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We don’t know what will emerge as President Trump’s plan to replace Obamacare, which he has promised to unveil immediately after the 2020 elections. But he has recently endorsed several proposals, and they could provide clues. Over the last two weeks, he has sought to re-emphasize health care as an issue, after a set of bruising legislative defeats in 2017. He directed the Justice Department not to defend the Affordable Care Act against a legal challenge. And he issued statements and tweets calling for Republicans to become “the party of health care,” at a moment when many of his party’s leaders had hoped to focus on different issues. (Sanger-Katz, 4/5)

Kaiser Health News: Podcast: KHN’s ‘What The Health’ The GOP’s Health Reform Whiplash

President Donald Trump last week insisted that Republicans would move this year to “repeal and replace” the Affordable Care Act. Or possibly not. Senate Majority Leader Mitch McConnell made it clear the GOP Senate did not plan to spend time on the effort as long as the House is controlled by Democrats. So, the president changed his tune. At least for the moment. Meanwhile, states with legislatures and governors that oppose abortion are racing to pass abortion bans and get them to the Supreme Court, where, they hope, the new majority there will overturn or scale back the current right to abortion. (Rovner, 4/4)

House Speaker Nancy Pelosi questioned whether a health-care proposal embraced by several Democratic presidential candidates would be too expensive and fail to provide the same coverage as the Affordable Care Act. Instead, Pelosi (D-Calif.) suggested Thursday that she would rather build on the 2010 law and is yet to be convinced the Medicare-for-all proposal pushed by many liberals would achieve its purported goals. “I’m agnostic. Show me how you think you can get there,” Pelosi said in an interview with The Washington Post. (Kane and Bade, 4/4)

Since it was proposed in the early 1990s as a bill to protect women “on the streets and in homes,” the Violence Against Women Act has been scrutinized by lawmakers, the Supreme Court, civil rights groups and the National Rifle Association, among others. The bill, which President Bill Clinton signed into law in 1994, was designed to protect victims of domestic crimes and reduce the stigma associated with domestic abuse. It must be renewed every few years by Congress, and on Thursday the House approved a bill that would reauthorize the act for a fourth time. (Rueb and Chokshi, 4/4)

The most contentious change sought by Democrats would expand gun laws to prohibit people convicted of crimes related to dating violence from possessing firearms. Federal law currently prohibits people convicted of or under a restraining order for domestic violence from accessing guns, but that doesn’t apply to dating partners who don’t live together or have children together. “We know victims of domestic violence are more likely to be shot and killed if there’s a weapon in the house,” said Rep. Madeleine Dean (D., Pa.), a member of the House Judiciary Committee. “So anything we can do to keep weapons out of the hands of abusers is something we must do.” (Peterson, 4/4)

The National Rifle Association opposed the bill — putting GOP lawmakers in a tough position of voting against a measure protecting victims of domestic and sexual violence or opposing the politically powerful gun lobby. The vote was 263 to 158, with 33 Republicans joining all but one Democrat to pass the measure. One GOP member voted present. (Davis, 4/4)

While the existing law already has protections for transgender individuals in shelters and housing, the new bill would add protections in prisons, allowing transgender individuals to stay in facilities for the gender with which they identify. Republicans spent time on the House floor objecting to both the existing and new protections, pointing repeatedly to a case last year in California where women alleged a transgender resident sexually harassed them at a women's shelter. Democrats disputed facts in the case and argued there was by and large no evidence that transgender residents cause problems at women's shelters. (Killough, 4/4)

President Donald Trump received a ring from an unusual caller on Wednesday evening: Democratic Sen. Doug Jones. The vulnerable Alabama Democrat urged Trump to accept more money for Puerto Rico as a way to unstick a $13 billion disaster aid bill that's stalled in the Senate. But Trump so far has been unmoved by pleas from both Democrats and Republicans. (Everett, 4/4)

Two senators are eying Congress' appropriations authority to influence a contentious debate over a change to national organ distribution policy. The issue was raised Thursday in a Senate health appropriations panel hearing with HHS Secretary Alex Azar. Panel Chair Roy Blunt (R-Mo.) and Sen. Jerry Moran (R-Kan.) are trying to intervene against a sweeping new policy that changes the geography-based system of liver allocation to one that prioritizes the sickest patients. (Luthi, 4/4)

So far, 325 tribes and states, including Montana, Idaho, Utah and Colorado, have joined forces to preserve a law that gives Native families preference in adoption of Native children. Texas, Indiana and Louisiana argue the Indian Child Welfare Act creates a special and unequal status for Native children that's unconstitutional. (Edwards, 4/4)

The Department of Health and Human Services will likely run out of money to take care of unaccompanied migrant children before the end of fiscal 2019, even after an internal transfer of $385 million earlier this year, Secretary Alex Azar told a Senate panel on Thursday. “It’s just not sustainable at this rate,” Azar said. “We need help, and at this rate, the funding even for this year will not be satisfactory.” (Siddons, 4/4)

The House Ways and Means Committee is poised to vote on a slate of as-yet-unintroduced drug pricing bills that would require sweeping disclosures from both drug middlemen and drug makers, according to summaries of the legislation obtained by STAT. The committee’s markup, which lobbyists say will be held Tuesday, will follow a flurry of drug pricing action on Capitol Hill in recent days. (Florko, 4/4)

Divisions are opening up among Democrats as they struggle over how to craft their signature legislation to lower drug prices. Progressive House lawmakers met this week with Speaker Nancy Pelosi's top health care staffer, Wendell Primus, to push for a drug pricing bill authored by Rep. Lloyd Doggett (D-Texas) that would impose severe punishments on pharmaceutical companies that refuse to negotiate prices with the federal government. (Sullivan, 4/5)

The Justice Department said on Thursday that three pharmaceutical companies— Jazz Pharmaceuticals PLC, Lundbeck LLC and Alexion Pharmaceuticals Inc.--agreed to pay a total of $122.6 million to resolve allegations they paid drug copays for their pharmaceuticals through copay-assistance foundations. The Justice Department alleged the companies violated the False Claims Act by illegally paying copays required by two federal health programs for the companies’ own products through purportedly independent foundations that the companies used as conduits. The Justice Department also said the claims in the settlement are allegations and there has been no determination of liability. (Dabaie, 4/4)

A federal law known as the Anti-Kickback Statute prohibits pharmaceutical companies from offering or paying, directly or indirectly, any remuneration — which includes money or anything else of value — to induce Medicare or Department of Veterans Affairs patients to purchase their drugs. The agreements come as federal prosecutors are more aggressively pursuing drug makers for wayward programs that provide patients with free medications, copay assistance, or help with navigating insurance coverage, as well as donations that are made to foundations that provide copay assistance. The feds are concerned these arrangements contribute to rising drug prices. (Silverman, 4/4)

In an unexpected development, Novartis (NVS) and Amgen (AMGN) filed competing lawsuits over a potentially lucrative relationship to jointly develop and market Aimovig, a new type of migraine treatment that some Wall Street analysts expect will become a multi-billion-dollar market. The trigger for the dispute was a deal between Sandoz, the generic unit at Novartis, which agreed to do contract manufacturing work for Alder BioPharmaceuticals, which is developing its own migraine treatment. (Silverman, 4/4)

Apollo Global Management LLC and CVC Capital Partners are among bidders vying for Perrigo Co.’s prescription pharmaceuticals arm, according to people with the matter. Carlyle Group LP, Altaris Capital Partners LLC and Cerberus Capital Management have also advanced to the next round of bidding for Perrigo’s Generic Rx unit, said the people, who asked to not be identified because the matter is private. The business could fetch slightly more than $2.5 billion, one of the people said. (Tan and Baigorrie, 4/4)

Dr. Scott Gottlieb plans to work on drug prices and other health policy issues as a part-time fellow at the American Enterprise Institute, after he leaves his post as commissioner of the Food and Drug Administration. His last day at the F.D.A. is Friday. In an interview, Dr. Gottlieb said he was not yet sure what other work he would pursue beyond the half-dozen or so days he’d spend each month at the conservative think tank. Although A.E.I., where Dr. Gottlieb once worked, opposed some regulations of vaping, it did not take part in the vituperative public attacks on Dr. Gottlieb for his work to end the youth vaping epidemic like much of the rest of the Washington conservative establishment. (Kaplan, 4/4)

Gottlieb said he is especially interested in trying to figure out how to pay for innovative treatments — including gene therapies for diseases such as hemophilia and sickle-cell anemia — that will be administered to patients just once but could have lifelong benefits. Some of those treatments are likely to have price tags of several hundred thousand dollars or more. (McGinley, 4/4)

"My colleagues and I am thrilled that [Gottlieb] is coming home to AEI," Michael Strain, an AEI resident scholar, tweeted Thursday. "It will be wonderful to have him back at the lunch table. And we will benefit so much from AEI being his intellectual home. I'm excited for the work he will be doing." (Hellmann, 4/4)

AEI is well respected in policy circles and advises Congress on the administration on major policies. Experts of the think tank have been critical of one of the Trump administration's boldest ideas to drive down drug prices: the proposed demonstration to set an international reference price model for Medicare Part B. (Luthi, 4/4)

Attorney General Letitia James of New York said on Thursday that she had filed a lawsuit against a for-profit stem cell clinic, Park Avenue Stem Cell, claiming it performed unproven, rogue procedures on patients with a wide range of medical conditions, from erectile dysfunction to heart disease. “Misleading vulnerable consumers who are desperate to find a treatment for serious and painful medical conditions is unacceptable, unlawful, and immoral,” Ms. James said in a statement. “We will continue to investigate these types of clinics that shamelessly add to the suffering of these consumers by charging them thousands of dollars for treatments that they know are ineffective.” (Abelson, 4/4)

The actions are part of a growing attempt by government officials to regulate a burgeoning industry that critics say has injured at least two dozen patients in recent years and cheated thousands more. Hundreds of clinics have popped up selling stem cell procedures — not covered by insurance, unproven by science and unauthorized by the government — that the clinics claim can treat ailments ranging from creaky knees to Alzheimer’s, Crohn’s disease and multiple sclerosis. Such clinics are “misleading vulnerable consumers who are desperate to find a treatment for serious and painful medical conditions,” New York Attorney General Letitia James (D) said in a statement, calling such behavior “unacceptable, unlawful, and immoral.” (Wan and McGlinley, 4/4)

Top officials at Memorial Sloan Kettering Cancer Center repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care, according to details released on Thursday from an outside review. The findings followed months of turmoil over executives’ ties to drug and health care companies at one of the nation’s leading cancer centers. The review, conducted by the law firm Debevoise & Plimpton, was outlined at a staff meeting on Thursday morning. (Ornstein and Thomas, 4/4)

Science publishers aren’t supposed to be in the disinformation business. And that’s precisely what a federal judge in Nevada was saying late last month when she slapped OMICS International with a $50 million penalty in a suit brought by the U.S. Federal Trade Commission. Judge Gloria M. Navarro agreed with regulators that OMICS, which publishes hundreds of journals and puts on scientific conferences, was guilty of “numerous express and material misrepresentations regarding their journal publishing practices.” (Marcus, 4/5)

The founder of Insys Therapeutics Inc put profits over patients' safety by bribing doctors to prescribe an addictive fentanyl spray, fueling the U.S. opioid epidemic, a federal prosecutor said Thursday at the end of a landmark trial. John Kapoor, who served as the drugmaker's chairman, and four colleagues are the first executives of a painkiller manufacturer to face trial for conduct that authorities say was tied to a drug abuse epidemic that kills tens of thousands of Americans each year. (Raymond, 4/4)

A week after reaching a $270 million settlement with the maker of OxyContin, Oklahoma’s attorney general Thursday dropped some claims in its lawsuit against other drugmakers in an effort to force them to pay the cost of the nation’s deadly opioid crisis. Attorney General Mike Hunter’s office filed a motion that dismisses claims of fraud and deceit, unjust enrichment and violations of the state’s Medicaid laws against about a dozen drugmakers. Hunter said dismissing those claims does not reduce the amount of damages the state is seeking. (Talley, 4/4)

Calls to address the opioid crisis resumed Thursday as lawmakers released a bill that aims to curb the flow of illegal opioids into the United States and another to help physicians learn more about a patient's substance abuse history. The separate actions by a bipartisan group of senators and another of House members are drawing fresh attention to the overdose crisis, which is a concern for both parties even though Congress cleared an opioids law (PL 115-271) just last year. One of the bills, a Senate measure, stands a good chance of becoming law, said co-sponsor Senate Minority Leader Charles E. Schumer, D-N.Y. (Raman, 4/4)

The eyes of the nation are on New Hampshire and how it’s using millions of dollars from the federal government to fight the deadly opioid epidemic. “Tracking Federal Funding to Combat the Opioid Crisis,” a new report from the Bipartisan Policy Center, looks at New Hampshire and four other states with high rates of opioid-related deaths. The Washington, D.C.-based think tank calls for more flexible funding and better coordination at the federal level as states grapple with the ongoing drug epidemic. (Wickham, 4/4)

Minneapolis and Hennepin County officials on Thursday released a sweeping set of recommendations for tackling the opioid epidemic, with a focus on reducing opioid use among incarcerated people and the local American Indian community. The recommendations, the result of over a year of work by a regional task force, look at solutions for preventing and treating opioid abuse in the Twin Cities. At a morning news conference, Minneapolis Mayor Jacob Frey said the recommendations would likely be implemented through future policies, budgets and grant applications. (Otárola, 4/4)

Currently, 19,199 Philadelphians are living with HIV. In 2017 there were 419 newly diagnosed HIV infections, according to the health department. But from 2016 to 2018, the number of new diagnoses reported in people who inject drugs has nearly doubled to 59, a number that is sure to rise when all the data are finalized, said James Garrow, spokesperson for the Department of Public Health. (Schaefer, 4/4)

At least 25 states now have laws protecting patients from surprise out-of-network bills, usually for emergency care they received at hospitals or ambulatory surgical centers. At least 20 states are considering legislation this year, according to the National Academy for State Health Policy. While states have provided protections for consumers with commercial health insurance plans, the laws do not apply to self-insured employer-sponsored health plans, which cover 61% of privately insured employees, according to the Kaiser Family Foundation. (Ollove, 4/5)

Sen. Lamar Alexander is planning a vote on a package of bills seeking to curb health care costs in the Health, Education, Labor and Pensions Committee early this summer, he said Thursday in a speech on the Senate floor. Alexander, who chairs the panel, is working with ranking member Sen. Patty Murray, D-Wash., and Finance Committee leaders Charles E. Grassley, R-Iowa, and Ron Wyden, D-Ore., on legislation to lower health care costs. The two panels share jurisdiction over health issues, and the Finance Committee has been probing the cost of prescription drugs this year, although Grassley has also indicated a broader interest in health care costs. (McIntire, 4/4)

Outpatient prices consistently exceeded prices for the same treatment delivered in office settings, underscoring the potential impact of site-neutral payments, according to new research. Health Care Cost Institute researchers looked at a set of nearly 30 services deemed to be safe and appropriate to provide in freestanding physician offices by the Medicare Payment Advisory Commission. Their analysis of commercial insurance claims from 2009 to 2017 found that more of that care shifted to outpatient facilities where the average price was always higher. (Kacik, 4/4)

There are lots of reasons patients don't shop for health care. Many follow a doctor's referral and don't look at their options. Others, like Hurley, don't have a reason to compare prices. And some patients who do review the cost of a test may assume that the higher-priced labs or hospitals deliver the best care — even though that is often not the case. (Bebinger, 4/5)

Amazon unveiled software on Thursday that allows health care companies to build Alexa voice tools capable of securely transmitting private patient information, a move that opens the door to a broad array of uses in homes and hospitals. The announcement was accompanied by the launch of six voice programs built by large health businesses ranging from Boston Children’s Hospital, to the insurance giant Cigna, to the digital health company Livongo. (Ross, 4/4)

A new, invite-only program from Amazon allows select healthcare groups—including hospitals and health insurers—to develop HIPAA-compliant skills for its voice assistant, Alexa. Developers who participate in the program, including HIPAA-covered entities and their business associates, are able to build voice skills that transmit protected health information in Amazon Alexa's HIPAA-eligible environment. (Cohen, 4/4)

The Trump administration has ordered a U.S. health tech startup to find a new buyer because of national security concerns about its China-based owner, a move that is likely to serve as a warning sign for a significant number of other American companies with Chinese investors. The order concerns the patient social network PatientsLikeMe, whose majority owner is iCarbonX, a Chinese digital health company. The news was first reported by CNBC on Thursday and confirmed to STAT by a person who had seen the terms of sale being circulated to potential buyers. (Robbins, Herper and Garde, 4/4)

America’s two biggest pharmacy chains are attempting to reverse their sagging fortunes by becoming go-to treatment centers for people with chronic illnesses. CVS Health Corp. and Walgreens Boots Alliance Inc. are remodeling hundreds of stores into medical-service centers targeted at customers with conditions like diabetes, heart disease and hypertension. The idea is to make customers just as likely to stop in for medicine, consultations and lab tests as for lipstick or a candy bar. The need is urgent. Both chains are under tremendous pressure to find new ways to counter slowing revenue from prescription drugs, which drive the bulk of their sales. (Al-Muslim and Terlep, 4/4)

CVS Health is expanding same-day prescription deliveries nationwide in the latest push by drugstores to keep customers who don’t want to wait and are doing more shopping online. The drugstore chain says it can deliver medications and other products within a few hours to homes or offices from 6,000 locations. The company started this service, which comes with a fee, in late 2017 in New York and expanded it to several cities last year. Rival Walgreens Boots Alliance Inc. also offers same-day deliveries in major cities and plans to expand this year. It has a partnership with FedEx Corp. to provide next-day deliveries as well. (Murphy, 4/4)

A federal appeals court on Thursday upheld a Kentucky law requiring doctors to show and describe a fetal ultrasound to patients before performing an abortion. In a 2-1 decision, the 6th Circuit Court of Appeals ruled the law does not infringe on the First Amendment rights of physicians. (Weixel, 4/4)

Kansas lawmakers want physicians to face criminal penalties if they don’t repeatedly tell women seeking drug-induced abortions that they may be able to interrupt the process partway through. That comes despite a lack of rigorous research that what’s being called “abortion reversal” works and amid concerns from the American College of Obstetricians and Gynecologists that the research supporting the treatment is unethical. (Llopis-Jepsen, 4/4)

Republican state Rep. John Becker has introduced legislation that would ban insurance companies from covering most types of abortions. Here are three takeaways:- House Bill 182 would prohibit health insurers and public employee benefit plans from covering abortions except to replant a fertilized ovum or to save a pregnant woman’s life. (Pelzer, 4/4)

Massachusetts has become the first state to approve money to offset the potential loss of federal funding to women’s reproductive health organizations since the Trump administration adopted a new rule meant to ban federally funded family planning clinics from making abortion referrals. Massachusetts follows Maryland, which in 2017 passed a similar law meant to protect funding for Planned Parenthood. (Leblanc, 4/4)

On Wednesday, the former vice president and potential presidential candidate Joe Biden released a video in which he discussed the importance of personal space. “Social norms have begun to change,” he said. “They’ve shifted, and boundaries of protecting personal space have been reset — and I get it.” Mr. Biden was responding to allegations by two women that he made them uncomfortable by coming too close, and by being too familiar and hands-on. His video was, in part, an acknowledgment that the rules of social engagement can change over time — along with perceptions of how much physical contact is appropriate, and where the boundaries of personal space lie. (Carey, 4/4)

Cancer immunotherapy drugs, which spur the body’s own immune system to attack tumors, hold great promise but still fail many patients. New research may help explain why some cancers elude the new class of therapies, and offer some clues to a solution. The study, published on Thursday in the journal Cell, focuses on colorectal and prostate cancer. These are among the cancers that seem largely impervious to a key mechanism of immunotherapy drugs. (Richtel, 4/4)

Testing for cancer in blood, urine or even saliva: That approach has been called the "holy grail" for diagnosing the second leading cause of death in the world, and it has been fueling an area of research that continues to raise eyebrows and questions. Doctors can diagnosis cancers in a number of ways, including taking biopsies of tissue where a suspected tumor might be; imaging tests such as X-rays, ultrasounds or MRIs; and screening tests such as endoscopies or colonoscopies. (Howard, 4/3)

Soon after the December 2012 shooting at the Sandy Hook Elementary school in Connecticut, in which a gunman murdered 20 children and six adults, a question began to haunt the parents of 6-year-old Avielle Richman, one of the victims that day. "I remember asking, 'Why would somebody walk into a school and kill my child?' " Jennifer Hensel told Anderson Cooper in 2013. "I need to know that answer. I have to have that answer." To search for that answer, Hensel and her husband, Jeremy Richman, drew on their unique expertise. (Hodge, 4/4)

People’s sexual partners could impact both their gut microbiome and their immune system, according to a new study from the University of Colorado, Denver, done in mice. Mice that received stool transfers from men who had anal intercourse had different microbiomes than mice whose stool donors only had vaginal intercourse, the study found. When researchers checked the mice’s immune systems, the mice whose stool donors had anal intercourse also showed signs that, were they human, they might have a higher risk of HIV infection. (Sheridan, 4/5)

Trying to get pregnant with in vitro fertilization is a gamble. But some fertility doctors think artificial intelligence could help tilt the odds in their patients’ favor. Currently, birth rates from IVF vary widely, from 31% for women age 35 and under to around 3% for women age 42 and older when using fresh embryos, according to the Centers for Disease Control and Prevention. To get pregnant, many women ultimately have to go through multiple rounds of IVF. The process can be time-consuming, emotionally exhausting and expensive. (Mullin, 4/4)

Pregnant women who work night shifts may have an increased risk for miscarriage. Researchers studied 22,744 pregnant Danish women, tracking their work schedules and hospital admissions for miscarriage using government databases. The study, in Occupational & Environmental Medicine, found that after eight weeks of pregnancy, women who had worked two or more night shifts during the previous week had a 32 percent increased risk of miscarriage compared with women who did not work nights. Working only one night shift a week did not significantly increase the risk. (Bakalar, 4/5)

Depressed patients don’t enunciate vowels as much as people who aren’t depressed. Their smiles are smaller. Suicidal individuals who speak in a breathy voice rather than a tense tone are more likely to re-attempt suicide. And patients with psychotic disorders, such as one form of schizophrenia, raise their eyebrows often when averting their gaze. These are among the behavioral biomarkers researchers have established using facial and acoustic analysis. With technology, they measure shifts not always discernible to the eye or ear, such as slight movements of facial muscles as well as subtle changes in tone and language. (Reddy, 4/4)

Few scenarios are harder to witness than the suffering of a seriously ill child. For kids with life-threatening diseases, survival often requires procedures that are painful and scary. But a Washington nonprofit is encouraging kids to be active in their own care by rewarding them for enduring their treatment. (Solman, 4/4)

It might just be enough to kill your buzz: A new study challenges the idea that a drink or two a day could actually be good for you. In a study conducted in China, the researchers found that moderate drinking slightly raised the risk of stroke and high blood pressure. They weren’t able to figure out, though, whether small amounts of alcohol might also increase the chances of a heart attack. People who have a drink or two a day have long been thought to have a lower risk of stroke and heart problems than nondrinkers. But scientists were unsure if that was because the alcohol was beneficial or if the people who didn’t drink had other health issues. (Cheng, 4/5)

Postpartum depression affects one in seven women. In March, the Food and Drug Administration approved the first drug specifically for postpartum depression. A month earlier, the U.S. Preventive Services Task Force released new guidelines recommending screening for depression in all pregnant and postpartum women and referring those at risk to counseling. But those advances help only if women in need are identified in the first place — a particular challenge for women of color and low-income moms, research shows, as they are several times more likely to suffer from postpartum mental illness, but less likely to receive treatment. (Patani, 4/5)

The right diet may improve gum health, a small study has found. German researchers studied 30 people with gingivitis, the inflammation of the gums that can cause redness, swelling and bleeding. A dentist measured the severity of their gingivitis and their levels of plaque, the bacteria-laden film that builds up on the teeth and can cause gum disease. (Bakalar, 4/4)

The rate of nonfatal assaults on American men 60 and older increased 75.4% between 2002 and 2016, a new government report estimates. For women, the assault rate increased 35.4% between 2007 and 2016. "These findings highlight the need to strengthen violence prevention among older adults," concluded the researchers from the US Centers for Disease Control and Prevention. "Unfortunately, few strategies have been rigorously evaluated." (Scutti, 4/4)

Oregon health officials have completed a first-ever analysis of a massive state effort to move people with severe mental illness into less restrictive settings, finding outcomes that a leading advocacy group said are “shocking.” Within half a year of leaving a residential facility, two in five people ended up in an emergency room, one in 10 went to the Oregon State Hospital and one in 20 became homeless, according to an Oregon Health Authority review released in February. (Zarkhin, 4/4)

James Lane has a backpack full of syringes slung across his shoulder as he goes to exchange used needles for sterile ones at a small booth set up by an Atlanta needle exchange clinic. The clinic, which operates in an area known as a hot spot for drug use in Atlanta, collects and distributes syringes. It’s among just a few of its kind operating publicly in Georgia and a godsend to Lane, who says he turned to heroin and cocaine to self-medicate for post-traumatic stress. “It’s not the right answer. I know that. But right now I’m able to sustain my life,” he said. He said he also exchanges needles on behalf of five friends who are embarrassed to show up in person. (Mansoor, 4/4)

Senate Bill 568, which passed 30-1, increases financial penalties for child care operations violating state standards, directs fines from violations to an account for safety training programs, requires many day care facilities to carry liability insurance and gives the state the power to place restrictions or special conditions on facilities that have shown a pattern of violations. (Collins Walsh, 4/4)

A bill to restrict guns on school grounds passed the House on Thursday in a mostly partisan vote. Under the proposed rules, anyone carrying a gun on school property or school buses would be fined and charged with a misdemeanor unless they're a member of the military or a law enforcement or school resource officer. (Gibson, 4/4)

Citing a past sexual harassment investigation at the University of Florida, Senate President Bill Galvano said Wednesday the Senate will not vote during this year’s legislative session on confirming the state’s new surgeon general. The move could put physician Scott Rivkees, named surgeon general Monday by Gov. Ron DeSantis, in limbo for months. (Sexton, 4/4)

Weksler said many of her colleagues have voiced their concerns on a community listserv about what the switch to Blue Shield might mean for students' access to services going forward, in a climate where there are more students seeking therapy than there are therapists to provide it. (Veltman, 4/4)

Kaiser Health News: On The Border, Volunteer Doctors Struggle To Provide Stopgap Care To Immigrants

It wasn’t the rash covering Meliza’s feet and legs that worried Dr. José Manuel de la Rosa. What concerned him were the deep bruises beneath. They were a sign she could be experiencing something far more serious than an allergic reaction. Meliza’s mom, Magdalena, told the doctor it started with one little bump. Then two. In no time, the 5-year-old’s legs were swollen and red from the knees down. De la Rosa noticed a bandage-covered cotton ball in the crook of Meliza’s elbow, a remnant of having blood drawn. During their time at the Immigration and Customs Enforcement detention facility, Meliza had been sent to a hospital, Magdalena explained, cradling the child with her 5-foot frame. (Barry-Jester, 4/5)

Federal lawmakers want more health care for veterans exposed to toxic PFAS chemicals, including at the former Pease Air Force Base. Around 400 military installations, including Pease, are thought to have PFAS contamination stemming from use of firefighting foam. (Ropeik, 4/4)

A Washington University study has shown that more than a dozen north St. Louis neighborhoods have high rates of childhood asthma. The study, soon to be published in the journal Social Science & Medicine, identified five ZIP codes in St. Louis that are hot spots for childhood asthma, meaning that they contain clusters for the city's highest rates of the illness. The report used census and health data from multiple government agencies. (Chen, 4/4)

The prospect of a 225-bed shelter in San Francisco’s trendy South Beach neighborhood has kicked off a bitter fundraising battle between area residents who say homeless people should be helped somewhere else and supporters who say no one should be sleeping on the streets. To some residents in the pricey and touristy neighborhood along the Embarcadero, plans to build a new homeless shelter amid expensive apartment towers threaten public safety and tourism. (Baron, 4/4)

Hawaii lawmakers on Thursday killed a proposal that would have banned flavored electronic smoking devices and e-liquids, saying they suspected teenagers would continue to get the products online even if sales were prohibited. Supporters said the bill was needed to fight an alarming surge in teenage vaping. Hawaii would have been the first state in the nation to impose such a ban if it was enacted. (4/4)

Eight nursing homes in Wisconsin operated by Dycora Transitional Health & Living have been put into receivership, providing another sign of the industry’s increasing struggles in the state. Dycora is the third company to have its Wisconsin nursing homes placed in receivership in roughly the past two years. (Boulton, 4/4)

At two public charter schools in the Sonoma wine country town of Sebastopol, more than half the kindergartners received medical exemptions from state-required vaccines last school year. The cities of Berkeley, Santa Cruz, Nevada City, Arcata and Sausalito all had schools in which more than 30% of the kindergartners had been granted such medical exemptions. Nearly three years ago, with infectious disease rates ticking up, California enacted a fiercely contested law barring parents from citing personal or religious beliefs to avoid vaccinating their children. Children could be exempted only on medical grounds, if the shots were harmful to health. (Ostrov, 4/4)

Stephanie Sena was about to have half her foot amputated, an urgent procedure to keep a blood infection from spreading to the rest of her body. But the surgeon required payment up front and the insurance plan the 39-year-old Villanova University adjunct professor bought months earlier was refusing to pay. She had less than 24 hours to come up with $1,920. (Gantz, 4/5)

The Texas House approved two new medical schools in Texas this week, one at Sam Houston State University and the other at the University of Houston. The decisions bring both universities' plans for medical schools one step closer to reality, though both still need Senate approval. (Anchondo, 4/4)

Phoenix insurance agency Lovitt & Touché has been purchased for an undisclosed price. A subsidiary of Marsh, the world's largest insurance broker and risk adviser, announced the transaction. Lovitt & Touché, one of Arizona's largest independent agencies with a history dating to 1911, has 181 employees in offices in Phoenix, Tucson and Las Vegas. (Wiles, 4/4)

An unvaccinated student in Arkansas was diagnosed with whooping cough, so now other junior high students have to take antibiotics in order to come to class, the Northwest Arkansas Democrat-Gazette reported. Whooping cough, also called pertussis, “is a highly contagious respiratory disease,” according to the Centers for Disease Control and Prevention. (Alanis, 4/4)

For years, medical marijuana dispensaries have allowed spouses and other caregivers to enter their premises by simply signing them in, whether they had a state-issued caregiver’s registration card or not. But word recently trickled out from the Cannabis Control Commission that caregivers without a card should be excluded, even though the law gives dispensary operators discretion to admit “visitors.” (Murphy, 4/4)

Thomas Jefferson University’s big gamble on cannabis may be beginning to pay off despite a recent series of setbacks that have included the departure of a key executive, the implosion of a venture to create the world’s largest medical marijuana patient database, and a stalled academic research program. (Wood, 4/4)

Tampa businessman Joe Redner has lost the latest round in his attempt to grow his own medical marijuana for juicing.But the strip club owner known for battling the government says he plans to appeal the decision by the First District Court of Appeal. Redner has a doctor’s orders to juice marijuana to keep his stage 4 lung cancer at bay. He says it’s kept him in remission for seven years. (Ochoa, 4/4)

By backing a flimsy, state-initiated lawsuit to throw out the entirety of the Affordable Care Act, President Trump has made himself and Republican candidates in 2020 vulnerable to attacks that they want to take health insurance away from millions of people. The president compounded the problem by saying Republicans are going to become the party of health care without having any plan, let alone a coherent proposal that would produce better results and could get through Congress. Republicans are now deeply divided on what should be done, and the president is no help in setting a course for the party. (Joseph Antos and James C. Capretta, 4/4)

Not only is President Trump’s administration in agreement with the lawsuit brought by 20 states attorneys general — and the Texas Public Policy Foundation — against the Affordable Care Act, President Trump is leading the way on developing an alternative plan to present to Congress.That plan should be simple — empower the states to find solutions on their own. Health care simply isn’t a federal responsibility. (Robert Henneke, 4/4)

When President Donald Trump boasted a little over a week ago that Republicans were preparing an alternative to the Affordable Care Act so good it would make the GOP “the party of health care,” many Americans suspected he was stretching the truth again. They were right. No GOP replacement for Obamacare is in the works. (4/4)

In my conversations with constituents, health care is still the top issue that comes up. At my recent town hall in Olathe, seven out of 10 questions were related to health care. That’s why I remain committed to working with anyone — regardless of party — to make sure more people can get care. The time is now to take action on health care. (Sharice Davids, 4/4)

As the nation readies for the next installment of the health care debate, the devil is in the details -- in recognizing there are many ways to reform our current system and appreciating that a complex mongrel of an approach is probably best to fit the diverse, multifaceted American health scene. Unfortunately, as the presidential election campaign approaches, it is more likely that terms like single-payer will be used as a polarizing cudgel to elicit support or mobilize opposition, exactly the opposite of the kind of thoughtful health care debate Americans deserve. (Richard M. Perloff, 4/5)

It didn’t take long for President Donald Trump to undermine his pledge to end new HIV transmissions in the United States by 2030 — an initiative that would save lives and taxpayer dollars. The promises made during the State of the Union are being undercut by the Trump administration’s budget, which includes a draconian $1.5 trillion cut to Medicaid — the largest source of insurance coverage for Americans with HIV — and the Justice Department’s support to invalidate the Affordable Care Act in court. In the two years since Trump was inaugurated, his administration has taken a number of steps that have jeopardized efforts to end the HIV/AIDS epidemic, including the administration’s relentless assault on the ACA and Medicaid. (Doug Wirth, 4/4)

Health care is always on the minds of the public, usually ranking among the top 3 concerns. Virtually all of the Democratic presidential candidates have discussed or will shortly detail health care proposals, whereas President Trump and the current administration recently expressed support for repealing the Affordable Care Act. With the presidential election just 18 months away, it is an opportune time to introduce a new health policy series in JAMA. ...The key question for policy makers is whether there are achievable health policies that will reduce the annual increase in health care expenditures yet at the same time increase access to care (fewer uninsured or underinsured), improve quality, and reduce inequities. Feasible policies likely must also maintain choice, which the majority of people repeatedly maintain is important to them. (Karen E. Joynt Maddox, Howard Bauchner and Phil B. Fontanarosa, 4/4)

According to Richard Mollot, the executive director of the Long Term Community Care Coalition, bedsores, a condition that results from being in the same position for too long, are “almost always preventable and quickly treatable . . . so there’s just no excuse.” So, when veterans at VA nursing homes were recently discovered to be suffering from a plethora of preventable problems, such as bedsores, what did VA do? They provided an excuse, of course.(Rory E. Riley-Topping, 4/4)

There’s a lot we don’t know about the legacy Donald Trump will leave behind. And it is, of course, hugely important what happens in the 2020 election. But one thing seems sure: Even if he’s a one-term president, Trump will have caused, directly or indirectly, the premature deaths of a large number of Americans. Some of those deaths will come at the hands of right-wing, white nationalist extremists, who are a rapidly growing threat, partly because they feel empowered by a president who calls them “very fine people.” (Paul Krugman, 4/4)

This week, there was an extraordinary gathering in an auditorium on the ground floor of the New York Police Department headquarters in Lower Manhattan. In that one room sat more than 300 police chiefs and other law enforcement officials from across the country and as far away as Australia and Northern Ireland. They were there to discuss a leading cop killer: suicide. For eight hours, they took a raw and honest look at both the forces that drive officers to this most desperate of acts and the dilemmas they face in dealing with it. (Karen Tumulty, 4/4)

In the late 1980s and early 1990s, cities struggling with the AIDS crisis began considering a then-radical idea: give drug users sterile needles and syringes so they wouldn’t spread HIV, the virus that causes AIDS. Underlying the idea was the acceptance that some drug use was inevitable and a belief that this kind of program could reduce its harms. Opponents saw it as declaring defeat. Syringe exchange programs, they said, would only encourage drug use, worsening the HIV epidemic. But cities like Philadelphia, where I now work, were desperate for solutions, so they opened syringe exchange programs anyway. We face a similar situation today with the opioid crisis. (Thomas Farley, 4/5)

If you're on Instagram or if you've taken the New York City subway lately, chances are you've heard of Hims, the men's health and wellness company with a penchant for advertisements featuring suggestive cacti and eggplants against pastel backgrounds. The Web-based startup targets the young male demographic with skin care products, multivitamins and erectile dysfunction medications. In January, just a few months after its first birthday, the company joined Silicon Valley's vaunted "unicorn" club: It received a venture-capital investment that put its valuation at $1 billion. (Vishal Khetpal, 4/4)

Facilitating inclusion of pregnant women in clinical research could help answer important questions about the effects of medication use during pregnancy and the ways in which pregnancy alters pharmacokinetics and drug effects. (Ahizechukwu C. Eke, Kelly E. Dooley and Jeanne S. Sheffield, 4/3)