local utility bills. Residents have gotten a 65 percent credit each month on their water use, while commercial accounts received a 20 percent credit. (Dennis, 2/28)

It has been decades since the plastics companies first arrived and silently started polluting this small village in northeastern New York, and four years since the death of a local man prompted his son to search for answers. Given that timetable, it is not completely surprising that the story of Hoosick Falls, where the local water was contaminated with high levels of a toxic chemical, has not come to a quick conclusion.  (McKinley, 2/28)

Brady Sullivan Properties, one of New Hampshire's biggest developers, will pay a fine for violating federal lead paint laws. According to the Environmental Protection Agency, Brady Sullivan did not disclose the existence of chipping lead paint to tenants of Mill West in Manchester before they moved in. Then the landlord exposed tenants to lead dust from a construction site below apartments. (Rodolico, 2/28)

Five months after dozens of Vallejo residents sought medical treatment after being overpowered by an unbearable odor that spread over their community, a collection of federal, state and local agencies have failed to follow up on the cause or declined to release results of their investigations. The fumes prompted about 800 phone calls to authorities, who imposed a shelter-in-place order covering much of the city of 118,000. The onset of the sickening odor appears to have coincided with a petroleum spill at the Phillips 66 refinery the same evening. (Goldberg, 2/28)

The New York City public school system has quietly replaced breakfast cereals made by the Kellogg Company, the titan whose name is virtually synonymous with cereal, with those from a small California upstart called Back to the Roots. The switch, which follows a student taste test that began last spring, adds menu options that are lower in sugar and sodium and higher in whole grains. (Strom, 3/1)

Unsecured creditors in North Philadelphia Health System's bankruptcy on Tuesday filed objections to the tax-exempt organization's plan to go $3 million into debt to help it get through bankruptcy, arguing that the system must prove its viability before borrowing more. The creditors committee, represented by Edmond M. George of Obermayer Remann Maxwell & Hippel LLP, in a filing Tuesday questioned "whether there is a reorganizational plan possible for the debtor, or whether liquidation should be the focus." Lawrence G. McMichael, of Dilworth Paxson LLP, North Philadelphia Health System's bankruptcy attorney, said the system would provide information to allay the creditors' concerns. (Brubaker, 2/28)

A bill to lower the penalties for first-time possession of small amounts of marijuana cleared a Republican-dominated panel in the Iowa Senate Tuesday. The same bill passed the Senate with broad bipartisan support when Democrats were in control two years ago, but it was not considered in the Republican-controlled House. (Russell, 2/28)

Federal regulators are auditing the District’s public health lab in response to botched Zika testing that erroneously provided negative results to at least nine pregnant women, D.C. Department of Forensic Sciences Director Jenifer Smith said Tuesday. At an oversight hearing before a D.C. Council committee, Smith said officials from the Centers for Medicare and Medicaid Services (CMS) had visited the lab Monday and Tuesday to review its operations and investigate how the mistakes were made. (Jamison, 2/28)

President Trump on Tuesday called on the Food and Drug Administration to speed the approval of drugs to treat life-threatening diseases, deriding the agency’s current process as “slow and burdensome.” In an address to a joint session of Congress, Trump said that the FDA approval process “keeps too many advances … from reaching those in need.” He noted that his speech was taking place on Rare Disease Day and cited the case of Megan Crowley, who was diagnosed with Pompe disease, a rare condition that leads to muscle and respiratory damage, and who was among the first lady’s guests during the joint session of Congress. (Kaplan, 2/28)

A young woman whose father founded a biotechnology company in pursuit of a treatment for her rare disease will be front and center on Tuesday night for President Trump’s address to a joint session of Congress. Megan Crowley, a college student who was diagnosed with Pompe disease at 15 months old, will be seated alongside first lady Melania Trump during the address. Beforehand, Crowley and her father, John, will meet with Trump in the Oval Office to discuss rare disease treatments. (Facher, 2/28)

Opening a new front in the war against big pharma, Sen. Bernie Sanders (I-Vt.) and a slew of Democratic colleagues introduced a bill Tuesday to allow commercial importation of drugs from Canada. The appeal is obvious; through cheap imported drugs, the United States would be able to take advantage of the government levers and regulation that other countries have used to bring down pharmaceutical prices. It's a far more politically palatable way to attack the problem of soaring drug prices than opening up an even more contentious fight over whether the U.S. government should meddle directly in pricing — and it has had wide popular and bipartisan support, including from Hillary Clinton and Donald Trump during the presidential campaign. (Johnson, 2/28)

Agroup of lawmakers is introducing yet another bill that would allow Americans to import prescription medicines from Canada. And in a bid to quell long-standing criticism of the notion, the latest effort includes several provisions designed to address concerns that medicines bought from online pharmacies in other countries may not be safe. Known as the Affordable and Safe Prescription Drug Importation Act, the bill would instruct the US Secretary of Health and Human Services to issue regulations allowing wholesalers, licensed US pharmacies, and individuals to import prescription drugs from licensed Canadian sellers. And the drugs would have to be made at facilities inspected by the US Food and Drug Administration. (Silverman, 2/28)

As payers continue to foot the bill for orphan drugs, sales of these rare disease treatments are forecast to grow 11 percent over the next five years — to $209 billion. And this is more than twice the expected increase in sales of all other prescription medicines, according to a new analysis. By 2022, orphan drugs are predicted to account for more than 21 percent of worldwide brand-name prescription drug sales, up from 6 percent in 2000. Last year, sales of orphan drugs, which are used to treat rare diseases for patient populations numbering less than 200,000, climbed more than 12 percent, to $114 billion. By comparison, sales of other brand-name drugs rose 2.4 percent, to $578 billion. (Silverman, 2/28)

Several big drugmakers are trying to quell the furor over high drug prices by revealing more information about their pricing and even pledging to keep a lid on increases. No one should expect to be paying less for medicine anytime soon, experts say, though the drugmakers' response to public pressure may help slow the rise in prices for some drugs. (Johnson, 2/27)

Over the last three years, pharmaceutical companies have mounted a public relations blitz to tout new cures for the hepatitis C virus and persuade insurers, including government programs such as Medicare and Medicaid, to cover the costs. That isn’t an easy sell, because the price of the treatments ranges from $40,000 to $94,000—or, because the treatments take three months, as much as $1,000 per day. To persuade payers and the public, the industry has deployed a potent new ally, a company whose marquee figures are leading economists and healthcare experts at the nation’s top universities. The company, Precision Health Economics, consults for three leading makers of new hepatitis C treatments: Gilead, Bristol-Myers Squibb, and AbbVie. (Waldman, 2/23)

Middlemen who manage drug benefits for employers and insurers should be under greater government oversight of their pricing and billing practices to make health care cheaper, an independent pharmacists’ group said. President Donald Trump’s plans to lower prescription drug costs will only succeed if greater transparency is imposed on pharmacy benefit managers, the group said in a letter to Health and Human Services Secretary Tom Price that was released Monday. PBMs include CVS Health Corp., which also operates retail pharmacies, and Express Scripts Holding Co. (Hopkins, 2/27)

[Eric] Pusey’s contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pennsylvania, bar him from volunteering the fact that for many cheap, generic medicines, co-pays sometimes are more expensive than if patients simply pay out of pocket and bypass insurance. The extra money -- what the industry calls a clawback -- ends up with the benefit companies. Pusey tells customers only if they ask. ... Clawbacks, which can be as little as $2 a prescription or as much as $30, may boost profits by hundreds of millions for benefit managers and have prompted at least 16 lawsuits since October. The legal cases as well dozens of receipts obtained by Bloomberg and interviews with more than a dozen pharmacists and industry consultants show the growing importance of the clawbacks. (Hopkins, 2/24)

The concern over soaring prescription drug prices continues to dominate headlines, attracting scrutiny from Capitol Hill and President Donald Trump, who said during a January press conference that the industry was “getting away with murder.” But some doctors — frustrated by what they see as unreasonable price tags and political stagnation — are coming up with do-it-yourself solutions. Their efforts to bring down costs for their patients highlight the arbitrary and often needlessly exorbitant prices of drugs in the U.S., they say. (Luthra, 3/1)

In a fit of anger, drug makers are urging the Food and Drug Administration to delay a final rule giving the agency greater leeway to police off-label marketing over concerns it would harm public health by “chilling valuable scientific speech,” according to a recently filed petition. The rule, which was issued last month, says drug makers must update product labeling if there is evidence indicating a company intended its medicine to be used off-label, or for an unapproved use. Doctors are free to prescribe drugs for any purpose, while court rulings determined drug companies can make statements about off-label uses only if the information provided is truthful and not misleading. (Silverman, 2/24)

The drug industry is going all-in on its push to shift the conversation about drug prices to one about value, and its top lobbyist said the industry would be opportunistic in the coming months in finding legislative and administrative avenues to advance policies in pursuit of that goal. The industry, represented here by the Pharmaceutical Research and Manufacturers of America, has some specific changes in mind that it says would free them to enter into more value-based contracts with health insurers. The group’s argument: Biopharmaceutical companies develop breakthrough medications that save lives, and they can be the answer to the problem of health care costs, rather than the cause. (Scott, 2/23)

Pharmaceutical company Perrigo Co., under pressure from an investor to focus on over-the-counter drugs, reached a deal worth up to $2.85 billion to sell royalties from its multiple-sclerosis drug Tysabri to pharmaceutical investor Royalty Pharma. Dublin-based Perrigo also disclosed on Monday plans to eliminate about 750 positions and said it’s reviewing its active pharmaceutical-ingredients business and continuing an “enhanced review” of the prescription-pharmaceuticals unit. (Armental, 2/27)

Drug maker Valeant Pharmaceuticals International Inc. said its revenue fell 13% in the fourth quarter, hurt by the performance of the stomach-drug business it tried to sell late last year as well as lower drug prices. Valeant’s shares, which have shed 79% of their value in the past 12 months, lost another 4.3% in premarket trading. (Jamerson, 2/28)

Having a child who suffers from Duchenne muscular dystrophy, a rare and fatal muscle-wasting disease that affects about 12,000 boys in the United States, is tragic enough. But watching drugmaker Marathon Pharmaceuticals seek a 70-fold increase in the price of a drug that can extend those patients’ lives — that’s beyond the pale. In fact, it’s outrageous enough that it should persuade California lawmakers finally to shine a light on how drug companies set their prices. (2/28)

The pharmaceutical industry in the United States is impressive. It is producing new drugs that can radically improve or even save people’s lives. But as these companies produce amazing advances, why does it appear that some are taking advantage of the very people the drugs are meant to help? Without painting the industry too broadly, if we are serious about controlling health care costs, we must look at the problems in the system. (Eric H. Shultz, 2/27)

Getting the FDA to approve drugs faster is seen as one way to get the access that many patients and their families want. Vice President Pence and many other legislators seem to have been persuaded that the FDA is the roadblock. It isn’t. The real barrier is payers of prescription drug benefits, such as health insurance companies and self-insured employers. The premise that the FDA needs to speed things up worked in the late 1980s when AIDS activists and cancer groups successfully pressured the FDA to make the drug approval process faster. But this won’t work today because payers, which weren’t nearly as influential 30 years ago, now regulate access to drugs. To speed access to new treatments, then, groups need to incorporate payers into their strategies. (Russell Teagarden and Arthur L. Caplan, 2/28)

Emulating a questionable re-branding role model, Valeant Pharmaceuticals International Inc. referred to itself as "New Valeant" in its quarterly earnings slides on Tuesday. Don't expect New Valeant to be much more successful than New Coke. The perma-troubled specialty pharmaceutical company has taken some positive steps under its new leadership team and CEO, including meeting its own reduced full-year revenue guidance for once and setting relatively conservative future goals. But there's not much that's new about the New Valeant. (Max Nisen, 2/28)

The hot new thing in pharma -- "biosimilar" drugs -- is getting so crowded that soon nobody will want to go there any more. Biosimilars are a relatively new wave of generic-like drugs that substitute for biologic drugs, which are made with living cells rather than chemicals. Many big pharma companies have jumped into the market with both feet. (Max Nisen, 2/24)

The American health care system, in many ways, is an outlier among the world’s economically advanced countries. One of the principal differences, and among the most expensive, is that the U.S. government takes a hands-off approach to the price of medicine. Pharmaceutical companies, which face price controls on drugs in most other countries, in effect, make up the difference with the exponentially higher prices they charge in the United States. American consumers, in effect, subsidize the rest of the world’s prescriptions. (3/1)

[Alpha] Whitaker, a single mom in Indianapolis who put herself through college, had to turn down a dream job because she didn’t have a safe way to get to work. Her bus route ended 10 blocks from the job, and she would have had to walk through a dangerous neighborhood — twice — every day. In choosing safety, Whitaker gave up a job with full health benefits, a 401(k) plan to help her save for her daughter’s education, and a salary that would have allowed her family to move to a safer neighborhood. These things — financial security, health insurance, education, and neighborhood — influence health. (Risa Lavizzo-Mourey and Victor Dzau, 2/28)

It's understandable that some Columbus Police officers are resistant about taking on treating heroin users who have overdosed, as the city expands its successful test of stocking cruisers with the antidote naloxone. Police officers aren't medics, and they have a big enough job on their hands responding to crime. But times change, and first responders' roles must adapt. (3/1)

The California Medical Board has also placed Los Gatos internist Mary Hutchins on probation after she excessively prescribed narcotics and psychotropic drugs to multiple patients. If you are a patient of one of those doctors, wouldn’t you want to know their status? And what happened? You deserve to know. (2/28)

I started and stopped writing this post many times because it’s mostly whining. But, dammit, it’s a consumer’s right to whine, so here it is: in my experience (YMMV) — and that of many others I know — the health care system largely treats patients like garbage. I was reminded of this fact during my recent experience dealing with my daughter’s broken arm. It started well enough. Our pediatrician has late hours and an X-ray machine, so we were able to skip the Friday night (and more expensive) emergency department visit for our initial diagnosis, and therefore missed all the attendant waiting and frustration. (Austin Frakt, 2/28)

The overwhelming stigma her story illustrates is one of the greatest challenges I’ve encountered in my 20 years as a physician treating women and girls living with HIV. I see this every day in my clinic: Many of my patients do not feel safe revealing their status to anyone for fear of rejection or violence. To make matters worse, California still has a number of laws on the books that, instead of promoting public health, criminalize people living with HIV and add substantially to the stigma surrounding it. (Edward Machtinger, 2/28)

Here’s good news for those who believe that free people deserve choices at the end of their lives. It comes from the Arizona House of Representatives by way of an astonishing 60-0 vote in favor House Bill 2076, a bill that furthers an individual’s right to self-determination. Now the Senate needs to pass the measure and Gov. Doug Ducey needs to sign it into law. (Linda Valdez, 2/28)

The health of the environment determines human health. The crowding and squalor of medieval cities, for instance, spurred the Black Death, which claimed the lives of about 60 percent of people living in Europe. The Great London Smog in the 1950s killed thousands of people in just one five-day period. Closer to home and the present, lead poisoning of children has been the longest-standing health epidemic in the United States. Lead in gasoline and paint has damaged the brains of millions of children since the 1920s. Fortunately, bans on leaded gas and lead paint have dramatically reduced the harms, although we still have much to do — as the Flint water crisis reminds us. (Joseph G. Allen, Ari Bernstein and Tracey J. Woodruff, 2/28)

Only a few weeks into a new administration and with it comes unwelcome medical news. The age-old debate about the safety and appropriateness of vaccination has been renewed and a vocal stage has been delivered to a small group of anti-vaccination zealots. Reports have circulated that Robert F. Kennedy, Jr, a highly visible critic of vaccination, has been invited to chair a commission on vaccination safety by the new administration. If it comes to pass, one result can be accurately predicted: This panel will become a confused platform of ideological rhetoric which diminishes trust in those scientific bodies charged with making sound judgments for the public welfare. This inevitable outcome is particularly unfortunate since there has never been any advance in medical history that has had a more positive impact on our lives than vaccination. (Bill Miller, 3/1)

When Republicans won in November, it looked as if 2017 would reflect a major legislative shift to the right. But two months into the 115th Congress and six weeks into the Trump administration, progress on fulfilling Republicans’ major domestic policy goals is looking further away, not closer. Plans to repeal the Affordable Care Act have quickly become a quagmire as lawmakers grapple with the risk of millions losing their health insurance. A corporate tax overhaul that has backing from House Republicans is running into serious opposition among Senate Republicans. (Neil Irwin, 2/28)

Obamacare has permanently shifted America’s health care debate, and Donald Trump’s address to Congress proved it. In the speech, Trump laid out five principles any Obamacare replacement must meet. First, “we should ensure that Americans with preexisting conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the health care exchanges.” (Exra Klein, 2/28)

Since President’s Trump’s election, worried centrists and progressives have entertained the hope that the populists in the president’s circle, though scary in their own ways, will nevertheless restrain the more traditional Republicans in the White House. Maybe chief strategist Stephen K. Bannon will convince Trump to invest in infrastructure and defend the social safety net, even as Vice President Pence and chief of staff Reince Priebus discourage the president from embracing the alt-right. (Stephen Stromberg, 3/1)

President Donald Trump's on-the-job training continues. On Monday he revealed to reporters that he had learned a valuable lesson about reforming Obamacare: It's hard. "It's an unbelievably complex subject," he told reporters Monday in the White House. "Nobody knew health care could be so complicated." (Clarence Page, 2/28)

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions. But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance. (Michael F. Cannon, 2/28)

In the letters nearby Bill Hazel, Virginia’s secretary of health and human resources, takes issue with our recent editorial on Medicaid expansion. We’re grateful for the chance to advance the discussion. The editorial pointed out that Congress might slash the federal reimbursements to states that expanded Medicaid — precisely what Virginia Republicans warned might happen. Hazel correctly points out that this has not yet occurred, and possibly never will. Fair point. His others? Not so much. (2/28)

Last week, Marsha Blackburn, a conservative lawmaker from Tennessee, held a town hall in her district. Citizens confronted her with pointed questions about the GOP plan to repeal the Affordable Care Act (ACA). Blackburn, a prominent member of the president’s transition team, responded by, uh, prevaricating her head off. (Steve Almond, 3/1)

Federalism has become a watchword in the acrimonious debate over a possible replacement for the Affordable Care Act (ACA). Missing from that debate, however, is a theoretically grounded and empirically informed understanding of how best to allocate power between the federal government and the states. For health reform, the conventional arguments in favor of a national solution have little resonance: federal intervention will not avoid a race to the bottom, prevent externalities, or protect minority groups from state discrimination. Instead, federal action is necessary to overcome the states’ fiscal limitations: their inability to deficit-spend and the constraints that federal law places on their taxing authority. A more refined understanding of the functional justifications for federal action enables a crisp evaluation of the ACA—and of replacements that claim to return authority to the states. (Nicholas Bagley, 2/14)