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Republicans are leaving Washington Thursday for a month of recess with no clear direction on what they’ll do next on Obamacare. Senate leaders want to just drop the issue altogether. Conservatives say they’re still fighting for repeal. Moderates want to launch a bipartisan effort to fix the shaky Obamacare system. The reality is that, after seven years of unity on repealing Obamacare, Republicans are rudderless on how to talk about or address the defining domestic policy issue of nearly the past decade for their party, and they have no clear plans despite holding all the levers of power in Washington. Now, they face a month away from the Capitol, answering to their home-state voters about their lack of progress. (Haberkorn and Demko, 8/3)

Senate Finance Committee Chairman Orrin Hatch (R-Utah) announced Thursday that the panel will hold a healthcare hearing in September, in the wake of a failed vote on repeal of ObamaCare. The hearing will be a chance for members of both parties to discuss the healthcare law, and it comes amid calls for a return to regular order and the committee process. (Sullivan, 8/3)

Fledgling efforts in the Senate and U.S. House of Representatives to develop bipartisan legislation to stabilize the individual insurance market could founder over clashing views on deregulating health plans. Democrats and a growing number of Republicans are eager to steady the struggling individual market covering nearly 20 million Americans to prevent an exodus of insurers and healthy customers. (Meyer, 8/3)

Most people do not become United States senators to pass a resolution declaring National Lobster Day. But Congress has had to settle largely for small-bore victories since President Trump was sworn into office, ostentatiously failing to pass a bill to repeal his predecessor’s health care law and achieving little substantive policy legislation. (Steinhauer, 8/4)

More than half of Republicans in a Quinnipiac University poll released on Thursday do not approve of the way their party has handled healthcare in Congress. Sixty percent of Republicans said they disapprove, while only 32 percent of Republicans said they approve. (Manchester, 8/3)

With health care reform to be looked at again by a U.S. Senate committee next month, U.S. Sen. Debbie Stabenow, D-Mich., is proposing letting younger Americans buy into Medicare coverage now limited to older people. Stabenow today introduced legislation that would provide an option for people between the ages of 55 and 64 to purchase Medicare coverage, saying more than a million people in Michigan fit that age bracket and many are "burdened by high insurance premiums, unaffordable deductibles and limited options." (Spangler, 8/3)

Interior Secretary Ryan Zinke shared a picture of him drinking a beer with Sen. Lisa Murkowski (R-Alaska) on Thursday, after reports surfaced that the secretary threatened to cut economic development funds in the Alaska over her vote on the healthcare bill. "I say dinner, she says brews. My friends know me well. Thanks Lisa Murkowski," Zinke tweeted while including picture of them both holding Alaskan brand beers. (Beavers, 8/3)

Sen. John McCain proclaimed himself in good spirits and said he's feeling in good health during his first week of radiation treatment for an aggressive form of brain cancer. ...McCain said he expected to be back on the Senate floor in September, against his physician’s wishes. (Ruelas, 8/3)

The Senate on Thursday gave final approval to legislation to finance the Food and Drug Administration, clearing the measure for President Trump and tapping drug manufacturers once again to help pay for the federal review of prescription drugs and medical devices. The 94-to-1 vote came just hours after the Senate passed a separate bill expanding access to experimental treatments for people with terminal illnesses. This bill, the Right to Try Act, will now go to the House, where more than three dozen lawmakers have endorsed similar legislation. (Pear and Kaplan, 8/3)

Drug and medical device makers would pay higher user fees under legislation the Senate approved and sent to the president on Thursday. ... The legislation rejects the Trump administration's recommendation to fund FDA reviews entirely through user fees. Doing so would have upended several months' worth of negotiations over the fees, which will generate between $8 billion and $9 billion over five years. The administration had argued that "in an era of renewed fiscal restraint, industries that benefit directly from FDA's work should pay for it." (Freking, 8/3)

The FDA user-fee agreements, which are renegotiated every five years with the makers of prescription brand drugs, medical devices, generic drugs and biosimilars, fund more than half of the FDA's operations. The agency would have to layoff more than 5,000 employees if the agreements are not reauthorized before the end of September. A reauthorization delay would also postpone the review of many drugs and devices. The bill passed 94-1, with Sen. Bernie Sanders (I-Vt.) as the lone holdout. (Kacik, 8/3)

[T]he easy passage on Thursday belies tougher behind-the-scenes negotiations. Senate leaders, along with Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), who together lead the Senate health committee, spent this week fending off controversial amendments that could otherwise have slowed the package’s path to the president’s desk, staff and health industry lobbyists said. (Mershon, 8/3)

“This is a bill that’s been done the right way,” said Sen. Lamar Alexander, R-Tenn., who oversees the Health, Education, Labor and Pensions Committee. “It’s an example of the way the Senate is supposed to work." (Siddons, 8/3)

The White House hasn’t said if it will sign the user fee bill. In a statement of administrative policy issued in July after the bill passed the House, the White House expressed concern with some minor provisions, though it did not threaten a veto. (Weixel, 8/3)

As surgeon general, Jerome Adams is expected to serve as a spokesman for President Donald Trump's health agenda. Adams, a practicing anesthesiologist, was appointed in 2014 by former Indiana governor and current Vice President Mike Pence to run that state’s department of health. Adams oversaw the state’s response when about 180 residents contracted HIV and hepatitis C as a result of  injecting heroin and prescription opioid painkillers. Adams worked to convince Pence to allow an emergency needle exchange program to help stop the outbreak. (Siddons, 8/3)

The “right-to-try” legislation has been championed by the libertarian Goldwater Institute, which has worked to pass similar legislation in 37 states. The federal version, now headed to the House, would bar the government from blocking patients from getting access to medications that have undergone only preliminary testing in humans. Patients first would have to try all other available treatments and be ineligible for clinical trials. The bill would provide drug companies some legal protection if a treatment results in harm. (McGinley, 8/3)

The bill, S. 204 (115), passed swiftly and easily in a Senate bitterly divided over health care. The powerful pharmaceutical lobby, which had quietly opposed an earlier version, kept an unusually low profile. The industry has been focused on fighting off any efforts to go after drug pricing, which President Donald Trump has said he would tackle. (Karlin-Smith, 8/3)

The bill’s language is actually somewhat broader than simply applying to the terminally ill. It says that a patient “with a life-threatening disease or condition…who has exhausted approved treatment options” generally can get experimental drugs if a doctor certifies it is necessary. (Burton, 8/3)

The new version emphasizes that drug companies wouldn’t be held liable for problems patients face using the drugs and that results from those patients couldn’t be used to undermine other clinical trials. It does, however, explicitly require the companies to report any problems to FDA — and adds exemptions that would let the agency use the results if it saw a public health risk or if the companies themselves request the consideration. The new version also makes it much more explicit that the bill doesn’t create any new “entitlements” for terminally ill patients, and that companies don’t have to provide the drugs. (Mershon, 8/3)

Aetna Inc. reported a stronger profit for its second quarter, boosted by limited medical spending and better-than-expected results from Affordable Care Act programs intended to reduce insurers’ risk on health-law insurance plans. The insurer, which joins others in the industry that have previously reported positive results, highlighted the growth and future prospects in its government business, particularly its continuing expansion in Medicare Advantage, the plans sold by private insurers under the federal program, as it continued detailing its strategy after the failure of its effort to buy Humana Inc. That deal was terminated in February after a federal judge ruled it would violate antitrust law. (Wilde Mathews and Vasquez, 8/3)

Aetna's second-quarter profit jumped 52 percent to top expectations, and the nation's third-largest health insurer raised its 2017 forecast again, this time well beyond analyst projections. Investors responded by pushing company shares to another all-time high price in Thursday trading. (Murphy, 8/3)

After dropping a deal for one of its biggest rivals and largely quitting Obamacare, health insurer Aetna Inc. may have been better off sticking to its knitting all along. The insurer raised its full-year forecast after posting second-quarter results that exceeded analysts’ expectations, helped along by its core business running health benefits for employers. Earlier this year, it called off a takeover with Humana Inc., and it has also pulled back from doing business in the Affordable Care Act -- insulating itself from Washington’s health-care turmoil. (Tracer, 8/3)

State officials said Thursday that they have seized control of Minuteman Health Inc., a small Boston-based insurer created under a program of the Affordable Care Act to provide low-cost policies. Officials at the Division of Insurance said the unusual step was necessary because Minuteman’s level of capitalization — or cash — is too low. (Dayal McCluskey, 8/3)

Minuteman Health, the company with the largest number of New Hampshire residents insured on the Obamacare exchange, is now under the control of the Massachusetts Insurance Department. Bay State Insurance Commissioner Gary D. Anderson announced on Friday that a court granted his request to place Minuteman Health into receivership to protect policyholders and health care providers. Anderson has been named “receiver” for Minuteman, which essentially puts him in control of the company. (Solomon, 8/3)

Under preliminary Obamacare rates announced by Covered California, premiums on exchange plans will rise by an average of 5.7 percent in Sacramento, Placer, El Dorado and Yolo counties. That’s less than half of the statewide average of 12.5 percent, and consumers could virtually avoid an increase altogether if they shop around. (Miller, 8/4)

Florida health insurers are seeking double-digit rate hikes for 2018 Affordable Care Act coverage, but this week state regulators asked insurers to submit backup plans to raise premiums even higher next year because of uncertainty surrounding the future funding of subsidies that help low-income Americans pay their out-of-pocket costs. The Office of Insurance Regulation said insurers need to account for the potential elimination of the subsidies, whose future funding has become an increasingly complex political question. (Chang, 8/3)

The federal government released more details Wednesday about how much health insurance rates could increase next year in Florida — and the spike could be dramatic for some. For individuals buying plans on HealthCare.Gov exchanges, the increase is 17.8 percent on average. But now the U.S. Centers for Medicare and Medicaid Services have released a breakdown of all the different polices in Florida, and how much each of those plans will go up. (Aboraya, 8/3)

President Donald Trump has dropped hints that he might stop the Affordable Care Act’s cost-sharing reduction (CSR) payments, through which federal funds flow to insurance companies to keep down coverage costs for low-income people. ...That’s left key Senate tax writers frustrated that there’s potentially another issue to take precious time away from their tax reform efforts. (Becker and Lorenzo, 8/4)

Startup health insurer Oscar Insurance Corp. hired Dennis Weaver as chief clinical officer to oversee work with doctors and hospitals and help build tighter partnerships with health systems. Weaver, a physician who was previously chief medical officer at health and education consultant Advisory Board Co., will start at Oscar on Aug. 14. The role is new, though he will take on some responsibilities previously held by Shaden Marzouk, the chief medical officer who left Oscar late last year. (Tracer, 8/3)

If you are like roughly half of Americans who get their health insurance through an employer, relax. The turmoil around "Obamacare" all but guarantees you'll still be able to do that. The reasons? Unemployment is low, skilled workers are hard to find — and people expect employers to provide health care. (Kellman and Rosenberg, 8/4)

The turmoil around the Affordable Care Act has created heartburn for health insurers. The industry is betting that a different government program will soothe its ills. Big insurers have retreated from Obamacare’s individual market, where fighting over the future of the health law has contributed to financial losses. They’re focusing instead on Medicare Advantage, a politically popular program that’s being embraced by a growing population of older Americans. (Tracer, 8/4)

Federal health officials have backed down from a controversial proposal that would have required private accreditors to publicly release reports about errors, mishaps and mix-ups in the nation’s hospitals and health care facilities. The Centers for Medicare and Medicaid Services had proposed in April that accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. (Ornstein, 8/3)

Kaiser Permanente will be tested to repeat the record $1 billion in operating income it posted in the first quarter. After all, the Oakland, Calif.-based hospital and managed-care giant is swimming against the same national trends that dented the earnings of investor-owned hospital chains in the second quarter. (Barkholz, 8/3)

Community Health Systems expects to sell another group of its hospitals with combined revenue of $1.5 billion, not including the 30 hospitals previously announced, CEO Wayne Smith said during a second-quarter earnings call Wednesday. Buyer interest is strong for an undisclosed number of hospitals, which carry mid-single digit margins for earnings before interest, taxes, depreciation and amortization, like the first 30 hospitals being divested, Smith said. (Barkholz, 8/2)

The CMS will give a $2.4 billion raise to inpatient hospitals in fiscal 2018. The increase is less than the $3.1 billion the agency proposed in April, but exceeds the $746 million bump hospitals received in fiscal 2017. In its final rule for the inpatient prospective payment system, released late Wednesday, the CMS also announced it was moving forward with plans to change the way it reimburses uncompensated care even though the approach was panned by the hospital industry. (Dickson, 8/2)

Amid all the turbulence over the future of the Affordable Care Act, one facet continues unchanged: President Donald Trump’s administration is penalizing more than half the nation’s hospitals for having too many patients return within a month. Medicare is punishing 2,573 hospitals, just two dozen short of what it did last year under former President Barack Obama, according to federal records released Wednesday. Starting in October, the federal government will cut those hospitals’ payments by as much as 3 percent for a year. (Rau, 8/3)

Hailed as the future of preventive care, wearable health devices allow doctors to keep closer tabs on the health of patients as they go about their daily routines. But as health systems consider these medical-grade devices, hoping to lower costs associated with hospital readmissions, they have also raised concerns about potential security risks to patients and to the hospitals connected with them. (Blau, 8/4)

While long drives and limited access to health care are familiar burdens for many rural residents, the problem is particularly acute for veterans in those areas. They are far older than other rural residents, and far more likely to be disabled, meaning more of them are in need of medical care. And there are a lot of them—one in four veterans lives in rural areas, compared to one in five adults in the general population, according to 2015 census data. (Fifield, 8/3)

President Trump touted a new program to increase veterans' electronic access to medical care as part of a broader tele-health push at the Department of Veterans Affairs. The initiative connects veterans with health providers via mobile phones or computers, and is intended to improve medical care especially for those needing mental health and suicide prevention services, Trump said. (Przybyla, 8/3)

A new poll shows veterans overwhelmingly support reforms to the VA's coveted health care program, but others say it's another attempt to advance efforts to privatize the VA, further fueling the brewing debate around the program itself. The poll, from the conservative veterans organization Concerned Veterans for America, shows that 98 percent of veterans polled and 95 percent of registered voters polled believe veterans should have greater ability to choose health care options outside the VA system. (Lowary, 8/3)

[Missouri Sen. Claire] McCaskill, the ranking member of the Senate Homeland Security and Government Affairs Committee, says she is disturbed by the IG’s finding that the VA made $5.5 billion of improper payments in 2016 or $500 million more than the previous year. The IG’s report issued in May, said the improper payments, for the most part, were made through two VA health care programs last year: VA community care, which allows veterans to seek care in the private sector rather than go to a VA health center, and a program that helps the elderly and chronically ill. (Pianin, 8/3)

It sounds obvious, but apparently not obvious enough to President Trump: Don't insult an entire state. Especially one that's critical to you and your party's future election hopes. But just six days after getting inaugurated, Trump went there. “I won New Hampshire because New Hampshire is a drug-infested den,” Trump told Mexican President Enrique Peña Nieto in a phone call between the two world leaders. The call was private, but The Post's Greg Miller obtained the transcript — plus an equally eyebrow-raising one of a call with Australian Prime Minister Malcolm Turnbull. (Phillips, 8/3)

New Hampshire's four-member, all-Democratic Congressional delegation expressed outrage at Trump's comments, as did Republican Gov. Chris Sununu. The governor said the state is making progress in addressing its heroin and opioid crisis on multiple fronts, including greater resources for law enforcement and drug abuse prevention, treatment and recovery. "The President is wrong. It's disappointing his mischaracterization of this epidemic ignores the great things this state has to offer," he said in a statement. (8/3)

The New Hampshire Republican Party didn't defend the president's description outright, but it replied on Twitter that the party has been working to combat the drug crisis. "Are @NHDems denying NH is in the middle of an opioid epidemic?" the tweet read. "NH Republicans have been working everyday to fight the crisis." (Lahut, 8/3)

There were an estimated 470 drug overdose deaths in New Hampshire in 2016, compared with 439 in 2015. In 2012, there were 163, according to statistics compiled by the New Hampshire Department of Health and Human Services. On Thursday, Mr. Sununu described the opioid epidemic in an email as “one of the worst health crises this state has ever experienced.” He said the government had doubled the resources devoted to prevention, treatment and recovery efforts. (Stack, 8/3)

President Donald Trump is under fire from New Hampshire’s political leadership following a report that he said the state was a “drug-infested den” in a call to Mexican president Enrique Peña Nieto. During the Jan. 27 call, the transcript of which was published by the Washington Post on Thursday, Trump pressured Peña Nieto to stop saying publicly that Mexico would not fund Trump’s proposed border wall, a key campaign promise. (Duffort, 8/3)

A lethal combination of corruption and criminal gangs fighting for control of a booming heroin trade has turned one two-lane road in Mexico’s Guerrero state into what many call “the corridor of death. ”The road links Chilpancingo, the Pacific Coast state’s capital, to heroin-producing mountains nearby, where rival gangs are vying for a bigger share of the lucrative heroin market in the U.S. Nearly 1,200 people were killed in the state this year through June after 2,200 died last year. Officials say nearly all were linked to organized crime. (Althaus, 8/4)

When Dave Mason left jail in October 2015 after his 14th criminal conviction, the odds were good that he would end up dead. A man with a longtime heroin addiction, Mr. Mason was entering one of the deadliest windows for jailed users returning to the streets: the first two weeks after release, when they often make the mistake of returning to a dose their body can no longer handle. (Williams, 8/4)

In one of the latest examples of the growing opioid epidemic, researchers found a seven-fold increase in the proportion of drivers killed while under the influence of prescription opioids since 1995. Researchers at Columbia University examined drug testing results for 36,729 drivers in California, Hawaii, Illinois, New Hampshire, Rhode Island and West Virginia who died within an hour of being in a car crash. (Toy, 8/3)

Nearly two decades of using heroin and a year of living on the streets of Philadelphia had led Steven Kemp to a simple conclusion: It was time to get sober. But when he staggered into a detox facility on a recent Friday night, his head brimming with the thought that suicide would end the pain, he was told he couldn't be admitted because he didn't have a photo ID. (Izaguirre, 8/4)

Two summers ago, we met a woman who went by the name Teacup. "I'm an active heroin user," she told us. "Thirty-three years as a matter of fact." We were in West Baltimore, reporting on a citywide effort to stop a growing opioid crisis. On a street corner known for its open-air drug market, health workers trained anyone passing by on how to use naloxone, a medication that can reverse an opioid overdose. They were trying to get naloxone kits into as many hands as possible. (Cornish and Hsu, 8/3)

This week, President Trump’s commission on combating the opioid crisis, led by Gov. Chris Christie of New Jersey, recommended that the president declare a national emergency. The problem has become significantly worse recently, so you might feel that you could use a little catching up. Here are 11 things you need to know. (Katz, 8/3)

The former White House drug czar questions the Trump administration’s commitment to dealing with the nation’s deadly opioid crisis while President Donald J. Trump continues to call for repeal of the Affordable Care Act. The 2010 law defined addictions treatment as an “essential benefit” that must be covered through insurance policies sold in ACA marketplaces and through the expansion of Medicaid. (Rodricks, 8/3)

A $136 million plan to convert the upscale Lodge and Spa at Cordillera into a high-end drug treatment facility is moving forward. The investment group behind the project closed on the lodge this week and the $20 million first-phase of renovation is slated to begin in September as the new owners, led by Concerted Care Group, convert the 56-room lodge, restaurant and spa into a private drug rehabilitation center. (Blevins, 8/3)

Along Kensington Avenue these days, people are dispensing with the niceties. A man panhandling on a recent Tuesday morning made his pitch, in Sharpie on cardboard, simple and clear: “Dope sick.” Dealers openly sought clients on the sidewalk. Users slouched against walls. And artist Kathryn Pannepacker stood outside the Kensington Storefront, inviting them all inside. There was air-conditioning in there, she told them, peanut butter and jelly sandwiches in plastic baggies, hot tea and cookies, and a craft project to complete. (Melamed, 8/4)

In his push against the opioid epidemic, Missouri Gov. Eric Greitens last month signed an executive order that would equip Missouri state troopers with an anti-overdose drug. What remains unclear is how long it will take to train troopers and other state law enforcement officers to use the drug, naloxone, and where the money will come from. (Sanderson, 8/3)

Philip Kirby said he first used heroin during a stint in a halfway house a few years ago, when he was 21 years old. He quickly formed a habit.“You can’t really dabble in it,” he said. Late last year, Kirby was driving with drugs and a syringe in his car when he got pulled over. He went to jail for a few months on a separate charge before entering a drug court program in Hamilton County, Ind., north of Indianapolis. But before Kirby started, he says the court pressured him to get a shot of a drug called Vivitrol. (Harper, 8/4)

In posts that careen between empathy, outrage, and snark, Dr. Jennifer Gunter presses a provocative crusade to protect women’s health, preserve reproductive freedoms — and, while she’s at it, dismantle all the dubious, dangerous medical advice she comes across in the wilds of the internet. (No, she recently explained to her male readers, you should not forgo condoms in favor of taping your penis shut during sex.) Gunter, a Bay Area gynecologist, shot into the media spotlight in recent months by taking on actress Gwyneth Paltrow, whose lifestyle brand, Goop, peddles — among other gynecologically suspect “wellness” items — jade eggs that women are advised to tuck into their vaginas to improve their spiritual and sexual health. (Keshavan, 8/4)

For a window into these broader patterns, we turned to a 2016 study from the Centers for Disease Control and Prevention, which looked at 18.5 million seniors taking medication for high blood pressure. The stakes here are high: When patients don’t take these drugs as directed, they’re at elevated risk of having a stroke or heart attack, being hospitalized, and dying early. The government researchers examined when patients filled and refilled their prescriptions, defining non-adherent patients as those who had access to their medication for fewer than 80 percent of the days after their first fill. (The seniors were all covered by Medicare’s Part D program and the data collected were from 2014.) (Robbins, 8/4)

Back pain is an excruciating fixture in millions of lives, but Vanderbilt University engineers are developing something that might be able to prevent it: smart underwear. They are developing a device, designed to be worn under regular clothing, that would activate elastic bands to relieve stress on back muscles when people are doing physical tasks. The project is supported by funding from Vanderbilt, the National Science Foundation and the National Institutes of Health, according to a statement from the university. (Tamburin, 8/3)

In the week since President Trump declared that transgender Americans would no longer be allowed in the military, some municipal officials have responded with an invitation: join our police force instead. Several cities — including Houston; Austin, Tex.; Aurora, Colo.; and Cincinnati — have encouraged transgender people to apply to their police departments. In Austin, San Diego, Seattle and other places, transgender officers already serve openly. (Astor, 8/3)

Increased exposure among pregnant women to a class of flame-retardant chemicals found in older furniture and other everyday consumer products is linked to lower IQs in their children, UCSF researchers found in a study that is certain to further ignite the debate over the chemicals. Examining data from nearly 3,000 mother-child pairs from previous studies done around the world, the authors concluded that every tenfold increase in women’s exposure during pregnancy to chemicals known as polybrominated diphenyl ethers, or PBDEs, was associated with a 3.7-point decrease in their children’s IQ. (Tucker, 8/3)

The Texas House gave tentative approval Thursday to a measure that would partially reverse a controversial cut to disabled children’s therapy services that was ordered by the 2015 Legislature. ... The $350 million funding cut outraged therapy providers and the families of children who receive their services, and a group of concerned Texans quickly filed a lawsuit seeking to block the cuts. (Wilson and Najmabadi, 8/3)

For students starting medical school, the first year can involve a lot of time in a lecture hall. There are hundreds of terms to master and pages upon pages of notes to take. But when the new class of medical students begins at the University of Vermont's Larner College of Medicine next week, a lot of that learning won't take place with a professor at a lectern. (Cornish and Gringlas, 8/3)

A leading abortion rights group endorsed Democrat Stacey Abrams campaign for governor, calling the Atlanta lawmaker a “true fighter for women and families.” The endorsement Friday by NARAL Pro-Choice America is the latest prominent national group to back Abrams. (Bluestein, 8/4)

Doctors performing abortions on minors would be required to report additional information to the state under a new measure given early approval by the Texas House Thursday. ... Under Murphy's House Bill 215, doctors would have to document how the minor obtained authorization to get an abortion. (Smith, 8/3)

A class-action lawsuit was filed Thursday in Maryland on behalf of women who attorneys say were sexually assaulted by a former Kaiser Permanente doctor. The lawsuit alleges that Kaiser ignored the complaints of patients who accused Bryan S. Williams of inappropriately touching them during exams, thus allowing him to continue practicing and assaulting women. (Bui, 8/3)

A dozen years ago, Texas health care administrators hired a company to help determine when taxpayers should cover the cost of dental care for the state’s poorer residents, particularly children. ... What happened instead was a case of epic mismanagement that threatens to leave Texas taxpayers on the hook for more than $130 million. (Dexheimer, 8/3)

Despite the state's growing racial and ethnic diversity and a yawning need for mental health services among people of color, Minnesota's health professions remain overwhelmingly white and seemingly walled off to diverse clients hoping to talk to providers who look like them. ... Minnesota and mental health officials don't deny there's a problem and say they're working on efforts to increase diversity, from exposing students of color to mental health careers to expanding college loan forgiveness program for providers who open practices in urban areas. (Sapong, 8/3)

By the time Keith Hobbs, a 23-year employee at Children’s Hospital Los Angeles, joined USC Verdugo Hills Hospital in Glendale as its chief executive, the once independent hospital had already spent more than two years under the Keck Medicine of USC banner. Along with the usual growing pains associated with an acquisition, Verdugo Hills Hospital had spent 2014-15 negotiating a new contract with unionized nurses who complained about staffing shortages as well as unsafe conditions and patient care. (Landa, 8/3)

Thousands of low-income patients may have to scramble to find new doctors this month after University of Chicago Medicine became the latest major health system to break up with IlliniCare Health, an insurer that administers benefits for the state's Medicaid program. U. of C. Medicine follows Northwestern Medicine and Advocate Health Care in walking away from IlliniCare Health, one of 12 Medicaid managed care organizations in the state. Medicaid managed care organizations are insurers that handle benefits for Medicaid, a state- and federally funded health insurance program for the poor. (Schencker, 8/3)

For people who take multiple medications to manage chronic conditions, traipsing back and forth from the pharmacy to pick up pills can make it harder to stick to their doctors’ orders. But because insurers often don’t allow consumers to fill partial prescriptions to make  medication renewal dates align, patients sometimes have no choice but to frequently shuttle to the drug store for refills. (Andrews, 8/4)

The National Cancer Institute (NCI) has denied the University of Kansas Cancer Center’s campaign for a much coveted “comprehensive” designation. But the center's certification as a nationally recognized center has been renewed for five years. "We were disappointed but not surprised to learn that we did not receive comprehensive status,” Dr. Roy Jensen, director of the KU Cancer Center, said in a statement. “On average, it takes an NCI-designated cancer center 15 years to achieve comprehensive status, and we received our NCI designation just five years ago.” (Margolies, 8/3)

The National Cancer Institute has denied the University of Kansas Cancer Center’s application to upgrade its NCI designation but approved the addition of Children’s Mercy Hospital to KU’s research consortium. Michael Artman, the chairman of the Department of Pediatrics at Children’s Mercy, said that means innovative cancer treatments like immunotherapy for more kids. (Marso, 8/3)

Ohio has failed a recent evaluation by the Cancer Action Network of the American Cancer Society, meeting just three of the network’s nine public-policy goals aimed at reducing cancer diagnoses and deaths. The state was highly criticized in three areas: for not prohibiting minors from using tanning beds; for allocating just 10.3 percent of the federal government’s recommended funding level for tobacco-control programs; and for appropriating less than one-third of matching funds to a federal award for breast and cervical cancer screening programs. (Viviano, 8/3)

A new UMSL graphic design class pairs design students one-on-one with dementia patients at a local nursing facility. Students work with individual patients to create design-centered activities that will help them access memories or provide a service. (Moffitt, 8/3)

Two Whitehall nursing home residents were hospitalized last month with respiratory infections caused by legionella bacteria. The Manor at Whitehall is now working with Franklin County Public Health and a private contractor to determine whether the bacteria came from the water systems inside the 150-bed facility on Langley Avenue. (Widman Neese, 8/3)

This has been a momentous week for health care in California.The Covered California exchange announced that its premiums will likely rise by an average of 12.5 percent statewide next year. On top of that, the exchange may add an average 12.4 percent surcharge to silver level plans if President Donald Trump stops funding critical subsidies that help reduce some consumers’ out-of-pocket expenses — or if uncertainty over their fate persists. (8/3)

The farmworkers who move through the region, harvesting and packing the produce, are at a higher risk for certain health problems — particularly diabetes and hypertension, says Judy Wold, clinical professor of nursing at Emory University, who directs a two-week program of health care services for farmworkers there during summers. The farmworkers also often face barriers to health care. (Simonton, 8/3)

A bill that would stabilize health care costs for tens of thousands of Texas' retired teachers for the next two years sailed through the House on final reading Wednesday, although its future is far from certain in the Senate as the political drama between the two chambers intensifies. Lawmakers in both Republican-led chambers have said the state should bear some of the rising costs for premium, deductible and out-of-pocket health expenses facing the state's retired teachers, who are expecting to see their health care expenses soar in 2018. However, the two sides are at odds about how to pay for it. (Zelinski,  8/3)

Legalizing marijuana, California voters were told last year, would create a “safe, legal and comprehensive system” allowing adults to consume the drug while keeping it out of the hands of children. ...But as state regulators prepare to begin offering licenses to marijuana businesses on Jan. 1, it turns out that a huge portion of the state’s weed is likely to remain on the black market. (Rosenhall, 8/4)

Was there an association between the social or medical risk of patients treated at physician practices and performance during the first year of the Medicare Physician Value-Based Payment Modifier Program? Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices. As value-based payment programs continue to increase in size and scope, practices that disproportionately serve high-risk patients may be at particular risk of receiving financial penalties. (Chen, Epstein, Orav et al, 8/1)

Does CareFirst’s medical home program, which provides financial incentives to primary care practices and care coordination for high-risk patients, improve quality of care and reduce hospitalizations, emergency department visits, and spending for Medicare patients? In a difference-in-differences analysis with 52 intervention practices and matched comparison practices, the program was not associated with outcome improvements for Medicare patients. Hospitalizations declined by 10%, but this was matched by similar changes in the comparison group, suggesting that outside market factors drove the decline in the treatment group. This medical home model needs further adaptions and testing before being scaled broadly for Medicare patients. (Peterson, Geonnotti, Hula et al, 7/31)

In this population-based study of Medicare beneficiaries from before the start of accountable care organization contracts to 2014, ranging from approximately 4.5 million to 10.8 million person-years, depending on drug class, differential changes in the use of and adherence to common antihypertensive, lipid-lowering, and hypoglycemic medications were minimal for accountable care organization patients vs patients of non–accountable care organization providers. Through its third year of operation, the Medicare Shared Savings Program has not meaningfully increased the use of or adherence to medications that improve outcomes for patients with cardiovascular disease or diabetes. (McWilliams, Najafzadeh, Shrank et al, 7/12)

With efforts to repeal and replace the Affordable Care Act (ACA) apparently on hold, some policymakers may ramp up efforts to strengthen the individual market, particularly in areas with few if any insurers. During the recent debate, a fair amount of attention was focused on counties at risk of having no health insurers in the ACA markets in 2018. As of July 31, 2017, 19 ACA marketplaces nested in mostly rural parts of Nevada, Indiana, and Ohio are at risk of having no insurer next year, according to the latest Kaiser Family Foundation analysis. Critics of the ACA say that the potential lack of insurers in these counties offers proof that the ACA is failing. But, does it? We analyzed these counties to see whether the story looks similar for Medicare Advantage plans, and found relatively few insurers offering Medicare Advantage plans in the counties that could have no exchange plans next year. In 7 of these 19 counties, there are no Medicare Advantage insurers, and in another 8 counties, there are two or fewer firms now offering a Medicare Advantage plan – well below the national average. (Jacobsen and Neuman, 8/1)

If either of us were building the American health care system from scratch, we’d probably end up in different places. We have contrasting ideas — one of us is a Democrat, the other a Republican — about what ails the system and how to reshape it. But this is not the time for more partisan fighting. It’s time to build a better system, even if incrementally, because that’s what the American people deserve. It’s time to put aside blame and stabilize a health care marketplace where premiums are expected to rise by more than 15 percent in most states and millions of people are worried about obtaining or affording coverage. (Reps. Josh Gottheimer (D-N.J.) and Tom Reed (R-N.Y.), 8/4)

The Senate’s defeat of this most recent attempt to repair America’s health care system gives Congress a golden opportunity to start over by applying a much smarter approach — not repeal or replace, but “reset.” Throughout my career in public office, I’ve learned that meaningful change happens only with bipartisan support, open debate, and the normal push and pull of the legislative process. (Ohio Gov. John Kasich, 8/3)

With John McCain’s dramatic “no” vote, the Health Care Freedom Act (HFCA) died early last Friday morning and with it any hope of repealing the Affordable Care Act (ACA) for the foreseeable future. While conservatives might prefer to blame incompetent vote-whipping in the Senate, the ACA could prove resilient for the same reason Medicare and Social Security have: most voters prefer not to wonder if they will be able to eat when hungry or see a doctor when sick. Any program that gives more economic security to a broad, politically powerful group will be dangerous to meddle with, even in these polarized times. (Scott Lemieux, 8/3)

Why did Obamacare survive? The shocking answer: It’s still here because it does so much good. Tens of millions have health coverage — imperfect, but far better than none at all — thanks to the Affordable Care Act. Millions more rest easier knowing that coverage will still be available if something goes wrong — if, for example, they lose their employer-sponsored plan or develop a chronic condition. Which raises a big question: Why did the prospect of health reform produce so much popular rage in 2009 and 2010? (Paul Krugman, 8/4)

The 6 percent of Americans who buy their insurance on the individual market are the small business people, contract workers, entrepreneurs, musicians, stay-at-home parents, job seekers, and the millions of Americans who can’t receive coverage through their employers. They are Republicans, Democrats, and Independents. Trump supporters and Hillary voters. And their ability to purchase coverage on the exchanges is in jeopardy, as mixed signals from Congress and the Administration have left insurers scrambling to decide whether to hike already costly premiums or pull out entirely—triggering the beginnings of collapse in some regions. (Bill Frist, 8/3)

It’s as if the summer turned into the perfect storm against the best-laid plans of Senate Majority Leader Mitch McConnell. Soon after Memorial Day, McConnell (R-Ky.) drew up a game plan around approving a rewrite of the Affordable Care Act by the end of June. The benefits were twofold, providing House Republicans a few weeks to approve the Senate version and send it to President Trump. (Paul Kane, 8/3)

It is fair to say that I’m more bearish on Obamacare than people to the left of me. But you can be bearish on Obamacare without thinking that it is going to melt down in a cataclysm so utter that the living will envy the dead (at least until a premium-induced heart attack causes them to join that happy group). You can be bullish on Obamacare without thinking that this program has achieved the platonic ideal of health insurance, leaving our citizenry with little to do except stroll around this new heaven, singing songs of praise for the almighty Cost-Sharing Reduction. Unfortunately, both sides of the debate are too fond of attributing these ultra-strong opinions to their opponents, and then triumphantly proving them untrue. (Megan McArdle, 8/3)

Under SB 562, a Medicare-for-all bill, not only would every Californian be guaranteed health coverage, but all premiums, as well as deductibles and copays, would be eliminated. ... Revenue to achieve a truly universal system could be raised with two fair taxes with exemptions for low-income residents and small businesses. (Deborah Burger, 8/3)

President Trump’s newly appointed Commission on Combating Drug Addiction and the Opioid Crisis, led by Gov. Chris Christie of New Jersey (R), issued its preliminary report Monday — and the recommendations were generally worthy. ... the president and both houses of Congress have spent the bulk of 2017 so far debating how much to cut Medicaid, which happens to pay for about a quarter of all addiction treatment. The House version of Obamacare repeal-and-replace legislation also could have watered down the requirement to include addiction treatment as an essential health-care benefit for private plans sold on the exchanges. Cutting health care amid an opioid epidemic makes no sense. (8/3)

For most of my surgical career, I gave out opioids like candy. My colleagues and I were unaware that about one in 16 patients become chronic users, according to new research by doctors at the University of Michigan. Even more alarming, research shows that relapse rates after opioid addiction treatment could be as high as 91%. In addition to expanding treatment, it’s time we address the root of the problem — overprescribing. My own aha moment came recently after my father had gallbladder surgery and recovered comfortably at home with a single ibuprofen tablet. (Marty Makary, 8/4)

As you would expect in a pandemic, the headlines were alarmist: we were reportedly locked in a race against time to protect millions of patients from a new virus of unprecedented virulence that had crippled the United Kingdom’s National Health Service (NHS) and was spreading rapidly across the country. Except in this case, the virus was not organic but digital. ... For NHS staff, the attack was stressful, grueling, and exhausting — not least for the legions of NHS IT workers who toiled all night to update and then patch thousands of health service systems. For doctors, it was a wake-up call. Underfunding ultimately left us horribly exposed to a predictable attack that threatened not just privacy but patient safety. (Drs. Rachel Clarke and Taryn Youngstein, 8/3)

Despite overwhelming evidence that sexual assault is endemic on college campuses, disproportionately affecting women, Education Secretary Betsy DeVos and Candice Jackson, head of the Office of Civil Rights, have signaled they will abandon Title IX’s application to the crisis of sex-based violence in our schools. (Debra Katz and Hannah Alejandro, 8/3)

In a series of meetings this month, Education Secretary Betsy DeVos signaled strong disagreement with the Obama administration’s aggressive erosion of due process protections for college students accused of sexual assault. While deploring the horrors of the offense, DeVos added that “a system without due process protections … serves no one.” This was a welcome change from the decrees issued by the Obama-era Office for Civil Rights (OCR), which had told colleges to avoid any due process safeguards that would “restrict or unnecessarily delay the protections provided by Title IX” to accusers. (KC Johnson and Stuart Taylor, 8/2)