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The Supreme Court will return on Wednesday to the question of whether a regulation requiring many employers to provide free contraception coverage for their workers under the Affordable Care Act violates a federal law protecting religious freedom. In 2014, Justice Antonin Scalia was part of a 5-to-4 majority that voted to limit the mandate, and his death last month raises the possibility of a tie vote in the new case that would leave in place conflicting appeals court decisions and a national legal patchwork. (Liptak, 3/23)

The Supreme Court will hear arguments on Wednesday in a case about access to contraception and religious liberty, Zubik v. Burwell, No. 14-1418. Here is a look at the parties and issues in the case. (Liptak, 3/23)

Contraception is among a range of preventive services that must be provided at no extra charge under the health care law. The administration pointed to research showing that the high cost of some methods of contraception discourages women from using them. Houses of worship and other religious institutions whose primary purpose is to spread the faith are exempt from the birth control requirement. Other faith-affiliated groups that oppose some or all contraception have to tell the government or their insurers that they object. The groups say doing so leaves them complicit because the government is using their insurers and health plans to provide the contraception. (3/23)

The effect that conservative Justice Antonin Scalia's death is having on the Supreme Court's most divisive issues will get another big test when the court convenes Wednesday in the battle pitting religious freedom and birth control. (Williams, 3/23)

Two years ago, Justice Anthony M. Kennedy played down the impact of the decision he had just joined in Hobby Lobby v. Burwell that relieved religiously objecting owners of certain businesses from providing contraceptive coverage to their employees. ... The solution Kennedy suggested — an accommodation that would insulate employers from providing the contraceptive coverage but still ensure that their employees receive it — will be at the heart of the discussion Wednesday when the Supreme Court undertakes its fourth consideration of what is popularly called Obamacare. (Barnes, 3/22)

As in the Hobby Lobby case, the justices are expected to focus on the 1993 Religious Freedom Restoration Act, which bars U.S. laws that “substantially burden” religious expression unless they further a “compelling governmental interest” that can’t be achieved through less-restrictive means. This time, the justices will directly examine the system devised by the Obama administration after the 2014 case. That workaround aims to retain coverage for individuals while meeting religious objections of nonprofit employers such as the Catholic charities overseen by the bishop and for-profit employers such as Hobby Lobby. ... Most lower courts considering the workaround system have sided with the government. ​The court’s likely swing vote, Justice Anthony Kennedy,​suggested in the 2014 Hobby Lobby case that the workaround could reconcile the competing interests of religious objectors and public-health policy. (Radnofsky, 3/23)

“We do not question the sincerity or importance of petitioners’ religious beliefs. But as seven courts of appeals have held, their legal claim stretches RFRA too far,” the Obama administration wrote in its brief to the high court. This is the second Texas case concerning women's health the high court has taken up this term. It is also weighing the constitutionality of Texas' 2013 abortion restrictions. (Ura, 3/23)

As she makes her nursing home rounds, as she has for 28 years, Sister Constance Veit gently grasps frail hands, steers wheelchairs with no-nonsense grace and doles out cheery compliments to those in her care. But the moment the nun gets behind the closed door of a conference room, her demeanor hardens. This is a sister at war. On Wednesday, Veit will be just a few miles from the Little Sisters of the Poor facility where she works in Northeast Washington — and a world away. She will be seated in her habit in the U.S. Supreme Court, a striking representative of the religious organizations fighting the White House health care law because of its requirement that employers cover contraception. (Zauzmer, 3/23)

The Obama administration plans on Wednesday to propose expanding Medicare to cover programs to prevent diabetes among millions of people at high risk of developing the disease, marking the sixth anniversary of the Affordable Care Act with the prospect of a new benefit, federal officials said. Sylvia Mathews Burwell, the secretary of health and human services, is scheduled to announce the proposal at a Y.M.C.A. here. Under the plan, Medicare would pay for certain “lifestyle change programs” in which trained counselors would coach consumers on healthier eating habits and increased physical activity as ways to prevent Type 2 diabetes, formerly called adult onset diabetes. (Pear, 3/23)

Obamacare has its sixth anniversary Wednesday and the White House is declaring victory over critics who said it would fail and multiple lawsuits seeking to have it declared unconstitutional. President Barack Obama signed the law, known formally as the Affordable Care Act, on March 23, 2010 after a big fight with Congress. Democrats held a slim majority at the time and passed the law without a single Republican vote. (Fox, 3/22)

The battleground over Medicaid expansion shifted to the Senate on Tuesday with supporters and opponents reiterating their arguments at a public hearing. Supporters say the New Hampshire Health Protection Program provides health coverage for nearly 49,000 low-income adults, helps to ensure a healthier workforce, puts the brakes on increases in health care and insurance premiums and is the best tool the state has to fight the opioid crisis gripping New Hampshire. ... But opponents said the program provides free health care to able-bodied adults by expanding the federal debt, while preventing the state from addressing other social service needs and providing a windfall for hospitals and insurance companies. (Rayno, 3/22)

Enrollment in a new Medicaid expansion program totals 38,298 as of March 15, with American Indians as 12 percent of the enrollees, members of a state panel overseeing expansion of the program in Montana were told Tuesday. The Montana Health and Economic Livelihood Partnership Oversight Committee reviewed the numbers for the HELP Act, passed by the 2015 state Legislature. (Drake, 3/22)

Montana’s new Medicaid expansion just got its first progress report, and it is exceeding expectations. Initial projections were for about 23,000 of the state’s estimated 70,000 Medicaid-eligible residents to take up the new coverage in its first year. Instead, in the first quarter, since its rollout on Jan. 1, enrollment is at 38,298. The report came Tuesday from the Medicaid expansion oversight committee that Montana’s legislature set up when it approved expansion last year. Supporters cheered the numbers, but some Republicans are still pushing for repeal. (Whitney, 3/23)

More than 38,000 previously uninsured Montanans have enrolled for health coverage from the state’s Medicaid expansion program — surpassing projections by thousands. ... State officials said they are especially encouraged by the number of young adults who have enrolled. ... Of those who have enrolled, 82 percent fall below the poverty line, roughly 12 percent have been American Indians and 46 percent have been between the ages of 19 and 34. (Houghton, 3/22)

In a largely symbolic action, the House voted Tuesday to preserve Kentucky's health insurance exchange, kynect, and its expansion of Medicaid under the Affordable Care Act. The votes, carried by the Democratic majority, came the same day as a new, national study found that states that have expanded Medicaid under the law also known as Obamacare are faring far better than states that have rejected the additional health coverage. But House Bill 5, to keep kynect, and House Bill 6, to preserve the Medicaid expansion, likely will die in the Senate, controlled by Republicans - which House Speaker Greg Stumbo acknowledged even as he spoke in favor of HB 5. (Yetter, 3/22)

In an effort to stem the epidemic of prescription drug abuse, the Food and Drug Administration will require its strongest warning on immediate-release opioid painkillers. The "black box" warning will alert users to the "serious risks of misuse, abuse, addiction, overdose and death" involved with taking opioids, a class of painkillers that includes morphine, Vicodin and Percocet. The warnings will appear on immediate-release painkillers, which are taken every four to six hours. (Szabo, 3/22)

Federal health regulators will add their strongest warning labels to the most widely prescribed painkillers, part of a multi-pronged government campaign to stem an epidemic of abuse and death tied to drugs like Vicodin and Percocet. The Food and Drug Administration announced Tuesday plans to add a boxed warning — the most serious type — to all immediate-release opioid painkillers, including some 175 branded and generic drugs. (3/22)

In a briefing for reporters, FDA Commissioner Robert Califf called opioid addiction one of the most "urgent and devastating public health crises facing our nation" and said the new labels were just part of the government's larger strategy for addressing it. But Sen Edward Markey (D-Mass.), who delayed Califf's confirmation while he demanded that the FDA overhaul its approval process for opioid medications, issued a statement saying that "the labels given by the FDA have done little to prevent opioid addiction. Unfortunately, it has taken the FDA far too long to address the grave risks of these drugs that have claimed the lives of thousands this year alone." (Bernstein, 3/22)

The actions follow separate FDA requirements unveiled last month, including that any new opioid go before an outside committee of experts unless the product has abuse-deterrent properties. In 2013, the agency mandated labeling changes for extended-release and long-acting opioids, which generally pack a larger load of medicine and tend to be favorite choices of addicts. But the immediate-release versions make up about 90% of the market, said FDA officials. The new rules—expected to go into effect by the end of the year, following comment—clarify that immediate-release opioids should be reserved for severe pain with inadequate treatment alternatives, the agency said. (Beilfuss and Burton, 3/22)

Califf said the FDA wants to warn doctors and patients about the dangers of the drugs while ensuring they remain available for patients who need them to alleviate pain. However, Califf stressed the drugs should be reserved for severe pain for which no alternatives are available. In addition to the risks of addiction and overdose from opioids, the new labels will also warn that chronic use of the drugs by pregnant women could lead their newborns to suffer from neonatal opioid withdrawal syndrome. (Stein, 3/22)

“Opioid addiction and overdose have reached epidemic levels over the past decade, and the FDA remains steadfast in our commitment to do our part to help reverse the devastating impact of the misuse and abuse of prescription opioids,” Dr. Robert Califf, the FDA’s new commissioner, said in a statement. (Scott, 3/22)

Health insurers’ bargaining power is set to grow. That is an issue for all health-care investors. The latest reminder: news Monday that health insurer Anthem is suing one of its vendors, the pharmacy-benefit-management company Express Scripts Holding. And this isn’t a small-change legal action. ... Major insurers such as Anthem have been bulking up of late. Last summer, Anthem agreed to purchase Cigna for $48 billion, while Aetna agreed to purchase Humana for $34 billion. The companies expect the deals to close sometime this year. Assuming they do, these deals would give the insurers more leverage than ever before as they negotiate prices with health-care companies. That could have implications for the pricing power of companies throughout the system. (Grant, 3/22)

Some health insurers are hoping to ease headaches that can flare when customers try to confirm whether a doctor is covered in a plan's network of providers. The trade association America's Health Insurance Plans will soon start testing a more efficient way to update insurer provider directories, which are becoming critical for finding the right fit as insurance evolves and coverage networks shrink. America's Health Insurance Plans, known as AHIP, will attempt to streamline directory updates by testing a new concept next month in California, Florida and Indiana. AHIP will have one health information technology company contact providers for regular updates on standard information like whether they are accepting new patients and if they are still in a coverage network. Then AHIP will share that information with several insurers. (3/22)

Venture capitalists and entrepreneurs have been investing and building new health insurance and related companies at a torrid pace—which may seem odd, because the industry is highly regulated and has relatively low profit margins. But widespread consumer dissatisfaction with dominant carriers and the Affordable Care Act's new marketplaces for individual plans has created an opening for innovators to come up with alternative approaches and has primed investors to take a chance on what they're pitching. ... However, these alternative companies, many of which are in their infancy, have a lot to prove. (Herman, 3/19)

With the expectation that more N.F.L. players will suffer dementia from repeated head hits, businesses that cater to people with memory loss are gearing up for what could be droves of new clients in the near future. One company, Validus, based in Tampa, Fla., has gone the furthest, striking a deal last year with the N.F.L. Alumni Association to provide special treatment to former players with dementia. (Belson, 3/22)

The expansion of memory-care living facilities is part of the ongoing evolution of senior citizen residential care, which has seen rapid changes over the past few decades. Few people move directly into nursing homes anymore. Rather, the first move these days for elderly Americans entering the last stages of life is usually into their own apartments within an assisted-living facility. Only later do they move into a skilled-nursing facility as their care needs expand. “Going from nothing to everything is rare,” Schnure said. Memory care is the latest wrinkle in the earlier slice of the continuum. About 70% of memory-care units are add-ons to assisted-living facilities. Only about 30% are free-standing, according to the NIC. (Sandler, 3/19)

Naloxone, also known by the brand name Narcan, has become a key tool in curbing overdoes resulting from the nation’s opioid abuse epidemic. The class of drug that includes prescription painkillers and heroin was involved in a record 28,648 deaths in 2014, and opioid overdoses have more than quadrupled since 2000, according to the Centers for Disease Control and Prevention. Recently released inmates are particularly vulnerable. Officials already widely distribute the drug to police, paramedics, drug users and their families. The push to equip inmates is new, fueled by research showing former prisoners in Washington state were nearly 13 times more likely to die of an overdose in the two weeks after their release than other people. (Gurman, 3/23)

In a 17-month span, nearly 1,000 people in Ohio died of opioid overdoses related to a powerful painkiller that is fueling a public health crisis in communities across the state, according to a new report by the Centers for Disease Control and Prevention. The report concluded that fentanyl, a drug 30 to 50 times more potent than heroin, is responsible for the majority of recent overdose deaths and is continuing to kill people in large batches. (Ross, 3/22)

The country’s broadening crisis of heroin and pain pill overdoses comes at a time when many centers for addiction treatment in the United States are operating at capacity. In the St. Louis region, providers report wait times of three weeks or more. A spike in addictions means more people seeking treatment, but at the same time, providers are constricted in their ability to expand. (Bouscaren, 3/22)

You've probably heard that a little booze a day is good for you. I've even said it at parties. "Look at the French," I've said gleefully over my own cup. "Wine all the time and they still live to be not a day younger than 82." I'm sorry to say we're probably wrong. The evidence that alcohol has any benefit on longevity or heart health is thin, says Dr. Timothy Naimi, a physician and epidemiologist at Boston Medical Center. He and his colleagues published an analysis 87 of the best research studies on alcohol's effect on death from any cause in the Journal of Studies on Alcohol and Drugs on Tuesday. "[Our] findings here cast a great deal of skepticism on this long, cherished belief that moderate drinking has a survival advantage," he says. (Chen, 3/22)

Last week, the Centers for Disease Control and Prevention told doctors they should really, really think twice before prescribing opioids for chronic pain. And now the doctors are telling us that meditation and cognitive behavioral therapy often work better than pain meds and other medical treatments for chronic back pain. It's the latest in a series of studies saying that low-tech interventions like exercise, posture training, physical therapy and just the passage of time work better than opioids, imaging or surgery for the vast majority of people with chronic back pain. (Shute, 3/22)

Only 2.7 percent of adults nationwide have all four basic healthy characteristics, a new study found. The report, completed by researchers at Oregon State University and other universities, examined if adults were successful in four areas that fit typical advice for a "healthy lifestyle"-- moderate exercise, a good diet, not smoking and having a recommended body fat percentage. Fulfilling those characteristics reflects a lower risk of cardiovascular disease, cancer, type 2 diabetes and other health problems, according to a news release from Oregon State. (Frazier, 3/22)

As scientists struggle to understand the threat posed by Zika virus, there's another viral infection that's a known danger in pregnancy and that harms 100,000 babies a year, even though it has been preventable with a vaccine since 1969. The disease is rubella, or German measles. Like Zika, the rubella virus often causes either a mild rash or no symptoms at all. ... As researchers try to figure out how much risk Zika virus poses to a fetus, Plotkin says it's deja vu for folks who lived through that extensive rubella outbreak. (Greenfieldboyce, 3/22)

You may have seen the NPR story about the University of Wisconsin, Madison scientists who are studying Zika virus. Dave O’Connor and Tom Friedrich are deviating from the ordinary method for disseminating research — publishing in a peer-reviewed journal — by posting their data as they collect it, in real time. O’Connor and Friedrich want to answer important unknowns about the virus, including how long the virus is present after infection, where in the body besides the blood it exists, and what the likelihood is that an infected mother will pass the virus on to her offspring. (Brooks, 3/22)

Hackers demanded a ransom from two more Southern California hospitals last week and federal authorities are investigating the case. Prime Healthcare Services Inc., a fast-growing national hospital chain, said the attackers infiltrated computer servers on Friday at two of its California hospitals, Chino Valley Medical Center in Chino and Desert Valley Hospital in Victorville. The company said the cyberattack had not affected patient safety or compromised records on patients or staff. (Terhune, 3/22)

In a perfect world, patients with advance directives would be confident that their doctors and nurses — no matter where they receive care — could know in a split second their end-of-life wishes. But this ideal is still in the distance. Patients’ documents often go missing in maze-like files or are rendered unreadable by incompatible software. And this risk continues even as health systems and physician practices adopt new electronic health records. So advocates and policymakers are pushing for a fix. (Luthra, 3/23)

When California’s aid-in-dying law takes effect this June, terminally ill patients who decide to end their lives could be faced with a hefty bill for the lethal medication. It retails for more than $3,000. Valeant Pharmaceuticals, the company that makes the drug most commonly used in physician-assisted suicide, doubled the drug’s price last year, one month after California lawmakers proposed legalizing the practice. (Dembosky, 3/22)

California’s aid-in-dying law contains a provision allowing doctors and hospitals to opt out of helping terminally ill patients access medications that would help them hasten their deaths, but that same exemption will not be carved out for state taxpayers, U.S. News has learned. The state government plans to assist in the cost of providing life-ending medications and doctor visits using $2.3 million already quietly tucked into Democratic Gov. Jerry Brown’s proposed budget in January, according to a spokesperson for California’s Department of Health Care Services. Of five states that offer aid-in-dying options, California will be the second, after Oregon, that covers the prescriptions using public funds. (Leonard, 3/21)

Hospitals in northeast Ohio say they are well prepared to handle a mass casualty event, such as the terrorist bombings that killed at least 34 people and injured more than 106 others in Brussels Tuesday morning. But federal funding for training and supplies has been cut by over 50 percent in the last decade, raising questions about preparedness in the future. (Evans, 3/22)

Broward County and major hospital systems in Jacksonville and Miami are challenging the Florida Department of Health about a proposed change in the way trauma centers are divvied up among various parts of the state. (Saunders, 3/22)

The Florida Supreme Court is declining to take up an appeal by the state Agency for Health Care Administration in a dispute about whether a Baker County hospital can challenge the approval of a potential competitor in nearby Jacksonville. (3/22)

Gov. Rick Scott on Friday suspended two board members, including the chairman, of the North Broward Hospital District because of concerns about interference in an inspector general's investigation of possible wrongdoing at the district. (3/22)

It’s not just Flint that’s got lead issues: It’s in all 50 states, and it’s in schools and day cares. Florida ranked ninth in the country for the number of water systems with excessive lead levels. Lead levels were at actionable levels 80 times from from 2012 to 2015. In Florida, tests ranged from 15.5 parts per billion to 340 parts per billion at the highest level. (Aboraya, 3/22)

In the Philadelphia region the business of moving patients by ambulance is on financial life support. The industry is reeling, operators say, because of poor pay from hospitals and private health insurers, a sharp rise in Medicaid patients, and efforts to squeeze bad operators out of the business of nonemergency care. (Brubaker, 3/22)

Wisconsin Attorney General Brad Schimel asked the U.S. Supreme Court on Tuesday to reinstate a requirement that doctors who provide abortion have admitting privileges at nearby hospitals — a regulation that has been blocked by lower courts as unconstitutional. (Marley, 3/22)

Ohio lawmakers should increase the tobacco tax, raise the tobacco-buying age to 21 and ban the sale of crib bumpers, according to a state panel tasked with addressing infant mortality. The recommendations are among dozens in a report by the Ohio Commission on Infant Mortality released Tuesday. (Sanner, 3/22)

The Public Health Committee voted 20 to 7 Monday to move forward a proposal that would allow minors with certain medical conditions to use medical marijuana. Under the proposal, minors would be allowed to participate in the state’s medical marijuana program if they have one of six conditions and permission from a parent or guardian, their primary care provider, and a physician who specializes in the patient’s condition. The qualifying conditions would be: severe epilepsy, a terminal illness that requires end-of-life care, cerebral palsy, cystic fibrosis, uncontrolled intractable seizure disorders, and irreversible spinal cord injury with objective neurological indication of intractable spasticity. (Levin Becker, 3/22)

A prison health-care company is asking a judge to allow it to pursue a challenge to the Florida Department of Corrections' decision in January to award a contract to another firm to provide health services at the majority of the state's prisons. Wexford Health Sources, Inc., filed a document Friday in the state Division of Administrative Hearings arguing that it should be able to continue a formal protest against the department's award of a $268 million contract to Centurion of Florida, LLC. (3/22)

When President Barack Obama signed the Affordable Care Act, six years ago this week, he addressed the rancor the health-care debate had inspired with a call to resist cynicism. “We are not a nation that does what’s easy," he said. "We are a nation that does what is hard. What is necessary. What is right. Here, in this country, we shape our own destiny.” (Sylvia M. Burwell, 3/22)

Court on Wednesday will again consider the Affordable Care Act’s requirement that all insurance plans provide free access to contraceptives. Some religiously affiliated nonprofit groups object — not to the requirement per se, but to the work-around the government devised to accommodate their theological opposition to contraception. The nonprofits do not have a strong case. ... All the nonprofits have to do is fill out a simple form. They claim it is sinful for them to sign the form, which enables a process whereby someone else takes the time and expense of distributing contraception to employees who want it. The nonprofits argue that the government is not simply asking them to “raise their hand” in objection. They would have to give the government the names of their insurers, which the government would use to arrange for separate contraception coverage. The government “is forcing them to hand over the keys” to their health plans. (3/22)

The Supreme Court will hear a second challenge to the Affordable Care Act’s contraceptive mandate on Wednesday in a case called Zubik v. Burwell. The plaintiffs want to extend the 2014 ruling in Burwell v. Hobby Lobby Stores, which recognized the right of certain for-profit companies to a religious exemption from the act’s requirement that employers’ health plans provide contraceptive coverage. This time, the objection comes from a handful of religious nonprofits that argue that the government’s religious exemption itself infringes on their religious freedom. (Elizabeth Deutsch, 3/23)

On Wednesday, the Supreme Court will hear arguments in yet another challenge to the implementation of the 2010 Patient Protection and Affordable Care Act, better known as Obamacare. Although the legal issues are complex, the case of Zubik vs. Burwell can be summed up in an old saying: “No good deed goes unpunished.” The good deed in this case is the Obama administration's decision to accommodate religiously affiliated employers who believe birth control to be immoral. (3/22)

My religion has always been a big part of my life. I was raised Catholic, received a Catholic education and taught at a religious school for years. My daughter is in Catholic school now. But the church’s attempts to block my access to health care have made me feel disillusioned. Frankly, I’ve lost a great deal of faith in its teachings. As a teacher at a religiously affiliated school between 2007 and 2015, my health insurance was managed by the archdiocese. It didn’t cover contraception. We were told that the plan was in line with the beliefs of the church. (Sonia Guizar, 3/22)

As a doctor and a researcher, I spend my days working with women in St. Louis as they navigate some of the most important decisions of their lives, including their reproductive decisions. I see the impact of political decisions — decisions that are disconnected from the lived experiences of women — in my daily work as I talk to women about finding the best contraceptive method for them. That is why I am so concerned about the Zubik v. Burwell case currently at the Supreme Court. (3/22)

Money always ranks high among the reasons for divorce. In the failing marriage between Anthem Blue Cross and Express Scripts, it's reasons one through 15 billion. That's how many dollars the party of the first part thinks its been cheated by the party of the second part. For those who missed the wedding announcement back in 2009, the first is the nation's second-largest health insurance company and his (or her) partner is the nation's biggest pharmacy benefits management firm, or PBM. They seemed to be in a marriage made in heaven, until household finances strained the relationship to the breaking point. (Michael Hiltzik, 3/22)

The contrast with Republicans is obvious. The House GOP released a budget that cuts domestic spending to levels lower than they were eight years ago, with the bulk of the cuts coming from programs for the most vulnerable. They would promote fracking, cut funding for renewable energy, end support for Amtrak and urban mass transit, shut down the Consumer Financial Protection Bureau, repeal the Affordable Care Act without a plan to replace it and turn Medicaid and food stamps into block grants for the states to savage. They would increase military spending. The Congressional Budget Office warned that under the House proposal, “economic output would be lower . . . because differences in federal spending and revenues would reduce total demand for goods and services.” Over the past decades, conservatives in both parties have failed the vast majority in this country. The CPC People’s Budget, like the Sanders platform, shows there is an alternative. Bold, big reforms can make our lives better. (Katrina vanden Heuvel, 3/22)

A scuffle last week over whether independent Vermont Sen. Bernie Sanders adequately supported former Secretary of State Hillary Clinton’s 1993-1994 health care reform efforts highlighted how the question of moving beyond the Affordable Care Act has emerged as a defining difference between the two candidates. The most recent dispute seems to have been resolved. But the larger issue remains. Just as we saw with President Lyndon B. Johnson's fight for Medicare in 1965, both candidates are presenting plans that while politically expedient, fail to adequately control costs. (Tony Lucadamo and Guian McKee, 3/22)

Fewer than half of Iowans polled approve of how Gov. Terry Branstad is handling his job, according to a February Des Moines Register/Mediacom Iowa Poll. His 42 percent disapproval rating reflects a level of dissatisfaction in this governor not seen since 1993. It would be no surprise if this is an indication of the frustration felt as he rams through his pet project of privatizing management of Medicaid health insurance. The move is creating uncertainty and disruption for hundreds of thousands of patients and providers. The majority of Iowans trust the state, not private companies, to operate the program, according to the same poll. But Branstad doesn’t care about what constituents want, or what makes sense, on this issue. In one week, Iowa will abandon a state-run Medicaid model that has worked well for decades. Managed care companies will take over the $4.2 billion government program. (3/22)

A few moments of inattentiveness can end in tragedy if patients with serious mental issues aren’t properly monitored. In 2014, for example, a patient left unattended at Universal Health Services’ Timberlawn Mental Health System in Dallas hanged herself from a closet doorknob with a bedsheet. The mental health unit’s policy required staff to check on patients every 15 minutes. In their investigation of the death, regulators found no evidence that this procedure was followed, even though staffers knew the woman posed a danger to herself. (3/22)

Two recent patient-safety initiatives—one designed to curb opioid overprescribing and the other a heart-device recall—reveal the limits of voluntary action when it comes to avoiding harm from drugs and medical devices. The Centers for Disease Control and Prevention issued voluntary guidelines last week for how physicians and hospitals should prescribe opioids for long-term pain relief. The CDC recommended starting with over-the-counter pills such as ibuprofen before switching to low-dose opioids if the initial treatment is ineffective. (Merrill Goozner, 3/19)

Calling all techies: The Substance Abuse and Mental Health Services Administration plans to award a total of $30,000 in prizes for apps that can be worked into recovery plans for opioid addiction. A number of digital health developers have turned their attention to the behavioral health space, which has traditionally existed in its own silo. But as new regulations have pushed for payment parity with physical health conditions, more investment is flowing into the sector. There's also growing awareness among health systems that they'll need to tackle mental health if they want to succeed with risk-based payment contracts that reward them for outcomes. (Beth Kutscher, 3/21)

Despite expanding primary prevention efforts, the majority of individuals will develop cardiovascular disease (CVD) during their lifetime.1,2 The discordance between short-term (10-year) and long-term (30-year to lifetime) cardiovascular risk is well established and is now reflected in the most recent clinical practice guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) on lipid-lowering treatment for primary prevention of atherosclerotic CVD (ASCVD).3,4 Specifically, these guidelines recommend that lifetime risk estimation can be used as a communication strategy for adults younger than 60 years who are free of ASCVD and not candidates for lipid-lowering therapy. Although a high lifetime ASCVD risk has not been recommended as a class I indication for lipid-lowering treatment, the acknowledgment of lifetime risk in the guidelines indicates a more comprehensive awareness of the importance of prevention of ASCVD over a life span. Risk estimation remains an imperfect science. However, by focusing on the key elements of risk prediction over a lifetime—the treatment thresholds, risk factor trajectories, and predicted outcome—advances can be made to more accurately identify individuals at an increased lifetime ASCVD risk to tailor optimal primary prevention strategies. (Maarten J.G. Leening, Jarrett D. Berry, and Norrina B. Allen, 3/21)