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The implosion of Ronny Jackson’s nomination to lead the Veterans Affairs Department may look like the Trump administration’s drama of the moment, but it carries big consequences for 9 million veterans in a sprawling health care system with uneven results and a precarious future. Not only does the VA have no leader, the veteran health care community is divided between conservatives inclined to privatize much of veterans’ care and those who want to invest more in fixing the current system. The impact can be seen across 170 medical centers and hundreds of clinics of varying quality that treat veterans who served in the U.S. military in every conflict since World War II. (Allen, 4/26)

Amid the noise over Dr. Ronny Jackson withdrawing from consideration for secretary of Veterans Affairs, key lawmakers and stakeholders vow the long-stalled VA Choice reforms will move forward as planned even as the timeline grows shorter and the focus has shifted to finding the next nominee. The House VA Committee this week was supposed to debate the bipartisan agreement reached last month, but that has been postponed until early May, and not all parts of the deal are set in stone, according to aides close to talks. (Luthi, 4/26)

Leaders from the Mayo Clinic, Partners HealthCare, and other large hospital systems have been quietly advising the Trump administration on how to improve the Department of Veterans Affairs, the Mayo Clinic’s chief executive said Thursday in Boston. (Dayal McCluskey, 4/26)

Another day, another casualty. Or two. By the time the sun set Thursday, Dr. Ronny L. Jackson was a failed cabinet nominee whose life had been picked apart for public consumption, and Michael D. Cohen was back in court facing possible criminal prosecution. A ride on President Trump’s bullet train can be thrilling, but it is often a brutal journey that leaves some bloodied by the side of the tracks. In only 15 months in office, Mr. Trump has burned through a record number of advisers and associates who have found themselves in legal, professional or personal trouble, or even all three. (Baker and Haberman, 4/26)

Ronny L. Jackson’s withdrawal from consideration to lead the Department of Veterans Affairs stanched an immediate political crisis for the Trump White House, but it sparked new questions over his future as the president’s doctor and the fate of the embattled agency. Jackson announced Thursday morning that he was pulling out of the nomination process amid a mushrooming cloud of allegations over professional misconduct, leaving in limbo a sprawling federal bureaucracy serving 9 million military veterans that President Trump has called a top domestic priority. Yet even as Jackson strongly denied the charges against him, calling them “completely false and fabricated” in a defiant statement, his position as Trump’s chief physician and a pending Navy promotion looked shaky. (Rein, Lamothe and Nakamura, 4/26)

Jon Tester didn't intend to play a central role in taking down President Donald Trump's pick to lead the Veterans Affairs Department. Yet that's exactly what the Montana Democrat ended up doing. And now, Trump is coming after him. (Everett, 4/26)

Job vacancies are fast becoming a singular threat to President Donald Trump’s administration, with a record number of openings that stretch from low-level appointments to the secretary’s office at the Department of Veterans Affairs. While civil servants have stepped up to fill gaps, their power and influence is limited — and many senior career government workers have quit or retired since Trump took office, taking institutional knowledge with them. (Woellert, 4/27)

Kaiser Health News: Podcast: KHN’s ‘What The Health?’ What’s Next For The VA?

The Trump administration has withdrawn the nomination of White House physician Ronny Jackson to head the Department of Veterans Affairs after allegations surfaced about inappropriate handling of prescription drugs, issues with alcohol and difficulties working with other White House medical unit staffers. It is unclear whom the White House will turn to next to take over the helm at the VA. (4/26)

Twenty Republican-led states are seeking to temporarily invalidate former President Barack Obama's health care law while their larger lawsuit against it proceeds. In a February suit, Texas and Wisconsin led a coalition arguing that the Affordable Care Act is no longer constitutional after the Republican-backed tax overhaul eliminated fines for not having health care coverage. Sixteen states with Democratic governors later sought to intervene. They suggested that Democratic attorneys general will have to defend the law because President Donald Trump's administration won't. (4/26)

Attorney General Ken Paxton is urging a federal court to eliminate Affordable Care Act regulations in Texas before the end of the year. Paxton and Wisconsin Attorney General Brad Schimel are leading a 20-state coalition that sued in February, challenging the constitutionality of the law. On Thursday, the coalition asked the U.S. District Court for the Northern District of Texas to grant a preliminary injunction by Jan. 1, 2019. (Wang, 4/26)

The CMS has once again allowed insurers and states to renew so-called transitional health plans that pre-dated Affordable Care Act coverage requirements and that don't have to comply with those rules. State officials have the option to end these "grandmothered" plans in the individual and small-group markets. But about three dozen states have allowed them to continue, even though experts say moving transitional plan enrollees into the ACA-regulated market likely would bring down premiums. (Meyer, 4/26)

The health care industry is largely united in opposition to the Trump administration’s efforts to expand short-term plans that don’t meet the Affordable Care Act’s coverage requirements. Groups representing insurers, hospitals, doctors and patients all offered strong criticism of the proposal in recent comments to CMS, warning that making it easier to purchase skimpier plans will siphon off healthier customers from Obamacare and further destabilize the law’s wobbly marketplaces. (Demko, 4/26)

The Trump administration will cut Planned Parenthood out of Title X family planning grants with an executive order expected in early May, according to a White House aide. It's the most drastic move in President Donald Trump's strategy to reshape Title X. The program offers family planning services for about 4 million people, and 1.6 million, or 40%, of these get their Title X-funded care at Planned Parenthood clinics, according to the Guttmacher Institute, a women's reproductive health policy think tank. Trump's 2018 and 2019 budget blueprints called for banning all federal funding to Planned Parenthood. (Luthi, 4/26)

Texas served thousands more people in its women’s health and family planning programs last year compared to the year before. But it’s impossible to say if the number of women accessing such services has returned to the levels they were at before massive budget cuts during the 2011 legislative session. (Evans, 4/26)

After the state pursued a multi-million dollar marketing campaign to enroll more women in the program, the number of women served in 2017 increased by 29 percent since last year, from 70,336 to 122,406, according to the new report, which was mandated by the Texas Legislature last year. The number of providers also increased 16 percent between 2015 and 2017 and the number of women who received long-acting reversible contraception, like intrauterine devices, also increased. In 2017, 10,203 women in the Healthy Texas Women Program and 7,675 women in the state’s Family Planning Program received a form of the contraception. (Chang, 4/26)

A planned House Foreign Affairs markup of the State Department policy bill has been indefinitely postponed, with members of both parties blaming Rep. Christopher H. Smith's insistence on debating abortion amendments for the delay. The New Jersey lawmaker is a senior Republican on the panel and has been considered a possible successor to Chairman Ed Royce, R-Calif., who is retiring at the end of this Congress. But the markup squabble could ultimately hurt his leadership prospects. (Oswald, 4/26)

Two Planned Parenthood groups — Comprehensive Health of Planned Parenthood Great Plains and Reproductive Health Services of Planned Parenthood of the St. Louis Region — are pushing for a preliminary injunction to block the law, which they say is causing "irreparable harm" to the clinics and their patients and imposing an undue burden on women's right to choose abortion. They’re squaring off in federal court against the Missouri Attorney General’s Office, which is representing the state. (homas, 4/26)

To its critics here, the needle exchange was an unregulated, mismanaged nightmare — a “mini-mall for junkies and drug dealers” in the words of Danny Jones, the city’s mayor — drawing crime into the city and flooding the streets with syringes. To its supporters, it was a crucial response to an escalating crisis, and the last bulwark standing between the region and a potential outbreak of hepatitis and H.I.V. When Charleston closed the program last month after a little more than two years of operation, it was the latest casualty of a conflict playing out in a growing number of American communities. At least seven other such exchanges have closed in the past two years, even as dozens of others have opened. (Katz, 4/27)

The war on opioids is making it tough for Evelyn Lopez to get narcotic pain medication. A doctor recently stopped prescribing an opioid she had taken for years, saying it wasn’t worth possible federal scrutiny. Ms. Lopez, a 53-year-old cancer survivor, also must travel 45 minutes to pick up another opioid prescription because her doctor isn’t allowed to call a pharmacy for a refill. “I have to jump through more and more hurdles,” said Ms. Lopez, of Hazlet, N.J., who has chronic pain from treatment for her non-Hodgkin lymphoma, which is in remission. “For people like me who depend on this medication, what they’re doing is a huge injustice.” (Armour, 4/26)

After three years of work, the state of Minnesota has finalized guidelines for how doctors should prescribe opioid painkillers that include starting certain patients on the lowest effective dose. (Collins, 4/27)

Drew was in his early 30s. His medical history included alcohol abuse, but he had been sober for several months when he became my patient. His previous doctor had given him a prescription for Ativan, or lorazepam, which is frequently used to allay tremors and seizures from alcohol withdrawal. My first inclination was to wean him off the medication by lowering the dose and telling him to take it less frequently. But inertia is strong in medical care, and Drew prevailed upon me to continue providing lorazepam at his regular dose for another month while he solidified his situation with a new job. (Schumann, 4/26)

The identity of one of California’s most notorious serial killers had been a mystery for decades — until this week, when law enforcement arrested a suspect. Investigators revealed on Thursday that they made the breakthrough using a remarkable tool: a commercial genealogy website. The unusual manner in which the Golden State Killer case was cracked has sparked wonderment — as well as privacy concerns about how law enforcement can and does use the genetic information that consumers give up to genetic testing companies. That’s because companies generally say on their websites that a customer’s genetic information can be shared with law enforcement if demanded with a warrant. (Robbins, 4/26)

Millions of Americans are doing it – packing up samples of their saliva and mailing it off to an online genealogy company to analyze their DNA and help trace their family tree. Without knowing it, they may be helping law enforcement crack difficult cases. (Kasler and Chabria, 4/26)

Joseph James DeAngelo, who authorities suspect is the so-called Golden State Killer responsible for at least a dozen murders and 50 rapes in the 1970s and 80s, was arrested more than three decades after the last killing with the help of information from an online genealogical site. Investigators haven’t disclosed many key elements about how and why they took this very unusual step to find a suspect. Here’s a look at the case and some of the questions surrounding it. (Balsamo, 4/27)

The Golden State Killer’s barrage of rapes and murders began in a gold mining area east of Sacramento in 1976. By 1986, it seemed to have stopped.Why? With the arrest Tuesday of Joseph James DeAngelo, 72, who has been charged so far with eight counts of murder, more than 30 years had passed since the last episode in the series. That long period of quiescence seems to fly in the face of the popular belief that serial rapists and killers are incapable of stopping. (Hoffman, 4/26)

The government estimates that autism is becoming more common, but it's only a small increase and some experts think it can be largely explained by better diagnosing of minority children. About 1 in 59 U.S. children were identified as having autism in 2014, according to a Thursday report from the Centers for Disease Control and Prevention that focused on 8-year-old children. That's up from 1 in 68 children in both 2010 and 2012. (Stobbe, 4/26)

Normally, health officials would prefer to see less of a disease, not more of it. But in this case, the higher number is probably a sign that more children of color who are on the autism spectrum are being recognized as such and getting services to help them, according to a report published Thursday by the Centers for Disease Control and Prevention. The data come from the CDC's Autism and Developmental Disabilities Monitoring Network. ADDM researchers pore over medical reports from pediatric clinics, neurologists, child psychologists, speech pathologists and physical therapists, as well as records of special education services provided through public schools. (Kaplan, 4/26)

The study, based on 2014 research, again identifies New Jersey with the highest incidence. One in 34 children in that state, or 3 percent, fall on what’s called the autism spectrum, which encompasses a range of social, behavioral and learning disorders ranging from the barely noticeable to the profoundly debilitating. (Young, /26)

Senate Minority Leader Chuck Schumer on Thursday said President Trump's new director of the Centers for Disease Control and Prevention (CDC) believes there isn’t a prohibition on his agency researching gun violence. Robert Redfield "agreed there is no longer a prohibition on the CDC conducting research on the gun violence epidemic," Schumer said after a meeting with Redfield. "That is a good first step but we have a lot of work to do to ensure the CDC initiates this extremely important research in the near future." (Weixel, 4/26)

A recent spate of infections linked to romaine lettuce is now the largest multistate food-borne E. coli outbreak since 2006, according to data from the Centers for Disease Control and Prevention. At least 84 people were infected in 19 states between mid-March and mid-April, the C.D.C. announced Wednesday, adding more than two dozen cases to its previous count. Because of the time it takes for an illness to reach the agency’s attention, illnesses contracted after April 5 may not yet have been reported, the agency said. (Chokshi, 4/26)

It's been nearly 16 years since cleanup work officially ended at New York City's ground zero, but the health effects for rescue and recovery workers are still making themselves known. Two studies published Thursday in the journal JAMA Oncology suggest that the firefighters who came to lower Manhattan after the Sept. 11, 2001, attacks on the World Trade Center face a heightened risk of cancer — and will continue to do so for years to come. (Kaplan, 4/26)

Not long before her seventh birthday, Amelia Eldred, a small dancer with big dreams of performing on stage, received a devastating diagnosis. Doctors discovered a 10-centimeter tumor in the femur in her left leg — and it had broken the bone, according to Birmingham Live. When the tumor did not respond to chemotherapy, doctors told her parents that the limb would need to be amputated, but they had a solution to help the active child maintain her mobility, according to the British news site. (Bever, 4/26)

For more than 200,000 years, Neanderthals successfully occupied the cold, dark forests and shores of Europe. Then early humans came along. Archaeological evidence suggests that human migrants from Africa arrived on the European continent around 40,000 years ago. About that same time, the Neanderthals all died off. (Netburn, 4/27)

Dr. Thomas Parran Jr., whose name graces the main building of the University of Pittsburgh Graduate School of Public Health, has also been called an architect of the syphilis experiments on black men and women in Tuskegee, Ala. While he was surgeon general, he was also aware that U.S. public health researchers were intentionally infecting with syphilis Guatemalan people who were mentally ill or in prison, in the name of research. Now, under pressure from students who say Parran’s role in these experiments shows his disregard for human lives, the university is grappling with whether to strip his name from the building, and by default, the school he helped found after decades of public service. (Satyanarayana, 4/27)

In a new paper in the journal Science Advances, researchers from Boston University and Israel offer an explanation for these "short arousals." They blame "neuronal noise" — random fluctuations in your neurons' voltage that sometimes rise to the level of waking you up. (Goldberg, 4/26)

Consuming caffeine during pregnancy may increase the risk for obesity in childhood, researchers report. A Norwegian study, in BMJ Open, involved 50,943 mother-infant pairs. The mothers reported their caffeine intake at 22 weeks of pregnancy, and the researchers followed their children over the next eight years. After adjusting for other variables, the scientists found that compared with the children of women who consumed less than 50 milligrams of caffeine a day, those whose mothers had 50 to 199 milligrams were only slightly more likely to be overweight at ages 3 through 8 years. (A cup of brewed coffee contains about 100 to 150 milligrams of caffeine.) (Bakalar, 4/26)

Not-for-profit health system ProMedica is taking a giant step outside of the traditional hospital space with its plan to acquire bankrupt nursing home provider HCR ManorCare for about $1.4 billion through a complex proposed deal. Running parallel to the deal is real estate investment trust Welltower's agreement to buy HCR's landlord, fellow REIT Quality Care Properties, in a cash deal for $20.75 per share, or roughly $2 billion. Welltower and ProMedica also formed a joint venture for QCP's real estate in which Welltower will own 80% and ProMedica will own 20%. (Bannow, 4/26)

Tenet Healthcare has spent $630 million to increase its stake in an Addison-based company that operates a 28-state network of outpatient surgery, imaging and urgent care facilities. Tenet, a national hospital operator based in Dallas, now owns 95 percent of United Surgical Partners International, an announcement Thursday said. Baylor University Medical Center owns the other five percent. (Rice, 4/26)

Congress promised in 1969 to eliminate black lung disease. But thousands of miners — including Jimmy Woolum — continued to die from it. Today, though the industry knows how to prevent black lung, there’s a resurgence of the disease among miners in Central Appalachia. (Ward Jr., 4/27)

Ron Briggs used to call himself a “good cash cow for the medical industry.” That’s because every few weeks, an ambulance would rush across the rugged, cowboy town of Dillon, Montana, sirens blaring, to revive him from a diabetic coma. The nation has a limited supply of healthcare dollars to spend on drugs and services, which is why the government and health plans require scientific evidence of patient benefit. This is especially important for the 30.3 million people in the U.S. with diabetes, whose medical costs in 2012 totaled $245 billion. He and his wife, Julie, a strong and mothering woman where Ron is concerned, gets choked up when they talk about those days, some four years ago. Those days before they found their “miracle” for treating his disease — the same miracle that would be at the heart of a criminal indictment, embroil them in a lawsuit and lead to their financial ruin. (Clark, 4/26)

But, in health care, knowing the sticker price doesn’t always help in understanding what you’ll actually pay. All sorts of factors can intervene — such as where you live and how far you are willing to drive for care or whether you have insurance and whether your insurer contracts for special prices at only certain hospitals. And the flat price doesn’t tell you anything about the track record of a hospital in performing the procedure. (Ingold, 4/26)

[Daniel] Tesfaye’s case, one of the hundreds examined by The Atlanta Journal-Constitution as part of its latest investigation of doctors and sex abuse, shows how the secrecy and influence that permeate the system can provide cover even for a physician graphically caught in the act. A decade before he treated Miller, Tesfaye had been admonished by the medical board in North Carolina, where he was then practicing, for inappropriate behavior with female patients. (Robbins, 4/26)

Since at least 2013, when a severely disabled Broward County girl died in slow agony from an untreated illness, the Carlton Palms Educational Center has been under an administrative microscope as state regulators sought vainly to shut it down. ...Many of the incidents are documented in a disturbing administrative complaint that seeks to revoke Carlton Palms’ license, citing a years-long culture of abuse and neglect that was “either fostered, condoned or negligently overlooked” by administrators. (Marbin Miller and Madan, 4/26)

In March, the worker’s union, SEIU 1199 New England, held a rally at the State Capitol to announce that some 2,500 workers from nine organizations intended to strike on April 18, seeking increased state funding and higher wages. These employees work for private agencies in group homes and day programs that receive state funding, with the majority of that coming from the state Department of Developmental Services. (Rigg, 4/26)

Companies in the business of growing human organs would be exempt from paying two New Hampshire taxes for the next ten years under a bill passed on Thursday by the New Hampshire House. Supporters of the bill argue that tax breaks will help kick start a nascent industry and ensure that New Hampshire becomes the ‘Silicon Valley of regenerative medicine.’ (Bookman, 4/27)

Mass. General officials said Thursday that they will form a clinical affiliation with Eastern Maine Healthcare Systems, or EMHS. The organization operates nine hospitals and is based in Brewer, Maine, nearly 250 miles from the Mass. General campus in Boston. (Dayal McCluskey, 4/26)

In hundreds of mailboxes each year, letters from state health authorities arrive at the homes of children with serious emotional disorders like hyperactivity and persistent depression. ...In every survey from 2006 to 2016, fewer than half of responding parents said their children saw positive results from services, placing Wisconsin in recent years near the bottom of the Midwest and nation in surveys that states complete for federal mental health grants. (Kyle and Linnane, 4/26)

Cases of hepatitis A have skyrocketed in Ohio and the Department of Health is encouraging at-risk individuals to get vaccinated. There have been 47 cases of hepatitis A so far in 2018, compared to five cases during the same timeframe in 2017, the Department of Health said in a statement on Thursday. (Brookbank, 4/26)

An explosion and asphalt fire at a Wisconsin oil refinery on Thursday sent huge plumes of smoke into the air that pollution experts said almost certainly contained large amounts of toxins, posing a serious health risk to those living downwind. Asphalt is a petroleum product that when burned emits chemicals in gaseous form and small particles that can linger long after the smoke dissipates, said Wilma Subra, a chemist with the Louisiana Environmental Action Network who has examined past refinery accidents. (Brown, 4/27)

St. Joseph Medical Center is among seven new sites where people may have been exposed to measles during an outbreak that has sickened 10 Missourians so far. ...The patient with measles went through the main lobby of the medical center and used elevators to get to the pediatric practice, but Beeler said the inpatient tower has a separate entrance and elevators. (Marso, 4/26)

A walk-in clinic is opening in Nolensville next week. Vanderbilt Health and Williamson Medical Center are opening their fifth walk-in clinic in Williamson County on April 30 at 940 Oldham Drive. Clinicians can treat common illnesses including coughs, ear and eye infections, flu, colds, sinus infections and stomach viruses. (Sauber, 4/26)

A big merger with HealthEast, the St. Paul-based network of hospitals and clinics, weighed on the financial performance last year for Fairview Health Services, contributing to a 25 percent decline in operating income. The effect was not a surprise given the relative profitability of the two health systems and should give way to better financial performance in the future, said Dan Fromm, the Fairview chief financial officer, in an interview Thursday. (Snowbeck, 4/26)

A proposed constitutional amendment known as Marsy’s Law failed in the New Hampshire House of Representatives on Thursday, despite a well-organized and well-financed effort by supporters. The amendment would have created a list of constitutional rights designed to give crime victims a greater say in the court system. (Moon, 4/26)

Wright Davis is among a growing legion of independent contractors and temp workers with few if any employment protections, and one of at least two such workers killed on the job in Massachusetts last year, according to a report released Thursday by the Massachusetts Coalition for Occupational Safety and Health, known as MassCOSH. Overall, 74 people in the state lost their lives because of work-related accidents and illnesses in 2017 — an 11-year high, reflecting a nationwide rise in worker deaths — and contractor and temp fatalities are expected to grow as companies rely more heavily on them. (Johnston, 4/26)

Millions of low-income Californians eligible for food stamps are not receiving the benefit, earning the state one of the lowest rankings in the nation for its participation in the program. Just three states — all much more conservative than the Golden State — have lower rates of participation, according to the latest available federal data. The poor performance stands in sharp contrast to California’s leadership on enrollment in Medi-Cal, the state’s version of Medicaid, which also serves people living in low-income households. (Gorman and Rowan, 4/26)

The opioid epidemic is the deadliest drug crisis in American history, and it demands a multifaceted response. This week, we focus on one crucial facet: medical treatments for opioid addiction, including buprenorphine and methadone. These drugs are proven to help people in recovery—so why aren’t they reaching everyone who needs them? Host Justin Milner talks to health policy expert Lisa Clemans-Cope about the evidence behind these treatments, the barriers to access, and the evolution of the opioid crisis. (4/11)

A new Kaiser Family Foundation analysis of short-term, limited duration health plans for sale through two major national online brokers finds big gaps in the benefits they offer. Through an executive order and proposed new regulations, the Trump Administration is seeking to encourage broader use of short-term, limited duration health plans as a cheaper alternative to individual market plans that comply with the Affordable Care Act’s requirements. Repeal of the individual mandate penalty – which currently applies to people buying short-term plans – is also expected to boost enrollment starting next year. (4/23)

In this cluster randomized trial that included 1680 patients, the implementation of systematic cross-checking between physicians resulted in a significant relative risk reduction for adverse events. The rate of adverse events was 10.7% in the control group vs 6.4% in the cross-checking group. (Freund, Goulet and Leblanc, 4/23)

In a previous trial of antiretroviral therapy (ART) involving pregnant women with human immunodeficiency virus (HIV) infection, those randomly assigned to receive tenofovir, emtricitabine, and ritonavir-boosted lopinavir (TDF–FTC–LPV/r) had infants at greater risk for very premature birth and death within 14 days after delivery than those assigned to receive zidovudine, lamivudine, and ritonavir-boosted lopinavir (ZDV–3TC–LPV/r). (Rough et al, 4/26)

Puerto Rico and the U.S. Virgin Islands (USVI) suffered significant damage to their infrastructure and health care systems from Hurricanes Irma and Maria in September 2017. Drawing on interviews with residents and key stakeholders as well as public reports, this brief provides an overview of the status of the recovery efforts six months after the storms, with a focus on the health care systems. (Artiga, Hall, Rudowitz and Lyons, 4/24)

“We will take care of our great veterans like they have never been taken care of before.” That promise from Donald Trump after he won his party’s presidential nomination is worth revisiting in light of the debacle (completely of President Trump’s own making) that surrounded the nomination, and subsequent withdrawal from consideration, of White House physician Ronny L. Jackson as veterans affairs secretary. Facing — for the third time in his presidency — the question of who should lead this critical agency, Mr. Trump needs to recall what is paramount: the welfare of the men and women who have selflessly served their country. (4/26)

Attacking the character of presidential nominees is among Washington’s favorite sports. But by creating and distributing a compilation of anonymous smears against White House physician Dr. Ronny Jackson, Montana Democrat Sen. Jon Tester appears to be setting a new Beltway record for unsportsmanlike conduct. Today Dr. Jackson, a rear admiral in the U.S. Navy, withdrew from consideration to be Secretary of Veterans Affairs. This followed Mr. Tester’s unique contribution to public discourse and civility—a collection of unsourced and unverified claims that the man lauded and trusted by Presidents of both parties is in fact a reckless, dishonest, mean-spirited drunk. (James Freeman, 4/26)

America hasn’t always, or even usually, been governed by the best and the brightest; over the years, presidents have employed plenty of knaves and fools. ...This year, however, the G.O.P.’s main priority seems to be making war on the poor. That war is being fought on multiple fronts. The move to slash housing subsidies follows moves to sharply increase work requirements for those seeking food stamps. Meanwhile, the administration has been granting Republican-controlled states waivers allowing them to impose onerous new work requirements for recipients of Medicaid — requirements whose main effect would probably be not more work, but simply fewer people getting essential health care. (Paul Krugman, 4/26)

Michigan is experiencing the longest sustained period of job growth since World War II, but you wouldn’t know it from the number of work-capable people on food assistance. Despite significantly lower unemployment, more residents receive food assistance today than in 2008. Back then, the unemployment rate was 8.4 percent and 12.9 percent of the state received Food Assistance Program (FAP) payments. Now, the unemployment rate has plunged to 4.7 percent, yet 13.4 percent of the population still claims FAP benefits. Part of this is due to a loophole in federal law that allows Michigan to exempt large numbers of able-bodied adults from welfare work requirements, even if they have no dependents. Amid a roaring recovery, the state is enabling adults fully capable of working to instead sit on the sidelines and out of the labor force. (Mimi Teixeira, 4/26)

Retirement and health care are intricately linked, though Americans often don't think of them in the same context. And just as many people are behind in accumulating the money needed to pay for a comfortable retirement, plenty are falling short in estimating and preparing for out-of-pocket health-related expenses. (Russ Wiles, 4/26)

As parents, we do everything in our power to protect our children. When we consider all the ways we keep our children safe, immunization may not always be top of mind. In reality, it’s one of the most important things you can do to protect your child, from the moment they are born through their teens and into adulthood. In fact, for kids born between 1994 and 2016, vaccines will prevent an estimated 855,000 deaths in their lifetimes. (Veronica McNally, 4/25)

Protecting hospitals’ computer networks is crucial to preserving patient privacy -- and even life itself. Yet recent research shows that the health care industry lags behind other industries in securing its data. (Mohammed Jalali, 4/26)

(Scott) Pruitt has become a one-man public-health risk to the air we breathe, the water we drink and the food we eat. From day one, he has worked to gut the EPA and hamstring its ability to protect the environment and public health. He works on behalf of the fossil-fuel industry and other industrial polluters, not the American people. That’s the greatest scandal — and the reason, first and foremost, he’s got to go. (Robert Redford, 4/26)

"As land goes, so goes man," says a cartoon by the late Des Moines Register cartoonist Ding Darling. About a century later, his warnings about environmental degradation feel more urgent than ever. Our soil is eroding because of a lack of land stewardship and a monoculture of corn instead of healthy biodiversity. Our waterways are tainted by runoff from phosphorus and nitrogen from livestock confinements. (Rekha Basu, 4/26)

Slapping a $3.03 tax on each pack is part of the state’s multipronged approach to dissuade people from smoking. Yet increasingly, the state is failing to reinvest its substantial tobacco-tax windfall into tried-and-true prevention programs that further reduce smoking rates and help people trying to quit. (4/25)

The failure of Congress and the Obama and Trump administrations to aggressively address the opioid epidemic is a bipartisan indictment of our political establishment. That’s not just because opioid overdoses have killed more than 250,000 people over the past decade. It’s because of the growing reasons to think other drugs could have been used much more safely for pain relief in place of habit-forming drugs like OxyContin and Percocet that have created so many American addicts. ...Now there’s more evidence from our own backyard that opioids have been grossly overprescribed. A recent report in The San Diego Union-Tribune detailed how county jail officials had cut back opioid prescriptions from nearly 1,000 in early 2013 to 23 last month after adopting best-practices standards that focused on the risk prisoners face from opioids and the effectiveness of far less potent medicines like acetaminophen and ibuprofen. This was done, reassuringly, with relatively few complications. (4/26)

Opioid use across the country is rampant, and the impact on our communities is terrifying. Lack of health insurance and ongoing stigma about mental health and substance use keep many from seeking treatment. (Eric Blevins, 4/27)

That a tiny market for conversion therapy to "cure" homosexuality still exists today is deeply sad, even infuriating. But here's the question: If a competent adult knows the most devastating critiques, and wants to pay for it anyway, should California law thwart him or her? The Assembly thinks so. Assembly Bill 2943, which State Rep. Evan Low shepherded through passage last week, declares that "the potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient." (4/27)

It’s the conversation no one wants to have. But on a chilly spring afternoon, 18 people have come to a small office building to start to have it. They are older residents of Cambridge and surrounding towns, and they’re meeting to talk about death — “but not so much about death,” says one of the presenters, paraphrasing the writer and physician Atul Gawande, “as about living a good life right up until the end.” The meeting is held at Cambridge Neighbors, a nonprofit group that helps people stay in their homes, and stay connected to their communities, as they get older, with programs ranging from wellness and exercise classes, to book groups, to assistance with transportation and grocery shopping. (Joan Wickersham, 4/27)